Healthcare will likely be thrust onto the front burner by the Obama administration in the coming weeks. As this happens we have to be prepared to debunk the usual crap foisted upon us by those against univeral coverage.
Last night I wrote about the challenges my parents are facing while being treated for cancer, even though they have good insurance. While some claim universal coverage would result in long lines, rationing, and bureaucracy, last nights diary demonstrated how our current system is already fraught with these problems.
Tonight I want to address an example of unfair pricing faced by the uninsured as well as those who are insured but get care that is recomnended by a doctor but considered "routine" vs. "medically necessary."
More below the fold...
A while back I visited the doctor for a routine physical. When the large bill came, I questioned it but was told it wasn't covered. Not having the time or energy to fight it, I actually paid it figuring I must have misunderstood my coverage. Total was $262.
A few weeks later another bill came for the same visit. With this bill I realized that insurance had covered the taking of blood from my arm but was refusing to cover any of the tests done with that blood (e.g. this new bill and the prior one for $262 were the tests). That seemed odd. I mean, why would they cover a $10 charge to draw blood but not cover what was done with the blood? If the tests weren't covered as "medically needed" how is it the blood draw would be covered?
After some questioning, it turns out the second bill should have been covered. Curious, I again asked about the $262 bill. After a long wait (in the end it took almost 18 months) that bill was covered as well. But here's the rub. What was a $262 bill for me turned into just $16.67 for the insurance company.
WTF!!!! That's a 94% discount for the insurance company! Or, said another way, if I had no insurance, I'd have to pay 15.7X more for the same service. 15X more money for a service if you aren't insured than if you are insured! 15X more expensive if the doctor codes it as "routine" instead of "medically necessary". No wonder people without health insurance skip care altogether.
I went for another visit recently and similar things occured. This time I was forced to pay a bill for a test that was covered in the past. The reason? This time the doctor "coded it as routine rather than medically necessary." The result - what cost the insurance company less than $15 last time cost me $60. I have insurance but I still wasn't able to get the "negotiated rate".
And here's the thing - the people making the decisions on this stuff have no incentive to code the bill in my favor. If the doctor's office codes the procedure as "non routine" they get less money. If the insurance company views the procedure as "non routine" they have to pay money. All this talk this week about moral hazard in the housing bailout and yet no one views this as a moral hazard?
I've been poking around about this issue and can only find old articles discussing it. One is from Marketwatch:
One of the ironies of our current system of health care is the uninsured -- those least able to afford health care -- are likely to be billed more, because they don't get the discounts negotiated by insurance companies and government health care programs like Medicaid.
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The congressmen cited a study by the Department of Health and Human Services that found California urban hospitals last year averaged a more than 300 percent mark-up from actual costs in their "master-list" prices.
Dick Davidson, the president of the American Hospital Association, responded with a statement acknowledging the complexity of the issues involved, and saying providers were trying to comply with federal rules that "seek to ensure that a hospital charges all patients receiving the same services the same price."
When I complained to my provider about the disciminatory pricing, I was told they "charged everyone the same price but they accepted a lower payment from the insurance company by contract." Even though I have insurance, I can't get the benefit of that contract when I have to pay.
In addition to the stuff I spoke about last night, those against universal care often suggest it will be too expensive. Just like few people realize the lines and headaches in the current system, few also realize the discrimination inherent in the system today. Well, here is a clear example where the current system is designed to discrinimate against those without insurance AND against those who have insurance but are healthy (thus only see the doctor for routine care).
We can make the system better and more fair for all and one way to start is to enforce fair pricing for all treatments no matter who is cutting the checks for payment. When faced with opposition to healthcare reform, this is another story that must be told to get the skeptical on board.
In short, I can't help but think the world is made up of two kinds of people: those who think we need healthcare reform and those who have never been sick enough to see how our current system works! With examples like this, it is clear we need reform now!