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Nobody wants to pay healthcare bills, Quinn says he knows why.

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AUTHOR: R Quinn on 7/25/2024

You are planning to get another tattoo, it costs $200.

You are going to take your best friend out for fine dining, it will cost $175.

You promised your children to take them to a local theme park, $200.

You receive a bill from your doctor because you hadn’t met your deductible, $200.

Which expense is unaffordable?

Okay, a bit of a trick question, but there is no doubt the answer is nearly always the medical expense is unaffordable. That’s because we have been conditioned (since around 1943 when health insurance took off) to believe medical bills should be paid by insurance – actually meaning anyone but ourselves.

Years ago I had an encounter with an employee’s wife who was incensed that our health plan would not cover Lyme disease vaccinations for her teenagers. She claimed her children were at risk and could die without the vaccine. I said she could always pay herself – $60 at the time. 

Boy, was that a mistake! She screamed, “You expect me to pay with my own money?” Remember, “could die”

This story may be anecdotal, but from years of experience, not an unusual attitude. How many times have you heard someone complain about paying a deductible – even before they were in the thousands? Have you ever heard complaining about a $35 prescription co-pay? How about a $35 dozen of golf balls? 

Think about this. The law says all forms of contraception must be free. Generally not expensive, often a voluntary purchase, but our mindset says it is unaffordable under all conditions – so they are “free.” Of course we know they are not free, the cost is buried in everyone’s premiums and taxes.

I was in the supermarket recently near the pharmacy. I women was arguing because a script was not covered by her plan. The pharmacist told her the cost with a discount card was $33.00. I’m not paying that, she said. Her shopping cart contained more than $33.00 worth of soda and junk food, including frozen White Castle hamburgers – which motivated me to buy some myself – I digress. 

Don’t get me wrong, I am not exempt from these feelings. I don’t want to pay a penny out of pocket on health care either.

The idea we should not pay for our health goes beyond actual care. Consider this comment I was sent. “If I paid into Medicare for my whole career, why am I having to pay $175 a month for Medicare after retiring? Someone please explain this to me.”

How about the move nationally and among states to exclude medical debt on credit reports? In NJ. a new law greatly restricts the ability for creditors to collect medical debt, thus providing another incentive not to pay. If you owe $400, you owe $400, right? Apparently not. 

Our collective attitude toward paying for health care is one of the drivers of high health care costs. We want someone else to pay and when they do we don’t care how much – well maybe when our premiums increase, but most people don’t even make that connection. 

There is always something to buy with our limited dollars that gives us pleasure, but not health care which most often is not pleasurable, but nevertheless a highly valuable purchase.  

The bottom line? Most Americans would prefer to have all their health care costs buried in taxes and that way health care will be “free.” Maybe someday we will all realize that. 

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Julie VanDore
6 months ago

May I suggest that this resistance in the face of any medical costs is born of fear. That is, if I agree to pay for this medication, visit, procedure etc (that I thought was covered) that I can reasonably afford, then someone is going to come after me with a $10,000 charge that I cannot afford.

Medical Billing in the US is opaque and confusing. We get bills when we least expect them and those bills are confusing and unclear. So, many people respond by resisting any costs at all.

Even those of us who have some financial savvy get hit with bills and costs that make no sense. What is it like for someone who doesn’t have that financial savviness to respond when they receive confusing bills that are in error?

Boomerst3
6 months ago

The people who cannot afford the really high hospital bills are not the ones you speak about. Also, regarding Medicare for $175, double that if you want to get gap insurance to pay the remaining 20%. My wife and I pay over $8,000 for part B coverage, even though we paid onto Medicare all our lives. This doesn’t count deductibles and co-pays either. The medical system in the US sucks. Be honest. Compared to other developed countries, we have failed. Many others have to forgo that coverage because it would eat up too much of their social security income. Many who cannot pay medical bills are not wasting money at a theme park, fine dining, tattoos and cases of soda. That’s a pretty skeptical, jaded and incorrect assumption.

Matt Morse
6 months ago

What a mess. My solution is to never use health care. I think I’d rather die young than have to navigate healthcare here or in any country.

mytimetotravel
6 months ago
Reply to  Matt Morse

Really? Going to set your own broken arm? Remove your own appendix? No vaccines, no antibiotics, no pain meds?

The non-system in this country is a mess, but I use it anyway. Other countries have actual, functional systems, funded with taxes.

Randy Dobkin
6 months ago

My wife had an ultrasound which we paid for out of our deductible. Then six months later the radiology biller sent us another bill for more money. After countless phone calls where my wife was told it would be taken care of, they sent the bill to collections. Now she has to ignore the bill collector’s phone calls twice a week. With the sorry state of our medical billing that NJ law may be a good idea.

Randy Dobkin
6 months ago
Reply to  R Quinn

No, the provider was in network.

Dan Smith
6 months ago

I was a pretty militant local union rep, well known and well-liked by the international union. I did however find myself on the other side of the HSA debate; I liked them. I believed that the higher deductible of the HSA’s was a fair trade-off for lower employee share of the premium and the opportunity to build tax free income.
To be fair the international had legitimate concerns: A fear that members would skip necessary medical care, they would resist contributing to the HSA, and of course that they would bitch incessantly about not getting care for free.
I rode the HSA train all the way to Medicare eligibility and I’m glad I did. Ended up with a healthy 5 figure account to carry into my senior years. 

