Just a thought about rising medical costs

One of the main problems with medical costs is insurance itself.  My son had oral surgery today (tied to orthodontic stuff).  The cost was horrific.  I didn’t think about it twice.  Aside from the fact that the oral surgeon came highly recommended (and it was my son under the knife, after all), I had no incentive to look for someone cheaper or to bargain with the doctor.  My insurance will pay about 60%-80% of the cost, and the remainder is, to my mind, a reasonable fee to pay out of my own pocket for the procedure he underwent.

I learned this lesson a long time ago.  As befits someone as highly strung as I am, I’m a night-time tooth-nasher (bruxism).  Although I belonged to Kaiser when I got my first jaw guard (back in the early 1990s), Kaiser didn’t make jaw guards, so it sent me to an outside provider.

I saw this orthodontist for about 4 minutes, his staff made a mold, he sent the mold to the lab, the lab made the jaw guard, I went back to the office for a 10 minute fitting — and that was the end of it.  I paid out of pocket for the jaw guard ($250, which was a reasonable price to me in terms of ending headaches and jaw pain), and Kaiser paid the orthodontist bill, which came to $800!

Because the person working in Kaiser’s payment office, the one who cut the check, had no vested interest in the bottom line, Kaiser never went to that orthodontist and said what any direct consumer would have said:  “Are you out of your cotton picking mind?!  Are you actually charging me $800 for less than 15 minutes of your time, plus 10 minutes of your staff time?  No way am I going to pay that bill.”  As it was, Kaiser paid 100 cents on the dollar.

Just something to think about it….

As for me, between paying work and a needy son, I’ll be incommunicado today (or, I probably will be).  Hope you all have a lovely Friday, and please feel free to leave any interesting comments you like here, including your take on yesterday’s summit.

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  • suek

    “Are you out of your cotton picking mind?! ”
    I’m positive that’s a racist comment…!!!


    Here’s something else to think about – What if you don’t have dental insurance?
    The days of a seeing a tooth as just a tooth are long gone. The tooth has 4 sides $$$!
    4 surface filling: $310.
    3 surface filling: $259.
    2 surface filling: $193.
    Single surface: $147.
    Novacaine gratis and all prices quoted are local.

  • jj

    You touch on an interesting point, and it’s one that seems widely unrealized.  Put simply: very few people in this country have any idea what anything medical actually costs.  They’ve never had the opportunity to see a real cost, because there’s always been an insurance company standing – to some degree or other, greater or lesser –  between them and their doctors.  A side effect of this has been to keep doctors and patients from ever needing to have to talk about it: the doctor’s office doesn’t negotiate prices with patients; it negotiates prices with the government, and insurance companies.  The patient never enters that process, and for the most part, except in the most general way, doesn’t even know the process goes on.
    So medical prices aren’t the result of market forces.  (Though I have on occasion made life much simpler by just paying a doctor for something.  Faced with the possibility of getting a check right now, here, today –  they’ll often cut anywhere from 25% – 40% off the price – and still feel fine about it.  So – what’s the actual “price?”  Who the hell knows?)
    For the first twenty-five years of my life I lived down the road from an old-fashioned family practitioner.  If something less than critical was bothering me I went over to his house during his office hours and joined a few other neighbors in his waiting room, what would have been the downstairs rec room of his house.    After a while he’d open the inner door to usher someone out, and say “next.”  If you were next, you went in and saw him.  No appointment, no nurse, no insurance, no BS of any kind.  Just you and him.  He had X-ray equipment, a darkroom, a lab, a small dispensary – everything right in the finished basement of his house.  I have had the experience of having him take an x-ray of my painful forearm, develop it, show me where it was broken, give me a whiff of either to keep me calm while he set it, and walk out forty minutes after arrival with it in a cast.  Forearm’s been fine for a bunch of decades, now.
    That no longer exists, as you’ve all probably noticed.  Now I go to a group, not a doctor.  I have a doctor in the group, but rarely see him.  He’s the foreman, ultimately in actual charge -I suppose – of me.  If I do insist on seeing him specifically I can certainly do so – but my appointment won’t be for a couple of weeks.  I don’t get to just walk over there and wait.  So I generally take whoever comes up.  There are a half a dozen doctors in the group, probably a dozen nurses and another half dozen aides of some kind, plus two people at computers who make the appointments.
    All of which perhaps makes some sense.  What doesn’t make sense is the other dozen people who spend the day also sitting at computers.  They spend their lives transcribing notes and reports into acceptable form for submission to insurance companies and medi-whatever, and dealing with insurance companies  and the government.  They’re all on the payroll of course, but not one of them has a thing to do with anything actually relating to medicine.  They are in the BS business, and their presence adds not a thing to the quality of the medical care.
    So the end result is that we become very accustomed to the idea that the charge for something is whatever they say it is, and only rarely do we look at a doctor and say, “that’s absurd!”  We are ignorant about whether it’s truly absurd or not.  We look at the costs the doctors have to carry, including the insurance they have to pay to keep sons-of-bitches like the one who broke Dow-Corning on account of the completely non-existent problems with silicone breast implants  away, and we don’t know whether a charge really is absurd or not.  We have no basis for comparison, because we have never been allowed to know a real cost.  Therefore we can’t negotiate, and the doctor says – quite justifiably – “look, if you’re putting this through insurance I won’t negotiate, because I have to pay someone to put it into acceptable form for them and file the paperwork, so it’s not worth it for me.”
    And that’s why, at least in part, the orthodontist gets $800 for fifteen minutes.  Because he has all the usual costs everybody has, plus he to pay someone in his office to sit there and bill Kaiser, and if he’s an orthodontist who works on kids he’s paying a minimum $100,000 a year in insurance, too.

  • suek

    My f-i-l was a doctor.  While in practice, he had one nurse/receptionist.  He had two patient rooms, his office, the receptionist’s area (including a records file) and a small waiting room.     He also made house calls and did charity work.
    When he retired, he moved to a retirement community, and while there would see fellow retirees up until about 3 years before he died.  He didn’t have an office, they just came to his apartment, visited and described their problems.  He’d use basic tools – stethoscope, blood pressure machine, thermometer  etc – and diagnose them or send them to a doctor’s office.  He could prescribe medication as seemed appropriate.   At about 3 years before he died, the cost of malpractice insurance became prohibitive since he offered his services without fee, so he gave up his practicioners license.  After than, he restricted his “practice” to “you should (or probably don’t need to) see your regular physician”.  I seem to recall that his malpractice insurance was going to jump to about $80,000 per year – though that seems so ridiculous as to make me doubt my memory.

  • Indigo Red

    No, suek, your memory probably isn’t in doubt. My phsycian in Tustin CA quit medicine because his malpractice insurance was about to cost him more than his income. He’d practiced for more than 20 yrs and never was sued, but still the insurance went up. And Obama wants us to believe that TORT reform will make no difference to medical care costs. Every time we lose a medico, the resultant costs are enormous.

  • jj

    My mother’s ob-gyn was an old family friend. An older guy, he’s been gone for a while now.  Told me once, at a party at my parent’s house, that his insurance was costing him $90,000 a year.  He’d never been sued, never had a problem, but his field was (and, one must suppose, is) seen as being pretty high-risk stuff, and a magnet for lawyers.
    That was in New York State, in 1970.


    Physicians / Doctors Salaries & Incomes in USA and the World

    posted by Digitaldoc, MD at 9:08 PM 4 comments. UK Family Docs making upto £380,000/year ! national averages around $160,000 like many US MD salary surveys show

    mdsalaries.blogspot.com74kCached  couldn’t copy and paste this site, but go to it by search – very interesting.