Monday, March 31, 2014

Affordable Care -- Just a first step


The myth of informed consent

In all this back and forth about the Affordable Care Act we are missing what is an equally important issue. -- the cost of health care in general.  There is excellent and detailed writing by Steven Brill on the topic, but it was hard to get through it without an elevation of my own blood pressure. Most remarkable in his reporting is the fact that the cost of most medical procedures is a well-guarded mystery. From one hospital to another the costs vary greatly and the amount that our insurance company covers is also done by some mysterious formula for procedures and medication.
 This brings me to my current shock about the cost of medication. After a persistent cough after a cold my doctor prescribed a steroid inhaler. When I went to pick it up the young pharm tech said apologetically that it was $135.00. It was probably the startled look on my face that caused her to say, “Wait, let me make sure that insurance covered its part.”
When she returned from the computer she looked even more startled than I and reported that the “out-of-pocket” cost was actually $1,017.00. Yikes! I didn’t know whether to be grateful that the insurance (theoretically) covered $882 or still be outraged by what the cost to me was going to be. In addition was concern over someone without insurance who might need such a medication and be unable to pay the “out-of-pocket.”
I support the Affordable Care Act and I urged my twenty something offspring to sign up through the health care exchange. They are not invulnerable and huge bills could come to haunt them and maybe their parents. The situation with existing plans could possibly end up, as it did for our daughter.  She had a minor bike accident and even after two years was still paying off the large part of her bill not covered by insurance.
Even after the exchange works and the benefits are in place, everything is not settled. We must continue to look for more transparency in the pricing of medical care and prescription drugs. Since the ACA is in part a full employment act for insurers, they might become our partners in this quest -- once they start getting more bills for inhalers costing $1,017. People should be compensated for their work and for the product they create, but behind this veil of mystery the consumer has no way of making decisions about the better choices in the medical field.
For every little medical procedure we are asked to sign a form indicating our informed consent. At this point in dealing with the medical system in general we are all operating with uninformed consent. Having health insurance is not going to completely address this and the battles over the ACA are unfortunately taking attention away from some of the real issues in medical care in this country. It’s possible for legislators on both sides of the ACA to work to create a more transparent system of medical costs, if they can resist the pressure and checkbooks of lobbyists. Then, we citizens will finally have the luxury of real informed consent.

2 comments:

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