Health care: can we put lipstick on this pig in a poke?
or, Why Does Aetna Hate Ruth Kaufman's Toe?
There are two strands here: denial of care, and lack of transparency.
My health insurance, for which I pay $395 per month, will not cover the foot surgery my doctor says I need: a toe joint replacement that is supposed to last 20 years and which will restore mobility and reduce pain.
Aetna won't cover this; according to them the procedure is experimental, though it has been FDA approved. Aetna will, however, apparently approve two other procedures: fusing my toe to my foot so it would never bend again, or removing the joint so the toe sort of flops around. Yuck. But both options are supposed to eliminate pain.
Apparently "experimental" means "Aetna doesn't like it."
Our intrepid health care "consumer" then considers the cost cutters' preferred approach: pay for it yerself.
Just how much does foot surgery cost, per foot? Despite numerous phone calls, calculating the exact total remains an unsolved challenge, because so many entities and individuals are involved...
Can you imagine a cost conscious consumer going into a department store and buying a dress without knowing precisely how much she'll pay? How can you dispute a charge after the fact, if you've been given and then used a product or service?
No matter how many times critics of the current system say it, it always seems to need saying again: treating health care like a classic market doesn't make sense. The imbalance between the buyer and seller's knowledge and need is huge, far too great for the buyer to have meaningful bargaining power. And without bargaining power on both sides, all those Econ 101 supply/demand graphs simply don't apply.
Even here, where the surgery is elective in the sense that it's not an emergency, the would-be buyer can't even determine the price she is being offered!
All this would be moot if Congress would pass H.R. 676.
(Edit: try L's kludge)