Tuesday, September 20, 2011

Haggling will reduce the cost of health care: The eternal hope of optimists

Consumer Reports Magazine, in its Oct. 2011 issue, has an article How to Haggle with your Doctor. Once again we have an article that directs the consumer, in this case a patient, to haggle with a physician over the cost of medical care. While being able to haggle with a physician seems like a great way to bring down the cost of that health service, the reality is that the physician has the least control over prices in healthcare. Now, some of you non-trusting souls will say yeah, it is all the insurances. Nope, that is also incorrect. The entity with the most control over prices in healthcare is the U. S. Government. As many readers of my past blogs already know, Medicare prohibits any provider from discounting or in any way changing a charge for any patient for any reason. That one regulation nullifies this article, but let’s look at some of the finer points of it. The article present three possible scenarios, 1) You are healthy, 2) The unexpected occurs, and 3) You are having an elective procedure.

In scenario number 1 the article states: “Physicians, nurses, and other providers have a professional obligation to take your financial resources into account when recommending and delivering care”. Actually, providers cannot take your financial resources into account. The provider must recommend the best option regardless of price. To do otherwise would appear as if the provider is only looking at your financial resources and not what is best for you medically. This is a big no-no from the federal government. The federal government wants the provider to recommend the best treatment, period. That is why physicians are the last people who truly know what procedures cost since they cannot use that information to determine their plan of treatment.

In scenario number 2, the article suggests that you review your medical bill with the doctor after the treatment to ensure that the treatment was necessary. Well, if you are alive, I would think that determines that the treatment was necessary. But let’s look at this from another business, food. How many of us would haggle with a chef after a meal at a restaurant? “The chicken did not meet my standards of preparation and thus I would like to have a 50% discount”. The next sound you hear is laughter from the chef and the request to pay or he will be forced to have you arrested for theft. Unfortunately, a provider cannot have you arrested for theft after failure to pay since a provider delivers a service, not an actual product. As to collecting after the medical treatment, I heard a great quote from a manager of a large acute care facility, “Can I have my medical treatment back?

The article then suggests that you ask a provider for the same discount that he takes from insurance companies. A provider signs a contract with an insurance company accepting lower reimbursement because the insurance company agrees to direct its customers to him for medical treatment. As an individual you have signed a contract with the provider that you will pay all fees as charged by the provider in accordance with your insurance contract. The provider has already agreed to a reduction in payment from your insurance company and now you want him to take less from you as well. Let me know how that works for you.

Section 3 actually has sound advice, which is do your research. Find out the costs, the charges, the results.

Health care is expensive because there is a perception that all diseases and injuries should be treated and cured and mankind should not suffer death any longer. Well, the reality is that man is mortal, man does die and the cost to keep man alive is, in some cases (cancer, heart disease, genetic complications and injuries) very expensive. It is a simple mathematical equation: the willingness to spend money on healthcare is directly proportional to the value one holds over one's quality of life. I for one have never haggled over my own or my family’s healthcare, and I would hope that you, dear reader, would not haggle over yours.

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