The topic of healthcare prices has long been something that infuriated me.
I think about it every time I have to go to the doctor. Every time I am inconvenienced by some bill or statement. I have so little faith in the co-mingled bureaucracies woven by insurance companies and hospitals that every envelope marked with the address of the insurer or hospital leaves me feeling a sense of overwhelming dread as to what I'm expected to pay or have to sort out yet again.
The sad part is that I'm one of the fortunate ones; I've spent most of my life with decent medical insurance. I read horror stories from other people, and what they have to go through, and on days where I'm in a more empathetic moods they leave me feeling bereft of hope for our country. Not only do I wonder how we as a society could have let things get this bad, but I wonder why we continue to put up with it.
Or worse, how people could be such monsters that they will defend our current system. Our government is crawling with such selfish monsters. People like Florida House speaker Will Weatherford who decried the decision to accept Medicaid expansion for the state. He told the story of his little brother passing from cancer, and his family being left destitute from the bills for treatment. Medicaid didn't help them! Charity from the hospital helped them! Which is what Florida needs! Not that nasty Medicaid stuff!
Only the story was complete bullshit. The bills were paid by a program funded by Medicaid. Whoopsie.
But this twit isn't alone. There are plenty of people throwing numbers out there showing how unsustainable our healthcare costs are, complete with predictions of bankruptcies and destitution. And yet, when I read stories of what suffering Americans are going through, I wonder: why is it so expensive in the first place?
I mean, really? Are people really not seeing the same things I am and thinking, Something just isnt right here?
Am I really the only one? Because I'm seeing some really outrageous things going on.
An article by Steven Brill was recently published in Time magazine about the cost of healthcare in America and it was truly infuriating.
I grabbed a notebook and began jotting down some facts from the article, and ended up filling quite a few pages with material that no sensible person would think would come from the "greatest country on Earth."
The story talked of Sean Recchi, 42, diagnosed with non-Hodgkins Lymphoma. They paid $469/month for an insurance plan, meaning they paid $5,628 a year, and it was 20% of their income, which by my math meant they made a modest $28,140 a year.
Even with insurance, the policy only covered $2,000 per day of hospital costs, and the hospital wouldn't take their insurance anyway. In order to create a treatment plan, they had to front $48,900. To actually begin treatment, they borrowed another $35,000 from family.
The hospital made them wait 90 minutes because they couldn't confirm the check cleared. They had to pay $7,500 with a credit card as a good faith payment that the check would clear.
What. The. Hell.
So...these insured Americans had to pay $83,900 up front just to have a first round of treatment for cancer.
What kind of things were they being billed for?
Tylenol on Amazon costs around $17 for a bottle of 100 (there was a cost of $1.49 here, but in checking, I don't see it and don't know if it was a typo...), the hospital charged $1.50 for a single pill.
A chest X-ray for $283, which Medicare pays $20.44.
Rituxan, a cancer drug, was charged to them to the tune of $13,702. A dose. The actual cost from the drug supplier to the hospital was around $4,000, which the hospital pays less for because they can get it in volume, so the actual price to the hospital would be an estimated $3,000 to $3,500. It cost the company about $300 to manufacture, test, package, and ship the drug.
There was the story of Janice, who experienced chest pains. She rode 4 miles by ambulance, and after 3 hours of testing, it was diagnosed as heartburn. Out of work for a year, she had no insurance. Her bill? $21,000.
The ambulance, for a four mile trip, was $995.
The doctors, whom she saw very little of in the ER, cost $3,000.
The hospital fees for room, tests, and equipment...$17,000.
Let's break some of the costs down some more. She had three troponin tests, which look for a protein that indicates a possible heart attack. Each test cost her $199.50.
Medicare would pay $13.94.
A CBC test was charged to her for $157.61. Medicare pays $11.02.
Diabetes test strips were charged $18 each. You can order them on Amazon for $0.55 each.
A stress test was performed with an injected dye and CT scan. $7,997.54. Medicare would pay $554.
How does Medicare get away with such low fees? Here's something I didn't know. Medicare, by law, is restricted to paying what is basically the actual cost of the procedure...including staffing costs, overhead, etc...plus about 6%, so there's some profit in there for the hospital. So when you see how much Medicare will pay for a procedure, that's more or less supposed to be pretty close to the actual cost of the procedure to the hospital.
The New York Times did an article on deficit cutting proposals that included cutting payments to hospitals, and Steven Safyer, the Chief Executive of the Montefiore Medical Center in the Bronx, sai that any cut to hospitals would be a cut to beneficiaries. The hospital couldn't afford these cuts!
His salary was $4,065,000.
His Executive Vice-President's salary was $2,220,000.
The head of their dental department was making $1,798,000.
That hospital's operating profit for 2010 was $196.8 million, 99.4% of which came from patient billing and only 0.6% from fundraisers.
Where do these prices come from? A dirty little secret hospitals apparently don't like to talk about. The Chargemaster. That's a list of prices charged for each service. This is the list they go to insurance companies with and start talking pricing from, and these are the prices given to the patients after treatment if they don't have insurance.
