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Momentum is growing, finally, for a crackdown on the disgraceful practice of price gouging in the healthcare industry – and the devastating effect it has on so many American patients and families.

Major national news coverage by, among others, the New York Times, Time magazine, and ABC news have focused an unflattering spotlight on hospitals, drug companies, insurers, medical device manufacturers, doctors, nursing homes, medical labs, and other sectors.

Hospitals, where patients are at their most vulnerable, have drawn probably the most scrutiny.

Such as the $55,000 bill for appendectomy surgery at Sutter General Hospital in Sacramento. The 20-year’s bill, first posted on the social media site Reddit rapidly went viral, then gained additional prominence with the help of ABC’s Sydney Lupkin.

Or the story of Sean Recchi, profiled by Steven Brill in Time magazine last year who had to pay MD Anderson Cancer Center in Houston $48,900, due in advance for treatment for non-Hodgkin’s lymphoma.

Or on a smaller scale, Chelsea Manning, hit with a $3,000 bill from a Port Huron, Mi. hospital for six stitches after she tripped while running, as New York Times reporter Elizabeth Rosenthal recently wrote.  

Hospitals have tried to deflect the unwanted attention by claiming the charges are random and that the big corporate hospital giants are just victims to being cruelly battered in the marketplace by the insurance companies or other industry players.  

But National Nurses United, and its research arm, the Institute for Health and Socio-Economic Policy, which has been collecting and analyzing hospital pricing data for more than a decade, puts the dissembling from hospital board rooms to rest.

New data released earlier this month by NNU shows that some hospitals jack up their prices up to 12 times  above their costs. And, that there are clear trends in the findings.

•    The more hospitals charge, the more they get back in payments.
•    Hospitals that charge the most have the biggest profits.
•    Charges are set the highest by large corporate chains, especially the for-profit hospital systems. And average charges are highest in states, like Florida which are dominated by such chains, and lowest in states like Maryland, which do a better job regulating their hospitals.
•    Lowest charges are found at publicly run hospitals, those operated by state, county, or local governments. Not coincidentally these are the hospitals that more often have the most disclosure of their budgets, hold public meetings, and have boards that can be elected and unelected.
•    As a result of failure to crack down on the abuse, charges continue to skyrocket. Hospital charges in the most recent year, 2011-2012, increased by 22 percent over 2010-2011, the single largest increase since IHSP began tracking the publicly available data.

The main hospital industry defense is that the charges don’t matter because Medicare and Medicaid set the rates they will pay and insurance companies negotiate discounts to the list price.

But the higher the starting charge, the more the insurer will end up paying. Then the profit-focused insurers, of course, just pass along their higher costs to employers, who shift the burden to employees in the form of higher co-insurance, deductibles, co-pays and other out-of-pocket costs, or to individual ratepayers.

Then there’s the uninsured who typically get the bill for the full list prices. Hospitals may write off the bill, so they can boast how much they supposedly provide in uncompensated care or “bad debt” after inflating the prices. Or they demand payment up front, or turn the patient over to bill collectors afterwards with patients and families facing financial ruin or bankruptcy.

In a 2005 Lewin Group study of hospital pricing practices for the Medicare Payment Advisory Commission, several hospital execs let the truth escape. “Our key goal is to help the hospital meet its profitability and cash flow needs,” said one. “Our price updates focus on areas that give us the biggest bang for the buck,” said another.

Nurses know well the terrible impact of high charges.

As NNU Co-President Jean Ross, RN told ABC’s Lupkin, skimping on care, patients often pay for it with their health. “If you are presented with a bill, and you know that bill is something you can’t afford, you’re not going to go in,” Ross said.

“The first question — instead of triaging their physical and mental state — is not how ill you are but what kind of insurance you have,” Ross said. “That never was asked before, not when I started nursing. That didn’t come up as a question, nor should it.”

Most RNs can cite similar experiences, patients delaying even life prolonguing treatment, such as chemotherapy, or cutting pills in half, or not going for the diagnostic test recommended by their doctor. Or paying the high costs and cutting back on other family necessities, like shelter or food. Or facing bankruptcy due to medical bills, still the number one cause of personsal bankruptcy in the U.S.

A Commonwealth Fund study released in November 2013 comparing 11 developed nations found the U.S. adults have the most likely to forego medical treatment due to cost and spend the most out of pocket on care.

More than a third, 37 percent of U.S. adults chose not to see a doctor, follow up with recommended treatment or filled prescriptions due to high cost, compared to just 4 percent of respondents in the United Kingdom. The difference? The UK has a national healthcare system which effectively controls cost – and does not exclude anyone.

Even industry analysis now cite the building pressure on policymakers, employers, consumers and the media to publicly reveal the prices charged and reimbursements they actually get is “forcing providers and payers to reconsider their long standing opposition to price transparency.”

That’s one important step. But stronger medicine is needed as well, such as:

•    Tougher regulation on price gouging by hospitals, and on other healthcare industry sectors that inflate prices, including pharmaceutical, insurance companies, medical device manufacturers, medical labs, nursing homes.
•    A crack down on non-profit hospitals that abuse their tax exempt status by inflating prices while providing little in return in charity care. A provision in the Affordable Care Act would allow the repeal of tax-exempt status for non-profits that engage in price gouging but it has never been enforced due in part to hospital industry lobbying.
•    Increased support for public hospitals, which have the lowest charges over cost and the most public oversight and accountability, yet face cut after cut in public budgets.
•    Transformation of our healthcare system from a profit-driven industry to one based on patient need with a uniform standard of excellent care and effective public controls of pricing practices. The best way approach, expanding and improving Medicare to cover everyone.

