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September 2019
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Views on healthcare costs while wearing an $800 knee brace

By Dan Pool, editor
    Sitting here with an $800 brace on my leg following knee surgery two months ago, I can offer firsthand perspective to a recent piece in the New York Times detailing the high cost of medical treatment in America.   
    The article, which mainly focused on colonoscopies, pointed out standard medical procedure in America is to go with the best option first and almost exclusively. When it comes to medical care a good-enough approach is rarely mentioned.
    But, as America grapples with how intertwined health spending is with the overall economic output, valid questions arise of whether cheaper alternatives might suffice in routine procedures.
    Consider some of the findings in the Times’ The $2.7 Trillion Medical Bill - Colonoscopies Explain Why U.S. Leads the World in Health Expenditures:

    • International Federation of Health Plans, a global network of health insurers, found that the United States came out the most costly in all  categories they monitor— and often by a huge margin.
    • Healthcare is a $2.7 trillion annual industry in this country.
    • A hospital stay in this country is roughly three-times as expensive as those in other developed nations (for the same length of time/same general services)
    • Americans spend an amount equal to 18 percent of our gross domestic product on healthcare.
    On a personal level, many of the factors cited in The Times described well my experience. For my knee injury, no consideration of price was ever given by the patient (me). As The Times found, with insurance, patients assume the costs will be covered by someone else so there is rarely any discussion of price or cheaper options.
    Healthcare is the only industry where customers don’t universally consider cost at the time of purchase. In fact they don’t even see the bills directly if they have insurance, so they are in limbo as a disinterested third party while the insurer and the medical providers hash out the payments.
    This was absolutely true in my case. In the first round, it’s up to the Progress insurance plan and Piedmont to sort through the numerous bills.
    A point often raised in the healthcare debate is if patients were informed that their insurance may not cover some of their treatment or they were told cheaper alternatives were possible,would it affect their choices?
         In my case, probably not. The orthopedic surgeon was confident in his diagnosis with the basic emergency room x-ray and didn’t order any additional tests/scans. However, had he felt an MRI was needed, as a patient, it would be hard to question a guy about to slice your leg open.
    There didn’t appear any extra perks during the surgery day. Piedmont Mountainside seemed to process me through and get me out as efficiently as possible. Maybe a real miser might have cut out some of the precautionary work but for me there was no overnight stay, nor barrage of tests (other than a chest x-ray which was said to be standard for anyone having surgery).
    Without lengthy discussion and education there was nothing I (as a basic patient) would ever think to question on price or options?
    So we’re back to my $800 brace. The price of this was never discussed or mentioned until the bill arrived. I can think of no other incident in my life where I walked (hobbled) out of a place with an $800 product without knowing the price. Nor are there any other industries that will let a guy leave with $800 in merchandise without a serious payment discussion.
    The brace might have been the one place, where I could say, “isn’t there something more economical?” If I were really hard up, I could have foregone the brace entirely in favor of two yardsticks and some duct tape I suppose.
    For myself (and most people I suspect) even if the cheaper/lesser option is available, you really don’t want to scrimp on what will lessen your pain and support your healing most effectively.
    There is no doubt a nationwide economic problem with healthcare costs exists, but from a patient’s perspective, cost cutting at the doctor may be as needed as a knee surgery but it’s likely to be just as uncomfortable.