Rick Connor
6 months ago
Reply to  Dan Smith

Dan, we did the same thing with accumulating a 5 figure HSA fund. When my company started offering HDHPs with an HSA it wasn’t that hard to do the analysis to see it was the best deal. It clearly depends on the detailed costs, but in our case the lower premiums made up for the higher deductible. If you were lucky and did not need to use any HSA funds, you could accumulate for the future. I think this makes a lot of sense for younger workers who are healthy. Even if you have to dip into the HSA for current medical costs, the tax savings usually makes it a better deal.

Nuke Ken
6 months ago
Reply to  R Quinn

Like Dan below, even if we had hit the out-of-pocket maximum every year, we still would have been no worse off than if we had elected the expensive traditional plan. Even if we weren’t “healthy”, it was still a better deal. In a good year, a couple could sock away $5000 in the HSA that they wouldn’t have otherwise had. In a bad year, the HDHP premium cost + out of pocket maximum would be about the same as the traditional plan’s costs. Maybe your company’s options were different, but most people I know could easily build a 5 figure surplus by electing HDHP/HSA.

Rick Connor
6 months ago
Reply to  R Quinn

Interesting question. I’ve always said you have to look at the details (premiums, deductible, co-pays, OOP max) to understand your best choice. Too many employees relied on anecdotes, gut-feels, guesses, and fear in choosing their medical plans. I tried to put some rationale behind the choice. My employer clearly made the HDHP with HSA an attractive choice; The main difference in our plans was the higher the premium, the lower the deductible. Co-pays and max OOP were the same. I’m sure other company’s plans may have different structures, and the choice could be different.

In the unfortunate situation you reference above, the person would have to do what you do with any bill you can’t pay – work with the provider, use emergency funds, charge it, borrow from family,…. With an HSA you can reimburse yourself in the future.

It is interesting to note that if I were still working at the same employer I would not have an HDHP with an HSA. The competition for employees with certain skill, experience, and accreditations has gotten so tight, especially in the DC area, that the company now provides “free” premium health care – $0 premiums.

Nuke Ken
6 months ago
Reply to  R Quinn

The plan I had included a family out-of-pocket maximum (not deductible) that was roughly the same as the required yearly premium for the traditional plan. People (modest income or not) paying the higher premium are out all that money regardless of whether they need services. You could probably contrive a low-probability scenario in which someone would be better off for a year or two with the traditional plan under such parameters. But over time, the math favors HDHP/HSA, at least with the options I was presented with.

Randy Dobkin
6 months ago
Reply to  Nuke Ken

Especially when the employer contributes to the HSA, which all three of my and my wife’s employers did.

Rick Connor
6 months ago
Reply to  R Quinn

Nothing wrong with using HSA funds to pay for current care. Any funds that accumulate for the future are a bonus. The point is what is the best total cost for the employee assuming the care is the same.

Nuke Ken
6 months ago
Reply to  R Quinn

In my experience, the premium for the high deductible plan was so much lower than the traditional options that it was almost impossible to not come out ahead.

Dan Smith
6 months ago
Reply to  Nuke Ken

OMG Ken, at age 64 my premium was still under $300/month, with a 5k deductible. The premium for a traditional plan was near $800. I figured the worst case was pretty much a wash. My good health saved me a ton of money.

Dan Smith
6 months ago
Reply to  R Quinn

I saw their side as well. My lifestyle and good heath worked to my advantage.

Dave Melick
6 months ago

Richard: I always enjoy reading your articles and today’s was great. My first health insurance policy had a $0 deductible and both my children were born under that policy. Fast forward through years teaching into administrative positions, ultimately as director of finance and human resources, and I completely understand what you wrote about people always wanting healthcare costs to be paid by others. That is simply not the case! I am now retired and fortunate to be eligible for a plan F medicare supplement policy. Just had rotator cuff surgery and am anxious to see how much (or how little) my responsibility will be. Keep your excellent articles coming!

Dave Melick
6 months ago
Reply to  R Quinn

Yes, that is what I am expecting. Didn’t explain that very well.

mytimetotravel
6 months ago

“Most Americans would prefer to have all their health care costs buried in taxes and that way health care will be “free.””

That is what all other “developed” countries do, and their citizens are very happy with the results. Not only is medical care free or nearly free at point of service, the overall outcomes are much better than in the US, even though medical costs are much lower.

See: https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/

And: https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022

mytimetotravel
6 months ago
Reply to  R Quinn

That doesn’t explain things like the maternal and infant mortality rates.

The UK situation is due to the Conservative government starving the NHS of funds and Brexit starving it of workers.

mytimetotravel
6 months ago
Reply to  R Quinn

Part of the problem with maternal and infant outcomes is down to inadequate pre and post natal care. Some may also be the result of the excessive number of Caesarean births in this country, in turn likely due to the fact that doctors can charge more.

Linda Grady
6 months ago
Reply to  mytimetotravel

I worked for years as a maternal/child public health nurse and couldn’t agree with you more, Kathy. I haven’t kept close track of trends since retiring, but it seems like the situation here in the US is only getting worse: higher rates of C-sections, poorer outcomes for all but especially for low socioeconomic families. Sad state of affairs.

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