What is “fair” payment for medical services?

I write this hoping to appeal to common sense. When are we going to stop putting the cart before the horse? 99 percent of the rhetoric surrounding health care costs centers on a “fair” way to pay for it, “fair” reimbursement levels, and who should pay this “fair” level of payment, when the real issue is the amount being charged in the first place. What exactly is “fair”?

The real central, causal issue is the very high cost of the care. Health care is the only thing I can think of that we buy without knowing what it is going to cost. The delivery system is convoluted and a mystery to the average person. I had 1 MRI. I got a bill for $350 from the person who conducted the MRI. I got a $600 bill from the facility where the machine is located. I got a bill from another doctor who read the MRI for $500, and another bill from a doctor who guided me through my treatment options. They were all great and did great work, and I am grateful for the treatment I received, but where is the accountability for the charges?

Can you imagine buying a TV, then getting a bill on your credit card for $50,000? Of course, it would never happen because you know the cost before you buy it. Every transparency bill sent to the MA legislature has been lobbied against by the Medical industry. Is that “fair”? My dentist wanted me to have two implants. I asked what it would cost. He told me. I told him if he could justify that price, I would do it. I never heard from him again.

Let’s face it. “Fair” means more. Where is this additional money going to come from? The answer is it comes from the patient, either in the form of premiums, deductibles, co-pays, and taxes. Yes, taxes. Where do you think the money comes from to pay the subsidies provided by Obamacare, or the various state Medicaid programs? I am in M, and the state budget for FY2019 is $43.1 billion. Mass Health alone is over 40 percent of that budget. That’s $17.24 billion of health care costs paid for by our taxes. Then there is a little thing called Medicare. In 2018, that was $731 billion, your taxes, and the individual payments made by Medicare beneficiaries.

So before we start worrying about who should pay the medical bill, shouldn’t we be analyzing and requiring justification of the bill itself? Medicine does three basic things: diagnoses the problem, treats the symptoms, and tries to cure the underlying disease. For the last 30 years, we have done nothing but treat the symptoms. It’s about time we did some deep diagnosis and start curing of the disease.

Medical costs are on a collision course with the U.S.’s sustainable economic structure. Unchecked, it will bankrupt this country.

Neal Biron is a benefits consultant.

Image credit: Shutterstock.com

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