Medicine: The costs are killing us

[SquidInk]

Grab a coffee... this one is lengthy. It does, imho, ask a critical question: why we are obsessed with who will pay these enormous 'healthcare' bills, and why do we fail to examine why these bills are so outrageous to begin with?

http://healthland.time.com/2013/02/20/b ... -us/print/

I got the idea for this article when I was visiting Rice University last year. [...] I was looking at the Texas Medical Center, a nearly 1,300-acre, 280-building complex of hospitals and related medical facilities, of which MD Anderson is the lead brand name. Medicine had obviously become a huge business. In fact, of Houston’s top 10 employers, five are hospitals, including MD Anderson with 19,000 employees; three, led by ExxonMobil with 14,000 employees, are energy companies. How did that happen, I wondered. Where’s all that money coming from? And where is it going? I have spent the past seven months trying to find out by analyzing a variety of bills from hospitals like MD Anderson, doctors, drug companies and every other player in the American health care ecosystem.

When you look behind the bills that Sean Recchi and other patients receive, you see nothing rational — no rhyme or reason — about the costs they faced in a marketplace they enter through no choice of their own. The only constant is the sticker shock for the patients who are asked to pay.

[...]

What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab? Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?

Recchi’s bill and six others examined line by line for this article offer a closeup window into what happens when powerless buyers — whether they are people like Recchi or big health-insurance companies — meet sellers in what is the ultimate seller’s market.

The result is a uniquely American gold rush for those who provide everything from wonder drugs to canes to high-tech implants to CT scans to hospital bill-coding and collection services. In hundreds of small and midsize cities across the country — from Stamford, Conn., to Marlton, N.J., to Oklahoma City — the American health care market has transformed tax-exempt “nonprofit” hospitals into the towns’ most profitable businesses and largest employers, often presided over by the regions’ most richly compensated executives. And in our largest cities, the system offers lavish paychecks even to midlevel hospital managers, like the 14 administrators at New York City’s Memorial Sloan-Kettering Cancer Center who are paid over 0,000 a year, including six who make over

I got the idea for this article when I was visiting Rice University last year. [...] I was looking at the Texas Medical Center, a nearly 1,300-acre, 280-building complex of hospitals and related medical facilities, of which MD Anderson is the lead brand name. Medicine had obviously become a huge business. In fact, of Houston’s top 10 employers, five are hospitals, including MD Anderson with 19,000 employees; three, led by ExxonMobil with 14,000 employees, are energy companies. How did that happen, I wondered. Where’s all that money coming from? And where is it going? I have spent the past seven months trying to find out by analyzing a variety of bills from hospitals like MD Anderson, doctors, drug companies and every other player in the American health care ecosystem.

When you look behind the bills that Sean Recchi and other patients receive, you see nothing rational — no rhyme or reason — about the costs they faced in a marketplace they enter through no choice of their own. The only constant is the sticker shock for the patients who are asked to pay.

[...]

What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab? Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?

Recchi’s bill and six others examined line by line for this article offer a closeup window into what happens when powerless buyers — whether they are people like Recchi or big health-insurance companies — meet sellers in what is the ultimate seller’s market.

The result is a uniquely American gold rush for those who provide everything from wonder drugs to canes to high-tech implants to CT scans to hospital bill-coding and collection services. In hundreds of small and midsize cities across the country — from Stamford, Conn., to Marlton, N.J., to Oklahoma City — the American health care market has transformed tax-exempt “nonprofit” hospitals into the towns’ most profitable businesses and largest employers, often presided over by the regions’ most richly compensated executives. And in our largest cities, the system offers lavish paychecks even to midlevel hospital managers, like the 14 administrators at New York City’s Memorial Sloan-Kettering Cancer Center who are paid over $500,000 a year, including six who make over $1 million.

Taken as a whole, these powerful institutions and the bills they churn out dominate the nation’s economy and put demands on taxpayers to a degree unequaled anywhere else on earth. In the U.S., people spend almost 20% of the gross domestic product on health care, compared with about half that in most developed countries. Yet in every measurable way, the results our health care system produces are no better and often worse than the outcomes in those countries.

WTF is the 'chargemaster'? Read on...

If you are confused by the notion that those least able to pay are the ones singled out to pay the highest rates, welcome to the American medical marketplace.

[...]

One night last summer at her home near Stamford, Conn., a 64-year-old former sales clerk whom I’ll call Janice S. felt chest pains. She was taken four miles by ambulance to the emergency room at Stamford Hospital, officially a nonprofit institution. After about three hours of tests and some brief encounters with a doctor, she was told she had indigestion and sent home. That was the good news.

The bad news was the bill: $995 for the ambulance ride, $3,000 for the doctors and $17,000 for the hospital — in sum, $21,000 for a false alarm.

[...]

Out of work for a year, Janice S. had no insurance. Among the hospital’s charges were three “TROPONIN I” tests for $199.50 each. According to a National Institutes of Health website, a troponin test “measures the levels of certain proteins in the blood” whose release from the heart is a strong indicator of a heart attack. Some labs like to have the test done at intervals, so the fact that Janice S. got three of them is not necessarily an issue. The price is the problem. Stamford Hospital spokesman Scott Orstad told me that the $199.50 figure for the troponin test was taken from what he called the hospital’s chargemaster. The chargemaster, I learned, is every hospital’s internal price list. Decades ago it was a document the size of a phone book; now it’s a massive computer file, thousands of items long, maintained by every hospital.

Stamford Hospital’s chargemaster assigns prices to everything, including Janice S.’s blood tests. It would seem to be an important document. However, I quickly found that although every hospital has a chargemaster, officials treat it as if it were an eccentric uncle living in the attic. Whenever I asked, they deflected all conversation away from it. They even argued that it is irrelevant. I soon found that they have good reason to hope that outsiders pay no attention to the chargemaster or the process that produces it. For there seems to be no process, no rationale, behind the core document that is the basis for hundreds of billions of dollars in health care bills.

[...]

That so few consumers seem to be aware of the chargemaster demonstrates how well the health care industry has steered the debate from why bills are so high to who should pay them.

The expensive technology deployed on Janice S. was a bigger factor in her bill than the lab tests. An “NM MYO REST/SPEC EJCT MOT MUL” was billed at $7,997.54. That’s a stress test using a radioactive dye that is tracked by an X-ray computed tomography, or CT, scan. Medicare would have paid Stamford $554 for that test.

Janice S. was charged an additional $872.44 just for the dye used in the test. The regular stress test patients are more familiar with, in which arteries are monitored electronically with an electrocardiograph, would have cost far less — $1,200 even at the hospital’s chargemaster price. (Medicare would have paid $96 for it.) And although many doctors view the version using the CT scan as more thorough, others consider it unnecessary in most cases.

million.

