We have great health care in the U.S. It is also unbelievably expensive. I think I know why.
This is the only industry I know of where you don’t find out the price of things until after services have already been rendered. After having a couple of bones fused and screwed together and a ligament sutured, I am on the mend. Beforehand, I asked my very competent doctor what it would cost. He said he didn’t know. “It depends on your insurance. Have you met your deductible? He has a fee. He doesn’t know what it is. The anesthesiologist has a fee. The surgery center has a fee. They don’t tell you what it is beforehand, but they make you sign a document that says you will pay it, no matter what it turns put to be.
This is an amazing thing. I try to imagine buying a car like this. A similar cost, actually. Me: “How much is the car?”
Dealer: “I don’t know.”
Dealer: “Well, the tire company has a charge, there’s the title, Uncle Sam gets his cut. It depends on how much you put down. We’ll send you a bill.”
You can get this information in advance of course, but it’s really hard. And people aren’t nice about it. I once had a test done.
Me: “So, how much does this cost?”
Receptionist: “I don’t know.”
Me: (Apologetically) “Okay, but I’m kind of curious. How do I find out?” Receptionist: “They’ll send you a bill.”
Me: “I know, but I’d like to know beforehand. So we can plan our finances.” Receptionist: “It depends on your insurance.”
Me: “What is the typical charge for this procedure?”
Receptionist: (Exasperated) “I really don’t know sir. I’d have to go find out.” Me: “I’m okay with that.”
Receptionist: (After 30 minutes of sitting in the waiting room.) “$80.” Me: “The test costs $80?”
Receptionist: “No, that’s your copay. Have you met your deductible?” Me: “So, you’re not going to tell me what this costs are you?”
Receptionist: (Openly hostile now.) “Why do you care? Your insurance will pay for it.” Me: Sigh.
The idea is, since it’s on your insurance you don’t need to know. You shouldn’t care and you certainly shouldn’t ask. And you certainly shouldn’t shop around. You’ll discover the charges for the same thing can vary dramatically from place to place.
This system drives costs up of course. And it leaves the 30 million people who have no health insurance up a creek.
This week my doctor says, “You’re doing good. You should get therapy for that ankle. It’s not necessary, but it will speed up the healing process.” Me: “What does that cost?”
Doc: “I don’t know.”
So I go to the physical therapist today. He’s bright, helpful and competent. He spent over 60 minutes with me. I know this is going to cost a bunch. While he’s shocking my ankle, I ask,
Me: “So how often should I be coming?”
PT: “Three times a week for two weeks, then twice a week until you’re better.” Me: “Just out of curiosity, what does this cost?”
PT: “I don’t know.”
Me: “You don’t know?”
PT: “I don’t do my own billing.”
Me: “Well give me a ballpark. What’s the going rate for a PR session?” PT: “It depends on your insurance.”
Me: “Does it?”
PT: “Have you met your deductible?”
Me: “I’m just curious what it actually costs.”
PT: “$150, or $200 maybe.”
Me: (Hallelujah! An answer.) So if I have a 20% copay, maybe $40 a session times ten sessions this month. $400? An the insurance company pays $1,600?” PT: “Yeah, probably, only this is your first session so it will cost more.”
It’s all worth it, but how do you budget for things when you don’t know the costs? And perhaps most people have gobs of money laying around, but in the universe where I live, an extra $400 in any give month really matters. And I’m not poor.
All of this leaves me wondering: How do the poor do it? What if you work for Wal-Mart at $8/hour and have no insurance? Or what if you’re like a Houston janitor, making $9,000/year, and you need mystery therapy at an undisclosed rate, what do you do? Let’s say you have have full health benefits in that janitorial job, but still have the 20% copay that will cost $400 this month, what will you do when you make only $750/month?
But we shouldn’t worry about all that. It would be socialist. So many say, “Not my problem.” “They should get a better job.” “Let them eat cake.”
People can ignore the poor, look the other way. As followers of Christ, we cannot. The one who multiplied the loaves and fish did not send the masses away. He who offered free health care to the poor could not take such a view. “Blessed are the poor.” We follow one who called his followers to care for the sick. Have we forgotten this, are we ignoring 2,000 passages in the Bible dealing with poverty, do we pretend it’s not right there in the gospels, or is it just an inconvenient message?
What would it look like if the middle-class church actually stood up or the poor?