The Most Expensive Nap

*Disclaimer* I am not a medical expert of any kind. These are just my personal thoughts.

I was somewhat baffled the other day when I got the non-bill from the hospital just letting me know that the MRI on my knee cost my insurance nearly $1800. That sum made me almost glad that the MRI showed I have a torn meniscus. I’d feel kind of guilty if it had turned out to be nothing major that had caused my knee to hurt for the past five months.

That's not my knee. Just an example.

What makes up the cost of an MRI? Why are they so expensive? And why does the cost vary from place to place? For my end of it, I lay nice and still under a blanket for 20 minutes listening to music and almost falling asleep. Most expensive nap ever. Clearly the cost must include overhead (lights, rent, heat, etc.), cost and maintenance of the machine, the technician’s fee, and the radiologist’s fee. Even looking at all that, it feels like someone is making a good profit here. After all, those machines last a long time and they do a pretty good number of MRIs in a year.

What really bothers me about health care in general is that, like this MRI, you often have no idea what medical costs will be or what goes into those costs. My grandfather got a pace maker installed (this was several years ago) and stayed one night the hospital. His bill was over $100,000. The vast majority of that cost was the actual pace maker. Considering how many people have pace makers, I have a hard time believing that it could possibly cost that much to produce. Unless they’re made entirely out of diamonds, which I don’t think is the case.

To my mind there are two problems here. First, there’s no good system for consumers to evaluate costs ahead of time. Second, you will pay any amount of money to not die. Both of these problems are compounded by the fact most people would rather have splinters shoved under their nails than try to read and understand the finer points of their health insurance policies.

Just think, if you are buying a car, a washer, a computer, or just about any other thing, you probably spend a good bit of time researching models and price before hand. You go to the store armed with a wealth of knowledge about GBs, upload speeds, and options. You ask hard questions, and when you do make a purchase, you feel like you got a good value.

How would you translate that to health care? Clearly, buying a service is different from buying a product. Take the example of choosing a hair stylist. There is a certain intangible of feeling comfortable, being set at ease, and liking the end product that is actually pretty similar to choosing a doctor. You can get the same result from lots of different, qualified people, but you usually end up with one person you’re devoted to. The big difference is that it’s relatively easy to find out what salons charge for their services. They will give you an easy to read and understand menu of prices. How do you do that with a doctor?

To my knowledge there is not a good tool that can show what various doctors’ offices charge for their basic services, let alone lab fees or other extras. Most people pay some kind of co-pay, so that’s no indicator either. How do you know without going if the doctor will be a good fit? I found four websites with reviews of doctors. I searched for my pediatrician on all of them. Two didn’t have her listed. One had her with four reviews; the other had two reviews. When I was researching a recent DSLR camera purchase, there were hundreds of reviews for the camera I was considering.

The tools that we use as savvy consumers just do not exist in the same volume for health care. How can we be informed consumers? It would require quite a bit of effort on an individual’s part to call every office and try to match up different pricing, if they’d even give it to you. Then there’s the question of matching it with your particular insurance.

What we’re left with is a blind consumer who mostly just guesses. If you get referred, you just go. If they tell you, it’s Dr. Smiley, then you go and as long as he doesn’t try to cut off the wrong leg, you’ll probably do what he tells you. And more likely than not, you’ll have no idea of where his fees fall from cheap to expensive, and there’s no particular incentive for you to wade in and find out.

All I can suggest is that if McDonald’s has to list calorie counts right on its menu, then doctors should list their fees right on their websites. Insurance providers should offer a way to search not just for network providers, but for effective, reasonably priced providers. And doctors and hospitals should compete for our business by offering good service and reasonable fees instead of banking on the fact that we can’t say no or we could die. I can’t help but feeling that if we start there, at the very root, we could both improve health care for individuals and reduce costs by eliminating the huge price swings that are currently in place.