Posted At Chicago Tribune

BY : Patty Dowd Schmitz

My family of four sometimes makes a choice between groceries and prescription drugs.

We have no corporate-sponsored health insurance, so we pay $974 each month for our family's individual coverage (a 70 percent increase from two years ago). We also have no prescription or dental insurance, which adds up to another $400 a month in related costs.

All told, our medical expenses top $16,000 per year.

For my family of four, paying for health-related products and services has simply become another economic choice we make regarding how we spend our income.

We purchase health-care services just as we purchase anything else--by trying to find the best bargains and shopping around.

On its face, making choices between medical costs and basics like groceries, water heaters and tires seems uncomfortable at best and abhorrent at worst to Americans accustomed to $10 co-pays that cover most medical needs.

But it's not just the poor and the elderly making these choices--it's the self-employed, the employees of small businesses, the newly retired who are caught in the "Medicare gap" and the millions of Americans who are simply uninsured.

The U.S. Census Bureau recently reported that a quarter of the population lacked health insurance in 2003, with working families accounting for 80 percent of the uninsured.

Add the millions more who are "underinsured" (those who pay high costs for minimal insurance), and the result is a large percentage of Americans who pay astronomical out-of-pocket sums for services like prescriptions and routine medical care.

But maybe there's a long-range silver lining here.

Those of us falling through the health-insurance cracks are probably among the most savvy of consumers in the health-care market. Medical costs are transparent to us.

We know that a well-child visit with immunizations could cost more than $150.

We know that a 30-day supply of asthma pills runs about $107.

And we know that a crown for a cracked tooth might be more than $1,000.

We ask questions of our doctors, and we don't accept care until we weigh the costs and benefits.

Kristie Darien, executive director of the legislative office of the National Association of the Self-Employed in Washington, believes that raising awareness of medical costs is a much-needed first step toward controlling the bloat that threatens to suffocate American health care.

"We're really pushing for a more transparent health-care system ... in understanding health-care products and services in a plain English, simple way," Darien said. "Right now you go to the doctor and pay your co-pay. But you don't really know what things cost."

Darien envisions a health-care system that tilts more toward health savings accounts and relies less on employer-subsidized insurance.

In this scenario, consumers buy health insurance only to cover catastrophic events such as major illnesses and emergencies.

They then put the rest of their insurance money into pretax accounts to cover routine expenses such as office visits, immunizations and prescriptions.

Many Americans without access to employer-sponsored health insurance are already moving toward this model, and Darien believes that larger corporations, which are quickly becoming overwhelmed by the high costs of providing health insurance (and which are increasingly passing these costs on to their employees), will soon follow.

With transparency comes accountability.

For Americans accustomed to making economic choices for everything from cereal to college education, more knowledge is one remedy for what ails health care. When we know what health care actually costs, we make more educated choices, which leads to greater competition in the health-care and insurance industries, which lowers costs and improves care for all of us.