Time: Bitter Pill: Why Medical Bills Are Killing Us

I came across this fantastic article in Time that further points out how ridiculous our healthcare system is. Kind of hard to believe the crap these hospitals and insurance companies are able to get away with.

Some highlights:

The first of the 344 lines printed out across eight pages of his hospital bill — filled with indecipherable numerical codes and acronyms — seemed innocuous. But it set the tone for all that followed. It read, “1 ACETAMINOPHE TABS 325 MG.” The charge was only $1.50, but it was for a generic version of a Tylenol pill. You can buy 100 of them on Amazon for $1.49 even without a hospital’s purchasing power.

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.

According to one of a series of exhaustive studies done by the McKinsey & Co. consulting firm, we spend more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia. We may be shocked at the $60 billion price tag for cleaning up after Hurricane Sandy. We spent almost that much last week on health care. We spend more every year on artificial knees and hips than what Hollywood collects at the box office. We spend two or three times that much on durable medical devices like canes and wheelchairs, in part because a heavily lobbied Congress forces Medicare to pay 25% to 75% more for this equipment than it would cost at Walmart.

http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/

This guy was just on the Daily Show. Looking forward to reading the article.

I never really understood how broken the system was until I had to go through it myself. The entire system is a complete racket.

Some of my friends in Guatemala took an 18 month old boy to the hospital (and no not some straw-hut sess pool, but a good hospital) he received IV treatments and a full work-up.

Grand total=$20 USD

Part of the problem is the healthcare industry is a racket.

The other part is insurance is a racket.

Another is medical supplies and pharmaceutical companies are a racket.

The last part is, Americans seem to go to the doctor for every little thing. Clogging up ERs with lame ass sicknesses. Clogging up hospital beds when they aren't warranted. My wife gets on me because when I get a cold, get sick or have an ache/pain, I don't immediately run to the doctor. I don't want to spend my life in ERs and urgent care centers. I want to be healthy.

We also have the mentality that we can get a "disability" for anything. I saw that in my previous job as a patient advocate who would sign patients without insurance up for programs. It clogs up the SS system when people want a "check" with their bad backs and trick knees. It ruins it for the people who really need the assistance and who are truly disabled.

What is not clearly delineated in itemized fashion is the uninsured patient who gets exactly identical care...for free.

These 'highlights' of overages make no sense. Seriously, when the entire country receives healthcare, insured or not, costs need to be accounted for somewhere.

No seriously. The system is not broken. There is no need to reform healthcare in this country.

The only developed country in the world where you can lose all of your accumulated wealth cause Mom gets cancer is guess where.

What is not clearly delineated in itemized fashion is the uninsured patient who gets exactly identical care...for free.

These 'highlights' of overages make no sense. Seriously, when the entire country receives healthcare, insured or not, costs need to be accounted for somewhere.

Maybe that's why every single time i use an emergency room or hospital, every single person involved (or not involved) bills me and my insurance company 4 and 5 and 6 more times after they've been paid

there's is no defense.

it's simple.

we are at the mercy of the industry, and they take complete advantage of it.

this used to be the "land of the Free".

Now it's the "Land of the Mark.". "Land of the Screwed."

"Home of the Cheat."

ti's everywhere, in every industry, in every home, the desire and willingness to completely **** over everyone else.

There is SO much fraud that there is not a single industry that can be trusted.

It's sad.

~Bang

This is the dude that was on with Stewart last night right? I shall sit down and wade through it later. Stewart was REAL impressed.

Hail.

What is not clearly delineated in itemized fashion is the uninsured patient who gets exactly identical care...for free.

These 'highlights' of overages make no sense. Seriously, when the entire country receives healthcare, insured or not, costs need to be accounted for somewhere.

that certainly does create price inflation......medical providers are almost like Robin Hood by federal decree

one reason for the high bills is to make up for the ones who do not pay.

But they should not bill a uninsured person more than what they take in payment from an insurance company

Example If I go to the dr I pay a 20 copay and the insurance company pays them a set fee far below what they bill. If an uninsured person goes to the DR he pays full price

Reading this article, I've rarely seen a better argument for a Universal Payer system. This is crazy, and completely inline with what I have experienced with my MS treatments...and to think people routinely get on the government for the notorious $100 hammer in the 80's. That's nothing compare with a $7 alcohol prep pad. Good grief...and this is the efficiency of private industry?

For what it's worth, Biogen mentioned on page 6, also make the MS drug I take. I have had 73 infusions thus far. The last 15 have come with the benefit of the copay assistance to drastically reduce my costs (props to Biogen). It's still noteworthy to me that I had more than 55 before anyone mentioned the possible help to me.

this used to be the "land of the Free".