Taken as a whole, these powerful institutions and the bills they churn out dominate the nation’s economy and put demands on taxpayers to a degree unequaled anywhere else on earth. In the U.S., people spend almost 20% of the gross domestic product on health care, compared with about half that in most developed countries. Yet in every measurable way, the results our health care system produces are no better and often worse than the outcomes in those countries.

WTF is the 'chargemaster'? Read on...

If you are confused by the notion that those least able to pay are the ones singled out to pay the highest rates, welcome to the American medical marketplace.

[...]

One night last summer at her home near Stamford, Conn., a 64-year-old former sales clerk whom I’ll call Janice S. felt chest pains. She was taken four miles by ambulance to the emergency room at Stamford Hospital, officially a nonprofit institution. After about three hours of tests and some brief encounters with a doctor, she was told she had indigestion and sent home. That was the good news.

The bad news was the bill: 5 for the ambulance ride, ,000 for the doctors and ,000 for the hospital — in sum, ,000 for a false alarm.

[...]

Out of work for a year, Janice S. had no insurance. Among the hospital’s charges were three “TROPONIN I” tests for 9.50 each. According to a National Institutes of Health website, a troponin test “measures the levels of certain proteins in the blood” whose release from the heart is a strong indicator of a heart attack. Some labs like to have the test done at intervals, so the fact that Janice S. got three of them is not necessarily an issue. The price is the problem. Stamford Hospital spokesman Scott Orstad told me that the 9.50 figure for the troponin test was taken from what he called the hospital’s chargemaster. The chargemaster, I learned, is every hospital’s internal price list. Decades ago it was a document the size of a phone book; now it’s a massive computer file, thousands of items long, maintained by every hospital.

Stamford Hospital’s chargemaster assigns prices to everything, including Janice S.’s blood tests. It would seem to be an important document. However, I quickly found that although every hospital has a chargemaster, officials treat it as if it were an eccentric uncle living in the attic. Whenever I asked, they deflected all conversation away from it. They even argued that it is irrelevant. I soon found that they have good reason to hope that outsiders pay no attention to the chargemaster or the process that produces it. For there seems to be no process, no rationale, behind the core document that is the basis for hundreds of billions of dollars in health care bills.

[...]

That so few consumers seem to be aware of the chargemaster demonstrates how well the health care industry has steered the debate from why bills are so high to who should pay them.

The expensive technology deployed on Janice S. was a bigger factor in her bill than the lab tests. An “NM MYO REST/SPEC EJCT MOT MUL” was billed at ,997.54. That’s a stress test using a radioactive dye that is tracked by an X-ray computed tomography, or CT, scan. Medicare would have paid Stamford 4 for that test.

Janice S. was charged an additional 2.44 just for the dye used in the test. The regular stress test patients are more familiar with, in which arteries are monitored electronically with an electrocardiograph, would have cost far less —

I got the idea for this article when I was visiting Rice University last year. [...] I was looking at the Texas Medical Center, a nearly 1,300-acre, 280-building complex of hospitals and related medical facilities, of which MD Anderson is the lead brand name. Medicine had obviously become a huge business. In fact, of Houston’s top 10 employers, five are hospitals, including MD Anderson with 19,000 employees; three, led by ExxonMobil with 14,000 employees, are energy companies. How did that happen, I wondered. Where’s all that money coming from? And where is it going? I have spent the past seven months trying to find out by analyzing a variety of bills from hospitals like MD Anderson, doctors, drug companies and every other player in the American health care ecosystem.

When you look behind the bills that Sean Recchi and other patients receive, you see nothing rational — no rhyme or reason — about the costs they faced in a marketplace they enter through no choice of their own. The only constant is the sticker shock for the patients who are asked to pay.

[...]

What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab? Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?

Recchi’s bill and six others examined line by line for this article offer a closeup window into what happens when powerless buyers — whether they are people like Recchi or big health-insurance companies — meet sellers in what is the ultimate seller’s market.

The result is a uniquely American gold rush for those who provide everything from wonder drugs to canes to high-tech implants to CT scans to hospital bill-coding and collection services. In hundreds of small and midsize cities across the country — from Stamford, Conn., to Marlton, N.J., to Oklahoma City — the American health care market has transformed tax-exempt “nonprofit” hospitals into the towns’ most profitable businesses and largest employers, often presided over by the regions’ most richly compensated executives. And in our largest cities, the system offers lavish paychecks even to midlevel hospital managers, like the 14 administrators at New York City’s Memorial Sloan-Kettering Cancer Center who are paid over $500,000 a year, including six who make over $1 million.

Taken as a whole, these powerful institutions and the bills they churn out dominate the nation’s economy and put demands on taxpayers to a degree unequaled anywhere else on earth. In the U.S., people spend almost 20% of the gross domestic product on health care, compared with about half that in most developed countries. Yet in every measurable way, the results our health care system produces are no better and often worse than the outcomes in those countries.

WTF is the 'chargemaster'? Read on...

If you are confused by the notion that those least able to pay are the ones singled out to pay the highest rates, welcome to the American medical marketplace.

[...]

One night last summer at her home near Stamford, Conn., a 64-year-old former sales clerk whom I’ll call Janice S. felt chest pains. She was taken four miles by ambulance to the emergency room at Stamford Hospital, officially a nonprofit institution. After about three hours of tests and some brief encounters with a doctor, she was told she had indigestion and sent home. That was the good news.

The bad news was the bill: $995 for the ambulance ride, $3,000 for the doctors and $17,000 for the hospital — in sum, $21,000 for a false alarm.

[...]

Out of work for a year, Janice S. had no insurance. Among the hospital’s charges were three “TROPONIN I” tests for $199.50 each. According to a National Institutes of Health website, a troponin test “measures the levels of certain proteins in the blood” whose release from the heart is a strong indicator of a heart attack. Some labs like to have the test done at intervals, so the fact that Janice S. got three of them is not necessarily an issue. The price is the problem. Stamford Hospital spokesman Scott Orstad told me that the $199.50 figure for the troponin test was taken from what he called the hospital’s chargemaster. The chargemaster, I learned, is every hospital’s internal price list. Decades ago it was a document the size of a phone book; now it’s a massive computer file, thousands of items long, maintained by every hospital.

Stamford Hospital’s chargemaster assigns prices to everything, including Janice S.’s blood tests. It would seem to be an important document. However, I quickly found that although every hospital has a chargemaster, officials treat it as if it were an eccentric uncle living in the attic. Whenever I asked, they deflected all conversation away from it. They even argued that it is irrelevant. I soon found that they have good reason to hope that outsiders pay no attention to the chargemaster or the process that produces it. For there seems to be no process, no rationale, behind the core document that is the basis for hundreds of billions of dollars in health care bills.

