There’s nothing like health care costs to make you really mad

Want to get really angry? Think about being the patient in one of these scenarios.

Consumer Reports recently described the travails of a heart transplant patient who carefully selected a hospital that participated in her health plan's network to make sure the expensive operation would be fully covered. However, she wasn't informed that the surgeons performing the transplant did not participate. After the operation, she received their bill for $70,000 and spent part of her recovery dealing with a collection agency.

The New York Times reported the story of a patient who researched his insurance coverage before surgery for herniated disks in his neck so he could plan for the expected cost. He thought he had investigated everything but failed to anticipate a bill for $117,000 from an assistant surgeon whom he was not told would be present during the operation and whom he had never met.

Bloomberg.com recounted the saga of a patient who broke both legs and needed two surgeries during a month-long hospital stay. While the hospital participated in her insurance plan, she was not informed until after her discharge that the surgeons for both operations and several other physicians involved in her care did not. Her bills totaled almost $15,000.

Consumer Reports tried to gauge public sentiment over some other costly health care practices. Between 80% and 91% of respondents to its survey expressed outrage over three of them: a hospital charge of $37.50 for a single Tylenol pill, a physician order that a patient undergo an MRI because the physician owned the machine, and a manufacturer charge of $1,000 per pill for a hepatitis drug.

Twelve percent of the respondents also reported paying more than $5,000 of their own money on medical bills during the previous year, even with insurance.

With stories like these, it is little wonder that the American health care system is the most expensive in the world by far. It costs almost 50% more per capita than the number two system, Switzerland, and more than twice as much as the systems in most other developed countries. And despite the high cost, our health outcomes lag behind those in most of those countries.

High health care costs in the United States are not an abstract problem. All of us see them in higher insurance premiums and strains on both federal and state budgets. But some of us feel them in a way that is more direct and often financially devastating – huge unanticipated bills that no amount of diligent preparation could prepare us for.

The Affordable Care Act may be helping somewhat. Early indications are that incentives for efficiency contained in the law are having some effect. But they are only a start.

While we ponder long-term solutions, there is an immediate need to protect individual patients from bearing the brunt of our expensive system of care. A new law in New York will require that providers inform patients in advance of their insurance network participation and which professionals might be involved in their care. This should be a model for other states to follow.

The hardest part of recovering from surgery should not be receiving the bills.

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