I recently had arthroscopic surgery on my knee to repair a torn meniscus and clean out the joint. Here’s some data on the cost and insurance coverage:
Total Cost of surgery: $15,966
Amount paid by me: $2,359 (15%)
Amount that Anthem BCBS refused to pay, forcing doctors and clinics to absorb: $9,269 (58%)
Amount paid by Anthem BCBS: $4,338 (27%)
The amount that Anthem did not pay results in large part from “in-network” versus out-of-network. Those numbers could be mere perception management, as Anthem highlights on their settlement statements how much the insurance saved me. It could be that the cost is inflated to make it seem as though I got a bargain. That is Marketing 101.
However, if I did not have insurance, I would have been billed the full $15,966, and they would use all of their muscle to enforce payment.
Insurers are in large part responsible for the high cost of health care because of their refusal to pay claims in full. Doctors and hospitals, not being stupid, merely raise the overall cost of all services to make up for those parts that insurance will not cover. The result is the famous $30 aspirin, which is unique to American medical care. In addition, insurers inflict high overhead on the whole system – the cost of commissions for salesmen, all of the elaborate schemes to filter out unhealthy clients (like eHealthInsurance.com, whose sole function is filtering), and all of the costs involved in dumping costs on government, hospitals and doctors, and patients and defending themselves in court. (Return on investment to stockholders encourages investors to sink their money into this pointless activity, this private for-profit health insurance, and further adds to our burden.)
I looked around a bit, as I am quite sure that in other countries this type of surgery would cost nowhere near $15,966. Here’s what I found:
The average for arthroscopic knee surgery in the US is about $8,600. The doctor told me afterward that my knee was pretty messed up, so my surgery could have been more extensive than average. I don’t know that $15,966 was out of line for this country and my procedure.
Other countries average the following costs for the comparative surgery that costs $8,600 in the US:
Mexico $4,446
Costa Rica $2,800
Norway $1,228
Belgium $2,366
Spain $6,699
Germany $2,115
Argentina $2,400
In other words, if I felt like traveling, I could have the procedure done in any number of countries for approximately what I paid out-of-pocket, likely with the same expertise and professionalism, as good doctors are everywhere. (Norway would have been nice, and the savings would have paid for the ticket.)
Recently-passed health care legislation does nothing to bring down our costs to be more reasonably in line with the rest of the world. We are uniquely expensive. Insurance companies surely play a large part in this, with their Cadillac overhead, and the costs they impose on doctors and hospitals, all of which could be eliminated with no suffering to any of us but them, about whom I care not.
But that is not all of it. I do not know what other factors make us so expensive. I’m all ears.
Piece of Mindful 