Posted on 08/31/2020 7:46:57 AM PDT by Kaslin
I flew on an airline for the first time in the 1970s. Back then airline ticket prices were high due to federal regulations. The government believed ticket prices had to be expensive to ensure enough profit for airlines to invest in quality. According to analysis by The Atlantic, the lowest price an airline could charge for a flight from New York to Los Angeles in 1974 was $1,441, adjusted for inflation. Forty years later – after deregulation – prices had fallen as much as 80 percent for some flights on that route. As The Atlantic put it, “Deregulation worked.”
This brings me to health care, which is heavily regulated at both the state and local level. There is a persistent belief by many health care industry stakeholders that medical care necessarily must be expensive. This is evident when regulators and industry stakeholders turn a blind eye to price gouging, excessive markups and unnecessary care. Not only do lawmakers do nothing about practices that are fraudulent in other industries, but stakeholders also refuse to even condemn the practices. Our government is seemingly doing all it can to ensure we pay far more for medical care than if competition were allowed to flourish.
About 98 percent of medical spending must be authorized by physicians, and doctors order nearly $3 trillion worth of medical services for patients annually. About one-third of health care spending is on hospital care. In recent years, hospitals have been buying up physician practices. The goal is to force employed doctors to order more tests, hospitalize more patients and boost fees higher than independent physicians receive. The Obama Administration tried to discourage future physician practice acquisitions by hospitals by making it less lucrative. Yet, hospital-owned practices already in place would continue to receive higher fees. The Trump administration went much farther and enacted site-neutral payments even for formerly grandfathered facilities, meaning all hospital-employed physician services would be reimbursed by the government the same as the independent physicians. Get this: a federal judge ruled against site-neutral payments because it would save Medicare nearly $1 billion a year, even though it would do so without benefit cuts. The judge has since been overruled by an appeals court.
Surprise medical bills are another example of politicians and insiders protecting non-competitive behavior. Surprise medical bills are a form of market failure when consumers cannot punish price gougers or denying them their patronage. Legislation limiting surprise medical bills is stalled in Congress because those who profit from them are big donors. In other words, Congress allows the industry to screw patients in return for money.
There are two opposing bills in Congress to end surprise medical bills. One would pay out-of-network providers as though they were in-network. Physicians groups who profit from surprise medical bills oppose this bill because it cuts off their gravy train. Another bill would create a government-run bureaucracy to arbitrate billing disputes between health plans and out-of-network doctors who want to charge more. This bill is more popular among those whose business model is ambushing patients with bills they did not expect. The reason presumably is because arbitrators can be influenced by lobbying or interference that locks in fees far higher than market prices. This is what happened in New York State where official guidance tells arbitrators to pay the 80th percentile of list prices. The 80th percentile of list prices is double, maybe triple the 50th percentile of in-network collected fees.
Surprise medical bills are perpetuated by a few bad apples from a handful of physician specialties. What they all have in common is their patients do not choose them. Nor can patients refuse their services when they are out of network and charge much higher fees.
Back in May, an appeals court in Colorado overturned a jury decision that found a patient did not owe a $228,345 surprise medical bill based on inflated chargemaster (list) prices. The patient thought she had done due diligence when she had initially been told her cost-sharing would only be $1,337. The surgery was supposedly more complex than anticipated, which lead to a $228,345 surprise medical bill. The appellate judges ruled the hospital should not have to litigate to collect its outrageous fees, because (in a nutshell), outrageous fees, opaque pricing and one-sides contacts are the status quo in health care.
Several years ago, a Texas woman was ambushed with a $17,850 surprise medical bill for an unnecessary post-surgical drug test. Her urine sample was purposely sent to an out-of-network lab known for price gouging. A simple drug test is readily available for $100 online. An in-office, “pee on a stick” test is about $1 when purchased in quantity by a doctor. Despite being reported to the Attorney General and to the Texas Medical Board, the physician lab owner did not lose his license. Presumably, everyone turned a blind eye because that’s just how health care is.
Another place where abuse is tolerated is when rural hospitals are allowed to bill for lab work they did not perform. This is quite common because rural hospitals have higher reimbursement rates than big-city hospitals because they have few patients and are critical to their small communities. Consider this: your Dallas-based physician orders lab work that is processed locally, but the tests are billed through a much more expensive hospital hundreds of miles away. Your cost-sharing could be much higher than necessary. Your premiums rise as a result. State and federal officials are beginning to see this needs to stop.
