A Sign of the Times on Medical Expenses

I’ve written several times in the past on my frustration that the powers- and pundits-that-be seem to focus on some folks’ lack of health insurance as being “the problem”, while failing to consider the real problem – that the health care Americans have come to expect is just so damned expensive.

I’ve just read an article (subscriber link) in Tuesday’s Wall Street Journal which does a great job of highlighting the expense problem:

American doctors rarely used to let costs factor into their treatment decisions. But rising prices — some cancer drugs now cost more than $100,000 a year — are dramatically changing that ethos in the field of oncology. Money issues are now disrupting relationships with patients, causing doctors to go into debt and threatening to interfere with treatment options.

Unlike most physicians, who write patients prescriptions that they can fill at a pharmacy, oncologists must buy many drugs upfront because they’re delivered intravenously in the office. As a result, doctors are on the hook until patients or insurers pay the bill. Reimbursement delays and denials are now more common as insurers clamp down on claims. Some patients can’t afford high co-payments.

"Twenty years ago, when I was in training, nobody really dealt with economics," says Stephen Hufford, an oncologist in San Francisco. The prevailing thinking, he says, was: "Cost should never be an issue in someone’s care."

That approach increasingly looks untenable. In February, after delays in payments from insurers, Dr. Hufford was working to pay off several hundred thousand dollars of past-due bills to his drug distributor. When he ordered $20,000 of chemotherapy for three patients he was to see the next day, he says the distributor refused to deliver the drugs unless he paid in advance and reduced his outstanding balance by another $20,000. He didn’t have $40,000 in his bank account.

With the general election campaign heating up, I expect that we’re going to hear more about “the uninsured problem” in the not too distant future.  I still say that focusing on that problem seems kind of short-sighted unless policymakers and the public in general don’t start looking at the entire system of financing health care, the costs involved…and perhaps what level of care is supposed to be provided as an apparent “right”.