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  •  Tip Jar (197+ / 0-)
    Recommended by:
    Cardinal Fang, Gowrie Gal, Mr Robert, Zinman, elwior, wilderness voice, coquiero, karmsy, blueoasis, myadestes, sillycarrot, tardis10, Jensequitur, Publius2008, rat racer, ruscle, doh1304, slowbutsure, TomP, Brecht, SteelerGrrl, peptabysmal, praenomen, wasatch, Horace Boothroyd III, T Maysle, Yo Bubba, Rosaura, meg, NancyK, Joieau, middleagedhousewife, Phoebe Loosinhouse, Ezekiel in Exile, LynChi, kurious, Josiah Bartlett, ban nock, lcrp, petral, on the cusp, sow hat, Hastur, annan, wayoutinthestix, Involuntary Exile, Aaa T Tudeattack, barkingcat, GulfExpat, dewley notid, PlinytheWelder, eyesoars, Norm in Chicago, Burned, LookingUp, cocinero, glitterlust, arizonablue, roses, tle, ATFILLINOIS, ferg, cotterperson, DavidMS, reflectionsv37, Nailbanger, JDWolverton, eagleray, triplepoint, yoduuuh do or do not, Alumbrados, misterwade, karma5230, kerflooey, Chaddiwicker, psnyder, PedalingPete, mrsgoo, 207wickedgood, WiseFerret, dotsright, BlueMississippi, basquebob, anodnhajo, tofumagoo, mslat27, Time Waits for no Woman, Eric Blair, supenau, bastrop, maggiejean, Anima, pixxer, notrouble, divineorder, RAW, J Orygun, petulans, lilsky, sc kitty, sea note, GeorgeXVIII, Turn Left, bob152, fixxit, Simplify, AJayne, mungley, wxorknot, TheDuckManCometh, dotdash2u, pcl07, mollyd, JanL, irate, asym, HedwigKos, deepeco, DRo, kaliope, Shelley99, carpunder, Sprinkles, Lovo, NegSpin, rapala, arlene, mksutherland, Book of Hearts, FloridaSNMOM, doroma, kefauver, srkp23, bakenjuddy, caryltoo, TomFromNJ, ER Doc, DerAmi, NoMoreLies, Babsnc, gundyj, gustynpip, Radical Faith, stevie avebury, COwoman, AZ Sphinx Moth, semiot, AJ in Camden, oortdust, aznavy, mikidee, Uncle Cosmo, stlsophos, weck, hlsmlane, Kurt from CMH, Cedwyn, sunny skies, afisher, JBL55, Jakkalbessie, CJB, kimoconnor, Shockwave, allergywoman, johnnygunn, Oh Mary Oh, wa ma, Betty Pinson, Gorette, tb mare, Stuart Heady, YucatanMan, Librarianmom, zerelda, IL clb, SeaTurtle, CorinaR, Steve In DC, OhioNatureMom, genethefiend, parse this, Siri, liberalz, MKinTN, jo fish, Byron from Denver, alasmoses, GreenMother, BachFan, marina, mconvente, RN4MERCY, denise b, LSmith, samddobermann, Mdfog10

    National Nurses United, (AFL-CIO): the new RN "super-union" representing 150,000 nurses from all 50 states!

    by National Nurses Movement on Thu Jan 23, 2014 at 04:11:15 PM PST

    •  But this is why the ACA is so IMPORTANT!!! (9+ / 0-)

      Repeat after me!  Obamacare health insurance will pay these hospital bills.

      I heartily agree that this has been an outrageous practice and hospitals deserve condemnation for this abuse.  Obamacare was created as a solution and as everyone gets coverage this problem will disappear.

      Of course for us poor citizens that unfortunately live in states with republican't governors, we're SOL if we can't afford the insurance without the subsidies or would otherwise qualify for Medicaid.  That too will slowly be addressed as more people learn how they are being screwed by republican ideologues and start voting them out of office.

      The republicons moan, the republicons bitch. Our rich are too poor and our poor are too rich. Ferguson Foont

      by Josiah Bartlett on Thu Jan 23, 2014 at 05:59:32 PM PST

      [ Parent ]

      •  sort of but not really (15+ / 0-)

        having more people covered will aid and abet the price gouging. More people being covered will actually enable the hospital and medical industry price gouging.  

        Yes, having more people have insurance is better than before. But the insurance industry profits will remain, and the diabolical pricing systems will continue, only with more customers.  And this new insurance will be expensive for many. For me to get a Silver plan with a $2500 deductible (effectively catastrophic insurance), will cost me $250-$300 a month (with partial subsidy).  That's over $3k a year for a plan that will essentially cover NOTHING unless I have a very serious accident or illness.  My mother was infuriated when I explained my situation to her.  "What f)(*ing good is a policy with a $2500 deductible?" Point noted.  I got a little hot defending ACA as better than status quo, but it is not really good policy at all. Just a little better than ridiculously stupid policy.

        ACA is a very, very modest step in the right direction. It is far from where we need to be.

        Power to the Peaceful!

        by misterwade on Thu Jan 23, 2014 at 07:37:32 PM PST

        [ Parent ]

        •  Some proceedures are covered without any deductibl (4+ / 0-)

          Under many insurance policies already in place, and especially under the ACA, there are services that are covered that don't get into toughing the deductible.  People always assume that the high deductibles have to be met first.  Yes, in some cases.  But that isn't true across the board. The details count.  And under the ACA, we are more protected from this than before.

          •  Very, very few procedures. (7+ / 0-)

            "I read New republic and Nation/I've learned to take every view.." P. Ochs

            by JesseCW on Thu Jan 23, 2014 at 11:27:58 PM PST

            [ Parent ]

          •  The "Extortion Generals" of the hospital world (5+ / 0-)
            Recommended by:
            Shockwave, wa ma, misterwade, elwior, mconvente

            are quite adept at finding ways to screw over their patients even when a procedure is "covered."

            One way I have personally experienced is to define what is "covered" so narrowly that the patient is charged for anything that requires the slightest action by the doctor.

            Health insurance through my last employer was junk, but at least it covered (after co-pay) routine visits to my GP & procedures like a routine colonoscopy.

            Or so I thought until rudely disabused of the notion.

            Those routine visits? The "physicians group" (a branch of a famous research hospital) has sent debt collectors after me claiming that for each visit I still owe them out of pocket more than the insurance covered in the first place.

            Why? Because insurer & provider defined "routine visit" as one in which nothing has changed for the patient.

            "How are you doing, Mr Cosmo?" Fine. "Any change in your known problems?" No. "Any new issues?" No. "Do you need refills on your prescriptions?" Yes. "OK, pick them up at the front desk & come back in X months." Elapsed time, 2 minutes, maybe.
            But the minute I mentioned any change in my health, ka-chingg! I would "routinely" get a bill for >$220 for never more than 10 minutes of face time with my GP, of which the "insurer" paid ~$100.

            When I called the provider's billing office they were quite adamant that the level of "service" justified their outrageous charges.

            And that "routine" screening colonoscopy? I had one done, long overdue, just before my COBRA ran out. Covered? Hah. "We found two very small polyps so we took them out & sent them to the lab." The good news is that they were benign. The bad news? ~$700 in lab charges that my "insurer" said I am responsible for.

            In health care, "fee for service" = "license to steal". And they do--over & over & over again. Even the non-profits.

