I haven’t had a doctor’s visit or prescription in years. But when I went to get one the other day, I learned a number of lessons.
Without using an HMO for my dermatologist, I obviously wanted to know how much an office visit was and what this or that procedure might cost. Frankly, they didn’t know. No one asks, and all they know are the co-pays. Something as simple as an office visit charge had to be looked up! The cost of medical care is virtually invisible, with all consumer “shopping” choices centering on differences in coverage (co-pays), not the real cost.
And so we have Lesson One: There is no free market in health care services, only in the insurance thereof. And thanks to “reform”, that is being eroded as well.
From the first visit, I learned that between the visit and upcoming procedure, the cost would be less than a single month’s HMO premiums. The question is if it would have been covered, would the charge have been inflated? I won’t speak for my doctor, but I know others who have very different accounting (read higher prices) for clients who are “covered”, be it an HMO or Medicare/Medicaid. The former is of no immediate concern to the parties involved because the premiums are what they are, so it doesn’t matter if the doctor, clinic, or hospital takes advantage by padding the bill. It’s even easier if the unseen taxpayer is the ultimate source of dollars, since they have no choice at all in contributing or where and how much of it actually goes to reasonable compensation for health services rendered.
But my perscriptions were the real eye-opener. I received a brand-name formulation of [[Doxycycline]], a common pharmaceutical. The cost for thirty 40mg pills is $417.64 — one month’s supply for not much less than my current mortgage payment. Now the distributor supplies free samples for the climic to pimp out. Maybe there’s a kickback, maybe there isn’t. But when I protested and asked for a different forumlation (such as taking two 20mg or half an 80mg, or something equivalent that was available as a generic), I was perspecribed a different anti-biotic. The cost for a month’s worth of medication? FOUR DOLLARS.
How can doctors with integrity casually perscribe a medication forumlated to not be available as a generic and get away with it as a matter of standard business practice thousands of times a day? It’s easy — the cost is “covered”. Invisible. It simply doesn’t matter because it will be paid for by extorted premiums or tax dollars.
Therefore, I present Lesson Two: HMOs and tax-funded coverage drives MUCH higher care costs simply because they will be paid for, free from the restraints of natural market controls of real supply and demand.
Mind you, HMOs charge what they have to to cover their costs, only limited by the number of subscribers. Now with forced coverage, they are reciving more customers by the force of federal law. But the public options are no better, and in fact worse, since the taxpayer’s interests is never adequately taken into account when establishing the fair value of services. It is no wonder the first major upward spiral towards today’s insane health care costs was the result of the invention of Medicare/Medicaid. The more “socialized” (government-run and funded), the higher the costs will rise, and with HMOs in the mix getting richer from the “reform’ that was supposed to hold them accountable, the recipe for disaster is set. In fact, it’s already playing out.
We can only hope for real reform on the fundamental issues of health care, not merely rearranging payers and profits for special interests while the masses remain ignorant of the very rules of the game — a game they may have already lost.