Now it's the "Land of the Mark.". "Land of the Screwed."

"Home of the Cheat."

ti's everywhere, in every industry, in every home, the desire and willingness to completely **** over everyone else.

There is SO much fraud that there is not a single industry that can be trusted.

It's sad.

~Bang

You're right. It's very, very rare that you find honest businesses these days. I go to a goodyear place to get my vehicle serviced. Been going to them for 7 years since I moved to the area. I won't to anyplace else becasue in those 7 years, they've never screwed me over once.

My truck is a 2007. Has only 45K miles on it because with my other job I was close to work. Now, I put 32 miles a day on it. Brakes have been squeaking and I had them check them figuring they may be due. They looked at them and said the wear was good for 45K and they might last me another 45K if I keep taking care of them. I was already ready for a $200 brake job before coming in there. They could have made an easy $200 with me, but they didn't. And if they thought there was something wrong with my breaks, he would have taken me out to the bay and showed me. Service like that keeps me coming back.

Wish it was like that everywhere. Businesses have gotten away from what the customer wants and that's good, honest service. They don't realize alot of times, price is not a big a factor as they think. I mean, I won't pay $1000 for a brake job, but I'd pay $200 (my guys said $159) for good service and a good job done on the vehicle.

---------- Post added February-22nd-2013 at 10:48 AM ----------

one reason for the high bills is to make up for the ones who do not pay.

But they should not bill a uninsured person more than what they take in payment from an insurance company

Example If I go to the dr I pay a 20 copay and the insurance company pays them a set fee far below what they bill. If an uninsured person goes to the DR he pays full price

True. If your visit costs $100 and you pay the $20 co-pay, the insurance company has a contracted rate with the facility and they may only pay $50 of the remaining $80. The hospital writes off the remaining $30. An uninsured patient will be charged $100, but he can also get a percentage off if he pays it in full. Some hospitals offer 25%-30% off the bill. But make no mistake about it, hospitals are making money, even with the influx of uninsured patients. County, State and Federal charity programs pay the hospitals what they lose in uninsured costs and write offs. I should know, I used to be a Patient Advocate. I would visit patients bedside who had no insurance and have them apply for these programs.

Maybe that's why every single time i use an emergency room or hospital, every single person involved (or not involved) bills me and my insurance company 4 and 5 and 6 more times after they've been paid

there's is no defense.

it's simple.

we are at the mercy of the industry, and they take complete advantage of it.

this used to be the "land of the Free".

Now it's the "Land of the Mark.". "Land of the Screwed."

"Home of the Cheat."

ti's everywhere, in every industry, in every home, the desire and willingness to completely **** over everyone else.

There is SO much fraud that there is not a single industry that can be trusted.

It's sad.

~Bang

If I didn't know better, I'd think I was reading a brilliantly observant Sorkin piece.

Nail squarely on the head John.

Hail.

Reading this article, I've rarely seen a better argument for a Universal Payer system. This is crazy, and completely inline with what I have experienced with my MS treatments...and to think people routinely get on the government for the notorious $100 hammer in the 80's. That's nothing compare with a $7 alcohol prep pad. Good grief...and this is the efficiency of private industry?

For what it's worth, Biogen mentioned on page 6, also make the MS drug I take. I have had 73 infusions thus far. The last 15 have come with the benefit of the copay assistance to drastically reduce my costs (props to Biogen). It's still noteworthy to me that I had more than 55 before anyone mentioned the possible help to me.

Not to sound insensitive to your issues, but consider who would be in charge. Have you been to DMV lately? Heard about how American public schools are around 25th in the world (or whatever the current numbers are), are you impressed with our justice sytem or the way the wars have been handled?

The US government has given me no reason to have confidence that they can mange my healthcare, but that's just my two cents...

You're right. It's very, very rare that you find honest businesses these days. .

I'm serious,, i'm so conditioned that when i DO find a company or a business that gives actual good service for a fair price, i GUSH over them. It's like finding gold.

And unfortunately, the threshold for that has been lowered considerably.

I like Verizon, i like their service, never had a problem with it.

But I know they cram my bill, and I know that my wife dutifully calls each month to get bogus charges removed. not much,, like 3 or 4 dollars after adding them up.. but they know that if they bill a million people 20 cents and only 1000 call..

So i'm conditioned to accept fraud and outright attempted thievery, and consider it 'good'.

~Bang

Not to sound insensitive to your issues, but consider who would be in charge. Have you been to DMV lately? Heard about how American public schools are around 25th in the world (or whatever the current numbers are), are you impressed with our justice sytem or the way the wars have been handled?