How are the prices calculated?
They're arbitrary.
Yeah. They're made up. The reason they stink is because they're pulled from someone's ass.
The numbers on the Chargemaster are where many of the numbers come from when citing statistics. The American Hospital Association ran ads in some Washington rag remind Congress that they shouldn't cut payments to hospitals because think of the poor and all the good they do for them; the hospitals paid $39.3 BILLION to the poor in forgiven fees and procedures!
Only that was based on Chargemaster pricing. By the author's research, that $39.3 billion dollars was really closer to $3 billion. A lot of money, sure, but hardly the nearly forty billion they were boasting they spent on those icky poor people.
Honestly, to read some of these stories you'd think that the primary goal of insurers and hospitals was to make sure being dead was cheaper than living. I've heard plenty about the uninsured...but being insured is hardly a guarantee you're better off than the uninsured. Scott came down with pneumonia. After 4 or 5 days in the hospital his wife went down to check on the bill...it was already at $80,000.
Their insurance had an annual payout limit of $100,000.
By the time he checked out of the hospital, the 161 page bill came to $474,064. After insurance, that bill was lowered to $402,955.
Would it surprise you to learn that they were charged between $84 and $134 for bottles of saline solution? You can get them packaged in drip bags on Amazon for $5.16.
There are reform measures out there. It's just that the government works hard to prevent them from passing. For example, Congress made sure that if two drugs were shown to be equally effective in treating a disease, but one drug was $4,000 and the other was $400, Medicare cannot say they'll pay for the cheaper drug and not the overpriced treatment. They are forbidden from negotiating prices on equipment or drugs. So hospitals can still make a nicer profit from the drugs by reporting how much the average retail price of them is, and conveniently dropping the part about rebates they get for buying in bulk.
There are some that say that the high prices paid in America are what subsidize R&D for hospitals and drug companies. But do we?
According to the article, the securities filings for pharma companies state they are spending around 15% to 20% of gross revenue on R&D, which are hardly enough to cut into the net profits they're making (and are accounted for after R&D.) In other words, if you do the math you'll find that the companies are making so much profit that our outstanding prices and fees are not necessary to fund their R&D efforts.
The article stated that if we were to regulate hospital costs the way other developed countries do, we'd save $94 BILLION a year.
Honestly, how can someone look at these numbers and not understand that something is seriously wrong with our medical system? There's a brilliant amount of spin in media keeping people from seriously questioning why things are so expensive in the first place. It's a common-knowledge joke, much like the $5,000 hammers in the army and $10,000 toilet seats on subs. Charged an extra fifty bucks for an Aspirin? Well, it was administered by a skilled nurse! Gotta pay her salary somehow! Har har...
Only it's not so funny when you're hit with thousands of dollars in fees because your insurance doesn't cover a procedure, or only covers to a certain point then you're on your own.
And thanks to the fact that the Chargemaster prices are based on arbitrary numbers, it should come as no surprise when hospitals charge you $50,000 on a bill that gets magically cut down to $10,000 after the right person makes a phone call to push the right buttons. Hospital bills are actually the opening to negotiation, something they don't tell their average patients. They claim they're willing to work with you and make a deal. Which is great, since the bill you end up holding is largely based on fiction.
An even bigger joke is that the prices on Chargemaster are sent to people without insurance as the full price owed. Insurance companies deal with the negotiation process all the time; they have people dedicated to just haggling with hospitals. But the uninsured...they often find themselves in a position of shellshock. They just got treated for an illness or catastrophic life event; it probably doesn't occur to them that in addition to the recovery efforts they would be slapped with the challenge of a four to six digit bill. Most people don't do a lot of shopping around for medical work when they're dragged to the hospital in pain.
And can you imagine having to deal with the choice of treating cancer or letting yourself die if it meant not putting your family in debt that will outlast you?
The people who are least able to afford the Chargemaster prices are the ones that GET the Chargemaster prices. How stupid is that?
If you can look at those prices and think that something isn't fundamentally broken with our medical system, I question what kind of person you are. Profits aren't a bad thing, but outrageous profits...that's different. There's something sinister about an institution that codifies a system of substantial profit on the backs of the suffering.
This is a wonderful illustration of a system that is screaming for regulation. Yet the government does nothing. Well, that's not entirely true. Congress has actually gone out of its way to make sure prices stay high. They worked hard to keep people uninsured, or at least keep people with plans that are beneficial to the companies providing the insurances out there. They work hard to keep up the appearance of wanting a population that is insured, when in reality the insurance is worthless if you have a major health event and the insurance doesn't cover more than a pittance of the bill. But it does make you look better in the statistics to say you're insured!
Try reading that article in Time. It's shocking. It's infuriating. It illustrates how fundamentally broken the system is. And worse, none of our representatives are doing their jobs and stepping up to fix this. Short of having a major economic collapse, I don't know what, if anything, will fix the situation.
After all, we hardly even talk about this problem. Without that conversation it's hard to see the situation improving anytime soon, despite how glaringly obvious it is.
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