Saw this post on the DailyKos that just so perfectly illustrates the state of our healthcare system.

Jollygreen does a great job of breaking down his costs and pointing out how the hospitals have increased their chargemasters in an effort to drive up their reimbursement. To top it off, the hospitals are pushing through as many people as they want simply processing transaction with no regard for things in context such as sending the bill for an ultrasound along with the bill for the other services associated with the miscarriage of that child one week later.

This just underscores again what poor business people most healthcare companies are.

Their approach to smaller reimbursements is simply to increase the billing amount. The approach to dealing with them is to simply low-ball them. Go ahead. Call up the hospital billing office and ask for a discount. They did not feel bad about simply raising the price with no rationale as to the amount. You should not feel bad about not using any rational reason for the lower amount you want to pay.

So I just got an e-mail from our insurance company about our health insurance. I just HAD to share it with everyone. Bless their hearts, it takes s o little to get insurance folks excited, like when your premium goes up only a little bit. So here it is…
Robert, it is not often that I get excited about someone’s insurance renewal but without fail, it happens once per year. This year, you’re it. Your benefits are going to improve, the premium for an individual employee will go DOWN $13/month and the premium for a family will only increase $17/month. This net result is a total monthly premium for the ENTIRE group increasing ONLY $23/month.
All this being said, I would like to discuss these changes with you and I will need you to sign off on the changes. Please give me a call at your convenience. I can be reached on my mobile phone if you don’t get me here at the office.Thanks! If I don’t talk to you today, have a great weekend.

So with the high cost of energy and that subsequently driving the cost of many things including delivering goods and services, it is small wonder that healthcare is starting to see people cut back.

I’ve seen a good number of articles already on people allowing their insurance coverage to lapse. They are forgoing the premium cost in an effort to save money. That’s a big short-term gamble. It’s a HUGE long-term gamble. Chances are, if someone drops their coverage, they won’t see a need to pick it back up until, well, they really need it. And then it’s too late.

And people are starting to cut back in other ways, too. In the face of efforts by employers to implement wellness programs and disease management programs, people are starting to act counter to that arguably wise practice. A recent WSJ post documents how Americans have begun to forgo those screenings and well care visits. that’s like not putting a new roof on a house until the rain water coming in has rotted out the floors from the leaks.

There are lesser ways to cut healthcare costs. Find a lower cost provider of the service you require (sorry for the shameless self-promo, but it’s what we do). Find a provider closer to you, so you don’t incur the fuel costs (again, sorry for the shameless self-promo, but…). Shop your prescription prices (um, sorry…). Just get engaged with your health and be aware instead of being passive. After all, it is your health, and if you don’t have your health, what do you really have anyway?

People find it hard to believe that healthcare is far more like used car sales than well…even used car sales.

So here comes another article on it from Kiplinger’s on how negotiable those pesky healthcare bills can be. This one talks about  a nearly 70% discount on the hospital bill.

“The doctors said he’s comin’, but you’ gotta pay in cash”

-The Eagles

We’ve enjoyed a bit of a free ride for the past several decades when it comes to healthcare. Employers and the government have picked up much of the tab. But now we are starting to pay the price literally. Increasingly we are asked to pay for medical services. Locally, The Tennessean just featured a piece on a doc who is going to charge his patients $1,500 annually to maintain access to him. We had best get used to it.

I have nightmares of other businesses becoming like our current healthcare system. In these night terrors, I go to buy groceries, pay a $20 co-pay and then get the bill 30-45 days later, can’t understand what it is I got, have already consumed the product and am expected to pay far more than I would ever have dreamed it might cost.

Predictable costs in healthcare will have to become more the norm. Concierge healthcare is becoming more popular. Just ask Jay Parkinson, M.D. who has had a concierge practice in NYC and is starting Hello Health. He uses REAL docs, not nurse practitioners like the retail based clinics (RBCs), but like the RBCs, Hello Health has [gasp] transparent pricing. You will actually know what you are paying at the time of service. Novel concept.

It’s a different way of thinking and doing business on the healthcare front, but it has tremendous merit.

Our unfettered access to the healthcare system has taken much of the responsibility for our health off of our hands.  As partial proof of that, we can point to our obesity epidemic, overprescribing of drugs for any small ailment and overuse of the system (even I have kids who go to the doc at every sign of a sniffle, and then feel silly for being asked what I’ve done to treat it - I noticed it and brought them to the doc). Not only have we stopped being responsible for the cost, but we’ve also stoped being responsible as a society for understanding and managing our health. I’m guilty.

Now we are paying the price.

Kudos to the Nashville Business Journal Health Affairs Editor-in-Chief Susan Dentzer for her insightful comments on many issues surrounding healthcare at the recent Nashville Healthcare Council gathering.

The attention grabbing headline of her corresponding article about the potential for healthcare to be the next sub-prime mortgage crisis rings true though I’m not sure it can all be pinned on HSAs as she does in her article.

Compare the two industries and beyond the similarities in dollars paid out, there are some disturbing lessons begging to be learned.

Housing runs in the hundreds of thousands of dollars for a family. Healthcare has the potential to do the exact same.