            The greatest trick the GOP ever played was convincing the devil they had a soul to sell.

            by Uncle Cosmo on Fri Jan 24, 2014 at 07:02:47 AM PST

            [ Parent ]

            •  PPACA colon cancer screening-no charge 2U-always (6+ / 0-)
              WAIVER OF APPLICATION OF DEDUCTIBLE FOR PREVENTIVE SERVICES AND COLORECTAL CANCER SCREENING TESTS.—Section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)), as amended by section 4103(c)(4), is amended—
              HR 3590 EAS/PP
               (1) in paragraph (1), by striking ‘‘items and
               services described in section 1861(s)(10)(A)’’ and in
              serting ‘‘preventive services described in subparagraph
               (A) of section 1861(ddd)(3) that are recommended
               with a grade of A or B by the United States Preventive Services Task Force for any indication or population and are appropriate for the individual.’’; and
               (2) by adding at the end the following new sentence: ‘‘Paragraph (1) of the first sentence of this subsection shall apply with respect to a colorectal cancer screening test regardless of the code that is billed for the establishment of a diagnosis as a result of the test, or for the removal of tissue or other matter or other  procedure that is furnished in connection with, as a result of, and in the same clinical encounter as the screening test.’’.
              If you walk in for a colon cancer screening test under the PPACA, your bill(s) as a patient must be $0 by law.
              •  That's good news but a tad too late for me :( (0+ / 0-)

                Looks like I should've waited on the colonoscopy, damn it all...

                Now how about those "routine" office visits? The physicians' group told me bluntly that they would charge me extra for anything I mentioned that was at variance with my status as of the last visit--& if the insurance wouldn't cover it, they'd be happy to send the debt-collector vultures after me (& have).

                The greatest trick the GOP ever played was convincing the devil they had a soul to sell.

                by Uncle Cosmo on Fri Jan 24, 2014 at 10:29:32 AM PST

                [ Parent ]

                •  Uncle, have you thought about (1+ / 0-)
                  Recommended by:
                  Uncle Cosmo

                  changing doctors?

                  They sound like they are more interested in being rich than being doctors.

                  If you CHOOSE to stay with them it's on you.

                  I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

                  by samddobermann on Sat Jan 25, 2014 at 04:43:49 AM PST

                  [ Parent ]

                  •  Yes I have, sam, but it ain't that easy (0+ / 0-)

                    Ditching a relationship that's been in place for nearly 20 years is tough. Doctor shopping is even tougher...& given the current pandemic level of financial rapacity in health care there is no guarantee it wouldn't be a frying-pan-to-fire move.

                    My GP has been pretty good over the years--very open to new ideas & suggestions, very proactive in the one instance when it looked like I might have a life-threatening condition. Only over the last few years, it seems, have the bastards she works for ramped up her patient load & pressured her to concentrate on things they could charge extra for. And unfortunately those employers have their tentacles fastened over Baltimore like Taibbi's infamous vampire squid.

                    But I will be a bit more active in looking around for alternatives.

                    The greatest trick the GOP ever played was convincing the devil they had a soul to sell.

                    by Uncle Cosmo on Sat Jan 25, 2014 at 09:23:39 AM PST

                    [ Parent ]

            •  That's all from before the ACA (0+ / 0-)

              So, what is the situation now?

              I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

              by samddobermann on Sat Jan 25, 2014 at 04:41:13 AM PST

              [ Parent ]

        •  ACA Basic Coverage Requirements (3+ / 0-)

          All policies offered on the ACA website MUST cover the following:  Hospitalizations, doctors visits, laboratories, prescriptions, preventative care/procedures (WITH NO COPAYS), outpatient services/tests, chronic disease management (diabetis, heart conditions, etc.), rehabilitative services/devices, maternity, pediatrics and mental health services/substance abuse.

          Subsidies are available for those who qualify (single ~ $46,000, couple ~ $62,000 and family of 4 ~ $94,200) for Silver, Gold and Platinum policies. Bronze policies do NOT qualify for a subsidy.

          So misterwade, your Silver plan is not catastrophic insurance (though those policies are available for people 26 to 30 years of age, but MUST include preventative services/tests/innoculations, etc. with NO COPAYS!).

          •  your have a point (1+ / 0-)
            Recommended by:

            but it is a small one. I understand that I get a check up or so without co-pay, but that costs me $3k worth of premiums. So I stand by my statement that a policy with a $2500 deductible essentially does amount to a catastrophic plan. You can quibble about the semantics if you like, but the facts on the ground are that little if anything will be paid for without a very serious illness or injury, which is the definition of a catastrophic plan.

            Power to the Peaceful!

            by misterwade on Fri Jan 24, 2014 at 09:51:00 AM PST

            [ Parent ]

            •  So if you don't get sick or hurt (0+ / 0-)

              then it won't cost you anything over the $3k. but you do expect that if you get something serious that needs say $100k in treatment that all will be paid except for the $2500 and a little copay?

              I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

              by samddobermann on Sat Jan 25, 2014 at 04:59:25 AM PST

              [ Parent ]

      •  Repeat after me: Dream on (12+ / 0-)

        My premium is $8.04 a month for a Blue Cross bronze plan - about the best I can afford. My deductible is $5250. That means I have health insurance, but not health care, because I still can't afford more than the minimum I need to stay alive. ( And yeah I get a few more services paid for now than before - not enough to make a huge difference). That's the same situation for a lot of people we know who are around 60 or older.

        The ACA means I won't lose my house to medical expenses if something happens before I go on Medicare in November. My wife still has a little over 5 years to go for that. It also means that Blue Cross, in my case, gets over $12,000 a year in tax dollars. I don't mind that some of that goes to pay for benefits for people who need it (maybe even me if I get unlucky), but I'd bet the execs at the "non-profit" Blue Cross here are well into the top 1% of wage earners too.

        A lot of that $12,000 is required because of excessive billing by hospitals, as the diary explains.

        And my state has a Democratic governor (for the entire 17 years I've lived here), 2 Senators, legislature and majority of the House delegation as well as a very well-run online exchange, and a great drug discount program for all state residents at no charge.

        No matter how cynical you become, it's never enough to keep up - Lily Tomlin

        by badger on Thu Jan 23, 2014 at 11:22:06 PM PST

        [ Parent ]

        •  Is that supposed to be $804.00 per month? (2+ / 0-)
          Recommended by:
          Shockwave, elwior
          •  No - $8.04 (0+ / 0-)

            For two people. We don't make a lot of money - I'm on Social Security and our business is on life support, but we do fine. We just can't afford a lot  of extras - like health care.