The US government has given me no reason to have confidence that they can mange my healthcare, but that's just my two cents...

In fact, I have many time considered exactly this question. I'd refer you to page 9. Single payer does not mean exclusively government run. From the example used: A data center run by BCBS, to an auditor (also private) to a payment center (private) backed up by a recovery system allowing firms to audit past payments for over payments with 80-90% of what is reclaimed going back to the government and 10-20% going to those who found the problem. Government role in medicare is to set up contracts, set up payment rates, and pay. Single payer need not be the mismanaged mess of a states's or county's DMV.

Get away from the chargemaster system currently in place. Can anyone really claim this is more efficient than medicare?

I'm lucky in that I have no horror storied with regards to health care or medical billing. The "worst" was when I went to the Dr. because I had constant Tenitus from a cold I had. The Dr. Asked if I smoked. I said here and there. she asked if I was interested in smoking cessation. I said no. a total of 25 seconds of conversation about it. Then I get billed by the insurance company for $100 for smoking cessation counseling...which they don't cover. I had to fight that one. I neither asked for, nor received counseling.

This part was interesting to me

Somehow plastic surgery is much cheaper today, but hospitals far more expensive.

2. Medical Technology’s Perverse Economics

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.”

His rationale speaks to the real cost issue associated with medical-malpractice litigation. It’s not as much about the verdicts or settlements (or considerable malpractice-insurance premiums) that hospitals and doctors pay as it is about what they do to avoid being sued. And some no doubt claim they are ordering more tests to avoid being sued when it is actually an excuse for hiking profits. 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.

Read more: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2LeBsMehU

What is not clearly delineated in itemized fashion is the uninsured patient who gets exactly identical care...for free.

These 'highlights' of overages make no sense. Seriously, when the entire country receives healthcare, insured or not, costs need to be accounted for somewhere.

Yea...that's not true.

You cannot deny a patient emergency care. But that is defined as up to stabilization. And hospitals have gotten pretty good at defining that.

What hospitals are terrible at is identifying uninsured patients. If you give a patient a $20K bill and never bothered to check their insurance status, I don't have much sympathy.

The other conclusion I draw from this article....I should start applying for jobs in the INOVA health system and get out of gov't contracting

The US government has given me no reason to have confidence that they can mange my healthcare, but that's just my two cents...

So instead you will leave it to profit-driven we only care about the bottom line private industries?

Does that make any more sense?

The insurance industry is seriously ****ed, unless you are the lucky one in it making a killing.

Then I get billed by the insurance company for $100 for smoking cessation counseling...which they don't cover. I had to fight that one. I neither asked for, nor received counseling.

That is fraud. I have seen multiple examples of it personally but people accept this as normal here from their healthcare providers.

If the US healthcare system was an auto shop and you brought your car in because of a starting issue, the first thing they would do is change the oil and charge you five thousand dollars for it. And $400 extra for the mechanic's uniform.

That is fraud. I have seen multiple examples of it personally but people accept this as normal here from their healthcare providers.

If the US healthcare system was an auto shop and you brought your car in because of a starting issue, the first thing they would do is change the oil and charge you five thousand dollars for it. And $400 extra for the mechanic's uniform.

The sad part was when I called the Dr's office, they said this happens "a lot". :doh:

Yea...that's not true.

You cannot deny a patient emergency care. But that is defined as up to stabilization. And hospitals have gotten pretty good at defining that.

.

and a patient admitted for stabilization that requires critical continuing care cannot just be discharged

ergo

we also provide many free health services that are not emergency care....billions upon billions of it

add

what's the answer?

http://www.kevinmd.com/blog/2010/11/duty-provide-emergency-medical-care.html

When does the duty to provide emergency medical care end?

Because other U.S. courts of appeals disagree with the Sixth Circuit on the point, Providence Hospital took its case to the Supreme Court. Since there is a serious risk of being assessed civil damages (either by the federal government or in a private lawsuit), the hospital argued, the court should clear up the legal obligations that the Act imposes. It also contended that the Act should mean the same thing everywhere in the country. The hospital has a good chance that the Supreme Court will agree to hear the case, since the Court quite often chooses cases where the lower courts are in conflict.

Yea...that's not true.

You cannot deny a patient emergency care. But that is defined as up to stabilization. And hospitals have gotten pretty good at defining that.

What hospitals are terrible at is identifying uninsured patients. If you give a patient a $20K bill and never bothered to check their insurance status' date=' I don't have much sympathy.[/quote']

Hospitals know they are uninsured, but when the ER doctor decides the patient needs to be admitted, the hosptial can't overide the doctor's decision. The ER doctor will get paid, but the attending doctor on the floor gets screwed as does the hospital.