(WEAU) -- Why is the cost of healthcare so high? It's a question many patients and even doctors are asking.
The Centers for Medicare and Medicaid Services says health care spending is projected to grow from $2.8 trillion in 2012 to $4.8 trillion by 2021. That makes the U.S. health care system the most expensive in the world.
For Roxann Rios of Wausau, the price tag behind her health is all too real.
--A cancer-survivors battle against the system
“I got my colon removed and my tumor in September 2012. I was living out of my car, homeless. I couldn't work obviously going through chemo. Then moved up here to start my life over,” said Rios.
Two years after being diagnosed, Rios can say she is cancer-free. She said everything was going fine, until she was surrounded by a mountain of medical bills. Now collections is collecting.
“The last one was $318,000 and some change. That was everything from the second I got diagnosed until last month when I went to the doctor. My surgeries were expensive, the MRI, the cat-scans, chemo. One chemotherapy session is almost $10,000 and I went through chemo for eight months,” she said.
On paper, Rios does well for herself. She’s a certified nursing assistant with no children and isn’t married. She said it’s one of the reasons why when she asks for federal or state help, she gets turned down.
“I started working and making more money, now they're starting to garnish my wages,” said Rios. “I got a letter yesterday from social service stating that I owe them $3000. They overpaid me.”
And to add insult to injury, Rios received a disconnection notice from the energy company, just as we were getting ready to interview her.
“I have to choose. Either I’m going to buy my meds and insulin this week or I’m going to pay $30 to $40 on my electric bill,” she said. Rios said she’s worried she may become homeless again because she can’t afford all of her payments.
The battle after cancer is one she says she can't win.
“I don’t even want to go to the doctor anymore because I know that's going to add on another couple grand to what I already owe,” she admitted.
Her story is one Dr. Hans Rechsteiner, MD has heard before.
--Dr. Hans Rechsteiner and the Tri-County Medical Society
“I personally had a patient come and see me with their bill and said, ‘What the heck? I was in the hospital for a few hours and I was in the operating room for 15 minutes and they're charging me $12,000’,” said Rechsteiner.
That's the dollar amount before insurance for an appendectomy, but still there was sticker shock for both doctor and patient.
“I was surprised myself. I had no idea. That's embarrassing to me. That's embarrassing for all of us that we order these things. We don't know. We should be in the know. We're falling down on our responsibility to our patients,” he said.
That's when Rechsteiner and a group of northern Wisconsin physicians from the Tri-County Medical Society decided they needed to speak up about the high cost of health care.
“We can't enact legislation, we can't write legislation, but we can create interest and that's where legislation comes from. That's where changes come from, by exposing the problem,” said Rechsteiner.
They took out a half-page ad in the Wisconsin State Journal, demanding health care reform through an eight-part resolution. One part calls for transparency.
“I mean you talk to the hospital and they would give you a song and dance, but that's improving with time now. The transparency thing is so that people will shop their health care, even though insurance is going to pay the bulk of it,” said Rechsteiner.
It’s giving the patient the ability shop for the best care and value, something Ryan Lasee of Abbotsford took upon himself to do. He had surgery to remove a benign spinal tumor about ten years ago. He quit his job to start his own business and a high deductible insurance plan.
“I was paying out of pocket. I wanted quotes and they wanted $4,000 approximately. I had heard about these MRI clinics and I found a place in Milwaukee for $600,” said Lasee. “They just served a flat fee.” He said hospitals need to present a new business model that gives customers a choice in where they want to get their care based on quality and price.
The resolution also says not-for-profit health care facilities should be exactly that, not-for-profit.
“They somehow fulfill the not-for-profit criteria by having foundations and shoveling money into this slot and that slot and they pay their top management a lot of money and they have a lot of building projects. I don’t understand how it's done, they make a lot of money,” said Rechsteiner. “In our resolution, we suggest it should be like a public services commission to review the not-for-profit statuses of all these places.”
According to a 2014 survey released by the Commonwealth Fund, the U.S ranks last out of 11 wealthy countries when it comes to health. Americans were the most likely to say they had access problems related to cost. The U.S. also ranked last in having healthy lives.
Rechsteiner said with the amount of money the U.S. spends on health care, this should not be the case. He said allowing health care to be accessible is another part of the resolution. It calls on the health insurance industry to pay out 85 cents in every dollar of premium and eventually get it up to 95 cents, where Medicare is.
