Alexa Karsdan’s medical bill for a sore throat reached over $28,000. NPR told her story recently, but I want you to know why I am actually glad this happened. Why is it good news that her charges were so exorbitant, and that her insurance paid over twenty-five thousand dollars for one laboratory test? This story is a brilliant illustration of fundamental flaws in our health care system. We hear many politicians using the language of consumers, markets, and competition in describing health care products and services. However, I cannot imagine any more opaque financial transaction in our society. A patient leaves a doctor’s office thinking they might be billed one hundred, or very generously, five hundred dollars for the services rendered. The fact that Ms. Karsdan’s bill for an upper respiratory infection was more than the cost of my family’s minivan is astounding. Price transparency is a vital, but not final, need in our system. Ms. Karsdan’s insurer paid $25,000 for one test that normally costs $653. That is a cost 38 times higher than it should be. This shows us that any budget estimates based on our current system of insurance expenditures could be extremely inflated. How can we know whether a given health policy will cost $38 trillion or $1 trillion? On another day, we can address the problem that this $25,000 test was 100 percent unnecessary for the patient’s treatment! If you were helping a friend who had been spending their money recklessly, you would not start their budget with the amount they had been spending. Instead, you would help them find the bare necessities that have to be paid each month. This is why the best arguments for US health policy will not start with estimates based on our current system of expenditures. We would be better served by focusing on comparison with the health systems of other developed nations as a starting point. I am a third-generation Kentucky primary care physician, and a member of Physicians for a National Health Program. I want every person in America to have access to high-quality health care in a system that is easy to understand. In order to get there, we will have to dismantle the profit-driven interests that invented surprise bills such as Ms. Karsdan’s. I support the (Expanded and Improved) Medicare for All Act sponsored by Representative Pramila Jayapal and championed by Senator Bernie Sanders, and I hope you will, too. As you consider these important issues, please take to heart the words of young father and activist Ady Barkan: “If the richest nation in the history of the world really decided to, we could guarantee health care as a right, and we could probably do it more quickly than people think – but the problem is right now, we’re not even trying.” Thad Salmon is an internal medicine-pediatrics physician. Source
