The Cost of Cancer

In our winter 2011 issue, we wrote about "financial toxicity" being an unwelcome side effect of cancer care, noting that even insured patients are increasingly going bankrupt because of soaring out-of-pocket expenses. It seems like nearly every day we hear another terrible tale of someone's financial hardship, and many of our readers have asked us to dedicate more coverage to the cost of cancer and practical steps patients can take to cope with it. Look for a special extended report on the subject with our fall issue.In the meantime, don't miss a word of Steven Brill's brilliant cover story in the current issue of Time magazine. Consider it a staff recommendation. In fact, it should be required reading for every American. Why? Because knowledge is power.To say it's an eye-opener is an understatement. Be warned: The piece is hefty--weighing in at more than 20,000 words--so you might want to take it in manageable doses. But do take it. Think about it. Discuss it. Because until we make a brutally honest assessment of why the cost of health care is so high, we won't be able to do anything about it.Brill begins with a fairly simple premise: The problem with health care in America isn't so much about who should pay for it but how much it costs. He begins by looking at hospitals, starting with nonprofit institutions, where profits are huge and patients get gouged. Astronomical markups on everything from high-tech medical devices to humble gauze pads are simply beyond comprehension. Insurance companies and Medicare are best positioned to bargain with healthcare providers so that patients don't pay these insane prices, but pity the poor souls who are uninsured or underinsured. By telling the stories of several patients and examining their medical bills, Brill spotlights everything that is wrong with our healthcare economy . Surprisingly, Medicare withstands the scrutiny. In fact, it works so well that Brill makes the case for lowering the enrollment age to include near-retirees. I think the case could be made to either open up the program for anyone who wants to buy into it or simply turn it into universal health care. As Slate's Matthew Yglesias observes, "Taxes would be higher, but overall health care spending would be much lower since Universal Medicare could push the unit cost of services way down."In addition to expanding Medicare coverage, Brill also offers a number of other solutions, such as reforming medical malpractice, taxing operating profits and imposing price controls--all good ideas, but highly unlikely. And until more Americans get involved and recognize the core problem, which Brill describes as "lopsided pricing and outsize profits in a market that doesn't work," nothing will get fixed. While Obamacare has "changed the rules related to who pays for what...we haven't done much to change the prices we pay," he concludes.A few take-aways:

You will never look at a hospital bill the same way again. They've become so indecipherable with codes and acronyms that an entire cottage industry has sprung up around helping patients understand what they're being billed for.If you're paying out-of-pocket costs for your treatment, negotiate with your doctor. Ask questions and discuss specific treatment and testing options with your doctor. Less expensive options may be available that can prevent you from hitting your insurance limit.

Don't be afraid to barter over the bill. Most billing representatives won't volunteer the information, but nearly everything is negotiable. Ask about charity programs, affordable payment plans, self-pay discounts and financial assistance. Do it before the bill gets turned over to a collection agency, when you still have room to negotiate.When all else fails, turn to a billing advocate or a claims assistance professional. Among other things, these independent contractors can review medical bills and determine proper payment, negotiate with providers, resolve claim problems and audit fees and charges.