Jacqueline Vance, RNC, CDONA/LTC

Everything has a price, and we all have become accustomed to knowing how much something is going to cost before we buy it. 

Go to the grocery store and you know what an avocado will cost you. Go on Amazon and every item’s price is there for you to see before you make a selection. If we go out to eat, the prices are on the menu; if we want landscaping, yes, we may be able to negotiate, but we know what the price is before we sign a contract.  

But in healthcare, things are about as transparent as an iron door! And, yes, I am about to jump on my soapbox.

The U.S. spends about 20% of our gross domestic product on healthcare, whereas most other developed countries spend half of that. In fact, according to a Time magazine article titled “Bitter Pill,” the U.S. spends more on healthcare annually ($2.8 trillion) than the top 10 countries — Japan, Germany, France, China, United Kingdom, Italy, Canada, Brazil, Spain, Australia — combined. 

And we don’t seem to get great value out of this exorbitant price tag, as our health outcomes are not any better, and are sometimes worse, than other industrialized countries. So just what exactly are we paying for?

Look at pharmaceuticals. If you have insurance and it’s a generic drug, sure, you know what your copay is. But if it’s not a generic and is a “tiered” drug, you have no idea until it gets rung up at the pharmacy. And we don’t always know what our plan covers. I almost passed out when I went to pick up lidocaine patches at the drugstore. My copay was $300. I said, “No, thank you, I’ll stay in pain.” And that was a generic! 

I was reading how U.S. pharma negotiates prices in secret with both pharmacy benefit managers and insurers (#hashtag lack of transparency!). We know the same drugs sell for less in places like Canada, like way less. (I bet my patches would have been affordable there.) 

Now, I know that the pharmaceutical industry will debate that they have to charge us these prices in order to recover their research and development costs. OK, so I get it that R&D is important. But why do we have to bear the costs for the whole wide entire world? And why should an industry that makes a bazillion dollars in profits make us pay for R&D over and beyond those bazillion dollars anyway? Makes my head spin!

I also read where our government is in the process of forcing hospitals to disclose to the public their secret price negotiations with the insurance companies. I recently saw an article about the disparity of prices of a CT scan. Guess what? You can expect to pay anywhere from $270 to $5,000 for a scan. It’s the same machine for goodness sakes! Why should it cost more in Chicago than in rural Tennessee?  And why is the price of a CT scan 33 times higher in a hospital emergency room than in the general hospital? The only answer I have is: “Because they can.”

So, speaking of “because they can,” I recently spent a morning in the ER for my back. (I have no idea what they bill will be.) They recommended a local pain specialist for me to follow-up with. I call, the receptionist asks what my insurance is, I tell her, and they can fit me in the next day. 

The next day I show up at the office and they have me fill out 8 forms (many asking the same questions — Argggh, I hate that!) and then the receptionist comes over with a calculator and shows me a figure and tells me this is the doctor’s consult fee and he will need that up front. 

As I pushed my eyeballs back in my head, I asked, what about insurance. It is at this time (#lack of transparency) she offers that the doctor is out of network with every provider. Now the figure she showed me was $1,000. Yup, you are seeing that right. 

So, I literally laugh and ask her if she thinks we are in Hollywood and he’s a pain specialist to the stars (and where is my champagne and caviar?).  I get up and start to leave and she kindly offers that the doctor takes payment plans if I put half down. (I won’t tell you what my response was since this is a family friendly blog.)

Let’s be honest: If she had told me what the costs were on the phone when I went to make an appointment (transparency), I would have saved the 50-minute drive and writer’s cramp.

I guess the burden is on us to start asking better questions. Do I really need the CT scan or whatever test? How much will this cost? Is there another option that isn’t as costly? Maybe we can force people to be transparent. 

OK, I am getting off my soapbox now. It’s killing my back! 

Just keeping it real,

Nurse Jackie

The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, Senior Director of Clinical Innovation and Education for Mission Health Communities, LLC and an APEX Award of Excellence winner for Blog Writing. Vance is a real-life long-term care nurse. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.