Many people, especially Republicans, wonder about the need for health insurance in the first place. Wouldn’t it just make sense to pay as you go, whipping out the credit card for routine doctor visits?
This sounds ridiculous when considering serious illnesses, but it may make sense in any system for small things. When a sty in my eye became infected I realized I had the perfect opportunity to test out “the system,” to the extent there is one, to see how pay-as-you-go might work.
The short version: I got sick and don’t have insurance. We all have our adventures.
Just about the worst picture of me ever. Usually it’s my living conditions that are described as “sty”.
First, we have the condition. My right eye is puffy and inflamed from what I knew all along was an infected eyelid, a sty turned into a habitat for bacteria. I have had this several times, and it’s know to be something which can come back. Usually, it goes away on its own after a few days.
This happened once when I was in Germany. I remember having to have a consultation with an Apotheker (pharmacist) and he wrote the prescription right there. The only difficult part of the whole process was understanding medical terms auf Deutsch. It cost me twenty-something Euros and probably twenty minutes before I was merrily on my way.
Let’s consider that the baseline for how a system might perform.
I did consult a pharmacist this time for the stuff, and the answer is that I needed a doctor to prescribe something. I chose for my doctor the Minute Clinic located in a Target store largely because it seemed to me that this was exactly the kind of thing which they would be set up to handle in the first place.
The wait was about two hours. Granted, this is the day after Labor Day so it’s hardly surprising. But it was long enough that if I wanted to get myself repaired whilst loading up on household supplies and whatever else Target stores have to offer it was a bit long.
Is it a market or not? Pick one. Please.
The doctor was apologetic, saying this was unusual. I accepted that. She took my vitals and told me my blood pressure was on the high side of normal, 134/94. That is useful information since I’ve never had that before. So it was worth the $89, discreetly billed.
Target has an in-store pharmacy, so it was simple enough to get the ointment prescribed. Or so I thought.
The lines at the pharmacy were reasonable but the process was complex. I asked how much it would be out-of-pocket, and after a few clicks I had my answer: $252.00. Wow! Didn’t they know my blood pressure was already a bit high? I was then asked if I was paying this myself, and I said “Yes!” as proudly as anyone without insurance ever will. The immediate problem went unsaid beyond that. A few more clicks on the keyboard and I was sent to someone else for consultation.
At that window a short conversation began. Would I be comfortable with a similar generic ointment? Of course! We can apply come coupons to cut the price down, click-click-click. OK, we have that in stock, just wait a bit. So off I was, uncomfortably waiting in and around the feminine hygiene products trying to not look creepy.
The stuff. Was it really worth all the trouble? (yes)
After a few minutes I was told it was ready. I still had no idea what it would cost, so I was expecting the worst. “It’s five forty, will that be cash or charge?” How much? I was still getting used to the $252.00 bill. Double that? No way!
Then, it appeared on the screen. $5.40. I had to blink my good eye a few times until the panic subsided. Oh. I think I can swing that.
What would this have cost overall if I had insurance? Did I just tap into the pool reserved for indigent people who frankly deserve it more than me? I have no idea. There’s no indication on the bill or the prescription as to what it really “cost.”
A short drive home and some goop around my eye and I am all set. Back to being as healthy as … well, I’m never really sure how healthy I am.
Was this a good experience? It wasn’t bad, but I liked how it was handled in Germany a lot better. There, it was cheaper and more free of hassle. In the end I don’t feel like I really learned what I hoped to about pay-as-you-go because it is unlikely that $5.40 covered anything.
Should this be a part of any system we develop in the future? The short answer is that we have a lot of work to do on our “system” no matter how you look at it and which model you favor. Pay-as-you-go should be an option for small things like this, perhaps as part of a Health Savings Account (HSA). But there still has to be a better way overall.
Barataria - The work of Erik Hare 
My first thought on this is why did the Minute Clinic person write a script for a very expensive ointment when there was a generic available. This is particularly offensive when it must be obvious that many users of these types of places are uninsured or whatever.
I was thinking the same thing. I am guessing that she has no idea what things cost.
Holy cow. $252! There is no reason it should cost that, unless you tell me it was the rarest, last-hope antibiotic because you’re allergic to the regular stuff. Which you didn’t say, so I’m assuming that’s not an issue. So regular, ol’ antibiotic ointment, maybe a little stronger than Neosporin.
There is no “free market” excuse that is good enough to justify that. And then you got the generic for $5.40! I’ll bet the generic was made in the factory with the same ingredients, just under a different contract. Ghod, I hate the people who do these things.
Yeah, I’m bitter.
And don’t get me started on HSAs. Working, barely middle-class people don’t HAVE any money to put into an HSA. It’s a joke the politicians like to play on their constituents.
Agreed. However you look at it, the $252 for some eye ointment is grossly unethical. One wonders how many people get taken in this way. Who is responsible? The prescriber? The manufacturer? The Pharmacy? Target? Some combination? If Erik had the time and interest, it would be really interesting to see an investigation of this…..