[...]

That so few consumers seem to be aware of the chargemaster demonstrates how well the health care industry has steered the debate from why bills are so high to who should pay them.

The expensive technology deployed on Janice S. was a bigger factor in her bill than the lab tests. An “NM MYO REST/SPEC EJCT MOT MUL” was billed at $7,997.54. That’s a stress test using a radioactive dye that is tracked by an X-ray computed tomography, or CT, scan. Medicare would have paid Stamford $554 for that test.

Janice S. was charged an additional $872.44 just for the dye used in the test. The regular stress test patients are more familiar with, in which arteries are monitored electronically with an electrocardiograph, would have cost far less — $1,200 even at the hospital’s chargemaster price. (Medicare would have paid $96 for it.) And although many doctors view the version using the CT scan as more thorough, others consider it unnecessary in most cases.

,200 even at the hospital’s chargemaster price. (Medicare would have paid for it.) And although many doctors view the version using the CT scan as more thorough, others consider it unnecessary in most cases.

I have to take a break. Upsetting stuff.

[SquidInk]

[SquidInk]

Because Stephanie and her husband had recently started their own small technology business, they were unable to buy comprehensive health insurance. For 9 a month, or about 20% of their income, they had been able to get only a policy that covered just ,000 per day of any hospital costs. “We don’t take that kind of discount insurance,” said the woman at MD Anderson when Stephanie called to make an appointment for Sean.

Been there. Not fun. I especially despise this one:

• “We don’t take that kind of discount insurance,”

Stephanie was then told by a billing clerk that the estimated cost of Sean’s visit — just to be examined for six days so a treatment plan could be devised — would be ,900, due in advance. Stephanie got her mother to write her a check. “You do anything you can in a situation like that,” she says. The Recchis flew to Houston, leaving Stephanie’s mother to care for their two teenage children.

[...]

The total cost, in advance, for Sean to get his treatment plan and initial doses of chemotherapy was ,900.

Best healthcare delivery system in the world? Wanna talk about that?

[SquidInk]

We don’t know the particulars of Janice S.’s condition, so we cannot know why the doctors who treated her ordered the more expensive test. But the incentives are clear. On the basis of market prices, Stamford probably paid about 0,000 for the CT equipment in its operating room. It costs little to operate, so the more it can be used and billed, the quicker the hospital recovers its costs and begins profiting from its purchase. In addition, the cardiologist in the emergency room gave Janice S. a separate bill for 0 to read the test results on top of the 2 he charged for examining her.

According to a McKinsey study of the medical marketplace, a typical piece of equipment will pay for itself in one year if it carries out just 10 to 15 procedures a day. That’s a terrific return on capital equipment that has an expected life span of seven to 10 years. And it means that after a year, every scan ordered by a doctor in the Stamford Hospital emergency room would mean pure profit, less maintenance costs, for the hospital. Plus an extra fee for the doctor.

Another McKinsey report found that health care providers in the U.S. conduct far more CT tests per capita than those in any other country — 71% more than in Germany, for example, where the government-run health care system offers none of those incentives for overtesting. We also pay a lot more for each test, even when it’s Medicare doing the paying. Medicare reimburses hospitals and clinics an average of four times as much as Germany does for CT scans, according to the data gathered by McKinsey.

[...]

According to a study in the Annals of Emergency Medicine, the use of CT scans in America’s emergency rooms “has more than quadrupled in recent decades.” As one former emergency-room doctor puts it, “Giving out CT scans like candy in the ER is the equivalent of putting a 90-year-old grandmother through a pat-down at the airport: Hey, you never know.”

[...]

Selling this equipment to hospitals — which has become a key profit center for industrial conglomerates like General Electric and Siemens — is one of the U.S. economy’s bright spots. I recently subscribed to an online headhunter’s listings for medical-equipment salesmen and quickly found an opening in Connecticut that would pay a salary of ,000 and sales commissions of up to ,000 more, plus a car allowance. The only requirement was that applicants have “at least one year of experience selling some form of capital equipment.”

In all, on the day I signed up for that jobs website, it carried 186 listings for medical-equipment salespeople just in Connecticut.

HELL YEAH!!! High margin! KA-CHING!

Unlike those of almost any other area we can think of, the dynamics of the medical marketplace seem to be such that the advance of technology has made medical care more expensive, not less. First, it appears to encourage more procedures and treatment by making them easier and more convenient. (This is especially true for procedures like arthroscopic surgery.) Second, there is little patient pushback against higher costs because it seems to (and often does) result in safer, better care and because the customer getting the treatment is either not going to pay for it or not going to know the price until after the fact.

Beyond the hospitals’ and doctors’ obvious economic incentives to use the equipment and the manufacturers’ equally obvious incentives to sell it, there’s a legal incentive at work. Giving Janice S. a nuclear-imaging test instead of the lower-tech, less expensive stress test was the safer thing to do — a belt-and-suspenders approach that would let the hospital and doctor say they pulled out all the stops in case Janice S. died of a heart attack after she was sent home.

“We use the CT scan because it’s a great defense,” says the CEO of another hospital not far from Stamford. “For example, if anyone has fallen or done anything around their head — hell, if they even say the word head — we do it to be safe. We can’t be sued for doing too much.”

Wait... what? Did he just say:

• "hell, if they even say the word head — we do it to be safe. We can’t be sued for doing too much.”

Why the hell not? Any other contractor can be. Investigative journalists used to love catching sole proprietors (like auto mechanics and renovation contractors) overcharging, over repairing, or replacing non-defective parts. We have entire associations like the Bureau of Automotive Repair to address such things. Again, the constellation of 'healthcare' provision industries believe they are somehow different, immune or otherwise not tethered to generally accepted standards of business. And they shield themselves behind legal fictions to doubly ensure they have no personal responsibility in these transactions.

Nice.

The most practical malpractice-reform proposals would not limit awards for victims but would allow doctors to use what’s called a safe-harbor defense. Under safe harbor, a defendant doctor or hospital could argue that the care provided was within the bounds of what peers have established as reasonable under the circumstances. The typical plaintiff argument that doing something more, like a nuclear-imaging test, might have saved the patient would then be less likely to prevail.

When Obamacare was being debated, Republicans pushed this kind of commonsense malpractice-tort reform. But the stranglehold that plaintiffs’ lawyers have traditionally had on Democrats prevailed, and neither a safe-harbor provision nor any other malpractice reform was included.

