I am one of those guys who never goes to see a doctor!  But in 2016 I became a grandfather.  The pediatrician of the newborn child warned the parents that everyone in contact with the child needed to have received a flu shot.  Dutifully I got my flu shot at a local clinic staffed by GPs.  The bill was $435.  As an MD myself, I tried to understand the billing which has dragged on for nearly 1.5 years and wondered whether I could draw some lessons for healthcare consumers in general.

$435: Provider bill for flu shot, Tetanus booster (which I apparently agreed to), and the visit per se (consisting of vital signs and a few questions about allergies and whether I had had adverse reactions to prior immunizations, etc.).

$128:  Medicare determines this amount is admissible and the doctors office can’t charge more

$48: Medicare pays this amount.

$80: The remaining amount that Medicare passes on to myself because of a yearly deductible

$45: collected by doctors office from my secondary insurance (Aetna)

Total collected by provider: $173 (37.5% of the bill). Total outstanding that provider will forgo:  $262 (62.5%)

Republicans currently in power would have a free-market style healthcare system.  Most people, including myself,  have no idea how much their medical care or procedure might cost.  Therefore we can not make educated decisions on what to buy, as you might do if you were buying a TV or a car.  I had heard that flu shots cost about $25 (as advertised in a local CVS store) and I assumed that would be my bill, roughly speaking.

In addition, Obamacare and Medicare/Medicaid are supposed to cover immunizations.  The thinking here is sound: if I have the flu and I have to travel to work using the New York subway or a bus, I will likely spread the virus to others.  So this becomes a public health problem.  This is how epidemics start. The problem has been around since the early days of small pox and polio vaccinations. Remember the massive programs of the 1950s when all school kids received free polio vaccines.  Have we simply forgotten?

Just out of curiosity I searched the web.  Here are the prices for flu shots at Costco:

Here are the prices for flu shots at CVS:

But there is a HUGE caveat.  Prices really differ from store to store! And some people who are unwilling to pay extra fees, charged at some stores, are simply turned away.

You should really read the blog entries and comments on the various sites, like this one for example!  Some people report having been charged up to $1000 for a vaccine.  Here is one comment from a patient who received a tetanus shot while in the hospital:

Charge for tetanus booster was $820. $215 for vaccine, $165 for administration of vaccine by the nurse, & $440 for the hospital pharmacy to take the vaccine out of their cupboard.

Containing an infectious epidemic is VERY expensive for the government (and for us as a society).  Just think of the Ebola outbreak in West Africa (2013-2016).

In addition to the loss of life, the outbreak had a number of significant economic impacts. In March 2015, the United Nations Development Group reported that due to a decrease in trade, closing of borders, flight cancellations, and drop in foreign investment and tourism activity fueled by stigma, the epidemic resulted in vast economic consequences both in the affected areas and throughout Africa. A September 2014 report in the Financial Times suggested that the economic impact of the Ebola outbreak could kill more people than the disease itself.

Here is a visual of the cost of aid from outside the affected countries.  There was good reason for spending money: Ebola cases made it on to the US mainland!  Containing the virus in West Africa was paramount.  Infectious diseases don’t need passports and they don’t care about immigration policies such as those of Donald Trump.

Perhaps it is now clear that prevention of epidemics, including the flu, by vaccine programs is a lot cheaper than trying to contain an epidemic when it is in full swing.

Vaccine programs are the ultimate public health measure and have saved more lives historically than any other medical intervention. Vaccines should be totally free – it is a good investment.