Why Do We Allow the Medical System to Rule Us?

Photo by Kristina Flour on Unsplash

Imagine walking into a store in the US and selecting an item. You look for the price tag and can’t find one, so you ask the store clerk how much it costs. The store clerk doesn’t know, but they make a phone call. You wait. Finally, the store clerk says he still doesn’t know the price, but there is a code that goes along with the item, and you can call a different person and give them the code, and then they can tell you the price. He gives you the code — a random string of numbers and letters — and the phone number to call. You call the number. You wait (and wait). Finally, someone answers and you ask them to give you the price. You give them the code. You wait. When they finally come back, they give you a price…and a caveat. This might not be the actual price, because, factors.

What factors?

Well, it will depend on how long it takes for your store clerk to ring up the item (the code you got was for a “medium” amount of ring-up time), whether any other person at the store needs to come take a look at the item first, if there is a security device on the item that needs to be removed, and whether you have a rewards card or not. Oh, and which rewards card you have — whether that rewards card is affiliated with this store directly or only indirectly, and then which sub-type of rewards card you have. Also, it will depend on how many times you’ve used the rewards card already in that calendar year. Also, also, the code you were originally provided might not be the right code in the first place, if the store manager realizes that you really ought to have purchased a different item altogether.

You ask how you can know if your rewards card is affiliated. You’re told to go to the website. On the website, there are a list of stores, but each one includes the caveat that the website might be out of date, so if you really want to make sure you’re at an affiliated store, you have to check with the store…who just told you to check the website.

You ask if you can get the pricing for those “factors.” The answer is yes, but you’ll need more codes. You ask for the codes. They don’t have them. You’ll have to call the store manager for those. Exasperated, but really needing this item, you get the number for the store manager and make yet another phone call. You wait. The store manager answers and says she’ll fax the codes for two of the “factors” but she can’t give you the others. You need a referral to a different store manager at a different type of shop for those.

You give up. You decide to just move forward and let the bill be whatever it is. You check out with your item and reach into your wallet to pay. The store clerk looks at you funny. You venture “How much do I owe for this?” The store clerk has no idea. “You should receive a bill in about 3–6 months. Or, actually, you’ll get a rewards statement first, letting you know how much the rewards card might have contributed toward the total cost, and then, a few months later, you’ll get an actual bill. Oh, and you actually might get several bills, because I have to send you mine, and I’m not an employee here — I’m a contractor — so mine will come in separate. Just like Bill’s over there.” The store clerk points to the security guard by the entrance, who waives. “His will come last, probably. He takes forever to submit his.”

That introduction to the problem is ridiculously long and drawn out, but that is exactly what happens if you actually inquire about the cost of any medical service or supply before you buy it.

In reality, the majority of US citizens never go through this rigmarole because they’ve learned to just accept the system the way it is — they use their “rewards card” (for which they pay a large amount every month) and just get the services their doctor tells them to get and then they pay the bill months later when it arrives.

But we would never stand for this insanity in other industries — even in complex, service-product hybrid industries like construction, we still get straightforward pricing and agreements. In my own industry (law), it is extremely difficult to estimate the total cost of a given matter, but we still provide the methodology for pricing and the terms of our agreements. So why do we let the medical industry get away with what can only be termed as medical-cost laundering?

Perhaps it is the hydra-effect — the industry is so big, and it has so many heads that there is no one part or person who is accountable. Every “store clerk” can shrug their shoulders and hand you a code, every code/estimate office can shrug their shoulders and send you to the “store manager,” every “store manager” can send you to the rewards center, every rewards center can send you to a different department (who probably won’t answer the phone anyway). If I wanted to hide from accountability in my industry, this is exactly what I’d do. I’d grow so large that the system would become the beast in control, not the humans who created the system.

Or perhaps its the fact that the industry is third-party mediated. We are collateral damage in the war between insurance, providers, and suppliers. Insurance finds loopholes in order to get out of paying for services and supplies, so the service providers and suppliers raise all the prices to make up for it, forgetting (or not caring) about the people who don’t actually use the insurance in the first place (or who got the wrong kind of insurance) and who now have to pay those heightened prices (unless they’re savvy enough to know the magic words “cash pay” or “can I get a charity application” or — God forbid — “can I see the Charge Master?”).

Maybe it’s because we’re dealing with health and health is, well, kind of important. So important that we’re usually willing to spend a LOT of money on it. Industries often take advantage of (1) need and (2) big numbers. Why? Because, psychology.

The human brain will pretty much do whatever necessary to sustain life, and it has not evolved to understand large numbers, at all. If you give a kid a number chart that ends in one billion and ask them to mark the place for one million, they will usually place it around the middle of the chart, when it really should be closer to zero. Adults aren’t much better. We don’t encounter real-life situations where we have to have an intuition for the difference between a million and a billion (or even a thousand and ten thousand), and so our brains aren’t high-functioning with large-number concepts.

Have you ever wondered why a real estate agent can demand 3–6% of the value of a house (a number randomly tied to how much you spend rather than to the service they provide)? It’s because you don’t really grasp how much that is. The number is too big, and the need for shelter too great.

Whatever the reason (or reasons), the medical industry has become a juggernaut that bows to no one. And when that happens, there are only a few ways the villagers can fight back. Here are a handful of suggestions I would encourage every US citizen to consider:

1. Look into medical sharing as an alternative to insurance. If you don’t have ongoing pharmaceutical needs, this is a very good way to give a middle finger to the industry. And you’ll have better service.
2. Look into Direct Primary Care as an alternative to insurance and in-network circus hoops. You’ll actually see your doctor when your appointment starts, they’ll actually sit down with you and talk things through, and you’ll know exactly what you’re paying for.
3. Ask every hospital you use for their Charge Master, their Patient Advocate phone number, and their charity application(s). Make them provide transparency. Call the numbers, demand estimates, make it harder for them to employ people who don’t know the answers than people who do.
4. Demand paper copies of the things you sign. Change any terms you disagree with before signing.
5. Demand actual notice of who is providing you services and whether that person is part of the facility you’re in. If you go in for an x-ray or mammogram or into an ER — ask every single person who helps you whether they are employed by the hospital/facility or are sub-contracted (i.e., will their bill come with the facility bill or separately).
6. Ask your doctor’s office to tell you what codes they believe will apply to your visit (before your visit) and what factors will affect those codes (if your doctor takes ten minutes with you instead of nine, will that change the code, for instance?).
7. Use Good RX and check pharmaceutical websites for discount codes. Don’t be afraid to ask your doctor to change the prescription type or quantity in order to qualify for discounts. Use the doctor’s online portal to ask questions or request changes— they can’t bill for answering those. Pharmacies have to adhere to the Good RX pricing. Don’t let them weasel out of it.

In other words — make it hard for them all. Demand transparency until the insurers, and providers, and suppliers, and pharmacies feel the burden of the ridiculous nature of how un-transparent and over-priced the entire industry is.

It will be a drop in the bucket, but even a single rainstorm can fill the wells.

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