[SquidInk]

Shocked by her bill from Stamford hospital and unable to pay it, Janice S. found a local woman on the Internet who is part of a growing cottage industry of people who call themselves medical-billing advocates. They help people read and understand their bills and try to reduce them. “The hospitals all know the bills are fiction, or at least only a place to start the discussion, so you bargain with them,” says Katalin Goencz, a former appeals coordinator in a hospital billing department who negotiated Janice S.’s bills from a home office in Stamford.

Goencz is part of a trade group called the Alliance of Claim Assistant Professionals, which has about 40 members across the country. Another group, Medical Billing Advocates of America, has about 50 members. Each advocate seems to handle 40 to 70 cases a year for the uninsured and those disputing insurance claims. That would be about 5,000 patients a year out of what must be tens of millions of Americans facing these issues — which may help explain why 60% of the personal bankruptcy filings each year are related to medical bills.

“I can pretty much always get it down 30% to 50% simply by saying the patient is ready to pay but will not pay 0 for a blood test or an X-ray,” says Goencz. “They hand out blood tests and X-rays in hospitals like bottled water, and they know it.”

After weeks of back-and-forth phone calls, for which Goencz charged Janice S. an hour, Stamford Hospital cut its bill in half. Most of the doctors did about the same, reducing Janice S.’s overall tab from ,000 to about ,000.

But the best the ambulance company would offer Goencz was to let Janice S. pay off its 5 ride in -a-month installments. “The ambulances never negotiate the amount,” says Goencz.

So even in this smarmy sector, we see traditional American innovation. It simply can't be smothered, no matter how hard the monopolists try. Just imagine the boundless opportunities - if only we would commit, as a people to doing healthcare right, top to bottom.

A manager at Stamford Emergency Medical Services, which charged Janice S. 8 for the pickup plus .38 per mile, says that “our rates are all set by the state on a regional basis” and that the company is independently owned. That’s at odds with a trend toward consolidation that has seen several private-equity firms making investments in what Wall Street analysts have identified as an increasingly high-margin business. Overall, ambulance revenues were more than billion last year, or about 10% higher than Hollywood’s box-office take. It’s not a great deal to pay off

Shocked by her bill from Stamford hospital and unable to pay it, Janice S. found a local woman on the Internet who is part of a growing cottage industry of people who call themselves medical-billing advocates. They help people read and understand their bills and try to reduce them. “The hospitals all know the bills are fiction, or at least only a place to start the discussion, so you bargain with them,” says Katalin Goencz, a former appeals coordinator in a hospital billing department who negotiated Janice S.’s bills from a home office in Stamford.

Goencz is part of a trade group called the Alliance of Claim Assistant Professionals, which has about 40 members across the country. Another group, Medical Billing Advocates of America, has about 50 members. Each advocate seems to handle 40 to 70 cases a year for the uninsured and those disputing insurance claims. That would be about 5,000 patients a year out of what must be tens of millions of Americans facing these issues — which may help explain why 60% of the personal bankruptcy filings each year are related to medical bills.

“I can pretty much always get it down 30% to 50% simply by saying the patient is ready to pay but will not pay $300 for a blood test or an X-ray,” says Goencz. “They hand out blood tests and X-rays in hospitals like bottled water, and they know it.”

After weeks of back-and-forth phone calls, for which Goencz charged Janice S. $97 an hour, Stamford Hospital cut its bill in half. Most of the doctors did about the same, reducing Janice S.’s overall tab from $21,000 to about $11,000.

But the best the ambulance company would offer Goencz was to let Janice S. pay off its $995 ride in $25-a-month installments. “The ambulances never negotiate the amount,” says Goencz.

So even in this smarmy sector, we see traditional American innovation. It simply can't be smothered, no matter how hard the monopolists try. Just imagine the boundless opportunities - if only we would commit, as a people to doing healthcare right, top to bottom.

A manager at Stamford Emergency Medical Services, which charged Janice S. $958 for the pickup plus $9.38 per mile, says that “our rates are all set by the state on a regional basis” and that the company is independently owned. That’s at odds with a trend toward consolidation that has seen several private-equity firms making investments in what Wall Street analysts have identified as an increasingly high-margin business. Overall, ambulance revenues were more than $12 billion last year, or about 10% higher than Hollywood’s box-office take. It’s not a great deal to pay off $1,000 for a four-mile ambulance ride on the layaway plan or receive a 50% discount on a $199.50 blood test that should cost $15, nor is getting half off on a $7,997.54 stress test that was probably all profit and may not have been necessary. But, says Goencz, “I don’t go over it line by line. I just go for a deal. The patient usually is shocked by the bill, doesn’t understand any of the language and has bill collectors all over her by the time they call me. So they’re grateful. Why give them heartache by telling them they still paid too much for some test or pill?”

,000 for a four-mile ambulance ride on the layaway plan or receive a 50% discount on a 9.50 blood test that should cost , nor is getting half off on a ,997.54 stress test that was probably all profit and may not have been necessary. But, says Goencz, “I don’t go over it line by line. I just go for a deal. The patient usually is shocked by the bill, doesn’t understand any of the language and has bill collectors all over her by the time they call me. So they’re grateful. Why give them heartache by telling them they still paid too much for some test or pill?”

Words escape me. Again, who is it that would place the words "world's best" anywhere near all of this?

[SquidInk]

A typical day in the MAW of the American 'system':

The 2011 outpatient visit of someone I’ll call Steve H. to Mercy Hospital in Oklahoma City illustrates those economics. Steve H. had the kind of relatively routine care that patients might expect would be no big deal: he spent the day at Mercy getting his aching back fixed.

A blue collar worker who was in his 30s at the time and worked at a local retail store, Steve H. had consulted a specialist at Mercy in the summer of 2011 and was told that a stimulator would have to be surgically implanted in his back. The good news was that with all the advances of modern technology, the whole process could be done in a day. (The latest federal filing shows that 63% of surgeries at Mercy were performed on outpatients.)

[...]

Steve H.’s bill for his day at Mercy contained all the usual and customary overcharges. One item was “MARKER SKIN REG TIP RULER” for . That’s the marking pen, presumably reusable, that marked the place on Steve H.’s back where the incision was to go. Six lines down, there was “STRAP OR TABLE 8X27 IN” for . That’s the strap used to hold Steve H. onto the operating table. Just below that was “BLNKT WARM UPPER BDY 42268” for . That’s a blanket used to keep surgery patients warm. It is, of course, reusable, and it’s available new on eBay for . Four lines down there’s “GOWN SURG ULTRA XLG 95121” for , which is the gown the surgeon wore. Thirty of them can be bought online for 0. Neither Medicare nor any large insurance company would pay a hospital separately for those straps or the surgeon’s gown; that’s all supposed to come with the facility fee paid to the hospital, which in this case was ,289.

