Healthcare in the United States

I don’t really think about health care in the United States. I am one of the many Americans who benefit from health care provided by my employer. Sure, I pay a very small amount each month for my family to be covered, but it pales in comparison to what my employer pays. I don’t give a second thought to taking my kids to the doctor, dentist, optometrist or even emergency room at the hospital of my choice.
So, when my fabulous friend Teresa received the insurance statement from her recent mammogram, I was shocked. No, shocked is not really the word. I’ll tell you the story and you can help me choose a word for my emotion.

The service listed on the statement was “x-ray”. I don’t know if you realize this, but there are several charges for each visit to the doctor. In this case, Teresa will be billed for the x-ray and reading the x-ray by the radiologist, two charges. That’s very minor compared to other medical filings, say to an emergency room. However, I digress. The submitted charge for the x-ray was $867.75. That is more than most people’s house payment. The fee was not the shocking part. The shocking part was what came next on the statement: “eligible charges: $130.16”, “benefits paid: $130.16”. Will Teresa receive a bill from the clinic that performed her mammogram, expecting her to pay the difference? No, she will not. Why not? Because the $130.16 is the agreed-upon charge between the clinic and Teresa’s insurance company.

Teresa’s question: “And if I had been without insurance, would I have paid $130.16?” Her response was just a tad colorful, so I will paraphrase: “NO!!” THIS is why American healthcare is in trouble. Because of a heinous yet obvious double-standard of healthcare providers. A person who doesn’t belong to the employer-provided-healthcare club will be tracked, harassed, and squeezed to pay an amount that the large conglomerate insurance companies are not expected to pay. If the clinics, hospitals and doctors agree to a particular “reasonable and customary” charge, why doesn’t it apply to everyone?

“That’s the beauty of capitalism!” you say? No, capitalism is not about squashing the people that hold our country together. The people who work hard at more than one job to make ends meet, and live just far enough above the poverty line to get no benefits from our government, and yet don’t work enough to be covered by their employers. These are the people we need to worry about. They are a very important part of our national strata. Just as geologists can look at the Earth’s strata (formation of rock) to gather information and facts from our physical history, so can sociologist with our people-history. What is history going to say about medicine overcharging those they KNOW cannot pay to make up the differences from the ones who CAN pay, but don’t have to?

I am all for negotiated rates. After all, I have long believed that the seller doesn’t set the price, but instead the buyer does. Something is worth only what someone is willing to pay for it. THAT is the beauty of capitalism. Price gouging the ones will the smallest voices is not. So, back to my earlier question: what emotion do I feel about this obvious injustice? I will use Teresa’s comment: It oughta be a crime.