Hoboken Mom Condo Living
Planning the long-term & juggling the everyday

When you go to hotels, do you ever read the published room rates on the backs of the doors? I often do and am constantly amazed and horrified at how much more people are willing to pay. I try to stay under $100/night for hotels, and I aim for 3 star establishments: the same room can cost three to four times as much for a less savvy shopper.

The same concept applies to healthcare costs. The reason why people go bankrupt when they lose their health insurance is not because they are sick; it is because they are paying 400% of what a health insurer pays for the same services, procedures and medication. Even those with insurance are vulnerable. It’s all about collective bargaining. HMOs use the power of their many members to force steep discounts with hospitals and physicians. Your average primary care physician gets reimbursed $68 per office visit. When you consider they have to pay for rent, electricity, computer systems (plus very expensive electronic medical record software, which can easily cost six figures for one private practice), staff salaries and malpractice insurance, they have to see one hell of a lot of patients to come out ahead. Let’s not even talk about what that does to the quality of patient care.

The goal of health insurers is to avoid expensive procedures and patients likely to cost them a lot of money. I once wrote a report detailing how HMO profits in New York almost exactly equaled hospital unreimbursed care in the same year. Patients can negotiate fees with physicians and hospitals, but they are unlikely to match the discounted rates achieved by health insurers because they don’t have leverage. Your average hospital stay costs $23k; few insurance plans cover more than 80% of expenses and they come with caps in coverage that are remarkably easy to exceed.

In finance, there are two types of fund analysis; top-down and bottom-up. Right now our government is trying to effect a top-down restructuring of the healthcare system. Given the partisan state of politics, I don’t know whether we consumers can wait for the government to wave a magic wand and fix our ailing system. There are few things I fear more than sickness and job loss. I save money to protect my family in case my husband loses his job, but I have no control over illness. If one of our family members gets really sick, it could finish us financially, especially if it is me or my husband. Nobody is invulnerable.

I think it is time for consumers to take matters into our own hands. Stop acquiescing to a healthcare system that is flawed, administratively bloated, and designed to exclude the sick. Patronize only physicians and hospitals who offer steeply discounted rates; I recently learned that PromptMD not only charges 60% less than standard primary care physicians, but they also have negotiated the same discount from specialists like radiologists and cardiologists. You may have to pay upfront and get reimbursed from your health insurance, but by not allowing doctors and hospitals to charge tremendously inflated prices, you are helping to change the wild wild west healthcare culture that has thriven in this country.