Health CARE, not Health Insurance

        I go to a non-profit HMO where everyone is on salary. Why then did my flu shot cost - in addition to the serum - a fee for the nurse to administer the shot?  And not a little fee.  $86.  What else was she supposed to be doing with her time?  I'm already being charged for an office visit.  I presume that charge is calculated to cover the salary and benefits of the medical personnel I see, plus the appropriate amount toward rent, electricity, other salaries, equipment and everything else that is part of the basic running of the clinic.
         And when my gynecologist (a nurse practitioner) spends no more than a few second noticing a vaginal polyp and then removing it, why does the statement show a charge for almost $700? Again, she was supposed to be seeing me during that time, I paid for the office visit, and she's on salary.  Plus there was a SEPARATE pathology/lab charge.  Is the excuse for the $700 charge malpractice insurance?  An extra $700?  As high as premiums are,  I doubt that is justifiable.
        But I do know what these extra fees pay for at least in part: all that infrastructure to create, track, and collect all those separate fees, and to pay the doctors and nurses when they spend time filling out all the paperwork instead of caring for patients, and to pay the people who identify all the separate things that might be charged for, and their supervisors who review those items, and then the economists who have to work out the appropriate prices for each separate item's pricing, and the bookkeepers and programmers who have to make sure the money is charged to someone and then collected. And the reams and reams of paper that this enormous effort requires.
        Since I have insurance, I don't pay any of that.  I only am charged a small co-pay for the office visit, but SOMEBODY is paying for it somewhere. In a sane health CARE system, I'd go to the clinic, get the flu shot or have the polyp removed, and would pay one standard office visit fee.  The employer of the doctors and nurses would pay them their salaries.  The end.
        True, many people currently employed in the health INSURANCE business, in the insurance companies, in the clinics, in the companies who employ the insured employees, would have to find other work.  I am sorry about that, but I think it is a price our society should be willing to pay. It would be a short-term detriment with an infinitely long benefit.

Maybe when we lucky insured folks get statements like I did from our providers, we should write to them and to whoever is paying the bill and question the charges?  In the short run, that would be terrible: even more people would need to be hired to address these insurance questions and insurance charges would go up even more.  But maybe in the long run, the employers would get wise, and demand a system that makes sense.

Drafted on 3/18/2010.  Minor revisions and actual publication 11/20/2012.

I am indebted to my friend Lisa Chu-Thielbar for the succinct formula "care not insurance."