The pain of paying for health care in the U.S.

A doctor checks an X-Ray.  

October 1st is when health exchanges will open. People who don't have insurance can shop around for plans. But here's the thing -- and this affects everyone: those with private insurance, those with work plans. You might know how much your deductible is, but actual treatment can range -- even in the same zip code. Unlike just about every other thing we spend money on, health care doesn't come with an upfront price tag. Elisabeth Rosenthal, a New York Times reporter and a doctor, spent a year investigating the cost of medical procedures in a series called "Paying Til it Hurts."

Rosenthal started the series by learning about colonoscopies. She found that the price of a good colonoscopy was all over the place. It can vary from $1,000-$15,000. So what can patients do to lower their costs?

"They can ask beforehand what the price will be because this is an elective procedure. The second thing I would recommend everyone do is ask about whether anesthesiology is included in that. What I saw from a number of patient bills was that the big, big charge was not actually for the colonoscopy, but for the anesthesiologist who put you under. The other thing I would warn people is we like to say under the Affordable Care Act these kind of screening procedures are going to be free to patients, but if anything is found during that procedure -- like if there is a little polyp to take off -- then it becomes not a screening procedure and you can be open to getting those bills," says Rosenthal.


Just how much will Obamacare cost you? Ever since Obamacare was signed in to law in 2010, it's been a bit of a mystery what that health care will actually cost a consumer. But as that deadline draws near, we're starting to get an idea of the how much people will pay and what they're going get for their money.


Rosenthal says Americans pay a la carte for most services. That means if you have three ultrasounds, you pay for each of them -- and oftentimes for the radiologist who reads them. That's what's known in the medical business as "fee-for-service."

"There are plenty of other countries that do fee-for-service, but they don't consider everything a service. So we define the doctor and the operating room and the blood pressure cuff and the blanket and the Tylenol each as a separate service. And we pay separately for that often. That's what's gotten out of control," says Rosenthal. "It's very unfair to consumers because you don't have a choice."

In October, when the health care exchanges open, Rosenthal says she will watch for what they cover and how well they cover it. She says the Affordable Care Act -- while it's really good at getting insurance for the millions of people who don't have it now -- doesn't directly deal with the pricing issue.

"I think it's incumbent upon patients to ask -- and to ask again and again. And to go online. There are a lot of services now that will tell you what different providers in your area charge for a service. You can comparison shop," says Rosenthal. "One of the ways that prices will come down is if people do become more price aware and more price sensitive."

About the author

Lizzie O'Leary is the new host of Marketplace Weekend.

Comments

I agree to American Public Media's Terms and Conditions.
With Generous Support From...