Show 1277: Why Our Healthcare Costs Are So High

Over the last year and a half, while the nation endured a terrible pandemic, patients with COVID-19 were treated even if they couldn’t foot the bills themselves. Will the high cost of COVID break the bank? Now that people will end up paying for treatment out of their own pockets, will more Americans than ever end up bankrupt? Dr. Elisabeth Rosenthal, editor-in-chief of Kaiser Health News, explains why our healthcare costs are so high.

Who Is Affected by High Healthcare Costs?

During this pandemic, vaccines have been available at no cost to the individual being vaccinated. In some places, COVID-19 tests were also supposed to be free of charge, or very affordable. However, Dr. Rosenthal tells about a physician who get such a test to be able to travel. Later, he discovered that the facility administering the test had charged his insurance company $54,000. Worse, the insurance company paid it. Because he had been administering the tests himself, he knew that the materials used were less than $10 worth. He was deeply disappointed that the insurance company was not interested in protesting the outrageous charge.

COVID-19 treatments like ECMO can cost more than a million dollars. The antibody cocktails can help reduce hospitalization, but they cost thousands of dollars. The new antiviral drug, molnupiravir, should make a difference for treating people with COVID. It will be less expensive than antibody transfusions, but Merck is charging the US government over $700 per patient. Federal funds supported early development of the drug.

The Mystery of Hospital Billing Codes:

Hospital billing codes appear mysterious, but they serve an important purpose for the hospital: they allow it to bill separately for each step in your care. This is one of the reasons healthcare costs are so high. If we want to ensure that healthcare is affordable in the future, hospital billing codes and the bills associated with them will need to become transparent.

The High Cost of Prescription Drugs:

At this time, Americans pay more for healthcare than people in comparable countries. It is not at all clear that we are getting our money’s worth. One area of particularly high healthcare costs is the prescription drug market. Congress gave pharmaceutical companies incentives to develop “orphan drugs” for rare conditions that wouldn’t be commercially attractive. Instead, the industry has taken those incentives to develop drugs with sky-high prices. Even everyday drugs like insulin may be too expensive for many people who need them, though. Some people skip such essential medications just because they can’t afford them.

Politicians are well aware of this problem. For years, they have campaigned on drug price reform. However, there’s been no progress. We consider a drug recently approved by the FDA for Alzheimer disease. Although it doesn’t seem to be very effective at reversing cognitive decline, it is pricey. Just imagine if a drug company developed a truly effective drug for this dementia. They could charge whatever they want for it. Would it break the bank for private insurance or for Medicare?

Advice for People Overwhelmed by High Healthcare Costs:

How can ordinary people fight an unfair bill? Dr. Rosenthal says it is really hard, but not impossible. She offers advice to listeners about addressing their medical bills.

This Week's Guest:

Dr. Elisabeth Rosenthal, Editor-in-Chief, joined Kaiser Health News in September 2016 after 22 years as a correspondent with The New York Times, where she covered a variety of beats from health care to environment and did a stint in the Beijing bureau. While in China, she covered SARS, bird flu and the emergence of HIV/AIDS in rural areas. Her book, An American Sickness: How Healthcare Became Big Business and How You Can Take It Back was a New York Times best-seller and a Washington Post notable book of the year. After graduating from Harvard Medical School, Dr. Rosenthal briefly practiced medicine in a New York City emergency room before converting to journalism. Nina Subin holds the copyright on the photograph.