            And don't think I'm not grateful to have health insurance - it doesn't do a lot for our health, except the health benefits of not worry about losing our house to a medical catastrophe.

            No matter how cynical you become, it's never enough to keep up - Lily Tomlin

            by badger on Fri Jan 31, 2014 at 04:43:25 PM PST

            [ Parent ]

          •  That I pay - you (collectively) pay over $1000 (0+ / 0-)

            every month, and I thank you all. But I think the money could be better spent than handing it over to Blue Cross.

            No matter how cynical you become, it's never enough to keep up - Lily Tomlin

            by badger on Fri Jan 31, 2014 at 04:53:11 PM PST

            [ Parent ]

        •  Correct me if I'm wrong but Blue Cross... (1+ / 0-)
          Recommended by:

 for profit.  It was non profit a long time ago.

          Daily Kos an oasis of truth. Truth that leads to action.

          by Shockwave on Fri Jan 24, 2014 at 07:27:02 AM PST

          [ Parent ]

          •  It varies. I know Vermont BC/BS was nonprofit (2+ / 0-)
            Recommended by:
            Shockwave, elwior

            when we lived there (2002-2010). The CEO made boffo bucks anyway. Don't understand how the IRS let's that happen.

            •  IRS can not set income limits. (0+ / 0-)

              You might look at one of the charity rating services and what the say about non profit management pay. Or look up any company you are interested in.

              I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

              by samddobermann on Sat Jan 25, 2014 at 05:04:42 AM PST

              [ Parent ]

          •  Having worked for two not-for-profit (1+ / 0-)
            Recommended by:

            insurance companies, I can tell you there isn't that much difference. A little, maybe.

            The organizations weren't allowed to make a profit, so at the end of the year it was all distributed to the exempt employees as bonuses. Mine were always pretty good, but I can only imagine what the higher-ups got.

            Putting it in your own pocket is just as much an incentive as putting it in the stockholders' pockets, if not more so.

          •  Premera - WA State Blue Cross (0+ / 0-)

            tried to go for-profit a few years ago and then backed off.

            I haven't looked, but I suspect their executives aren't exactly donating their time. And they're one of the companies making newly insured transplant candidates wait 90 days before even beginning the assessment process.

            No matter how cynical you become, it's never enough to keep up - Lily Tomlin

            by badger on Fri Jan 31, 2014 at 04:46:22 PM PST

            [ Parent ]

        •  For lower income people (0+ / 0-)

          those policy deductibles are less than stated.

      •  For the life of me I don't get how (2+ / 0-)
        Recommended by:
        wa ma, tb mare

        ObamaCare will solve this simply by paying the hospital bills.

        On the surface that would to to aid and abet them.

        •  because the gouging (1+ / 0-)
          Recommended by:

          is partly due to non-paying accounts.  with more people insured, fewer people have non-paying accounts.  prices should normalize.

          Please don't dominate the rap, Jack, if you got nothin' new to say - Grateful Dead

          by Cedwyn on Fri Jan 24, 2014 at 06:55:22 AM PST

          [ Parent ]

          •  I don't really consider it to be "gouging" (0+ / 0-)

            if the funds are used more or less legitimately, as you seem to be saying.

            What makes me skeptical that they are is that "for profit" private hospitals have much higher costs than the public hospitals serving disadvantaged areas that common sense would dictate have many more (proportionately) non-paying  customers.  So THEY should be the ones charging the exorbitant rates, but they're not (which they should be if your premise held)

        •  There are more rules in the ACA (0+ / 0-)

          that concern hospital charges. But DK people refuse to look at anything in the law outside of Title I which covers insurance.

          I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

          by samddobermann on Sat Jan 25, 2014 at 05:06:55 AM PST

          [ Parent ]

      •  ACA is better than nothing - NOT what we wanted (0+ / 0-)

        We wanted to have insurance manage the paperwork for a single payer plan. (as is done in most countries like Canada) Insurance companies fall all over themselves to get the paperwork-record keeping contracts in Canada and Switzerland (for example) and they are limited to 3-4% profit, heavily regulated and severely punished for screwing up. The ACA is a a PURE, FOR PROFIT EXPANSION. PURE monopolistic health care where insurance companies STILL get to decide, not doctors or nurses. And worse, the bill required Tax Money to separately pay for the PREMIUMS for 30-40 million more people (ie guaranteed profits). It is as much a move in the right direction as putting aside a penny a year is a move in the right direction toward having a retirement account.

        •  this is bull. There is more to the (0+ / 0-)

          ACA than the insurance provisions.

          The federal law cannot set prices for the private insurers but it can for the Medi's and insurers tend to follow with an add on.

          The ACA is pushing to other types of payment than item by item.

          I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

          by samddobermann on Sat Jan 25, 2014 at 05:12:22 AM PST

          [ Parent ]

      •   That is why the ACA as provisions (0+ / 0-)

        to reduce hospital costs.

        Hospitals are working on managing to reduce costs over all and to improve quality at the same time. They will not be paid to fix their own errors nor for overruns in costs covering the uninsured.

        There are requirements for transparency which require hospital to publish costs which will eliminate much of that.

        Even if you live in a repub governed state you can get subsidies. And more of them will be taking up the Medicaid programs.

        I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

        by samddobermann on Sat Jan 25, 2014 at 04:38:01 AM PST

        [ Parent ]

  •  My son visited the ER and checked in (88+ / 0-)

    overnight for acute mesonteric adonitis.  We were afraid it was appendicitis, but it turned out not to be.

    Price for ER visit, tests and overnight stay?  $15,000.

    That is the price for a semester at a private college.  That is the price of a car.

    For ONE NIGHT in the hospital, no medical intervention needed.

    I freaked out on the business office.  I explained to them that this was gauging, that it is insane to charge this much and expect patients to agree to prices without knowing what the prices are.

    Patients have no recourse.  I have never felt so helpless in my life.  It has to end, this business model is literally unsustainable.

    Great diary, thank you.

    I blog about my daughter with autism at her website

    by coquiero on Thu Jan 23, 2014 at 04:31:42 PM PST

  •  Hubby had a heart attack in 2011 - (45+ / 0-)

    We went to the emergency room at Plaza Medical Center. The first question that the 'financial representive' asked was how we were going to pay for this. I was too distraught to even think about it - I just gave her my insurance card. Then she told me that I needed to make an initial payment on the bill, and it could be as low as $100.