Americans spend nearly one-fifth of our national income on health care. High prices and services more costly than necessary are tolerated in health care because lawmakers, regulators and stakeholders all want the industry to be awash in other people's money. It doesn’t need to be this way. In every other industry, consumers and suppliers route out waste, fraud and abuse whenever they encounter it.
My wife and I are 66. We had health insurance our entire life until the day Obamacare took effect. That was the day we cancelled all health care insurance. There has been one Dr. visit since then, which we paid for out of pocket. It was pretty cheap.
But we’ve saved about $100,000+ after tax dollars on health care insurance.
And the one doctor visit was well under the deductible anyway. i.e. insurance wouldn’t have covered it.
We just do it the old fashioned way - we watch our health. And the new-fangled way - the internet makes general practitioners almost obsolete.
All this and we don’t wear masks or social distance during this virus scare.
I need some cool neck and back surgery. Docs approve, the insurance denies forcing secondary problems which they also deny. FUBO and justice Roberts, you’re killing me.
With rare exception; the entire health care system is incompetent AND corrupt.
That’s what happens when antitrust laws and other laws are NOT applied to an industry. The “mighty” Rand Paul even tried to legalize this theft in his failed O-Care replacement bill wording a while back.
It’s because of Deep Insurance. Last time I took someone to a doctor, she paid $25 cash for a 15-minute visit and a look at her tonsils. Insurance would have turned the same visit into $175.
Congress just can't figure out how to require physicians and physician groups to accept whatever terms the insurance companies want. That's the actual issue.
List price on a chest x-ray at my local hospital is $998. I kid you not. The system is broken and our kids/grandkids will pay for it. Big time.
Health Care is Overpriced Due to Obama
I believe you. Blood tests plus the labs to interpret is billed over $1,000 total. Plus since the virus crap, very time I call the doc for a refill( used to be just pharmacy call) they bill me my co pay and bill insurance $173.00( multiply by seven since April).
Any specialists are extra or sometimes a percentage covered and I’m paying over $1000.00 a month for insurance
Funny they don’t mention lawyers, the cause of malpractice insurance going through the roof and another reason for high cost.
The system is largely corrupt and inefficient. It needs to be destroyed and rebuilt. Look back to when Nixon let his buddy Kaiser convince him to allow hospitals for profit. That was the beginning of outrageous medical costs.
Medicine is a criminal enterprise. Eisenhower should have been warning us about it AND the military industrial complex.
I got a bill from an out of network ER provider years ago when I had a kidney stone. The hospital was in network and not a surprise but that wasn’t the whole bill. The ER group charged as much as the hospital for the maybe 5 to 10 minutes the doctor attended me. Instead of giving time to me he was giving it to a screaming moron who had taken bath salts.
I called the billing group and offered a settlement and then offered it in writing by certified mail. They refused a 60% settlement and I refused to pay saying I never agreed to pay a separate doctor when I was admitted but instead agreed to pay the hospital. Never heard another word until they turned it over to a collection agency who I ignored after the first encounter when they asked why I didn’t care about my credit rating. Since I have never borrowed money in more than 30 years I just don’t care about that. Never did pay them but I offered a reasonable settlement but not the equivalent of thousands of dollars an hour.
Medicine is a criminal enterprise.
Good luck with that. Really.
My wife went from good health and zero issues, to pancreatic cancer and $50k chemo treatments every two weeks.
I pray you avoid any of that.
And the insurance plan takes their lead from Medicare.
Anyone thinking we don’t have government run healthcare already is not aware how prices are determined.
We will refuse any cancer treatment. One of our friends was completely cured over ten years ago of stage four breast cancer - using the Gerson treatment. Another, after his first run of Chemo, decided to, during his breather period before his next run, use cannabis oil. He then went back to the doctor for tests to see how strong the next run would be. The doctor said it was in complete remission and he would need no more chemo.
The doctor asked him if he had been taking anything for it. When my friend told him what he had been doing, the doctor got very angry with him.
i.e. most of the expensive treatments that modern health insurance covers are not treatments we would take. So why pay big bucks to cover them? It’s like having pregnancy coverage at 66. No point.
Also, as Christians, we know the Lord will take us at a time of his choosing and he is the great healer. He is there for us for all needs, rather than Kaiser.
And as the apostle paul said, “to live is Christ and to die is gain”.
As I said, good luck. Really. I hope that works for you.
Thank you!
It’s not just malpractice lawyers getting rich. The CEO of our local “Baptist” hospital made the real estate news for buying the most expensive house in our area one week last year.
Spoken like someone who does not have any idea what he is talking about.
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