The myth of informed consent
In all this back and forth about the Affordable Care
Act we are missing what is an equally important issue. -- the cost of health
care in general. There is excellent and detailed writing by Steven Brill on the topic, but it was hard to get through it without an elevation of my own blood
pressure. Most remarkable in his reporting is the fact that the cost of most medical procedures is a well-guarded
mystery. From one hospital to another the costs vary greatly and the amount
that our insurance company covers is also done by some mysterious formula for
procedures and medication.
This brings me
to my current shock about the cost of medication. After a persistent cough following a cold, my doctor prescribed a steroid inhaler. When I picked it up
the young pharm tech said apologetically that it was $135.00. It was probably
the startled look on my face that caused her to say, “Wait, let me make sure
that insurance covered its part.”
When she returned from the computer she looked even
more startled than I and reported that the “out-of-pocket” cost was actually
$1,017.00. Yikes! I didn’t know whether to be grateful that the insurance
(theoretically) covered $882 or still be outraged by what the cost to me was
going to be. In addition was concern over someone without insurance who might
need such a medication and be unable to pay the “out-of-pocket.”
I support the Affordable Care Act and I urged my
twenty something offspring to sign up through the health care exchange. They
are not invulnerable and huge bills could come to haunt them and maybe their
parents. The situation with existing plans could possibly end up, as it did for
our daughter. She had a minor bike
accident and even after two years was still paying off the large part of her
bill not covered by insurance.
Even after the exchange works and the benefits are in
place, everything is not settled. We must continue to look for more
transparency in the pricing of medical care and prescription drugs. Since the
ACA is in part a full employment act for insurers, they might become our
partners in this quest -- once they start getting more bills for inhalers
costing $1,017. People should be compensated for their work and for the product
they create, but behind this veil of mystery the consumer has no way of making
decisions about the better choices in the medical field.
For every little medical procedure we are asked to
sign a form indicating our informed consent. At this point in dealing with the
medical system in general we are all operating with uninformed consent. Having health insurance is not going to
completely address this and the battles over the ACA are unfortunately taking
attention away from some of the real issues in medical care in this country. It’s
possible for legislators on both sides of the ACA to work to create a more
transparent system of medical costs, if they can resist the pressure and
checkbooks of lobbyists. Then, we citizens will finally have the luxury of real
informed consent.