A quick search gave me no idea how much it “really costs”. It will take time, so I decided to write this blankly. Yes, I would like to know. I was thinking about trying some neosporin, but it is my eye …. pH differences and all, so I didn’t. I thought I’d try to do it “right”. My guess is that the $252 is the insurance cost, which is to say that they can get away with it. Some guy off the street? I wonder what the brand-name expensive one was now.
What if you had insurance and lied saying that you didn’t?
Exactly! This wasn’t a very good experiment, was it? But then again, I wanted to get it over with.
Well, that is another point–when people are sick, in one way or another, they are rarely at their negotiating best. They are worried, scared, vulnerable ….
Yeah, I think that’s the amazing experience of being from the US and having a minor illness in just about any other country. One, Two, done – no 15 receptionists per doc/nurse, filing your telephone book sized collection of forms out in triplicate, no dodging bubonic plague victims in the ER waiting room, no MD’s in their residency sleepwalking thru the 20th hour or their 24 hour shift, no taking “fish” antibiotics your friends bought from ebay, no stories from your construction worker neighbor flying up to Canada to get surgery for his back, staying in a 4 star hotel, paying cash, and still coming out ahead, no paying $600 / month for Obamacare while knowing your enormous deductible makes it unlikely you will ever use it for anything routine…
But ya know, if you get something really serious . . .
The problem is the health care system is designed to make money, rather than provide a public good. Same as a lot of things.
It is dysfunctional in so many ways, it’s hard to know where to start. There is no clear knowledge of what anything “costs” or what’s really involved.
PS- what made your experience in Germany better wasn’t the payment scheme (though that too is dysfunctional in the US), it was the cost structure of the care/drugs itself.
Indeed, with all of the training necessary to be a pharmacist, I see no reason why they couldn’t prescribe things like this. In Germany there is a national registration so my use of antibiotics would be recorded. I think this is reasonable – it’s not good to use them willy-nilly. But a pharmacist can certainly handle this. Nurses can handle many small things, too. That is definitely part of the lesson here.
YES! But possible, here, too, if only you ask/willing to wait to ‘see’ – 🙂 And feeling better about the whole thing after reading An American Sickness:How Healthcare Became Big Business and How You Can Take it Back by Elisabeth Rosenthal – – 🙂 Here’s the link for info: https://www.amazon.com/dp/B01IOHQ9LO – – P.S. – I’m ‘prone’ to styes – just like my dad – – usually keeping an eye on B vitamins (in all their glory) AND warm cloths at the ‘get go” instead of hoping it will ‘go away on it’s own’ is my own ‘home remedy’ – 🙂 But…doesn’t mean that’s what will work for you – just sharing….cuz I have felt your pain – in my teen years, until I learned to pay attention and take care of the first ‘uncomfortable signs…” LOL 🙂
I would love to read that, and I am thinking about it for People’s Economics. The thing is that no other nation has the problem the way we do. We can find literally dozens of good systems which work better than ours. It doesn’t really seem to matter which model we choose – the commitment to quality care without someone outside the system making a profit is critical. Incidentally, it’s not just profit which is a problem, but a lack of uniform billing – it takes loads of worker hours just to figure out a bill and then how to pay a bill, etc. I was just told by someone in a biz like this that they offer a 30% cash discount because they don’t have the insurance hassles. There you go.
It is really a good book an highlights much that I experienced during my own healthcare journey AND as Office Manager in a health clinic – and yes, every thing you said about cash discounts is true – here in Colorado? It was ‘less money billed/paid’ if I went to my fave physician for healthcare, but alas, to comply with LAW, I was put on Medicaid and could no longer go see my efficient, cost-effective doctor, cuz, he didn’t do Medicaid billing, and so, it was a risk for him to even see me, much less charge me – since then? I am doomed to go see office that can’t: A.) Get you in same day B.) Do more than one thing per visit C.) Provide full bill to show me what was billed in full, minus my piddly co pay – And I tell ya! it stinks and the ship has been full of rats for some time – – just so aggregious now, I’m about ready to be the poster child for Civil Disobedience and Anarchy on this topic – – LOL – BTW – I honestly reported that each month, for the average over all, for the year, I’m making income $32 – $168 dollars over the cut-off – I, foolishly, celebrated when I had healed enough to work enough, to reach this ‘next milestone in recovery’ – Now? I swear to Gawd – if the idiocy of the system doesn’t induce a second stroke, I don’t know what will – – People’s Economics! Rock On! 🙂 (P.S. I may be the first to go through the wall and get my nose bloody – you will write and send care packages, right? P.S. – I don’t like brownies/chocolate/ or otherwise (even though I’m from Colorado…LOL) – – Some good ole fashioned oatmeal cookies or gingersnaps will be appreciated – – – LOL
Yuck! I hope it gets better!