What my dog taught me about healthcare

Marlene Beggelman, MD

Marlene Beggelman is a physician and a member of Right Care Boston and the RCA Steering Committee. The following piece is one of many that RCA members wrote at the RCA Op-ed write-a-thon.

A visit with the veterinarian used to cost $40 two decades ago. Now I don’t leave their office with less than a $300 bill. A recent ultrasound for my 12-year-old Shih Tzu, Manny, was $700, on top of $600 for blood work. I also can’t help but note that as vet prices have risen, so have the number of iffy tests and procedures that are recommended.

For example, after the ultrasound, the vet recommended surgery that would cost $5000 and, by all accounts, had a slim (10-15%) chance of improving Manny’s health, and a 100% chance of making him miserable.

I’m a physician and I study health care costs. These recent trips to the vet, along with Elizabeth Rosenthal’s eye-opening book, An American Sickness, have opened my eyes to some interesting similarities between health care and veterinary care:

Insurance increases the cost of care.

Veterinary costs have more than doubled since 1996 when pet insurance was first introduced. Insurance distributes health care costs among many people, which allows any one of us to afford care when we become ill. But it also allows prices to be ratcheted up without too much pushback because they show up as small premium increases. Physicians and vets charge whatever they can, and insurers are happy to pay as they pass the increases along through higher premiums. Insurers get their piece of the pie whether costs go up or down, and they don’t want to alienate hospitals, so there’s no incentive to put the brakes on runaway prices. Ditching insurance isn’t an option, though, because newer technologies are unaffordable without it.

Those without insurance pay the most

Pet insurers negotiate a discount for care with veterinarians, but poor suckers like me without pet insurance pay full fare no matter how out of sync it is with the real cost of the service. The same holds for human health insurance where those least able to afford it (the uninsured) pay ridiculously higher prices.

Price is a secret

You may have seen a story that went viral last year, about a couple that was charged $40 to hold their newborn baby and didn’t know they were charged until they got the bill. Similarly, pet owners are hit with bewildering bills during very vulnerable moments. One cat owner told me she was quoted $125 to euthanize her pet. After the procedure, she was handed a bill for $300 and told that there was an additional charge of $70 to listen to the pet’s heart for proof she had passed. In health care and pet care, there’s no firm price tag; you don’t know what you are in for until after you’ve made the purchase.

Every little thing is extra

The patient (or patient’s owner) gets billed for every little item. This is called “unbundling” in medical billing. For example, a Boston-area pet owner was quoted $4200 to remove his dog’s molars, with separate charges for anesthesia prep, IV insertion, gum incisions, suturing, and syringe disposal fees. I recently saw a maternity bill in which the mom was charged $40 to have the baby walked from the nursery to her hospital room.

Over-treatment is rampant

It becomes tempting for professionals to order more and more tests of less-certain value when they are compensated for them. A few years ago, ABC’s 20/20 ran a story in which they sent perfectly healthy dogs to vets to see if unnecessary tests would be ordered. They found that several vets were willing to put the dogs with tarter-free teeth under general anesthesia for teeth cleaning. Pet care may be paralleling medical care in which one-third of treatment is unnecessary or ineffective. Reaching for useless interventions at the end-of-life, as in my dog Manny’s case, is a type of over-treatment that torments everyone and literally costs a fortune.

Monopolies are driving up costs

As corporations take bigger bites of the health care apple, prices have consistently gone up rather than down. As Elisabeth Rosenthal writes, hospitals have increasingly consolidated over the past decade into behemoth health systems that dominate regions and demand high rates from payers. Hospitals buy physicians’ practices, big hospitals buy little ones, and then they are all gobbled up by national conglomerates. Private equity firms have figured out that creating local monopolies for health care and pet care can spell big profits. As purely businesses, they are willing to be ruthless and have no qualms about bankrupting people who become ill.

The same forces of corporatization, perverse incentives, and profiteering are driving health care and vet care spending to unsustainable levels. Between 1996 and 2012, our own health care spending surged by almost 50 percent and pet medical spending jumped by 60 percent. We desperately need action to reform our unbalanced, non-transparent, and unfair health care systems, and we need it yesterday. Even my dog could tell you that.