In the Dark

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One of the great medical breakthroughs of the last couple of decades is the diagnosis and treatment of sleep apnea. For some people, like me, snoring actually blocks off the airway during sleep. After some time without being able to breathe, they tell me, I awaken just enough to reopen the airway. This obstruction can happen many times during the night, turning sleep into a form of debilitation.

Sleep apnea is treated quite successfully by a CPAP machine. I wear a mask like a pilot’s, and all night long the machine maintains just enough air pressure to keep my air- ways open. Periodically, however, I need to replace the mask and tubing. Formerly, with standard medical insurance, this was “free” – I didn’t have to pay for the replacement. So when I recently contacted the company about replacing the mask and tubing there was no discussion of the price. There was also no discussion of the fact that the company was planning to send a whole new headgear unit, when all I needed was the mask and tubing. Again, why discuss something that is normally “free” to the patient?

Nevertheless, there’s no such thing as a free lunch. As I told President Obama in my open letter (November 2009), I’ve recently changed to a relatively high deductible plan ($1,200 is all that’s allowed in Maryland) with an HSA (health sav- ings account). This made me vitally interested in reading the four-page bill for the mask and tubing, a.k.a. “explanation of benefits.”

Granted, it was shipped FedEx, and had very nice brochures, but I was still unprepared for the size of the bill. It showed a whopping $868. Mysteriously, a bunch of the bill was “not allowed” (sounds like they’re trying to get away with something, doesn’t it?), but the part I needed to payout of my HSA was still $325.

Now, there is nothing technically complicated about this plastic and cloth apparatus. I’d expect to buy something this low-tech for under $30 in the real world – if it weren’t covered by insurance, and people had to pay for it themselves. But now that I do have to pay for these things myself, it seems obvious that the medical system is hugely out of whack. (Sorry I don’t know the correct economics jargon.) We patients have been making no effort whatever to contain costs. Why should we care if the price of everything is ridiculous? We care only about the part that we have to pay.

That’s what’s wrong with the system. And our politicians offer us everything but attempts to restore some consumer interest in price discipline.

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