You may live in a community in which, when you go to the doctor for a routine checkup, you understand what the bill will be.
If you have a grandfathered health insurance policy, or no insurance, you find out what the bill will be, get your checkup, and pay a bill (or bills) that match your expectations.
Or, you have a major medical policy that complies with the terms of the Patient Protection and Affordable Care Act of 2010 (PPACA), and you know that your checkups are part of the PPACA preventive services package.
You know that, under PPACA, checkups are supposed to be “free.”
You go to an in-network doctor, get your checkup, and, hurray: It’s “free.”
You, your employer, the taxpayers, or some combination of you, your employer and taxpayers paid premiums to the health plan. The health plan paid your doctor. But the plan and the doctor took care of all that money stuff outside of your line of sight. You just went in, got poked and prodded, and promised to eat less and exercise more.
In theory, maybe you helped improve the quality and efficiency of the U.S. health care system by giving and getting information that will catch small, cheap problems before they turn into big, scary, life-ruining, budget-busting problems.
And maybe the same thing is happening to your individual health clients, or the employees of your group plan clients.
One little glitch: If you’re in an area like mine, that simple checkup never, ever seems to be anything that looks remotely like “free.”
See also: On the Third Hand: Bad Consumer
The “free,” routine checkup always turns into some kind of shockingly big bill.
I live near New York City. When I tell friends and relatives what I do, their eyes immediately glaze over.
But, yesterday, I was at a barbecue, and the conversation turned from whether the grape leaves in the yard were edible, and whether the mulberries littering the yard were tasty enough to justify the mess they made, to checkups.
Men and women with graduate degrees and jobs that involve being hard-headed bean counters were sharing horror stories about how much their checkups had cost, and why.
Doctors managed to transmute a free checkup lead into office visit gold through a number of clever strategies.
Any time a patient asked a question about some ordinary symptom, the encounter instantly got out of its meek preventive checkup rags and into a sick visit ball gown.
Any time a patient got one of the “free tests” available as part of the PPACA preventive services package, such as a blood cholesterol screening, the patient had to schedule a second visit that was, amazingly enough, an expensive consulting visit that was most assuredly not a checkup to get the results.
A 49-year-old with no special symptoms was being spooked into going to get a colonoscopy when that would still be an expensive diagnostic screening, rather than scheduling it for the week after his upcoming 50th birthday, when the procedure would be part of the preventive services package.
On the one hand, maybe this is just one of those strange New York things, like using cabs for everyday transportation and ordering food other than pizzas from restaurants that deliver. If so, oh well.
On the other hand, if this is really happening in the rest of the country as a routine matter of course, then I think this is a truly terrible thing for wellness. It introduces patients to the concept that their primary care doctors are greedy thieves who just want to milk as much money out of the patients as possible and have no interest whatsoever in whether the patients stay well.
On the third hand, insurers might like the idea of patients recognizing that doctors are often a bunch of thieves.
On the fourth hand, in the long run, I think rebranding doctors as thieves could be terrible for any insurer or policymaker hoping to use wellness programs and condition management programs to hold down the cost of providing a decent level of health care, and for health care providers that want taxpayers to keep paying huge amounts of taxes for other people’s health care.
Why would consumers tell those crooks about their personal health concerns, if mentioning aches and pains is going to lead to unexpected $400 bills?
And why would patients be sympathetic to Medicare or Medicaid providers who complain about being underpaid when the patients can see firsthand, in their everyday lives, that doctors are billing like a bunch of mobsters with stethoscopes?