What you can learn with a $190,000 heart operation

If you get your health insurance from your employer, the chances are pretty good that last week your co-pays — the amount you pay just for showing up — went up. So did your out-of-pocket maximum and your deductible. In short, it’s going to cost you a lot more to use your health care.

Source: The Commonwealth Fund

Before we start the usual blame game on the Affordable Care Act, it’s important to remember that co-pays, out-of-pocket limits, and deductibles have been going up for years as employers try to shift more of the cost of health care to the consumer under the theory that if consumers shop around, they’ll choose wisely and create a more competitive health care environment, forcing health care providers to lower the cost.

This is an academic discussion that takes place in ivory towers of politics and business and there’s a flaw with the idea: it’s absurd.

Stephen Brill made that abundantly clear with his Time story two years ago. “This is not a free market,” he said. “You don’t get health care because you want it. You enter the market unwillingly. You know nothing about the products being offered. You have no choice in the products being offered.”

Brill, who has now turned that essay into a book, got his own dose of reality when he had heart surgery while finishing the book, which will be featured this Sunday on “60 Minutes.”

“There I was: a reporter who had made hospital presidents and hospital executives and health care executives and insurance executives sweat because I asked them all kinds of questions about their salaries and about their profit margins,” Brill tells Fresh Air’s Terry Gross. “And now I was lying on a gurney in a hospital in real fear of my life.”

“When we’re sick, we are not a savvy consumer of health care,” he told CBS this week. “The only thing we know is we’re scared and we want to get better.”

Now that the new Congress has started work in Washington, much of the attention is on Obamacare. Brill, who notes there’s nothing in Obamacare to bring down costs, has plenty of criticism for ACA, largely because it was put together only with the “permission” of lobbyists for the health care industry. The same people who will influence the bill’s destruction.

Who’s calling the shots here? The same people who’ve always called the shots, he says.


Even the people who run health insurance companies don’t understand the system. Brill says he took the explanation of benefits for his hospital stay to the CEO of UnitedHealthcare. He couldn’t figure it out.

So what hope is there for mere mortals?

What defines “affordable” in health care is a shell game, the New York Times suggests today.

Insurance premiums are slowing their meteoric rise, it notes. But that’s because co-pays, deductibles, and out-of-pocket limits are going up so fast.

To contain costs, many large corporate employers are offering high-deductible plans, also known as consumer-directed plans. At about one-third of large companies, it is the only option available, according to the National Business Group on Health. The plans require employees to pay for a greater share of their medical costs upfront, before the plan starts making payments. The goal is to make employees comparison-shop for medical services, something not always easy to do, particularly in emergency situations.

“It’s quite shocking when you see the range of costs for the same services in a market,” said Brian Marcotte, president and chief executive of the National Business Group on Health. “But employers are also trying to get employees to play a greater role in managing their care.”

In 2013, 81 percent of workers were enrolled in a health plan with a deductible, according to Commonwealth Fund, compared with 52 percent in 2003. The average per-person deductible has more than doubled over that period, rising 146 percent on average. In 2013, the average per-person deductible exceeded $1,000 in most states, and exceeded $1,500, on average, in seven states.

“It can only get better when people decide as taxpayers they’re not going to let lobbyists in Washington for the hospital industry, for the drug industry, for the medical device industry have their way,” Brill says, nothing his book is really how “the country doesn’t work,” using “the largest and most screwed up industry in the country” to illustrate it.