Nonsense!

Two days before the health care reform bill was passed in the United States, five American doctors took out a full page advertisement in the New York Times, declaring, “If your hair stylist charged for a basic hair cut depending on your insurance, this is what would happen.” A list of very different prices according to the type of health insurance followed, from the least expensive for the best insured to prohibitively expensive for the uninsured.

What would you say, continued the doctors, if McDonald’s applied this same principle? Their espresso “would certainly not be on their dollar menu!” because the fast-food giant would have to pay bureaucrats so much to manage that web of different costs.

These doctors called upon Barack Obama to pass “a simplified law,” of which the first point would be “that care providers charge everyone the same fee for the same service.” It would be up to the insurance companies to establish their level of reimbursement.

This advertisement went straight to my heart, because I have personally encountered this problem. Doctor B., who cares for one of my recalcitrant knees, has tried to persuade me several times: “Tell your readers what you’ve told me so that they might understand that, in America, health care works upside down.”

Obviously, I have not done so. A journalist is not paid to write about his vain miseries. But Doctor B. insisted. With this latest anecdote, he ended up convincing me. If I can contribute to an understanding of the — at times surreal — economic environment that the Obama administration must negotiate in order to carry out its reformist ambitions, well. . .

The anecdote, then: This week, Doctor B. asked me to undergo a magnetic resonance imaging (MRI). Obligingly, his secretary called the radiography department in his hospital. Prudently, in light of previous experiences, I ask her to verify the cost. Having posed the question, her eyes grow wide and, almost whispering, she announces: “$2,500” (€1,850). I’ve already been confronted with this situation. I explain to her that I’ll find another way.

Three months earlier, I had to undergo an initial MRI. The radiographer asked the ritual question: “Who provides your insurance?” The cost of this service depends on the agreement you have with them. I explained, as usual, that I use the health care coverage of French nationals abroad. I showed them the card. And, like every time, I was told that the department “did not contract” with that insurance company. I explained that I would pay out of pocket for the service, before being reimbursed.

Somewhat reassured, the radiographer consulted her list of fees and tells me: “$1,650.” I am speechless for a second. “Ma’am, are you serious?” She looked at me as if I had just fallen from Mars.

“Is something wrong, sir?”

“Ma’am, for that price I could buy a round-trip ticket to Paris, undergo three fully reimbursed MRIs and, furthermore, I’d be able to see my children!”

Uproar. “Please take a seat.” Clearly at a loss, the radiographer rushed toward the phone. Three minutes later, she called me back and said: “$460, will that be acceptable?” It’s payable in advance, but I already knew that. I’m speechless all over again. Let’s say it is acceptable, yes. My American friends have told you that health care over here is nonsense. I’ve had multiple occasions to find that out: A specialist has already taken $550 from me for a 10-minute consultation without the least examination! Health care in the United States is most often a product subject to the simple laws of supply and demand, with its “ethical” characters, its pimps and its huge margin of negotiation.

But that? An identical service for which the cost had been quadrupled! I asked for an explanation. The radiographer gave me one. Let’s face it: I didn’t understand a thing — the insurance language was so full of technical terms. This is why I was not be surprised later when the hospital asked me to pay not four, but six times the cost. I simply said “no,” called the radiography department and asked if it would be possible to pay the same fee as before. Which they again granted me. That’s all I know now; American doctors, as far as I can tell, are lost in speculation in their divergent exegesis on this case. . .

Obama’s reforms will very noticeably enlarge the population’s coverage and will put an end to the most striking abuses of private insurance: The rejection, without recourse, of those insured parties judged “too costly” being one of the worst abuses. The United States is ranked 22nd out of the 26 wealthy nations studied in the latest health care assessment by the OECD.

According to a recent report by the Robert Wood Johnson Foundation, an American woman is 11 times more likely to die during her pregnancy or during childbirth than an Irish woman. And the life expectancy of an African American from New Orleans is less than that of a Honduran. Obama’s reform will allow the United States to progressively close up these gaps.

On the other hand, and even if the pricing policy of insurers is partially constrained by this reform, by leaving the heart of the system intact, a system that the United States is the only developed nation to use, the “yes we can” president will not manage to shake up this “nonsense” or its most ludicrous aspects. But, on the occasion of a second round, who knows?