Last winter when I was in Boise for the legislative session I got a call late one evening from Katy my oldest daughter. She is in nursing school and lives just down the hill from us.
“Dad? Mom fell and hurt her wrist and it is really painful.” She went on to say it had happened a few hours before on a steep, icy graveled street. Now it hurt to bend it.
“Is it deformed? Does it look swollen or bent?” I’m trying to see if we can skip an ER visit at 8PM. But it sounded like the pain was significant so I suggested they go to the ER.
When I signed up for health insurance with the State of Idaho as State Senator I was given just a few choices. There was the usual plan with a $500 deductible, a $5000 deductible or an HMO. I chose the $5000 deductible because that was like the Health Savings Account plan we had before as an individual. I hope the state allows HSAs soon. On the state plan I pay $36 twice a month. My wife and I had paid $400 a month when we bought the high deductible HSA on our own. I assume the state is subsidizing the cost some, but that is a huge difference. I believe a lot of the price difference has to do with the size of the risk pool.
On Martha’s trip to the ER I figured with our high deductible we would pay the whole ER charge. I called my wife back later in the evening and was happy to find out the x-ray (necessary?) was negative and an elastic brace and some ibuprofen had really helped the pain. Martha even admitted the pain was better before she got to the ER. I found that happened a lot in my practice, folks started feeling better soon as they made an appointment. It seems when Katy had called me she had suggested the ibuprofen to Martha and I guess it kicked in while she was waiting. A week later it was fine.
I waited for the bill. It came in a couple weeks: $800. $450 for the x-ray alone. But it said not to pay anything until they submitted it to insurance. I didn’t understand that, since we had the high deductible. But we waited some more. A couple months later we get a statement from the hospital saying we now had to pay just $400, since that was what the contract with the insurance allowed them to charge. So we got a discount just by being in the insurance pool, even though we had the high deductible. This is the magic of risk pools. And it is also the cost of going alone.
I believe this pricing shell game has allowed cost shifting between purchasers of health insurance. Medicaid lowers what they will pay, prices for employer based insurance goes up. They drive a hard bargain and then the small group purchasers see their premiums go up. This cost shifting as well as the indirect cost of insurance has blunted the market strength to drive down costs.
But we are talking about what health insurance costs here not health care. The REAL savings we can arrive at will be when we can appropriately decide to use the test (x-ray of the wrist). This is where real savings will occur. Read this about ankle x-rays. There is hope.