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HealthCare Checkup

The Seattle Times health-care team tracks the local impact of the Affordable Care Act.

December 5, 2013 at 11:08 AM

One way Obamacare could nudge down medical costs

At the end of my daughter’s annual checkup this year, her doctor asked if we had any concerns. Almost as an afterthought I mentioned the little wart at the end of one of her toes (note to self: get my kid flip- flops for the gym pool and showers!).No problem, said the pediatrician. In a flash she pared away some of wart with a small scalpel and froze what remained with liquid nitrogen on a Q-Tip. It took five minutes.

Historically, I have been a lazy health-care shopper. My family has always had insurance through employers and we’re generally healthy. I never ask what something will cost (chances are the doc won’t know anyhow) and I rarely scrutinize doctor’s bills.

That’s before I got the wart invoice.

Our doctor’s office billed $269 for the procedure, which was coded as “DESTRUCTION EG, LASER SURGERY.” Our insurance carrier, Aetna, got that reduced to $204.40, and that’s what we’re going to have to pay. For wart removal.

The New York Times this week published two more articles on the cost of U.S. medical care in its “Paying Till It Hurts” series. The series compares the costs of various procedures at hospitals and clinics around the country, and between nations. It’s terrifying. A story Monday delved into stitches costing $500 a piece. An article yesterday documented ambulance rides lasting two blocks and costing $900.

What gives? Reporter Elisabeth Rosenthal explains:

The main reason for high hospital costs in the United States, economists say, is fiscal, not medical: Hospitals are the most powerful players in a health care system that has little or no price regulation in the private market.

And that brings me to the terrific stories my Seattle Times’ colleagues wrote earlier this week about the new insurance plans available in the state, and the limited number of hospitals many of them include in their coverage. For example, five of the eight insurers selling plans in the state’s Healthplanfinder exchange don’t include Seattle Children’s. As a result, the hospital has sued the state for allowing the sale of plans that don’t include them, arguing Children’s provides unique care that legally must be part of a comprehensive plan.

So what do rising medical costs and the narrowing of health insurance coverage have to do with each other?

Under the Affordable Care Act, insurance companies are required to include 10 essential benefits in their plans, such as prescription-drug coverage and maternity care. They are limited in what they can offer for deductibles and out-of-pocket expenses. But they can, for the most part, pick and choose which hospitals and clinics are included in their network of providers.

“That is the only way the carriers can keep their prices down,” said Sean Corry, who is president of Sprague Israel Giles, a Seattle insurance brokerage, and who has served on various committees working to reshape health care in Washington.

Corry expects that as insurance carriers take a harder look at who is in their network, hospitals will need to offer services at better prices. It could, in time, push down U.S health-care costs — costs that are many times higher than those paid in other countries.

“This is the first opportunity in the 30 years that I have been a broker, where I am seeing a crack in the ability of the providers to demand a price,” Corry said. “That is a fundamental change in the market that over time is going to stabilize rates.”

But until that happens, if it happens, I plan to invest in flip-flops and a bottle of generic wart-removal medicine.




Comments | Topics: Affordable Care Act, health insurance, Healthplanfinder


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