Cost has been a major factor in the health care reform discussions from day one. When it comes to health care, most people would rather have someone else pay for their care. But we can’t all pass the cost onto someone else – eventually somebody has to foot the bill. The way I see it, there are two issues: One is fairness, and the other is value.
How can we most fairly spread the total cost of care for all Americans across the whole population? Should sick people pay more than healthy people? Should overweight people pay more than their slender neighbors? Should a family with six children pay more than a family with one child? Should older people pay more than younger people? Should people with higher incomes pay more for their health care than lower income families? These are the sort of questions that address the issue of how to fund our current high-priced health care. And they are a huge part of the reform debate, including all the discussions about mandatory health insurance and guaranteed issue coverage.
But value in health care is another cost issue, and one that I don’t believe has been adequately addressed in the current health care reform bills. Earlier this year, we had to call a plumber to have some work done in our bathroom. He did a great job, and our total bill came to $165, including parts. A week later, our son caught his finger in a door, ending up with a pretty severe cut. We took him to the emergency room (unfortunately it happened after the lower-priced urgent care center had closed for the evening) where he had an x-ray and got three stitches. We’ve started to get the EOBs from Humana, and so far the total amount that we’re expecting to be billed is over $1,400 (that’s after the network negotiated discounts, and there are likely more EOBs to follow).
We have an HSA qualified policy with a $5,000 deductible, so we’ll be paying the whole bill for our son’s finger ourselves. But that’s not really the point. Regardless of whether a bill is paid by the patient or by the health insurance company, we all need to be asking ourselves whether we’re really getting a good value for our money. When the average household income in America is just over $50,000 a year, does it make sense for a cut that requires three stitches to cost more than $1,400? Health care spending in the US is 16% of our GDP, which is dramatically out of proportion with what other countries spend. And all of those dollars being spent on healthcare aren’t available to be spent on other things like education and quality food and clean energy.
Both the plumber who came to our house and the PA who stitched our son’s finger performed a very necessary service for us. Both are highly skilled in their areas of expertise, and we’re grateful for the work that they did. But was the work that the PA did ten times more valuable than that of the plumber?
Perhaps the question we should be asking is not who should be paying for healthcare, but rather, why in the world are we paying so much in the first place? Health insurance premiums will continue to rise as long as health care costs do the same. It won’t do any good to try to address premiums without first figuring out why we’re paying so much for our health care in the first place, and doing something about it.