    Fast forward to three months later, hubby has recovered and is doing fine, and I attempt to find out whether Plaza has any financial aid. The 'financial representative' told me that since I paid the $100 up front, then I would not be able to apply for any financial aid. WTF?

    You think I would have learned my lesson, but no - I had my appendix out at Plaza in 2012.

    The final straw was a visit to the Plaza ER in the middle of 2013. They were unable to diagnose my severe abdominal pain, despite the fact that I had already had my appendix out. They gave me a CAT scan, which didn't reveal anything. So they gave me a scrip for Bentyl and one for Phrenergan to stop the stomach cramps and nausea. $800 for nothing, including charging me for an IV that I don't remember getting.

    A month and a half later I went through my PCP and had my gall bladder removed. It was gangrenous. So basically Plaza did nothing to help my health, and charged me $800 in the process.

    Having a for-profit hospital makes no sense, unless you're going to specialize in optional surgeries, like nose jobs and tummy tucks.

    I see you drivin' 'round town with the girl I love / And I'm like / Please proceed, Governor. - Dave Itzkoff

    by Jensequitur on Thu Jan 23, 2014 at 04:47:57 PM PST

  •  Profit Centered Medicine (30+ / 0-)

    Really... you have no idea until you or someone you love gets sick...

    I wonder why healthcare spending is down?

    Maybe it is because of people like my Mom, who just died from a "preventable" cancer, decided to live life up until the few days before She died... because She knew the alternatives..

    She got her WI medicaid packet the day She died...

    More than a third, 37 percent of U.S. adults chose not to see a doctor, follow up with recommended treatment or filled prescriptions due to high cost, compared to just 4 percent of respondents in the United Kingdom. The difference? The UK has a national healthcare system which effectively controls cost – and does not exclude anyone.

    So... what do we pay for our lives?

    I'm so with you on this everything...

    •  So sorry to hear this, sillycarrot. It's just (3+ / 0-)
      Recommended by:
      OhioNatureMom, RN4MERCY, sillycarrot

      heartbreaking to hear.......could have been prevented. It's so hard to lose your mother under any circumstances, you have my condolences.

      That quote is really amazing. I had no idea it was such a high percentage.

      "extreme concentration of income is incompatible with real democracy.... the truth is that the whole nature of our society is at stake." Paul Krugman

      by Gorette on Fri Jan 24, 2014 at 07:45:59 AM PST

      [ Parent ]

    •  But the Brit system EMPLOYS (0+ / 0-)

      the doctors and OWNS the hospitals and clinics. And it is having problems; austerity has hit it too.

      Doctors make big bucks here — that is most of them. Primary care which is most important us paid least but should be more. But most all specialists make in the 1% range.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Sat Jan 25, 2014 at 05:38:07 AM PST

      [ Parent ]

  •  Great diary - (29+ / 0-)

    This has got to stop, it's breaking people. I got a $4,000.00 bill for just 2 hrs. in the ER, I got a bottle of pain pills and a screened cup to piss through to catch my kidney stone. I passed it at home a couple days later, but the bill was WAY more painful than the stone!
    I checked on getting in the VA system, and made it because POOR. Boy, what a blessing! I'd rather be just poor than bankrupt to boot! I get a yearly physical, and last year had to get a colonoscopy because OLD. It cost me a whopping 8 BUCKS.
    A fan of Socialized medicine? You betcha!

  •  Now you know (19+ / 0-)

    why we don't have single payer.
    Under the ACA the insurance companies will blame the hospitals, collude with the hospitals, and the Feds will subsidize the whole process.
    And the public outrage will not form because we won't see it.
    I told you .
    Actually, the ACA might slow down the process, as at least some of this is due to hospitals overcharging to compensate for insurance companies refusing to pay legitimate claims, but that is not an ACA defense, except for the maliciously cynical.

  •  hospital price gouging (8+ / 0-)

    i'm not surprised by this report.  if you add up all the dollars for the inflated costs of medical care across the spectrum of players in the system including the money spent on lobbying we could have a vibrant universal health care system , save money, and have better outcomes-no more shopping for the lowest cost health care provider to treat your heart attack or a cut that requiring 4 stitches.

    •  man, you said it, irocdk. Too bad they don't (1+ / 0-)
      Recommended by:

      listen to people who can figure that out! Too much money and too many people who want it all for themselves.....

      Like Gov. Rick Scott. I was listening to his deposition about his fraud. He didn't know how many hospitals his corp had, didn't know the name of the corp he founded and was CEO of. In fact he did not remember so many things I do believe he would have argued the meaning of the word "wife" and denied knowing his own child. And he was head of the largest health corporation in the world!! Governor Scumbag.

      "extreme concentration of income is incompatible with real democracy.... the truth is that the whole nature of our society is at stake." Paul Krugman

      by Gorette on Fri Jan 24, 2014 at 07:50:22 AM PST

      [ Parent ]

  •  Die-ins (4+ / 0-)

    on the steps of the Capitol.

    Let congress step over the head an dying. The media will be there to film it.

  •  Overnight NYC Hosp: 68k (24+ / 0-)

    My friend had chest pains, and spent exactly 1 night in a New York City hospital.  The bill was $68,000.00

    The symbol for the Republican party shouldn't be an elephant -- it should be a unicorn.

    by Deadicated Marxist on Thu Jan 23, 2014 at 05:17:58 PM PST

  •  That charge masters (10+ / 0-)

    existed in secret for so long, and were utterly arbitrary in what they stated the costs of procedures should be, is by itself reason to move to a true single payer system imho.

    Best healthcare system in the world..but at what?

    Nicht durch Zorn, sondern durch Lachen tödtet man. ~Nietzsche

    by somewierdguy on Thu Jan 23, 2014 at 05:19:57 PM PST

  •  Glad I still look at what's on the rec list (11+ / 0-)

    sometimes you find a gem like this one.

    “Conservation… is a positive exercise of skill and insight, not merely a negative exercise of abstinence and caution…” Aldo Leopold

    by ban nock on Thu Jan 23, 2014 at 05:41:39 PM PST

  •  The day I showed up for my surgery (22+ / 0-)

    as I was checking in the financial person asked me if anyone had told me there was a copay of $1,250 in advance.

    I said, no, no one had told me about it, and I didn't have that much money in my account, and did this mean I wasn't going to have the surgery that I had been prepping for for 24 hours and that my physician thought was so urgent he called me personally at home and told me he was scheduling me for his first open surgery date?

    I was reluctant to have the surgery as it was, and probably would have delayed having the surgery if I knew the copay was that high.  I was already terrified about being cut open and being under general anesthesia and having a tube down my throat, and here I was being asked for $1,250 at check in time when my anxiety was at its highest.

