Want to cut healthcare costs? You may be on your own

Our country spends twice as much on healthcare as any other nation on earth. My state of California is home to 3 million people whose health coverage has annual deductibles of $1,000 or more, putting many into a financial bind regarding their care options.

That has a lot to do with a push toward what the industry has termed "consumer-directed healthcare," but is generally just dumping onto laypeople the burden of weighing granular clinical and compartmentalized cost data to make decisions that could have profound impacts on their lives.

A CEO of one of the leading medical groups in the western U.S. told me a few years ago that he didn't think consumer-directed healthcare could work. There was simply too much data for the average person to digest.

His organization made front-page news when it became one of the first medical groups to post prices for basic care in its waiting rooms. But in the long run, he actually thought it wouldn't make much of a difference.

I thought that was a little cynical, but I'm beginning to see he has a point.

My wife's recent experience is an excellent example. She was definitively diagnosed with "what is probably a lymph node, but might be something else." Her physician insisted she undergo an invasive procedure to learn more.

We learned the hard way about a year or so not to take such medical advice at face value. My wife's primary care physician referred her for an MRI when she went through spell of extreme tiredness that has since abated. The test was inconclusive, and our plan left us on the hook for nearly $1,000. I am not kidding when I say I would have derived more satisfaction from setting that money on fire.

This particular procedure would cost us around $1,200--not including the lab work.

You have questions for your doctor, but what do you do when he doesn't return your phone calls? I finally tracked down his email address. This seemed to command his attention: he was not used to getting emails from patients, nor answering questions.

"Whenever people get a test result like this, they want the answer yesterday," the doctor said bluntly when we got him on the phone. Aside from all the data I had dug up from peer-reviewed medical journals suggesting otherwise that a rush may be unwarranted, it seemed to be case closed.

Drilling down with the doctor made my wife's situation more clear: a fairly borderline case routinely referred for further work because that's what everyone is accustomed to doing. The doctor finally admitted that undergoing another screening in three months wouldn't make a bit of difference. He also expressed some astonishment at our costs, and some sympathy.

"I hate those types of plans," he said. Whether he would incorporate their existence in his future decision-making processes remains to be seen.

Of course, this makes me wonder about all the other patients who undergo the more invasive procedure without a second thought.

There are a lot of those people. Most patients comply with whatever their physicians say. They don't insist on asking questions, or that their doctor return their calls. They don't have a relative who's a clinician or, much worse, a snarky healthcare journalist.

As far as I can tell, there's not a single health plan educating consumers to ask their doctors appropriate questions regarding their conditions. There's not a single health plan that educates providers on the notion that their diagnoses could inflict a financial burden on their patients, and to be prepared to suggest alternatives.

Meanwhile, almost all plans continue to ratchet their premiums upward of 20 percent a year, blaming skyrocketing medical costs, or "healthcare reform" that hasn't even come close to being implemented.

This cynicism about healthcare finance has begun to spread. I had to go see a specialist whose front office staff demanded $250 up front and assured me with the straightest of faces my insurance company would reimburse me for overcharges. I calmly replied that any overcharges would be resolved by my filing a dispute with my credit card company.

My examination lasted a grand total of five minutes. The doctor filed a claim with my insurer for two procedures that weren't performed, conveniently bringing the charges on my end well beyond $250.

This physician interaction will begin with the promised credit card dispute, and could build to a fraud complaint filed with the state medical board. But its conclusion will be dictated on my terms.

If healthcare costs are ever to be gotten under control, the other 300 million Americans will have to begin behaving in this fashion. The notion of living in a country where everyone is as cranky and confrontational as myself is not at all pleasant. But there's little joy in the notion that you must tackle a monumental task all alone. - Ron