In all, Steve H.’s bill for these basic medical and surgical supplies was ,882. On top of that was

The 2011 outpatient visit of someone I’ll call Steve H. to Mercy Hospital in Oklahoma City illustrates those economics. Steve H. had the kind of relatively routine care that patients might expect would be no big deal: he spent the day at Mercy getting his aching back fixed.

A blue collar worker who was in his 30s at the time and worked at a local retail store, Steve H. had consulted a specialist at Mercy in the summer of 2011 and was told that a stimulator would have to be surgically implanted in his back. The good news was that with all the advances of modern technology, the whole process could be done in a day. (The latest federal filing shows that 63% of surgeries at Mercy were performed on outpatients.)

[...]

Steve H.’s bill for his day at Mercy contained all the usual and customary overcharges. One item was “MARKER SKIN REG TIP RULER” for $3. That’s the marking pen, presumably reusable, that marked the place on Steve H.’s back where the incision was to go. Six lines down, there was “STRAP OR TABLE 8X27 IN” for $31. That’s the strap used to hold Steve H. onto the operating table. Just below that was “BLNKT WARM UPPER BDY 42268” for $32. That’s a blanket used to keep surgery patients warm. It is, of course, reusable, and it’s available new on eBay for $13. Four lines down there’s “GOWN SURG ULTRA XLG 95121” for $39, which is the gown the surgeon wore. Thirty of them can be bought online for $180. Neither Medicare nor any large insurance company would pay a hospital separately for those straps or the surgeon’s gown; that’s all supposed to come with the facility fee paid to the hospital, which in this case was $6,289.

In all, Steve H.’s bill for these basic medical and surgical supplies was $7,882. On top of that was $1,837 under a category called “Pharmacy General Classification” for items like bacitracin ($108). But that was the least of Steve H.’s problems.

The big-ticket item for Steve H.’s day at Mercy was the Medtronic stimulator, and that’s where most of Mercy’s profit was collected during his brief visit. The bill for that was $49,237.

According to the chief financial officer of another hospital, the wholesale list price of the Medtronic stimulator is “about $19,000.” Because Mercy is part of a major hospital chain, it might pay 5% to 15% less than that. Even assuming Mercy paid $19,000, it would make more than $30,000 selling it to Steve H., a profit margin of more than 150%. To the extent that I found any consistency among hospital chargemaster practices, this is one of them: hospitals routinely seem to charge 21⁄2 times what these expensive implantable devices cost them, which produces that 150% profit margin.

As Steve H. found out when he got his bill, he had exceeded the $45,000 that was left on his insurance policy’s annual payout limit just with the neurostimulator. And his total bill was $86,951. After his insurance paid that first $45,000, he still owed more than $40,000, not counting doctors’ bills. (I did not see Steve H.’s doctors’ bills.)

Welcome to the insurance 'limit'. What? Oh, I see another massively consolidated industry of monopolists limiting their exposure to ordinary cost-of-doing-business type liability. Nothing to see here, move along.

Use of the terms 'blue collar' & 'worker' instead of the more diminutive & submissive term 'employee' is of particular interest. Clearly the author is a filthy anti-American marxist. Discount the entire article.

When Pat Palmer, the medical-billing specialist who advises Steve H.’s union, was given the Mercy bill to deal with, she prepared a tally of about $4,000 worth of line items that she thought represented the most egregious charges, such as the surgical gown, the blanket warmer and the marking pen. She restricted her list to those she thought were plainly not allowable. “I didn’t dispute nearly all of them,” she says. “Because then they get their backs up.”

The hospital quickly conceded those items. For the remaining $83,000, Palmer invoked a 40% discount off chargemaster rates that Mercy allows for smaller insurance providers like the union. That cut the bill to about $50,000, for which the insurance company owed 80%, or about $40,000. That left Steve H. with a $10,000 bill.

Sean Recchi wasn’t as fortunate. His bill — which included not only the aggressively marked-up charge of $13,702 for the Rituxan cancer drug but also the usual array of chargemaster fees for basics like generic Tylenol, blood tests and simple supplies — had one item not found on any other bill I examined: MD Anderson’s charge of $7 each for “ALCOHOL PREP PAD.” This is a little square of cotton used to apply alcohol to an injection. A box of 200 can be bought online for $1.91.

,837 under a category called “Pharmacy General Classification” for items like bacitracin (8). But that was the least of Steve H.’s problems.

The big-ticket item for Steve H.’s day at Mercy was the Medtronic stimulator, and that’s where most of Mercy’s profit was collected during his brief visit. The bill for that was ,237.

According to the chief financial officer of another hospital, the wholesale list price of the Medtronic stimulator is “about ,000.” Because Mercy is part of a major hospital chain, it might pay 5% to 15% less than that. Even assuming Mercy paid ,000, it would make more than ,000 selling it to Steve H., a profit margin of more than 150%. To the extent that I found any consistency among hospital chargemaster practices, this is one of them: hospitals routinely seem to charge 21⁄2 times what these expensive implantable devices cost them, which produces that 150% profit margin.

As Steve H. found out when he got his bill, he had exceeded the ,000 that was left on his insurance policy’s annual payout limit just with the neurostimulator. And his total bill was ,951. After his insurance paid that first ,000, he still owed more than ,000, not counting doctors’ bills. (I did not see Steve H.’s doctors’ bills.)

Welcome to the insurance 'limit'. What? Oh, I see another massively consolidated industry of monopolists limiting their exposure to ordinary cost-of-doing-business type liability. Nothing to see here, move along.

Use of the terms 'blue collar' & 'worker' instead of the more diminutive & submissive term 'employee' is of particular interest. Clearly the author is a filthy anti-American marxist. Discount the entire article.

When Pat Palmer, the medical-billing specialist who advises Steve H.’s union, was given the Mercy bill to deal with, she prepared a tally of about ,000 worth of line items that she thought represented the most egregious charges, such as the surgical gown, the blanket warmer and the marking pen. She restricted her list to those she thought were plainly not allowable. “I didn’t dispute nearly all of them,” she says. “Because then they get their backs up.”

The hospital quickly conceded those items. For the remaining ,000, Palmer invoked a 40% discount off chargemaster rates that Mercy allows for smaller insurance providers like the union. That cut the bill to about ,000, for which the insurance company owed 80%, or about ,000. That left Steve H. with a ,000 bill.

