Bill Him Not Me

Richard Quinn

NOBODY, INCLUDING ME, wants to spend their hard-earned money on health care. That, of course, is illogical if you’re being treated for an illness or relieved of discomfort. Nevertheless, we don’t want to use our own money. That’s why we have health insurance—to cover everything. Or at least that’s our expectation.

When I ran employee benefits, I had many debates with workers about their health care bills. When a doctor charged significantly above the reasonable and customary fee, the plan always paid too little, or so employees felt. They might accept that the doctor deserved more, just not from their pocket. A woman learned our plan didn’t cover a vaccine she deemed essential for her children. She asked if I expected her to pay the $60 fee out of her own pocket.

Many times, when the plan limit on a service was reached, patients would cease care rather than pay themselves. Suddenly, a medical necessity wasn’t. Even senior executives called me wanting to know why the plan didn’t pay 100% of their charges.

Out-of-pocket health care costs are not a line item on the typical family budget. We’ve been conditioned to see the expenses associated with health care differently from any other spending. That’s why surveys find that health care is almost always deemed unaffordable. But we never get that feeling from money spent on other things. Take the family out to eat for $75—it’s no big deal. Pick up a prescription with a $75 copay, and it’s unaffordable. But $75 is $75, right? Actually, when it comes to health care spending, that’s never the case.

Nothing associated with health care is viewed as an obligation to spend our own money. That’s why it’s so easy to vilify insurance companies if a claim is denied or a copay required. It’s also why, despite the rhetoric, you can’t find a definition of what constitutes “affordable” health care.

I have an ongoing debate with a friend in England. His perception is his health care is free. As a retired senior, he pays no premium, no out-of-pocket costs and no tax that’s solely designated for health care.

Eventually, the U.S. will have a health care system with no premiums and little or no out-of-pocket costs. The cost of the system will be paid invisibly from general tax revenue, and thus our health care will also be “free.”

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