My wife and I decided to go out for dinner. She’s on a restricted diet with a few allergies. I don’t have much in the way of restrictions, but I’m very hungry and we’re on a budget. There are several restaurants in town and we head over to one that looks affordable. At least it looks affordable from the outside. It’s called the “Bronze Budget Bistro”, but you never really know until you enter.
The host greets us at the door and seats us at a good table. He hands us each a menu. The first thing we notice is that there are no prices. Further, there are only vague descriptions of each item.
- Patty Melt with side*, $ Market Priced
- Best Burger Bargain**, $ Market Priced
- Veggie Wrap, Gluten Free*** $Market Priced
*”Side” offers vary each day and not available at all on some days.
** May or may not have actual burger, depending on form of payment
*** “Gluten Free”: may mean free of gluten or may reflect that there is no charge for gluten as included with the wrap. Terms applied depend on form of payment.
Our server arrived and offered us water, which we appreciated. A bus person brought rolls and butter for the table. Shortly after, the host came by and informed us that there may be a charge for the water and the bread.
“Excuse me”, I said, “But this is all very confusing. How will we know if there is a charge for the water or bread and what are the prices for the items on your menu!?”
The host smiled, and replied in a well-rehearsed manner, “That all depends on what credit card you are using sir. For example, if you are paying with United Express, the water and rolls are free, the sandwiches are all $11.95, and the gratuity of 20% is automatically added. However, if you are paying with Diner’s Choice, water is $1.00 per glass, no refills, rolls are $5.00 for the basket (butter included) and the sandwiches are all $5.00, gratuity optional.”
We decided on the Diner’s Choice payment because it seemed to be the less expensive option. We were wrong- more on that later.
Our server arrived and my wife asked about the gluten free veggie wrap, and informed that we would be paying with Diner’s Club. My wife is allergic to gluten. The server gave us the bad news that Diner’s Club does not cover gluten free meals, but United Express does. She went on to say, however, that the Best Burger Bargain, when paid for with Diner’s Choice, contains no burger and no bun and it’s gluten free – but not listed as “gluten free” so it’s covered!”
“If it’s a burger without a burger or bun, “My wife asked, “What is it?”
“It’s a bowl of chili”, the server replied. “You’ll love it!”
I ordered the Patty Melt only to discover after ordering it, that the side was raw okra. Had I used my United Express, it would have been fries. I told the server that I would remember that next time. She replied “Oh, next time could be different, depending on the code for okra and the code for potatoes. Codes change depending on who enters them and how they are entered”…which made no sense to me but was the best answer I could get.
In the end, we got the bill and to our surprise, it was $125!
I called the host over and demanded an explanation
“Certainly sir, let’s me explain your bill. You had two sandwiches at $5 each, a basket of rolls at $5, two glasses of water for $2, and then there are the co-pays that bring it to $125.”
“Co-pays?”
“Yes sir, co-pays. There are no co-pays with American Express, but there are with Diner’s Choice. Did you not see that in the fine print at the bottom of the menu? The co-pays cover the cost of linens, dishes, flatware, utilities, taxes and all other expenses required to operate the restaurant. Diner’s Choice does not cover this.”
“So I really should have gone with United Express?”
“Well sir, yes and no”.
“What do you mean yes and no”
“Well, yes in the future, once you meet the deductibles of United Express they cover it, but no; it would not have mattered this time. ”.
And so it goes.
It’s time for Universal Single Payer, Medicare for All.
…seafood meals are sometimes listed as market price. At least you can ask your server up front what that day’s price is before deciding to order.
Anecdotal, I know, but I have a friend who works for a doctor’s office and she spends half of her day on the phone with insurance companies trying to find out what things are covered and what they will pay. Personally, I’ve had things not covered and then miraculously covered a few months later when the billing clerk tweaked the billing code. One procedure went from $17 to $95 depending on a few factors.
Those are two fixes that we could implement locally in Massachusetts right now. Maryland style cost controls and putting a stop to hospital consolidation. Evan Falchuk talked up both solutions in his campaign, as did Don Berwick in addition to his single payer push. Nothing illustrated the failure of the political class to address this issue in the campaign more than Berwick’s ideas failing to gain traction with our nominee. Coakley endorsing hospital consolidation using the law Baker implemented as Weld’s DHS director was about the highlight of her health care plan. Atul Gawande, a great health care writer in general, has had some similar pieces arguing about simple to implement cost controls in health care that do not require single payer, which Vermont’s failure can show us, will likely only succeed if it is implemented nationally.