Sean Recchi wasn’t as fortunate. His bill — which included not only the aggressively marked-up charge of ,702 for the Rituxan cancer drug but also the usual array of chargemaster fees for basics like generic Tylenol, blood tests and simple supplies — had one item not found on any other bill I examined: MD Anderson’s charge of each for “ALCOHOL PREP PAD.” This is a little square of cotton used to apply alcohol to an injection. A box of 200 can be bought online for

The 2011 outpatient visit of someone I’ll call Steve H. to Mercy Hospital in Oklahoma City illustrates those economics. Steve H. had the kind of relatively routine care that patients might expect would be no big deal: he spent the day at Mercy getting his aching back fixed.

A blue collar worker who was in his 30s at the time and worked at a local retail store, Steve H. had consulted a specialist at Mercy in the summer of 2011 and was told that a stimulator would have to be surgically implanted in his back. The good news was that with all the advances of modern technology, the whole process could be done in a day. (The latest federal filing shows that 63% of surgeries at Mercy were performed on outpatients.)

[...]

Steve H.’s bill for his day at Mercy contained all the usual and customary overcharges. One item was “MARKER SKIN REG TIP RULER” for $3. That’s the marking pen, presumably reusable, that marked the place on Steve H.’s back where the incision was to go. Six lines down, there was “STRAP OR TABLE 8X27 IN” for $31. That’s the strap used to hold Steve H. onto the operating table. Just below that was “BLNKT WARM UPPER BDY 42268” for $32. That’s a blanket used to keep surgery patients warm. It is, of course, reusable, and it’s available new on eBay for $13. Four lines down there’s “GOWN SURG ULTRA XLG 95121” for $39, which is the gown the surgeon wore. Thirty of them can be bought online for $180. Neither Medicare nor any large insurance company would pay a hospital separately for those straps or the surgeon’s gown; that’s all supposed to come with the facility fee paid to the hospital, which in this case was $6,289.

In all, Steve H.’s bill for these basic medical and surgical supplies was $7,882. On top of that was $1,837 under a category called “Pharmacy General Classification” for items like bacitracin ($108). But that was the least of Steve H.’s problems.

The big-ticket item for Steve H.’s day at Mercy was the Medtronic stimulator, and that’s where most of Mercy’s profit was collected during his brief visit. The bill for that was $49,237.

According to the chief financial officer of another hospital, the wholesale list price of the Medtronic stimulator is “about $19,000.” Because Mercy is part of a major hospital chain, it might pay 5% to 15% less than that. Even assuming Mercy paid $19,000, it would make more than $30,000 selling it to Steve H., a profit margin of more than 150%. To the extent that I found any consistency among hospital chargemaster practices, this is one of them: hospitals routinely seem to charge 21⁄2 times what these expensive implantable devices cost them, which produces that 150% profit margin.

As Steve H. found out when he got his bill, he had exceeded the $45,000 that was left on his insurance policy’s annual payout limit just with the neurostimulator. And his total bill was $86,951. After his insurance paid that first $45,000, he still owed more than $40,000, not counting doctors’ bills. (I did not see Steve H.’s doctors’ bills.)

Welcome to the insurance 'limit'. What? Oh, I see another massively consolidated industry of monopolists limiting their exposure to ordinary cost-of-doing-business type liability. Nothing to see here, move along.

Use of the terms 'blue collar' & 'worker' instead of the more diminutive & submissive term 'employee' is of particular interest. Clearly the author is a filthy anti-American marxist. Discount the entire article.

When Pat Palmer, the medical-billing specialist who advises Steve H.’s union, was given the Mercy bill to deal with, she prepared a tally of about $4,000 worth of line items that she thought represented the most egregious charges, such as the surgical gown, the blanket warmer and the marking pen. She restricted her list to those she thought were plainly not allowable. “I didn’t dispute nearly all of them,” she says. “Because then they get their backs up.”

The hospital quickly conceded those items. For the remaining $83,000, Palmer invoked a 40% discount off chargemaster rates that Mercy allows for smaller insurance providers like the union. That cut the bill to about $50,000, for which the insurance company owed 80%, or about $40,000. That left Steve H. with a $10,000 bill.

Sean Recchi wasn’t as fortunate. His bill — which included not only the aggressively marked-up charge of $13,702 for the Rituxan cancer drug but also the usual array of chargemaster fees for basics like generic Tylenol, blood tests and simple supplies — had one item not found on any other bill I examined: MD Anderson’s charge of $7 each for “ALCOHOL PREP PAD.” This is a little square of cotton used to apply alcohol to an injection. A box of 200 can be bought online for $1.91.

.91.

I can hear the apologists now: "This pricing is due to the fact that the 'uninsured' & the 'illegals' refuse to pay for medical services!" To them I would say the following: since you are making the accusation, the burden rests with you. Prove to the world that your 'freeloader' egg came before the 'corporate price-gouge' chicken. In other words, the argument is circular. There are clearly ER rooms full of folks who can't pay. I would wager that a large percentage of those people are there because the price of medicine/insurance is astronomical. But I would also wager that the fact a person is unable to pay these outrageous prices is not an automatic indication that same person is a debauched criminal freeloader, out to get 'stuff' from 'the rich'. Your mileage may vary.

[SquidInk]

As 2012 began, a couple I’ll call Rebecca and Scott S., both in their 50s, seemed to have carved out a comfortable semiretirement in a suburb near Dallas. Scott had successfully sold his small industrial business and was working part time advising other industrial companies. Rebecca was running a small marketing company. On March 4, Scott started having trouble breathing. By dinnertime he was gasping violently as Rebecca raced him to the emergency room at the University of Texas Southwestern Medical Center. Both Rebecca and her husband thought he was about to die, Rebecca recalls. It was not the time to think about the bills that were going to change their lives if Scott survived, and certainly not the time to imagine, much less worry about, the piles of charges for daily routine lab tests that would be incurred by any patient in the middle of a long hospital stay. Scott was in the hospital for 32 days before his pneumonia was brought under control. Rebecca recalls that “on about the fourth or fifth day, I was sitting around the hospital and bored, so I went down to the business office just to check that they had all the insurance information.” She remembered that there was, she says, “some kind of limit on it.”

“Even by then, the bill was over ,000,” she recalls. “I couldn’t believe it.”

'OBAMA!' Parasites!

The woman in the business office matter-of-factly gave Rebecca more bad news: Her insurance policy, from a company called Assurant Health, had an annual payout limit of 0,000. Because of some prior claims Assurant had processed, the S.’s were well on their way to exceeding the limit. Just the room-and-board charge at Southwestern was ,293 a day. And that was before all the real charges were added. When Scott checked out, his 161-page bill was 4,064. Scott and Rebecca were told they owed 2,955 after the payment from their insurance policy was deducted. The top billing categories were ,376 for Scott’s room; ,799 for “RESP SERVICES,” which mostly meant supplying Scott with oxygen and testing his breathing and included multiple charges per day of 4 for supervising oxygen inhalation, for which Medicare would have paid .94; and 8,663 for “SPECIAL DRUGS,” which included mostly not-so-special drugs such as “SODIUM CHLORIDE .9%.” That’s a standard saline solution probably used intravenously in this case to maintain Scott’s water and salt levels. (It is also used to wet contact lenses.) You can buy a liter of the hospital version (bagged for intravenous use) online for .16. Scott was charged to 4 for dozens of these saline solutions.

