A Broken System

My shoulder had been bothering me for over a year, so this past summer, I decided to have it looked at.

I have Anthem Blue Cross insurance, and my doctors on the plan are very good. They told me that I have a bone spur digging into some tissue in my shoulder, and that I’d need surgery to fix it.

Medically, everything went like clockwork. My appointments were timely and convenient. My doctors, nurses and technicians were professional, efficient and competent. They offered a reasonable diagnosis and treatment plan, and they explained everything clearly and thoroughly.

But once I began dealing with insurance, everything went to Hell.

I’ve been calling Anthem Blue Cross and the hospital where I was scheduled to have the surgery for weeks, trying to get a simple answer to the question: How much will this cost me?

Nobody will give me an answer, and everybody I’ve talked to has either passed me along to another person, or refused to get back to me.

I finally found one person who told me that the hospital costs alone will be $19,000 (yes, U.S. Dollars). That’s $19,000 for an outpatient procedure that will keep me in the hospital for a total of 4 hours! That breaks down to $4750/hour just for the hospital visit, which seems wrong.

I kept pressing Anthem Blue Cross for the my out-of-pocket number. It doesn’t seem like it should be a difficult question to answer, because they have all of my information, such as my plan type, total spent on premiums for the year, etc.. But nobody at Anthem Blue Cross, nor my hospital will give me an accurate (or even ballpark!) out-of-pocket cost until I actually schedule the surgery.

If you think about it, that’s like a restaurant not telling you how much the food is going to be, until you’ve ordered it.

After several months of this runaround (and more than a year of sleep-depriving shoulder pain), I finally pull the trigger and book the operation.

The hospital called me two days before the operation and finally gave me a number I’d be looking for. Since my insurance plan requires me to pay 30% of the total cost, my out-of-pocket cost is going to be $3754.79 – for the four hours that I will be in the hospital, is going to cost me $939/hour.

After determining that the cost was more than I could afford this year, I canceled, and chose instead to live with the pain.

Some may argue: “$3800 isn’t that much to pay for pain relief.”

Well, it’s much more than $3800. It’s $3800 PLUS all of my monthly insurance premiums, my co-pays, my enormous deductible. I suppose I could just cancel my insurance to reduce my expenses, but wait…I can’t! That would be against the law! I’m required by law to pay my enormous monthly health insurance premiums – you know, because of the so-called Affordable Care Act?

The bigger question is: Why are hospital’s charging such enormous rates? Regulation, litigation and, of course, insurance costs are an obvious factor, but the answer hospitals used to give is: “Because of all the uninsured people coming in, we need to cover those costs as well.” Well, with Obamacare (the “Affordable Care Act”), there are no longer any uninsured people in the country, right? Why aren’t hospitals passing the savings along to patients.

Those who pay for health insurance, of course, are picking up the tab for those who don’t, so now we have to pay higher premiums and the high costs that hospitals used to blame on the uninsured but continue to charge us for!

My wife has a joke, “You don’t have to worry about healthcare if you are rich or you are poor.”

Granted, the poorest of the poor in this country haven’t noticed much of a change – they still get their uninterrupted free care. Wealthy people are watching their health insurance costs go up, but they’re still able to pay the bills…

…but otherwise, the Affordable Care Act (Obamacare) has solved nothing.

· Young people and low-income people still can’t afford the premiums and absurdly high deductibles that the law requires.

· Middle-class people are watching their premiums and deductibles skyrocket (and now “get” to continue paying for their kids who can’t afford their own legally-mandated insurance until they’re 26 years old).

· Insurance companies – who are now passing the expenses of having to cover pre-existing conditions on to all of their customers – are even complaining.

· Doctors and hospitals are still complaining about the additional administrative costs and time-consuming hassles, and they’re still not being reimbursed accordingly for Medicare and Medicaid patients.

And it’s all by design. The ACA was intended to be a failure so that people would start clamoring for a single-payer/socialized medicine program like Canada and the UK.

For those who think single-payer is the way to go, just remember: Canada only has to cover a population of 33 million people; the UK only has 53 million people, and both of those countries have to regularly ration healthcare. The US has over 300 million people – with more needy immigrants flooding in every day.

We need to find intelligent leaders who will fix this mess. Leaders who will consider the needs of those of us who actually pay for the service – not just the vendors, lawyers, lobbyists, hospitals and everybody else who benefit from our money.

In the meantime, my shoulder is killing me.