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Struggling with the high cost of health care

KOMU PHOTOS/Eric Staszczak

With Democratic presidential debates well under way, health care has been a frequent conversation on the table, especially the cost of it. As a health reporter at The Atlantic can attest, that cost is often large, unexpected and the source of so much debate.

Olga Khazan, a staff writer at The Atlantic who primarily covers health, gender and science, joined “Take Care” to discuss her article, “Americans are going bankrupt from getting sick” and what it means for our current health care system.

Millions of people are struggling with medical debt, and it’s not just people who don’t have insurance that are affected. Khazan said health care is so expensive because hospitals and emergency service providers can set their own price for the services they provide.

“A lot of times, a hospital is basically … a box with a bunch of doctors in it, and the doctors don’t necessarily take your insurance,” she said. “That’s where those high prices come in.”

When it comes to who is most affected by medical debt, Khazan said it’s not just low-income people without insurance; it’s a large swath of the population. If you don’t have insurance, she said, you’re going to be hit especially hard, but at the same time, hospitals might have a charity care program for the uninsured.

“Even people who have great insurance will get bills that are extremely high … because some of the providers were out of network that they had interacted with in their hospital stay,” she said.

Khazan said this is mostly a United States phenomenon, and that’s because, unlike places like the United Kingdom and Canada, the U.S. does not regulate health care prices, nor is everyone insured.

“We have this kind of unique system that’s set up, employer-sponsored health care, that really creates the situation that we have now with a lot of people getting these really high medical bills,” she said.

Hospitals have become businesses in the past few decades, Khazan said, so that means prices can vary widely and seemingly come out of nowhere. In her article, Khazan used the anecdote of a woman who had a medical issue and someone had called an ambulance.

"It's really hard to know what different procedures are going to cost ahead of time. It's a total roll of the dice."

In the middle of what turned out to be a mini-stroke, the woman wondered if she should refuse the ambulance ride. This emergency-situation decision-making is a direct result of the way our health care system works in our current climate, she said. And, unfortunately, there’s no way to plan for emergency situations like that.

“But there’s not really a way to make sure that the ambulance that you’re going to take is going to be covered by your insurance,” Khazan said. “There’s not really a way to make sure that every doctor you see is going to be covered by your insurance. … It’s really hard to guarantee, in emergency situations, that you are going to be in the clear after you get out.”

Another thing that happens to a lot of people is they’ll get a bill from a hospital, and while it may be big, they may think that’s the only bill they get. But then more bills come, often from different doctors that saw the person or different services they had.

This is a common problem in our health care system, and Khazan said the best way to avoid getting stuck in this situation is to call the hospitals and doctors and try to negotiate.

“It’s really trying to get the hospital to meet you in the middle and some of those other doctors who are billing you,” she said. “That’s the advice, but sometimes, people who have just been in the hospital aren’t really in the position to negotiate a high-stakes thing like that because they might be really sick. So, it is, unfortunately, still really unfair.”

Make the situation even more unpredictable, Khazan said, is that there’s almost no way to know up front about some of these charges because hospitals typically don’t publicize costs for their services.

“It’s really hard to know what different procedures are going to cost ahead of time,” she said. “It’s a total roll of the dice.”

For those that are stuck with bills, some of those bills can get rolled into collections, causing a collection agency to come after you. These agencies, Khazan said, are often much more willing to negotiate payment than hospitals because they’re just trying to collect anything at all.

Similarly, medical debt buyers buy debt for pennies on the dollar and try to collect as much as they can. They’re willing to negotiate because they just want to make a profit, Khazan said, which has led to a whole underground economy on collecting medical bills.

All of these problems are precisely why a lot of the political debate right now is centered around changing the health care system completely.

“A lot of what these kinds of stories spark is this desire for a total overhaul of the health care system,” she said.

Bernie Sanders and Elizabeth Warren have proposed a single-payer system, Khazan said, where practically everyone is treated like a Medicare patient, but it’s not that simple.

“That has some challenges associated with it as well,” she said. “Some people say that would be too expensive thing to do.”

But, for as long as there are startling statistics about the cost of health care, Khazan said, these conversations aren’t going to go away.