Labyrinth

Manfrengensen likes to run the numbers for our little organization. He takes pride (as he should) in keeping us fiscally sound.

A couple of years ago, he told me that he thought one of President Bush’s ideas made a lot of sense.  So, I did the natural thing and sniffed his lapel for traces of opiates.

Manfrengensen figured out that it would be more economically sound for us to invest in a health savings account (HSA) like the ones President Bush was touting.  In theory, HSA’s sound like a great idea. Consumers drive the medical economy by negotiating prices for their own health care.  Sounds good, doesn’t it?

The way an HSA works, is that you buy insurance, at a lower cost, with a certain deductible amount that you pay out of pocket. Though you can pick whatever deductible you want in order to dial down your monthly premium, let’s pick a round number, — say, five or ten thousand dollars for the whole family. Then you put that money into a savings account that you dip into whenever you go to the doctor or hospital.  You pay less in premiums every month, plus you earn interest on the money in your account.

Again, in theory, a good idea.  In practice though, I imagine that most Americans couldn’t (or wouldn’t) be able to put the money aside for their health management.  Most people can’t afford to put that kind of money in an account, and lots of those who do have the money, would probably rather spend it on more tangible goods like expensive cars, homes or shoes.

In addition, I don’t believe that the “consumer driven” economy of health will ever come to fruition.  The idea is that if people have an economic stake in their own health maintenance, they will be not only be more discriminating about the ailments they seek care for, but they will be able to shop around and thus find the best prices for their care.

So far, I am finding the latter not to be the case at all.

In the last few years, I have suffered from migraines, and after several months of chronic attacks, I finally went to see a neurologist last summer.  He’s great, said it seemed like the classic migraine scenario, but suggested that I get an MRI just to be sure.  So, okay, I want to get an MRI.  How much do they cost?  You’d think it would be relatively easy to find out.  But it’s not.

First I called the place doing the MRI.  They couldn’t tell me.  It would depend, the nice, patient lady said, on what my insurance company was willing to pay based on what kind of policy I had with them.  She suggested I call the insurance company, as they would be the only ones capable of telling me that number.  I said, “Can you give me a ballpark?” And she said, “Well, it could be anywhere from eight hundred to five thousand dollars.”  That’s a big ballpark.

So, I called the insurance company, armed with the diagnosis codes the nice, patient lady gave me.  The insurance company said they couldn’t give me that information, that the MRI place needed to call them. They said the price of the MRI depended on what price the doctor or the office had negotiated with the insurance company. So I called the MRI place back.  The woman there was very nice and obliging.  She called me back two minutes later and said that the insurance company told her that they “don’t give out that information.”

In other words, I was chasing my tail. I think it’s like flying to Florida.  You never know what the price really is until the day you book your trip.  Today the insurance company’s paying $800, but if you submit the bill tomorrow, they spin the wheel and the compensation could be something else entirely.

So, finally, I went to get the MRI, in total blindness, and I waited for the bill.  It came in around two grand.  Well spent, but again, not the consumer driven health care system we’re supposed to be talking about.

Manfrengensen needs to have his own thing done at some point, so he told me he was going to try to find out what it’s going to cost.  I didn’t say anything, because he had to follow his own path, but yesterday he reported that he had gotten the same runaround that I had.  Needless to say, I wasn’t at all surprised.

I’m not saying that HSA’s aren’t a good idea.  Actually, I think ours is serving us well.  But I do think that if you want demand to determine the price of health services, somebody needs to tell the suppliers that the rules of the game have changed.