    I guess some people have that kind of money lying around, but I'm not one of them.

    Then there was a complication and what was supposed to be day surgery ended up requiring a night in the hospital.  I cried and cried because I knew I was racking up extra charges.

    When the bills started coming in afterward I did not even open them.

    And I have decent insurance (at least I thought it was decent)

    I always wondered why  they couldn't be satisfied with the 80% of the bill that the insurance paid.  They take much less from Medicare

    Politics is like driving. To go backward put it in R. To go forward put it in D.
    Drop by The Grieving Room on Monday nights for support in dealing with grief.

    by TrueBlueMajority on Thu Jan 23, 2014 at 06:02:35 PM PST

  •  The part that frosts me is that my % of the (21+ / 0-)

    bill is based upon the hyper-inflated cost of the procedure, so I end up paying MORE than the actual cost of the procedure even with "good" health insurance.

    This happened to me last year when I had to have an MRI for undetermined pain that could have been a serious problem with my pancreas. I don't remember the exact numbers (I tried to forget about it) but essentially I learned after the fact that my "co-pay" was actually more than the market cost for the procedure.

    So the hospital charges an inflated rate, the insurance company "negotiates" it down and I end up paying 150% of the market price after having fully met my large annual "deductible".

    What's wrong with this picture? Another part of the scandal that is our for-profit health care system.

    "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

    by annan on Thu Jan 23, 2014 at 06:06:38 PM PST

    •  You need to check that out. (0+ / 0-)

      you shouldn't have to pay more than the contracted copay on the cost to the insurer.

      Maybe you should have checked that. Did you call your insurer for help?

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Sat Jan 25, 2014 at 05:47:23 AM PST

      [ Parent ]

  •  As a COPD sufferer, (6+ / 0-)

    I know what exorbitant medication prices are all about.  I'm using three different inhalers right now.  One, albuterol, is fairly cheap, "only" $67, but the other two, Atravent and Qvar are outrageous.  I got my first Atravent at Walgreen's, who cut the price of $360 to $306; however, they won't discount Qvar, which goes for a whopping $600 a pop!  Fortunately, I have a friend in Arizona who has a friend who makes frequent trips to Mexico.  He gets them for me there.  Prices?  The albuterol is $5 and the Atravent $37.  Since the Qvar is new for me, I don't know what it'll cost down there, but I'm guessing well under $100, maybe even under $50.  

    Some of my worries will be over on the 1st of February when my Medicare supplemental policy will kick in; however, when I reach the "doughnut hole", I guess I'll start getting the stuff from Mexico again.  

    -7.13 / -6.97 "The people never give up their liberties but under some delusion." -- Edmund Burke

    by GulfExpat on Thu Jan 23, 2014 at 06:20:10 PM PST

    •  Albuterol was generic for 20 years. Then they (4+ / 0-)
      Recommended by:
      ER Doc, NoMoreLies, kimoconnor, RN4MERCY

      had to come up with a new non-CFC version.

      The first company to bring that to market got a new drug patent, although all they did was change the damned propellant.

      That's why it costs so much.  It should be about 10 bucks.  That's what it was before the new CFC free version.

      Medicaid generally only pays for it through a nebulizer, because that's available generic.

      "I read New republic and Nation/I've learned to take every view.." P. Ochs

      by JesseCW on Thu Jan 23, 2014 at 11:38:20 PM PST

      [ Parent ]

    •  Shop for you scripts. (0+ / 0-)

      One woman did that. She got an over $100 quote from one place but started calling around and for the SAME medication got prices ranging for $11.xx at Costco to over $400 at CVC iirc. This was covered on PBS NewHour recently.

      The doughnut hole is shrinking but the $$ you pay in mexico won't go to "fill" that hole.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Sat Jan 25, 2014 at 05:53:31 AM PST

      [ Parent ]

  •  "The Plot to Keep Health Care Prices from... (14+ / 0-)

    the Consumer.

    The Fiscal Times article explains that  consumers and patients have almost no information about the prices they pay for health care, and asks:

    ...Have you ever walked into a doctor's office and seen a price posted for all the tests, products or procedures that might be offered during your visit? At the hospital?
    The problem is that there are different charges for the same services and procedures, even in the same geographic regions:
    ...Health care providers are more like airlines than the local Best Buy or Macy's" (in pricing). "They charge different patients different prices depending on who insures them...
    (With the uninsured being charged the highest prices.)

    How much price variation is there?

    "...significant price variation – sometimes more than 100 percent – for the same healthcare services in the same geographic market..."
    Insurance companies don't want to share pricing information, citing:
    ... "proprietary information and preexisting confidentiality agreements with providers..."
    Drug companies and medical device manufacturers have high llist prices for products, but negitiate discounts--of different amounts--with different facilities...  
    ...and then require each to sign a contract that forbids releasing pricing data to their competitors across town...
    At least two bills have been put forward in Congress to require more transparency in health care pricing.  So far, none have passed.
  •  55K? Hah. (20+ / 0-)

    My 13-year-old son's surgeon billed us $72,000 for his fee alone for my son's appendectomy last year. We'd gone to an in-network hospital upon referral from our in-network primary doctor, but since the surgeon the hospital assigned was out-of-network (we weren't told that in advance) our insurance company told us they had no obligation to pay. The $13,000 out of pocket limit we had on out of network providers under our policy didn't apply, either, because that applied only to what our insurance company considered reasonable and customary charges. Eventually, the surgeon took the $2,000 our insurance company later offered (their in-network rate) and wrote off the rest. But, what a nightmare.

  •  WTH? (8+ / 0-)

    I thought the ACA included a provision to end hospital overcharging.  Oh, wait.

    December 16, 2013

    The Obama administration is in no hurry to enact Affordable Care Act-related rules intended to prevent hospitals from potentially overcharging patients, according to Time Magazine.

    And it gets worse.
    "Then Treasury Secretary Timothy Geithner, or current Treasury Secretary Jack Lew, could have written the regulations with his staff the day after the law was signed (in 2010), and there is nothing John Boehner or Ted Cruz could have done about it," the article observed. "After posting the rules in the Federal Register and a brief comment period, the regulations would have taken effect."

    I am become Man, the destroyer of worlds

    by tle on Thu Jan 23, 2014 at 06:35:04 PM PST

    •  NO, cause the regs were not (0+ / 0-)

      written by Geithner. They have to be written in the HHS. Some have been written and put into effect.