Mortgages can easily hit $1200 per month in expense. And at $1200-1400/month for family healthcare coverage, average healthcare premium costs alone are comparable to the size of a mortgage note for many families.

And houses have to be maintained. You need a new roof or air conditioning (that’s where I’m living right now). Those are not small expenses running $5K-$10K per instance. Under all too common circumstances, a major illness can generate bills into the tens and hundreds of thousands of dollars beyond premium.

The financial implications of healthcare are clear. They are equal to if not greater than housing expenses for most Americans. But that’s where many of the the similarities end. And this is where it starts to get worrisome. It is potentially far worse than the mortgage crisis.

With housing, you can see it, feel it, touch it. Now ask yourself if you know what tests your doctor ran that last time you saw them.

With housing you decide when to buy. You decide what the right size house is and the best schools. Healthcare is often times unplanned or in a best case scenario, that pregnancy might give you 7-8 months forewarning, but the cancer did not nor did the broken leg (don’t tell me you were planning on breaking your leg unless of course you had a ski trip planned).

In buying a home, you do your research. Find out what other people are paying. Compare features. Ever tried to find out the price of a strep throat test? Pretty basic, but we’ve tried it, and it’s all across the board. For that hip replacement surgery, did your doc ask if you wanted a plastic of a titanium hip, or did he put in what your insurance would cover or simply what he was trained on and what he knows?

With housing you get all sorts of disclosure information about costs. In fact law requires it. Pardon the uncontrolled laughter, but do you have any idea what you are going to be charged walking into your doctor or the ER? There is no pricetag on healthcare for the most part. Cost transparency does NOT exist and what you pay and what someone else pays for the exact same service can vary dramatically.

In buying a home, you budget for it. It’s a big expense. You don’t go outside of your means and say “Damn it all, that’s what I want and by gosh I’m going to get it even if it’s five times what I can afford.” (OK so those days only recently ended in housing). In healthcare, other than premiums, do you have a budget? Are you on a plan with a deductible? Do you have a co-insurance that saddles you with 10 or 20% of the costs incurred? That can be an unbudgeted $500 or even $10 thousand dollars or more.

Which leads to the terms. For a home, you set up terms. You pay out over 30 years or so. Truth in lending requires them to show you how much you will actually pay out in interest, etc. over the 30 years (try to avoid passing out when you see that one by the way). In home-buying, you set up terms that you are (at least theoretically) able to meet with your income. Healthcare is potentially a home-sized expense. And it generally runs its course within 60-90 days. Not a lot of time for an expense that is potentially the size of your home.

So if you default on your home loan, they repossess it. That’s the pledged asset because on debts that size, no one is going to give you the money for the purchase without securing an asset. Healthcare is really different. They can’t make you take back that nasty gall bladder or break your leg again (though the collections tactics they use sometimes border on that). There is no asset pledged against the expense. Hospital wants the money? You don’t have it. their option is to try to force you to liquidate your assets - like your home. The one you lost in the mortgage crisis?

Does healthcare have the potential to be the next sub-prime mortgage crisis?

No, it has far more potential.

So it would appear that I’m not the only one less than thrilled about the balance billing practices of some hospitals:

Here’s what the WSJ had to say.

In an unexpected move, we are closing 600 of our satellite offices throughout the country. While there will be no impact on our top line, we should see a significant improvement in our bottom line as there will be far fewer Starbucks out there where we can abuse our expense accounts.

Please bear with us during this difficult time and hope for the best as we deal with Christopher’s withdrawals.

So the Mass. attempt at “socialized” healthcare turned one year old today. CONGRATS!

Our resident Bostonians on staff @ change:healthcare, George and Vic, must be so proud. Oh wait, they’ve already fled the state to be here.

Nevertheless the plan seems to be working well according to Julie Appleby of USAToday - residents are getting better coverage…and premium rate increases of 5.1 to 9.4% unless you take the person profiled in the article who got a 45.7% increase in premium over the first year’s premium. Wow! Even the private insurance industry is hard pressed to pull that one off!

An excerpt from the article: “I almost fell on the floor,” says Pelletier, 55, of Newbury. “Costs are getting out of control.”

No kidding.

People will eventually make the connection. The decisions you make regarding their healthcare - when to go, whom to see, and what to pay - are what ultimately determines the premium. The premium is an effect, not a cause.

Happy Birthday!

The best thing about this job is that we get to meet some really great people. Today we met some outstanding folks who are going to make a difference.

Cover America made a stop right here in Nashville today and a few of the change:healthcare team had a chance to catch up with them. The cross country trek to capture stories of consumers’ difficulties with the healthcare system is part of a Consumer Reports effort on the healthcare front.

We really enjoyed meeting Meg, Blake, Pauline and Liz. Even got our photo with the RV in Centennial Park, in the shadow of Hospital Corporation of America (oh, how we love the irony of that one). Many thanks to these folks for what they are doing - fighting for the healthcare consumer.

Meg is getting a much deserved break after three weeks on the road, and we wish her a happy mini-vacation.

The rest of the crew is headed on to eastern Kentucky before hitting Virginia. We are going to try and hook them up with our favorite West Virginian, Bob Coffield of the Health Care Law Blog when they hit Charleston.