In a previous post (Insurance Woes Part 1) I explained the peer-to-peer review process, which is something Dinner Table Doctor must participate in regularly. It sounds like a good idea: two doctors discussing a patient’s case to make sure that person is receiving the best care. In reality it is a process designed to save money for an insurance company, and it inconveniences both patient and caregiver.
Recently I had yet another frustrating experience with my health insurance provider. My daughter, who is a college student in Columbus, visited a physician there using our insurance since she is only 19. I received a bill for $39, which seemed more than fair. Went I went online to pay the bill, the charge was for $140. I decided to call the caregiver to double check the amount. I was told the first charge was before it was submitted to insurance. The new amount was after the visit was submitted to my insurance.
“You are telling me that BECAUSE I HAVE INSURANCE the price for the single visit has more than tripled?”
“Yes, I guess so. Seems crazy! Maybe you should call the insurance company.”
I asked if the doctor could charge my daughter as if she had no insurance and we could just pay the “out of pocket” price. She said it was too late since the visit was already submitted to the insurance company. The customer service representative seemed equally flummoxed and suggested I try calling Anthem.
I called the insurance company and was told the same thing. The price for the visit was far cheaper with NO insurance. This customer service rep was also confused and surprised. She patiently explained that we had a high deductible, a fact of which I am painfully aware. Even though we had not yet met the deductible, how could an identical service cost two such wildly different amounts? What is the point of having health insurance? Is it merely for catastrophic illness, such as a cancer diagnosis? Unfortunately, the answers to these questions remain elusive. The only obvious conclusion is that healthcare costs in the United States are out of control and a solution is long overdue.
White Bean and Tomatillo Soup
This frustrating process of phone calls occurred while I was making my new favorite soup recipe. DTD and I got an entire bushel of tomatillos (toe-ma-TEE-yos) at the last farmers market and have been using them in several different recipes. We bought these from one of our favorite produce suppliers at the market — Quiroz Family Farms from Salem, Ohio. If you have never had a tomatillo, they are sort of like a green tomato and have a very acidic flavor. They are popular in Mexican and southwestern dishes. Some people call them husk tomatoes because they are covered with a papery husk that you need to peel before cooking them.
You have probably had tomatillos in salsa verde (green salsa). I made a giant batch of salsa with my bounty, but an entire bushel meant I had the leisure to experiment with some other recipes as well. I came across this yummy soup on The Simple Veganista, and it was so easy that I could even make it while on the phone pulling out my hair over health insurance woes. It is a vegetarian soup, but you could certainly add chicken or pork if you want. The soup has enough flavor that no meat is necessary, and it uses a whole bunch of tomatillos. We added the optional corn and thoroughly enjoyed the sweet crunch along with the tangy tomatillos. The northern beans add fiber, which makes DTD a happy guy! Pair it with a salad and some bread or nachos and it’s a great, quick meal. Find the recipe at this link.
Why Does Healthcare Cost So Much in the U.S.?
If you search this phrase on the internet, you will get no definitive answer and a whole lot of theories, all of which DTD and I discussed while enjoying our comforting soup. Some say our high costs are a result of exorbitant administrative fees, the high cost of drugs, the market driven nature, or the pay scales for healthcare workers. Regardless of the reason, the cost of healthcare in the U.S. is excessive, and we aren’t getting our money’s worth. According to the Johns Hopkins Bloomberg School of Public Health, Americans on average continue to pay much more for healthcare than citizens of other countries, yet we have less access to quality care. We outspend other countries and still have fewer resources. Despite major attempts at reform, healthcare costs have been rising for decades and there doesn’t seem to be an end in sight.
Confusion and Resignation
As a population, it seems we are resigned to rising healthcare costs and willing to live with the pending doom of a catastrophic illness. We are rolling the dice, hoping insurance will take care of us even though increasingly we can barely afford care even while employed fulltime. Deductibles are rising and copays are too. DTD has had many a patient refuse to schedule a much-needed MRI or other procedure because the copay is simply unaffordable. Sadly, the incidents of cancer diagnoses skyrocket at age 65, because this is the age most people go on Medicare. Imagine if they could afford to visit a doctor earlier and to have the necessary tests or procedures. When we are able to pay for healthcare, frequently the resulting bills are confusing, and the process of scheduling appointments is convoluted. There have been times when I have difficulty interpreting a bill even with DTD’s help. If a doctor can’t figure this out, something is wrong.
What is the Solution?
I have no idea and neither does DTD. We are both inclined to wish for universal healthcare, but we also recognize the fear and uncertainty that our government would be unable to run such a huge program effectively. One thing we both agree on is that basic healthcare is a human right. This belief really solidified when I was diagnosed with leukemia. A life-saving medicine exists for the type of leukemia I have, but it is unaffordable without some type of insurance. Knowing a medicine exists and that certain people don’t have access to it because of lack of insurance or due to high deductibles or copays is heartbreaking. Cancer is only one of many conditions requiring lifesaving treatment. Diabetes, heart disease, allergies, asthma, and even mental health are all conditions that some people cannot treat due to cost. If we truly care about our children and about making our country great, then we should make sure everyone has basic healthcare needs met.
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