“I think people in the industry, if they were aware of some of the outrageous stuff we put in our resolution they would think we're radicals but the general public hasn't really woke up to it yet. I think, their response to what we've done is pretty small so far. It’s a complex issue,” he said.
The resolution also calls for tort reform in the nation, one that follows Wisconsin’s example.
“It’s a positive thing. Our state medical society has been leaders in the nation and we have excellent tort reform in Wisconsin that’s a model for the rest of the country,” said Rechsteiner. “Say I operate on someone and it doesn't go well. It's possible, so it goes to court and the jury agrees with the person who had the bad operation. The jury says, well this is malpractice and so all of that person's costs should be covered. If they lost time at work, that should be covered. If they’re going to lose work for the rest of their lives, that should be covered, and he had a lot of suffering with his family so we want $3 million for that. That’s where the problem is for malpractice across the country. We get these outrageous settlements where lawyers get 30-50 percent.”
The resolution also asks patients to take ownership and be responsible enough know what's going on, much like Garth and Tasha Davis of Neillsville who found out three months ago, just how expensive having a baby can be.
--The cost behind having a baby
“I just added it up again and it was $21,000 in change. Our insurance maximum out of pocket was $9000,” said Garth.
Tasha said she thought she was in pre-term labor back in January and rushed to the hospital. When she returned home and received a bill, she noticed one of the added costs seemed a bit too much.
“I went in and they said, okay you need to take a wheelchair. So they pushed in the wheelchair and then we got that bill back in January and it was $547 and that was really shocking. So I was like, I’m turning it down. If I can walk, I’m going to walk,” said Tasha.
Garth said their second next bill showed another $500 “ambulatory” charge for a wheel chair although Tasha had refused a wheel chair.
“I just wish they would go over the bill with you if you want to before you leave the hospital and just try to work out for patients more for cheaper costs,” said Garth.
--Why is the cost of health care so high?
“Unfortunately, the consensus of our opinion after the research is that it has a lot to do with greed and it doesn't really reflect how much it costs to reduce these services,” said Rechsteiner.
He said the costs are associated with charging what the market will bear and that sometimes the market will bear a high cost.
“That's the way the situation is in America, as opposed to foreign countries where they don't tolerate those types of prices,” said Rechsteiner. “If the stuff is so expensive that people are avoiding us because they can't afford to come to us, then it really is about their health and we have people out there who won't go see the doctor because they're afraid of the costs and they’re neglecting themselves. That's horrible.”
He said in the end, people will blame the big hospitals, big clinics, the doctors, health insurance companies, pharmaceutical companies, etc. But the public has some responsibility too in taking care of themselves.
“One of the reasons it costs more in America is we have an obesity epidemic here,” he said. “We don’t take very good care of ourselves so of course it costs more to take care of us. So that’s one thing – get off the couch and take care of ourselves better and another thing is to shop. Demand transparency and quality.”
He said its quality and transparency that’s needed for the public to bring health care reform and a better health care system for the U.S.
The Tri-County Medical Society's resolution was taken to the Wisconsin Medical Society. Rechsteiner said it sparked a lively debate and will move forward to a committee.
--Response from providers
We tried reaching out to Sacred Heart Hospital, Marshfield Clinic and Oak Leaf Surgical Center, but did not get a statement.
We did hear back from Mayo Clinic Health System:
"Mayo Clinic Health System strives to provide expert, whole-person health care in an environment that is conscious of cost to the consumer. It’s important for patients to be informed about their medical care — regarding both quality and cost. We encourage patients to ask questions so they can make informed decisions about their care.
Our state is fortunate to have had such information available for many years via Wisconsin Hospital Association websites, CheckPoint and PricePoint.
Upon request, Mayo Clinic Health System provides patients with cost estimates prior to their visits. Our staff also works one-on-one with patients in need to develop payment plans over time. We also provide charity care that can range up to 100 percent of patients’ bills. In 2014, Mayo Clinic Health System in northwest Wisconsin is projected to provide $30 million of charity care to our patients.
Health care costs and the cost of health insurance are a national, state and local concern. Patients with health insurance also are encouraged to contact their insurance company for information related to coverage, benefits and out-of-pocket costs. Insurers can clarify for consumers the breakdown of care provided and its cost to them."