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9/9/2009
I dare you - just ask “How much will it cost?”

It’s up to you and me. Only you and me. Not Barack Obama, not Max Baucus, not Olympia Snowe and certainly not Dr. Steve Kagen.

Well, and it’s up to the insurers and the hospitals and the physicians to not mess with us, doing whatever they have to do to be honest and upfront and transparent with consumers.

In speaking to a crowd of 450 at Appleton’s “Rally for Responsible Reform” last night, the “Value” and “LEAN”-meister, Dr. John Toussaint, ticked off $4 trillion in savings over 10 years that would result from increased transparency and incenting efficient, higher quality care for patients. Our own world-renowned health care maven shared a few lists of how to get there. Very good stuff. But stuff the system must do – not stuff I can do today!

Speaker Dan Madigan said “stay fit and stay well.” Ok, I’ll acknowledge that’s important. But since credible and repeated reports about prevention not being the end-all to controlling costs, my heart goes through a few less palpitations of excitement when I hear talk of wellness. Again, good stuff, but not great, cost control-wise..

What really makes a difference is when YOU start caring how much it will cost.

I challenge you. I dare you. The next time you set foot into any kind of medical situation – eye checkup, dental work, your annual physical or a quick checkup or unexpected malady…promise you will ask the question. HOW MUCH WILL IT COST?

(Now, if you or some significant other in your environs is in a serious, time-sensitive situation – by all means get treatment. Damn the cost and negotiate it later.)

I’ve written about price and quality transparency tons of times. These paragraphs, from my May 13 FP piece, illustrate the point. Repeat after me – I dare you: HOW MUCH WILL IT COST?

… my husband and I are on a very high deductible health insurance plan. In addition to paying a high portion of our health insurance premiums, we also budget thousands of dollars annually to fund our own HSA and pay for all our health care needs. So it’s our money we’re saving and by gum, we’re being wise consumers, doing our part to be careful about health costs.

That’s not to say we’re stingy. We’re smart. Not stingy.

Over the weekend, I was concerned about a lingering, painful earache. I drove over to Urgent Care on north Richmond Street (Appleton). How much does it cost? “Well, it depends on how the provider codes it, beginning at $120.” Hmm. Well, that was a pretty straightforward answer. Good! But I was looking for the $39 variety clinic visit. A couple of folks were in line, and I felt a bit sheepish about it (gosh, why?), but politely I said, no thank you, I believe I can pay less. Isn’t there another clinic nearby?

Indeed, there was a ThedaCare clinic a block or so away inside a ShopKo store. $45 for a visit with a nurse practitioner (same as the staffing at the first clinic). I loved it. No line (I was lucky). And two delightful staff members. Took my HSA debit card, no insurance filings. And I (and the whole system!) saved at least $65!

My husband recently had dental work done; an antibiotic wash was prescribed. I recalled the last time he brought this stuff home, the bill for 16 oz. was $36. I suggested he try a hydrogen peroxide rinse (99 cents) for a day or two to see if it did the trick. And did the trick it did. Ok, thousands on dental work and I’m trying to save $36. It’s the darn point of the matter – and more of us ought to be doing it.

If you didn’t read this piece by Pete Kennedy, you must [Yes, you must. It’s excellent.] take a look at it. Pricing questions get under dermatologist’s skin. All Pete wanted to know was how much it was going to cost to get his darn wart removed. And he was politely obstinate about it.

We’ve got to all be doing this stuff guys. All of us. Repeat after me: “How much will it cost?” “No, not just the co-pay, how much will the whole thing cost, my insurance company and me?” “Please don’t tell me ‘it doesn’t matter how much it costs because the insurance company will cover it.’”

No, don’t you dare tell me that.

Here’s the deal Mr. President. You and your minions have done zero, nix, nada about controlling way-out-of-bound costs. Don’t tell me we have no plan. And don’t tell me I’m exaggerating with falsehoods. Our army of hundreds of millions of responsible Americans will save our health system a cool $4 trillion - so we can all afford to cover those that can’t afford to insure themselves. Mr. President: Keep the government off our back.