      The lobbyists USE that comment period extensively. They can get it extended in certain ways.

      Do not take TIME as gospel. (And don't take gospel as gospel.)

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Sat Jan 25, 2014 at 06:22:05 AM PST

      [ Parent ]

  •  There seems to be some confusion (12+ / 0-)

    about how all this works, so I'd like to step in and explain the $55,000.00 bill as I work in medical billing.

    The hospital charged $55029.31.  

    By contract, the insurance companies set the reimbursement rates, not the hospitals, so the hospitals charge high to make sure they aren't charging less than the insurance companies contracted rates.

    In the detail is a line saying Allowance - Insurance C/A $37,448.31

    That means the hospital has to write off money to bring the charge down to the contract rate. (C/A)

    In this case, they wrote off $37448.31.

    That means the bill was really $17,581.00, not $55029.31.

    Of the $17,581.00 that was approved by the insurance company, Aetna paid 6,461.47 leaving a balance of 11,119.53 for the patient.

    It's not clear why the patient was billed so much.  Perhaps he had a $10,000 deductible, but my point is that the hospital could charge whatever they want and it has absolutely nothing to do with what they get paid.

    Let me be very clear on this.  The hospital could have charged $200,000.00 for this bill and the patient would have still owed 11,119.53.  The only thing that would have changed is the line saying they wrote off $37,448.31.

    If the hospital had charged $200,000.00, that line would read:

    Allowance - Insurance C/A $182,419.00

    Aetna would have still paid the 6,461.47 and the ending balance owed by the patient would have been the $11,000.00

    We don't have access to the patients insurance statement which would show why he owed so much.  In all likelihood, he has a $10,000 deductible.

    I am not saying the charges for medical treatment in this country are not outrageous, but it's important to understand how these things actually work.

    The insurance companies have contracts with the hospitals that specify exactly how much they will 'allow' for each procedure.  The patient is never billed for this amount as you can see from the bill.  The difference between the contracted amount and the amount charged by the hospital is written off.  The amount approved by the insurance company has absolutely nothing to do with how much is charged.  Their fee schedule is fixed and negotiated in advance.

    So the surgery actually cost approximately $17,000 even though the hospital billed higher.  Aetna paid $6,000 and the patient owes $11,000 and we cannot tell from the bill exactly why Aetna did not pick up more of the bill.

    So containing costs really becomes a matter of what the insurance companies approve and what they agree to pay and not what the hospital charges at all.  If the hospital charges above the insurance companies agreed upon rate, they have to write that amount off, which they did in this case to the tune of $37,000.00.

    So again, the premise that the more a hospital charges, the more they get paid is absolutely false.  Their reimbursement rates are set by contract.

    All insurances work this way, even Medicare.  The physician or hospital can charge whatever they like, but they have to write the bill down to whatever Medicare says is reasonable and customary and then Medicare pays 80% and the patient pays 20% and it does not matter one bit what the original bill says.  Medicare sets the rate and approves an amount and that amount is what Medicare and the patient pay, not the billed amount.

    I agree that medical care is out of control in this country, but we need to have a rational discussion and understand exactly how the actual billing works.  Hospitals and doctors do not set the rates.  Insurance companies do.

    •  Good post praying manatheist (4+ / 0-)

      Years back many commercial insurers would reimburse a % of charges so as long as the charges were reasonable (compared to other providers) commercials would reimburse at a % of charges.

    •  There is a lot of negotiating between insurance (2+ / 0-)
      Recommended by:
      MKSinSA, SoCalSal

      companies and health care providers. If I'm the insurance company I don't believe the amount the provider is requesting (with good reason), and if I'm the hospital I don't believe the amount the insurance company is offering (with good reason).    

    •  nothing rational at all about the process you (7+ / 0-)


      And as we learned in the Time expose last year, the uninsured get the full motherfucking bill!  If they get an advocate, maybe they get some of it written off. But there is nothing logical, rational, or ethical about what you described. They should have a price for a procedure, period. It shouldn't fluctuate based on the circumstances of the patient. And they DO get more when they overcharge, because some pay without fighting. Fuck them!

      Power to the Peaceful!

      by misterwade on Thu Jan 23, 2014 at 07:54:51 PM PST

      [ Parent ]

      •  The uninsured do get the full bill, (6+ / 0-)

        but they don't have the resources to pay the bills and the costs are passed onto the insured, just like the poor using the ERs as primary care costs are passed along to the insured.

        It's one of the principal concepts behind Obamacare.  Have everyone insured, so that everyone gets the insurance discounts.

        People who can't even afford insurance are not normally in a position to pay off an inflated hospital bill.  Hospitals know this and will work with patients and give them insurance rates.

        Unfortunately, as I said, people who previously have not been able to afford insurance certainly cannot pay off even discounted hospital bills.

        The bill that was the focus of this diary, the $55,000 bill.  The hospital knows that an uninsured person cannot pay even the $17000 amount.  They routinely offer that as an option but seldom get paid because someone who cannot afford insurance cannot afford a hospital bill for something as serious as an emergency appendectomy.

        Your anger is understandable, but focuses on the wrong culprit. The culprit is a profit driven system that makes money, pays CEOs and dividends to investors at the cost of healthcare.

        The only answer is universal care.  Everything else is a dead end.

        And just to be clear, I never stated there was anything logical, rational or ethical about the current system.  That is a strawman.  My only purpose was to explain the reality of the situation because many people don't understand that part of the equation.

        •  my target is the right one (1+ / 0-)
          Recommended by:

          I agree, but did not state, that the only answer is universal care.  Agreed. But I'd still like to knock some teeth out the hospital and insurance company executives.

          I have stated, not to you, but to people around me for many years that healthcare should not be for profit.  And the ones that call themselves "non-profit" are scamming the system for tax breaks. Just like the NFL.

          I get that you are just explaining from an inside view and are not advocating for the system. You ended one comment with a statement about taking a "rational" view, and that set me off.  

          We are on the same page.

          Power to the Peaceful!

          by misterwade on Thu Jan 23, 2014 at 08:33:51 PM PST

          [ Parent ]

        •  "The costs are passed on to the insured"???? (0+ / 0-)

          Are you sincerely trying to pretend that for-profit hospitals would charge less if only, gosh darn it, not for those pesky insured?

          Are people actually recommending the horseshit you're spewing?

          Do you even Capitalism?

          They're charging absolutely as much as they can.  They are making as much fucking profit as they can.

          They will NOT lower prices now that number of uninsured will be falling by half.  Because it was greed, not the uninsured, that drove prices this insane in the first place.

