Biological Warfare and the Cost of Insured Medical Care

A few weeks ago, at one of Kelly’s many preschool storytimes, a young boy sneezed without covering his mouth and covered me and Kelly with, um, germs. Kelly escaped the biological onslaught somehow, probably with the magical phrase of admonition: “That was yucky!” I wasn’t so lucky.

The next day, I had a sore throat. By the time my son’s birthday party rolled around, I had a full-blown cold. Soon, I was choking out dry, hacking coughs like a severe asthmatic in a cigar bar. It was so bad, Peter bought me cough suppressant drugs and insisted I take them, even if only as a courtesy so he could sleep in peace at night. I hate them and swear they give me a hangover, but I love Peter, so I dose up.

I happened to have a doctor’s appointment two weeks into my body’s war against preschooler’s disease. I told my doctor about the cough, she listened to my lungs and diagnosed me with something like, um, “bronchiolitis.” There wasn’t much to be done about it, but she gave me a prescription for some antibiotics, mostly just cuz she could, not that she even expected them to make a big difference.

The big surprise, though, was when it came time to pay the doctor’s bill. Since I don’t have any chronic conditions, and we’re paying for our own insurance, it makes sense for us to have a high deductible. It’s much cheaper to pay our own way for routine health visits and prescriptions than to pay for more comprehensive insurance. In any case, it meant I was paying directly for my visit to the doctor.

ABC News reporter John Stossel wrote the problem with health insurance isn’t the people who don’t have it, but the number of people who do. I told the clerk at the desk I needed to pay for the doctor’s visit, and after confirming with me who my insurance provider is, they checked off several items, and told me I needed to pay $285. I asked them if it would be any cheaper if I paid as if I didn’t have health insurance, and they didn’t have to send a bill (confirming my payment to be marked against my deductible) to my insurance. That was a lot lower: $135. I paid that, explaining that if I hit my $5,000 deductible, which I could only hit given some (admittedly possible) medical catastrophe, $300 wouldn’t make much of a difference. But the $150 I saved today would, by all odds, make a difference to me now.

Before you get all worked up about “artificial” costs added to insured coverage, I have to say getting paid from the insurance companies does seem to be a major pain. For instance, when Kelly got her 6-month vaccination shots, our insurance paid a percentage of them. But what percentage of what cost took months to figure out. We’d get bills, I’d have to call her doctor’s accountant (a very nice woman whom I got to know on a first-name basis), she’d explain the costs, recognize the insurance company would need to pay a higher percentage, and delay my payment date. I’d call the health insurer and speak to an equally nice person there, who reviewed my coverage, said the shots were supposed to be billed at a lower price, and reissue a bill to me and my doctor. We went back and forth like that for six months, and the shots were still fairly expensive. But what a massive cost in wasted time that was for all of us: after all the accountant and the insurance rep weren’t working for free, and in the end, I just wanted a number I could pay off, not a folder full of revised bills and hours wasted on the phone.

The next time Kelly needed shots I went to our county clinic and got the shots for free, because Santa Clara County gives free immunizations to any child under 12 willing to wait in a crowded waiting room downtown for about an hour during a workday.

For my medical care, I do wish there was something in between so-prohibitively-expensive-you-need-insurance and free. For instance, I got my first mammogram last year. It cost $220. If I go to a clinic in the barrio, with an appointment, on specific days of the year, I can get a mammogram for free. Personally, I’d prefer something less than $220, but closer to home. But there’s nothing in between, for the uninsured but not impoverished.

And as much as I like the idea of “free” socialized health care, I have to look to countries with such care, like Canada, and recognize that nothing’s really free, and John Stossel really is right when he says those who pay for their health care themselves improve the system’s competitiveness by actively choosing what they need and what they’re willing to pay for it.

For instance, I decided to forego a mammogram this year, and my doctor was unconcerned. If she’d told me I absolutely needed one, well, maybe I’d try to bargain a lower price for one with the billing department at the hospital. I also found out the antibiotics my doctor prescribed would cost almost $60 (though the cheapest online drugstore I know) for the full 6-pill run. I’m nowhere near death, over-the-counter cough suppressants are nasty enough, and I’d rather spent that money on another Teaching Company course or some cute boots. Besides, my immune system gets stronger if it fights an infection to its death. And I could use that immunity the next time some snotty kid sneezes on me at storytime.

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