Jo Egelhoff, FoxPolitics.net

COMMENTS

When I broke a bone a little over a month ago, the subject of cost never came up. Not at the urgent care center, my doctor's office or the hospital where the operation took place. If I hadn't been in pain, I might have asked, but I'm sure the response from the providers in the trenches would have been, "I don't know."

Rich Eggleston (Wed Sep 09 08:18:23 2009)

Thanks for the Kennedy link Jo. Very interesting. I had a similar experience with my dentist recently. Very depressing.

David (Wed Sep 09 08:20:13 2009)

Between the times that my last 2 children were born, a normal birth in the Phoenix area went up so much that it exceeded a C section just a few years before. My wife and I shopped around, chose a nurse practioner and a DO hospital that kept the rate about half of what it would have been if we used an MD, and a "regular" hopsital. This savings of over $2300 (this was 17 yrs ago) was significant to us, as we were then self insured.

In another incident, my then infant son, a few yrs before, in 1986 had a blocked tear duct. I was incensed at the bill. I did not so much begrudge the ophtnamologist and the anesthesiologist their $175 each so much as the hospital charge which was $325 for LESS THAN FIVE MINUTES!! But because I was busy with other stuff, and because the insurance company paid it anyway, I did not dispute any of this. I surely would have taken a much more significant interest if I had to pay it myself.

Anecdotal, I know, but more proof that when third parties pay, costs go higher.

Ken Van Doren (Wed Sep 09 08:31:41 2009)

Bravo, Jo! The lack of a consumer-supplier relationship ("How much will it cost?") has contributed enormously to the problem of high health care cost. We need to enable more people to have HSA's so they have a financial incentive to ask "how much?". Insurance should be for the big things, with consumer-spend dollars used for all the front-end stuff. Great article!

Tom (Wed Sep 09 12:35:05 2009)

go ask a hospital how much it will cost to get a hip replaced. you will get everything EXCEPT a direct exact cost.

better yet, when you fall off a roof and are convulsing try to negotiate a rate for care. that's why medical savings accounts are such a scam.

steve wells (Wed Sep 09 16:55:29 2009)

I am currently buying my own health insurance on unemployment. How much is it costing to give health care to the illegals? Do the insurance companies really need those "fancy" building?

carleen (Thu Sep 10 08:21:25 2009)

The only thing that was accomplished here is that you now know that you are asking the wrong person at the wrong time. If you are to need medical care call ahead and ask how much it will cost (duh problem what about emergencies, which covers most medical care that costs more than normal). Can't call those in ahead of time. You will be put in touch with someone who will give you the cost. If you are having a heart attack and want to know how much it will cost, good luck finding that out. My question would be how sick are you expected to be? A really bad heart attack costs more than one that is mild. Mild heart attacks sometimes turn into serious herart attacks which costs more. If a doctor is fixing your broken finger and he finds that your break after examination is going to require pins instead of a regular set, how does the doctor know that when you walk in the door. Not like pricing a car.

Mike (Thu Sep 10 09:12:33 2009)

Please note Mike, that my comments reflect the difficulty in asking about prices in emergencies. The rest of your comments indicate you have never in your life asked a medical provider for a price. Try it sometime. It's much more difficult than it should be. Not always easy to predict at the beginning, but certainly in cases other than emergencies, costs should be easily available for all procedures. And certainly in emergencies, it's our responsibility as consumers to very carefully review any invoicing to be sure the billing jives with our treatment. We all must be part of the solution. I don't see that you've proposed any.

Jo (Thu Sep 10 09:34:56 2009)

No Jo that's not true I said ask the right people that is a solution if I have ever heard of one. Let me give you an example. I recently went into the dentists office and needed a fitted mouthguard and asked the dentidt how much it would be and he replied what will it be used for. I said to wear while playing basketball. He said that will be $60 dollars and I had him make me one. I also recently had braces put on my teath. I had five yes five opinions on how to handle the job and recieved as I walked out of each of the offices five proposals on how the work would be completed and five cost estimates in hand as I walked out the door. I made a very informed decision based on cost and methodology. I know that the dentist office is not a hospital, but that was my recent positive experience with cost and healthcare.

Mike (Wed Sep 16 10:18:09 2009)

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