Healthcare

What’s really wrong with our health care system?

1. Nobody knows the fair and accurate price for anything. So called transparency is therefore irrelevant

2. Every payer from Medicare to Medicaid to private insurance to individuals pays something different

3. The private sector is subsidizing the public sector

Let’s start by having one price paid by all payers.

Look at these bills I just received. The first bill is for four hours in an emergency room. Note the price of one MRI.

More important, look at “adjustments.” Of the $20,183 bill $18,455.70 was not allowed by Medicare. Had this claim not been Medicare, that disallowed amount would be far less. The poor person without insurance would be billed $20,183.

The following is a bill to transport patient (my wife) from first to another hospital about 40 minutes away. Again, most of the charge is ignored. In both cases I must pay the balance because my supplemental coverage does not kick in until I have paid $1,000 out-of-pocket in addition to my deductible.

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9 replies »

  1. I have several theories on this subject as to why healthcare costs are so high and higher than inflation. Just like student loans, Medicare is a blank check for providers. But you say that Medicare has limits as to what they will pay. So how does a provider get more money out of Medicare? Bill at outrageous rates. If you need to make $100, bill $300. Medicare will average all the average costs billed, run some calculations of what is a “customarily bill” for a service and pay a percentage of that. Over time, the billing rates go up, and Medicare will eventually follow. Once this spiral process started decades ago, it has not stop. There is no need to stop raising the billing price. Sticker price has nothing to with costs anymore. If they stop, then they may never get ahead of the curve again and go bankrupt.

    I was trying to remember what the cost of my first crown was back in 1981. My crown I believed was very close to what I was quote this year. Why is that. Pulling a tooth does not seem like it costs a lot either but I only had one non-wisdom tooth pulled so I really can’t compare the costs. Some crowns are made overseas now, maybe that is why costs have not risen so fast. But I believe it is because most dental plans have limits. The dentist know this and do better to control costs. I am putting off my crown until closer to the end of the year to ensure any unexpected dental issue are covered first. But it does seem like all my dentist have always have a long list of things to do to my teeth that never ends. (In fairness, I do have bad teeth. I have no enamel).

    My solution is same price billing to all providers and uninsured a like. I would start with the lowest price that a provide has provided in the past three years. This should bring the cost down for the uninsured real fast.

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  2. I have experienced similar charges for my daughter. The issue is the Ambulances will only transport to the hospital that is closest to your home not to the hospital that your provider uses if you don’t live in that area. which I think is what needs to be revised. Their answer is(ambulance drivers) there aren’t enough ambulances in this area to go out of the area. If that issue could be resolved, those high costs could be avoided. Paying that much is outrageous which I doubt Medicare will pick up. I do not know how that issue can be resolved without a law saying that unless the person ‘s condition is life threatening, they are to be transported to the facility that they have their insurance with to avoid those high costs. However, when it is life threatening that is their policy. Perhaps a private ambulance service however, even with being transported to a hospital that is in the area, it takes days before the Coordinator will coordinate the transfer, leaving a bill from a non participating hospital that is extremely large. Someone needs to look into those expensive transfer charges.

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  3. Inconsistent pricing is a deliberate attempt to confuse those paying the bill…for illegal aliens receiving FREE medical care not so much.

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    • No that’s not it. It’s not pricing that’s inconsistent, it’s the difference between pricing and what’s negotiated or in the case of Medicare and Medicaid what’s set by government as the allowable fee. There should be one fee that all payers base payment on, but that would drive up Medicare and Medicaid payments.

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      • I have always wondered do these medical providers who bill thousands of dollars, only to take hundreds of dollars to satisfy the bill, get to claim we billed $$$$$ but only got paid $$, so we pay less taxes or are non profit. How can any hospital claim to be a non-profit and not make a profit, crazy. Maybe if we got rid of all non profits, churches, foundations, PACs included and made them all pay a10% tax government debt would not be 22 Trillion Dollars.

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      • Make them pay the tax and have the 10% tax on all non-profits go to paying down the national debt, nothing else. You could pay the national debt off in about 25 years. It would also, decrease the amount of interest paid each year on the debt, which is going to be a major problem going forward.

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