An American Sickness: How Healthcare became big business and how you can take it back

This is the second “U.S. healthcare diagnosis” book that I have read.  Overall “An American Sickness” is a depressing read and illustrates similar problems as my last post from “The Healing of America”. 

In her analysis, author Elisabeth Rosenthal details several impacts of money in medicine including:

  • Decoupling medical procedures into individual items and services resulting in an abundance of billing
  • “Ghost doctoring” where physicians can monitor multiple patients using nurses and proxies but still bill a physician rate
  • Pharma companies playing the patent game using small and insignificant changes to drugs to protect and extend their lucrative patents.
  • M&A driving hospital and insurance consolidation resulting in economies of scale that RAISE prices while NOT improving quality of care.

However, while a wholesale change to the healthcare system appears many years off, author Elisabeth Rosenthal, provides some helpful and simple tips at the end of the book.  These tips can drastically reduce an individuals exposure to large and unexpected medical bills.  I will highlight my favorite ones here.

  1. Ask Questions of your doctor
    • Is there a lower costlocation for my tests to be sent?
    • Do you have an ownership stake where my surgery will occur?
    • Are there lower costs drugs that have a similar effect?
    • Understand where your procedure will occur – will there be a facility fee or a hospital charge (even at a doctors office)
  2. Read the fine print and be thoughtful
    • If a healthcare provider asks you to agree to accept financial responsibility – add the clause as “long as the providers are in my insurance network”.  While this may not prevent them for sending you to an out of network provider, it will provide you negotiating leverage when the bill comes
  3. Be clear on what care you are receiving
    • Do you need these tests or are the providers being complete?
    • Are you being admitted to a hospital or being kept under observation status?
    • If a doctor stops in to see you – ask why and who they are.
  4. Challenge any bill that seems to be out of order
    • Many major healthcare bills are a result of multiple providers (doctors, labs, hospitals, recovery) sending information to your insurance carrier.  Negotiate hard on the items that are not covered by insurance
    • Request an itemized bill

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