Then there was the 2,303 charge for “LABORATORY,” which included hundreds of blood and urine tests ranging from to 3 each, for which Medicare either pays nothing because it is part of the room fee or pays to . Hospital spokesman Russell Rian said that neither Daniel Podolsky, Texas Southwestern Medical Center’s

As 2012 began, a couple I’ll call Rebecca and Scott S., both in their 50s, seemed to have carved out a comfortable semiretirement in a suburb near Dallas. Scott had successfully sold his small industrial business and was working part time advising other industrial companies. Rebecca was running a small marketing company. On March 4, Scott started having trouble breathing. By dinnertime he was gasping violently as Rebecca raced him to the emergency room at the University of Texas Southwestern Medical Center. Both Rebecca and her husband thought he was about to die, Rebecca recalls. It was not the time to think about the bills that were going to change their lives if Scott survived, and certainly not the time to imagine, much less worry about, the piles of charges for daily routine lab tests that would be incurred by any patient in the middle of a long hospital stay. Scott was in the hospital for 32 days before his pneumonia was brought under control. Rebecca recalls that “on about the fourth or fifth day, I was sitting around the hospital and bored, so I went down to the business office just to check that they had all the insurance information.” She remembered that there was, she says, “some kind of limit on it.”

“Even by then, the bill was over $80,000,” she recalls. “I couldn’t believe it.”

'OBAMA!' Parasites!

The woman in the business office matter-of-factly gave Rebecca more bad news: Her insurance policy, from a company called Assurant Health, had an annual payout limit of $100,000. Because of some prior claims Assurant had processed, the S.’s were well on their way to exceeding the limit. Just the room-and-board charge at Southwestern was $2,293 a day. And that was before all the real charges were added. When Scott checked out, his 161-page bill was $474,064. Scott and Rebecca were told they owed $402,955 after the payment from their insurance policy was deducted. The top billing categories were $73,376 for Scott’s room; $94,799 for “RESP SERVICES,” which mostly meant supplying Scott with oxygen and testing his breathing and included multiple charges per day of $134 for supervising oxygen inhalation, for which Medicare would have paid $17.94; and $108,663 for “SPECIAL DRUGS,” which included mostly not-so-special drugs such as “SODIUM CHLORIDE .9%.” That’s a standard saline solution probably used intravenously in this case to maintain Scott’s water and salt levels. (It is also used to wet contact lenses.) You can buy a liter of the hospital version (bagged for intravenous use) online for $5.16. Scott was charged $84 to $134 for dozens of these saline solutions.

Then there was the $132,303 charge for “LABORATORY,” which included hundreds of blood and urine tests ranging from $30 to $333 each, for which Medicare either pays nothing because it is part of the room fee or pays $7 to $30. Hospital spokesman Russell Rian said that neither Daniel Podolsky, Texas Southwestern Medical Center’s $1,244,000-a-year president, nor any other executive would be available to discuss billing practices. “The law does not allow us to talk about how we bill,” he explained. Through a friend of a friend, Rebecca found Patricia Palmer, the same billing advocate based in Salem, Va., who worked on Steve H.’s bill in Oklahoma City. Palmer — whose firm, Medical Recovery Services, now includes her two adult daughters — was a claims processor for Blue Cross Blue Shield. She got into her current business after she was stunned by the bill her local hospital sent after one of her daughters had to go to the emergency room after an accident. She says it included items like the shade attached to an examining lamp. She then began looking at bills for friends as kind of a hobby before deciding to make it a business.

The best Palmer could do was get Texas Southwestern Medical to provide a credit that still left Scott and Rebecca owing $313,000. Palmer claimed in a detailed appeal that there were also overcharges totaling $113,000 — not because the prices were too high but because the items she singled out should not have been charged for at all. These included $5,890 for all of that saline solution and $65,600 for the management of Scott’s oxygen. These items are supposed to be part of the hospital’s general room-and-services charge, she argued, so they should not be billed twice.

[...]

We can’t apply for charity, because we’re kind of well off in terms of assets,” she adds. “We thought we were set, but now we’re pretty much on the edge.”

,244,000-a-year president, nor any other executive would be available to discuss billing practices. “The law does not allow us to talk about how we bill,” he explained. Through a friend of a friend, Rebecca found Patricia Palmer, the same billing advocate based in Salem, Va., who worked on Steve H.’s bill in Oklahoma City. Palmer — whose firm, Medical Recovery Services, now includes her two adult daughters — was a claims processor for Blue Cross Blue Shield. She got into her current business after she was stunned by the bill her local hospital sent after one of her daughters had to go to the emergency room after an accident. She says it included items like the shade attached to an examining lamp. She then began looking at bills for friends as kind of a hobby before deciding to make it a business.

The best Palmer could do was get Texas Southwestern Medical to provide a credit that still left Scott and Rebecca owing 3,000. Palmer claimed in a detailed appeal that there were also overcharges totaling 3,000 — not because the prices were too high but because the items she singled out should not have been charged for at all. These included ,890 for all of that saline solution and ,600 for the management of Scott’s oxygen. These items are supposed to be part of the hospital’s general room-and-services charge, she argued, so they should not be billed twice.

[...]

We can’t apply for charity, because we’re kind of well off in terms of assets,” she adds. “We thought we were set, but now we’re pretty much on the edge.”

Fools.

What happened to the American myth/dream that told us all as grade schoolers (paraphrased), 'do good in school (KA-CHING!), work hard at you job no matter what it is (KA-CHING!), and you will live a wonderful life." ?

It all turned out to be extremely potent propaganda, as that simple idea slowly transformed into: pay tens or even hundreds of thousands for a marginal product (education), then if the education debt isn't suffocating you, maybe start a business (and open the most ridiculous can of worms you ever imagined as you simply attempt to provide an honest & valuable product or service in your community), then pay an additional few hundred thousand (in most places) for a sub-standard mass produced tract home, which due to market manipulations, will soon be nearly worthless. By the way, all of the consumables you need for every day life (such as food) will be found at widely dispersed locations, necessitating the constant purchase of newer more expensive vehicles (which are a losing proposition, no matter how you slice it). Of course there is convenient financing for all of this. Just another point or two on the top.

Have a nice day. Oh, and stay healthy... heh, heh.

