This commentary is by Walter Carpenter of Montpelier, who works in Vermont’s tourism business and is a writer and a health care activist. In 2006, at the point of death, he says, he had to shop around and negotiate the price of his life because he did not have insurance.
I was excessively appalled and disgusted by Andrew Garland’s commentary, “Keeping a keen eye on the cost of care,” which proposed having patients shop around as a way to control our atrocious health care costs.
As someone who has had to do this before — to shop around and negotiate the price of my own life as if I were a used car — I know from experience that there are not enough superlatives in the English language to describe the profund indignity of having to do this.
Mr. Garland, who is vice president of client relations and external affairs at BlueCross and BlueShield of Vermont, stated that Vermonters spent an astonishing “$7.95 billion on health care in 2020 — over $12,600 per person living in our state.”
With these costs, why are there so many uninsured and underinsured in Vermont? We could insure every resident in Vermont three times over, and no one would have to go “shopping” as if our health care, our lives, were a bag of groceries. Where is this money vanishing if we still have these atrocious wait times and the costs keep going up while our access to care and its quality keeps going down?
This proposal perhaps has at least one benefit. It would put the onus for controlling costs onto the backs of the patients, absolving the current status quo for any accountability or responsibility for the scandalous amounts of money we pay for what we get in return for health care.
It is like the national pastime of blaming the homeless and the poor for their conditions and not our system of low-wage exploitation with its high costs. It is the same here as our medical capitalism, unique in the democratic world, seeks to monopolize and raise prices as high as possible, then blame the patients who need health care for these costs.
Shopping around may work for Mr. Garland and his ilk. He presumably has the inside information to do this in his position with BlueCross and BlueShield of Vermont. He presumably has the knowledge of medical pricing, unfathomable to most patients like me who have to go up against it. I’m sure that his job title with BCBS also carries some extra sway with it.
It is complete fantasy to think that a patient who is undergoing the stress and trauma of a disease, and without this knowledge and sway, also has the time and the luxury to “shop around” for care, both of which are more readily available to the insiders.
How could the average patient understand, for example, that the fee negotiated with a surgeon is one thing, only to discover in those surprise medical bills, so familiar now, that the hospital charges are separate fees?
I had to learn these things the hard way as I was fighting both our insurance/hospital system and the illness to stay alive. The stress for gaining this knowledge is immeasurable. No one reimburses us for the struggles and the excess time we have to put in to find the “best deals.” Yet, we have to reimburse BCBS dearly for its time.
To put the responsibility onto the patient and blame us is not the answer to our never-ending rise in health care costs. We can try all the schemes we want to — like managed care, for example, where we are considered so irresponsible that we have to be “managed” by outside entities that have their profits in mind far more than our care.
Nothing has worked; nothing will work, except to stop making health care an industry and to take the market out of it. Every other democratic nation does this. They don’t require the robbery of high-deductible plans or of schemes like HMOs or ACOs to deny us care. They have removed the cancer of the market out of health care. They have established fee schedules, which everyone involved accepts as a matter of course. Pharmaceuticals cost less, no one is uninsured, and no one goes bankrupt. No one has to undergo the indignity of “shopping around” while sick.
Because of this, the international average of per-capita health spending across these nations is half of ours.
As someone who has been through this “shopping around” before, I say a huge “No, thank you” to the idea of the patient as a consumer in an industry run more or less along the typical American corporate mantra of a return on investment. We in Vermont could do better than this — that is, if we wanted to.
