Say you have a bad back. And say I give you $4,000.
What do you want to do?
Your back really bothers you. You’ve missed a week of work. Most days you take a few ibuprofen. Sometimes the pain goes down your leg.
Your doctor suggests an MRI.
Do you take that $4,000 to the hospital, get the MRI, and learn how badly your back has deteriorated?
“My insurance should cover that,” you exclaim. But think for a moment. As far as you’re concerned, the test is free. I just gave you $4,000.
But no. You’d like to visit Hawaii. Or pay off your car. Or take a vacation with the kids. You shouldn’t have to use your $4,000 to pay for a medical test!
And there’s the crux of the problem. In the medical field, everybody is spending someone else’s money. The test would be worth it to you if someone else were paying. But if you have to part with $4,000 in cold, hard cash, somehow the test doesn’t seem quite so necessary.
Theoretically, insurance covers tests that are “medically necessary.” If your doctor says you need it, you must need it. Not necessarily so, I say.
What if you would not consent, under any circumstances, to undergo back surgery or epidural injections? What do you gain with an MRI?
There are currently 100,000+ family physicians in the U.S. according to the American Academy of Family Physicians. What if each of us ordered one less MRI this year? That would equal $400,000,000 in savings. (Of course, with insurance discounts, the savings may only equal half that.)
It’s fairly easy to see why insured patients consent to tests of borderline necessity. It’s not their wallet that will suffer.
But why do doctors order tests that may not be strictly necessary? The reasons are numerous. We doctors don’t want to miss something – we may be sued, or a patient may suffer, or we may be accused of rendering insufficient care. We don’t want to be responsible for healthcare rationing, nor of treating patients unequally.
Patients want the best treatment – especially if someone else is paying – insurance, Medicare, Medicaid, the VA. But ultimately it is our money, our tax dollars. Getting expensive tests will never result in lower insurance rates. The money your employer pays toward your insurance is really your money – you just don’t see it.
“But I want to know,” some patients say, regarding an MRI of their back. But what if the test makes no difference in the treatment or the outcome? Do you really want to know badly enough to take that $4,000 and hand it to the hospital administrator?
Americans have come to believe in testing rather than clinical judgment. We’ll believe an x-ray before the educated opinion of a physician. Somehow it’s consoling to see a black and white report. And doctors are not immune. It says so right here, in this report, a doctor may say to bolster his or her own conclusion.
America, we need to change. Doctors and patients have to trust each other. An MRI of the back is only one example where significant savings are possible.
(Sorry if you expected me to tell you how to save money on back pain today. That’s tomorrow’s blog.)
Potential annual savings on back MRIs (a gross underestimate):
$4,000 x 1 per each of 100,000 family physicians = $400,000,000
Actual savings: Readers, let me know. Please share your success stories or ideas to help others by sending an email to: firstname.lastname@example.org
If you found this article helpful and would like to accelerate your savings, check out my book, 101 Ways to Save Money on Healthcare, available online, in libraries, and through bookstores everywhere.
© Cynthia J Koelker, MD – All Rights reserved