[SquidInk]

(the article mentioned: http://articles.latimes.com/2012/may/27 ... s-20120527 --- good news)

~*~



~*~



Didn't we have a word for this kind of thing once? Give me a minute, I'll think of it...

[SquidInk]

Remove the middlemen. Immediately.
Encourage small scale 'local' solutions.
Make room for true American innovation.
Or maybe you prefer to perish?

[Riddick]

why we are obsessed with who will pay these enormous 'healthcare' bills,

Because we'll have one helluva problem paying them if we have to come up with the dough ourselves?

and why do we fail to examine why these bills are so outrageous to begin with?

Because if we DON'T have to pay them all by ourselves, it doesn't seem as big of an issue?

who is it that would place the words "world's best" anywhere near all of this?

Collectivist capitalists and their cronies who find too much of a good thing is never enough, and don't care how they get it or how it's done or which lackey party in DC does their bidding, so long as they can keep lining their pockets?

What happened to the American myth/dream that told us all as grade schoolers (paraphrased), 'do good in school (KA-CHING!), work hard at you job no matter what it is (KA-CHING!), and you will live a wonderful life." ?

The myth is being overshadowed by the reality that the America Bedford Falls was in has passed into antiquity, and in its place we have Pottersville?

Remove the middlemen. Immediately.
Encourage small scale 'local' solutions.
Make room for true American innovation.
Or maybe you prefer to perish?

Maybe it's not a preference per se, just a subconsious death wish?

[Dude111]

I have to take a break. Upsetting stuff.

Yes it is...... BIG PHARMA IS 99% GREED AND MOST PPL DONT REALISE IT! -- Its good you do!

[SquidInk]

Originally posted by Riddick (responses in red)

why we are obsessed with who will pay these enormous 'healthcare' bills

Because we'll have one helluva problem paying them if we have to come up with the dough ourselves?

• Is this a bug or a feature, in your opinion?

[/b]

and why do we fail to examine why these bills are so outrageous to begin with?

Because if we DON'T have to pay them all by ourselves, it doesn't seem as big of an issue?

• Bug or feature? Of course, I have my opinion, but I also realize I may have gone careening off the Cliffs of Cynicism, and splashed into the Sea of Despair.

[/b]

who is it that would place the words "world's best" anywhere near all of this?


Collectivist capitalists and their cronies who find too much of a good thing is never enough, and don't care how they get it or how it's done or which lackey party in DC does their bidding, so long as they can keep lining their pockets?

• Nothing to add here. It's truth, plain and simple.

[/b]

What happened to the American myth/dream that told us all as grade schoolers (paraphrased), 'do good in school (KA-CHING!), work hard at you job no matter what it is (KA-CHING!), and you will live a wonderful life." ?

The myth is being overshadowed by the reality that the America Bedford Falls was in has passed into antiquity, and in its place we have Pottersville?

• I had to go a googlin' to remind myself of the particulars - but yeah, I think it's something like that.

[/b]

Remove the middlemen. Immediately.
Encourage small scale 'local' solutions.
Make room for true American innovation.
Or maybe you prefer to perish?

Maybe it's not a preference per se, just a subconsious death wish?

• Quite possible, if not probable. Less and less subconscious each day too.[/b]

[SquidInk]

Yes it is...... BIG PHARMA IS 99% GREED AND MOST PPL DONT REALISE IT! -- Its good you do!

Ok... that explains why this guy is representing them down in DC!



"It's too late.
You should have paid him
when you had the chance.
Now you've reached your
claim limit for this year.
How about a CT scan? Heh heh"

[Riddick]

As I consider "insurance" to be by and large a racket, to answer your questions Squid? I'm of the opinion obsessing over who'll pay the exorbitant bills and not asking why the bills ARE so exorbitant are "bugs".

People in general have gotten so they forget there was a day folks took care of their own health costs - then "insurance" came along to cover the costs of catastrophic life-threatening concerns or long-term illnesses, to help keep folks from going to the poorhouse.

Thing is, as insurance was expanded to cover more and more things outside of major medical events, the cost of EVERYTHING started to climb towards the stratosphere.

Today, never mind the catastrophic stuff, price-tags on some of the most common everyday mundane health procedures could easily bankrupt some folks if they were forced to pay out-of-pocket - Yet, the exorbitant cost DOES come out of EVERYONE's pocket in the form of premium payments -

The rate the price on those are going up, folks will start obsessing over who'll pay for their insurance. Who knows, perhaps we'll see Washington respond with both establishment of and a universal mandate for the "health insurance insurance" industry.

IMHO that's what you get when you buy whole-hog into their racket - a 100% "fool coverage" policy. The system we have isn't just buggy, it's outright DAFFY!

[kbot]

I read in one of the earlier posts the question "What is the charge master".

Maybe I can answer this (somewhat) since I work with our's so much.

Basically, the chargemaster is the pricelist of everything that is provided or performed in a hospital. Look at it as comparable to the pricelist in say, your local auto mechanic's shop. Same thing. It's a list of what is charged.

That is not to say that this is what we get PAID, which is determined by a number of factors. Insurers sign contracts with healthcare facilities or health groups, in order to ensure savings for their customers. Medicare (CMS), read that as "the government" sets the rates. Once that is done, HMOs and private insurers follow-suit in setting their rates.

So, while a hospital may "charge" a certain dollar figure, don't believe that this is what they get paid.

Also, as with any other business, what is charged - as allowable under the law and rate-setting as defined by the government, btw, is based on geographical/ regional differences. Differences in rates are also based on the TYPE of facility. So, acute care facilities get paid one rate, academic teaching hspitals get paid at a different rate, cancer care hospitals (of which there are five nationally) get paid at a jch higher rate than all other facilities. All this - and more, is defined by Medicare (the government).

As an aside, I saw on tv, some author who wrote a scathing article in Time Magazine concerning the "exhorbitant salaries" being paid to healthcare workers. Initially he singled-out the hospital CEOs, but quickly reverted to what has become the new scapegoat of "healthcare workers" in general as being the reason why healthcare costs are so out of control. I personally challenge anyone, including the author of the aticle to walk in the shoes of anyone who works in healthcare, starting with the CNAs and nurses who haev to literally wipes people's asses for a living, getting exposed to HIV/ AIDS, hepatitis and a whole host of other organisms, potentially bringing this all home to your loved ones, dealing with wack-job suicides, gang-fights, drug addicts and domestic disputes as "normal working conditions" - perhaps getting minimum wage for the privilege (or not getting raises for years) and then not complain about how "overpaid" these people are. If the author's intent was to escoriate insurance and some facility execs, then, he should clearly state this is the case. All the author is doing is demogoging fixing facts with perception.