by Lee Kurisko, MD
One of the fundamental problems with US health care is that patients do not function as consumers in a meaningful way and are not cost-conscious because third parties control the majority of the dollars in health care transactions. Without being consumers that foot the bill, patients are not interested in prices of medical services. Unchecked by what people are willing to pay, service providers are not motivated to keep costs down and charge reasonable prices. In most other economic sectors, this interaction is constantly at work such that almost all goods and services drop in price and rise in quality as time passes. One does not need to think too hard to come up with examples. Cell phones used to be in the purview of only the ultra-rich. Now almost everyone has one. Food costs, as a percentage of income, have been dropping for decades. Health care is one of the few sectors where prices continue to rise faster than the background inflation rate.
Veterinary health care and health insurance is dirt cheap compared to these products for humans. Pets have health care needs as do people. Dogs have very compressed life spans living, on average, and depending on breed, life expectancies are about 10 to 15 years. Within a few years of being an energetic puppy, they face geriatric health issues, and yet pet health insurance is unbelievably cheap!
My eight year old giant breed dog has health insurance, and the last time I renewed the annual premium, it was $320 dollars despite the fact that as a giant bread, she is now in her senior years with an attendant increased risk of health problems. When she was a pup, it was less than $150 per year.
The plan that I chose for her has the highest deductible available at $1,000. It does not include routine check-ups, vaccinations and preventative meds for ticks and fleas. I know with certainty that these expenses need to happen. No third party can insinuate itself into these transactions to make them cheaper.
Insurance is normally purchased to be compensated for large and unexpected expenses. About 1.5 years ago, while chasing a squirrel in the woods, she tore the 
anterior cruciate ligament in her left knee. As a result, she was very lame and required major knee surgery. In a human, I would expect the billed charges to be in the order of $50,000. For her, the cost was $2,850! Why the huge disparity? In fact, the surgery may be more complex in a dog. Unlike in humans, the tibia (shin bone) is cut and repositioned along with placing a graft for the actually ligament. She has now so much metal in her knee that she would set off the metal detector at the airport.
The difference is that as a recipient of veterinary care, unlike human health care, I remained a consumer even when I made a catastrophic claim. I paid the $1,000 deductible. The vet clinic charged $2,850. The insurance covered $1,800 and gave me the check, rather than the vet clinic. I paid the clinic the $1,800 dollars rather than the insurance company, and I chipped in the extra $50 bucks to make up the difference. Knowing how much I would be reimbursed, I was motivated to deal with a clinic that charged a reasonable price. Even when making a catastrophic claim, I remained a consumer with a vested interest in the price!
By always directly paying for service, even in the setting of catastrophic claim, I remain conscious of costs. My dog has also had some problems with her elbows. Occasionally we have done x-rays, but it is always preceded by a discussion with the vet as to whether the obtained information will be useful and change the way the problem is managed. With veterinary health care, there is a conscious balancing of costs and potentially obtained benefits. This virtually never occurs in human health care. If a test provides even the slightest shred of value, which may simply be idle curiosity, the test will proceed even if it costs thousands of dollars.
As an aside, Bella has had a problem with her elbows since she was very young called elbow dysplasia. This is a pre-existent condition. In the more free market of pet insurance, compared to the human health insurance market, the company offered me a plan that covered everything except her elbows! This is not a perfect solution, but I am still able to access the benefits of pet insurance. If the plan did cover her elbows, given the high probability of a problem, the cost of insurance would skyrocket and it would not be true insurance, but prepaid medical care. Legislators foolishly believe that they are able to craft laws that intrude into the private transactions of the marketplace and make things cheaper in some magical utopian way. Things are worth what they are worth. Artificially dropping a price only leads to reduced quality and access. In the US Leviathan of third parties intruding into health care, things just get more and more expensive, and despite the promise of Obamacare to “bend the cost curve down”, costs continue to rise. The exclusion of Bella’s elbows from her insurance plan is not a perfect utopian solution, but there is no Utopia, the literal translation of which is “nowhere”. I wish that human legislators could accept this.
Lee Kurisko MD is Chief Medical Officer with MediBid and radiologist with Consulting Radiologists Ltd. based in the Twin Cities. He is Medical Director of Diagnostic Imaging at St. Francis Regional Medical Center in Shakopee, Minnesota. He is trained in Family Medicine, Radiology, Neuroradiology and Nutritional and Metabolic Medicine.
Photos provided by Lee Kurisko, MD