          Anger is understandable, but your defense of insatiable greed at the cost of human life certainly isn't.

          "I read New republic and Nation/I've learned to take every view.." P. Ochs

          by JesseCW on Thu Jan 23, 2014 at 11:44:51 PM PST

          [ Parent ]

          •  Whoa. Have you actually read these posts? (4+ / 0-)

            There's no defending going on here - there's providing information.  Which gets recs.

            You owe the poster an apology.  And then you need to actually read (and understand) comments before seeing red.

            •  The central damned premise is that for-profit (0+ / 0-)

              hospitals would happily lower prices if not for treating the uninsured.

              It's fucking bullshit.  The person promoting that view is advancing a pernicious lie.

              Take an Econ survey course at your local JC.  That's not how capitalism works.  

              Apologies are owed to those harmed by this lie.

              "I read New republic and Nation/I've learned to take every view.." P. Ochs

              by JesseCW on Fri Jan 24, 2014 at 12:52:54 PM PST

              [ Parent ]

              •  But someone/group has to (0+ / 0-)

                pay for the services to the uninsured. That is covered some by tax money at the local, state and federal level plus by charing more to those who are insured.

                That is fact. Not your general  theory.

                In fact, hospitals are cutting costs BECAUSE the ACA is cutting supplementary medicare payments to hospitals who have a lot of uninsured.

                I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

                by samddobermann on Sat Jan 25, 2014 at 06:31:27 AM PST

                [ Parent ]

          •  There are very few uninsured (1+ / 0-)
            Recommended by:

            patients in Massachusetts hospitals.

            Are the prices lower?

            Are the prices fair?

            Are the prices in line with those of advanced European countries?

            •  That is an unfair comparison (0+ / 0-)

              European countries have universal healthcare, which in my opinion is the answer to our problems.

              As long as there is profit involved in our healthcare system our prices will always be too high.

              Because we're paying companies profit that could be used for healthcare.

              There is just no getting around the fact that a healthcare system based on profit will always be more expensive than a healthcare system based on healthcare.

              I am not defending our system, merely explaining how the nuts and bolts of the billing of insurance by hospitals currently works.

              I'm for single payer, as I have repeatedly said in previous posts.

            •  Problem in MASS is too many big (0+ / 0-)

              Brand name hospitals which have market clout and big training institutions. But over all.

              Prices will never be in line with European countries because doctors especially specialists want to be in the top 1% here, providers of equipment including hips and knees etc want their stock prices high and pharmaceutical companies need to keep their shareholders happy.

              I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

              by samddobermann on Sat Jan 25, 2014 at 06:36:19 AM PST

              [ Parent ]

          •  Almost nothing in your post (1+ / 0-)
            Recommended by:

            fairly represents what I said.

            I would like to address your first sentence that hospitals could charge less if not for the pesky insured.

            The exact opposite of this is what I said and is the premise behind Obamacare.  Right now, because of uninsured people not being able to pay their bills, the costs are passed on to the insured in the form of higher premiums, therefore we want more people to be insured so the costs are fairly distributed among the populace.

            This is just insurance 101 and is at the heart of mechanic that makes Obamacare work.  If less uninsured people have to go to the ER for primary care, then health costs come down.  This is not my theory, this is the theory behind ACA.

            And the hospitals do not get to say what they are paid by private insurance companies, Medicare or Medicaid.  As I outlined in my original comment, these rates are set in stone by contracts between the hospitals and the insurance companies and mandated by law in the case of Medicare and Medicaid.

            I'm not going to explain the process as I covered it very thoroughly in the parent comment, but to reiterate, the hospitals can charge as much as they like, but they don't get paid that amount, they get paid what their contracts with the insurance companies say they will get paid and write off the rest.

            The theory behind the ACA is not just to bring costs down by steering people away from expensive and unnecessary ER visits, it is to distribute costs more fairly among all of the population and give help to those who cannot afford insurance by giving them Medicaid coverage or cheaper rates supported by the government.

            The earlier people get help for a medical condition, the lower the overall cost for that particular incident.  Taking off a skin lesion in a physician's office is much cheaper than having that lesion turn into skin cancer which the patient with no insurance then lets progress until a trip to the ER is necessary and then a long hospital stay with surgery and chemotherapy.  That is where the cost savings come into play, not with the hospitals lowering their rates.

            Or at least, that's the theory behind the ACA.

            •  This is bullshit. Pure, and unadulterated. (0+ / 1-)
              Recommended by:
              Hidden by:
              Right now, because of uninsured people not being able to pay their bills, the costs are passed on to the insured in the form of higher premiums, therefore we want more people to be insured so the costs are fairly distributed among the populace.
              I understand that the Heritage Foundation has pushed this lie ever since they started advancing the plan that became the ACA.  That doesn't make it true.

              Insurance companies don't pay for the uninsured.  The insured don't "pay for" the uninsured.

              Your employers charge as much as they can possibly get for their services (and often, more than that).  They will not lower their rates as more people get insurance, will they?

              No, the cost of the uninsured comes out of their damned profits, or is picked up through taxes.  But it does not contribute to the cost of insurance.

              It's why the ACA doesn't work, and isn't lowering prices.

              I don't know how people sleep at night after spending their time on-line advancing corporate lies and actively trying to deceive fellow workers.  I just fucking don't know how they live with it.

              "I read New republic and Nation/I've learned to take every view.." P. Ochs

              by JesseCW on Fri Jan 24, 2014 at 12:58:36 PM PST

              [ Parent ]

              •  Hide rated for calling out someone (0+ / 0-)
                on-line advancing corporate lies and actively trying to deceive fellow workers.
                Why don't you call your insurer and ask. Look up the CEO and email him.

                Besides, as she explained, the big cost reductions will come from people being able to dee a doctor earlier in any disease process to prevent the high cost of adanced disease care.

                Like years of diabetic care preventing gangrene and amputations of legs. Like preventing strokes by treating high blood pressure.

                Even if the RATE of each procedure stayed the same the total COST of care would decrease.

                I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

                by samddobermann on Sat Jan 25, 2014 at 06:45:23 AM PST

                [ Parent ]

                •  Because I'm capable of basic goddamn reason. (0+ / 0-)

                  Right wingers always abuse every shred of "authority" given to you, down to simple HR's.

                  Her central goddamned argument was that the poor lil' for profit hospitals just HAD to charge more because of the uninsured, resulting in us all paying more.

                  That's so goddamned stupid that I don't believe it's possible that she, or you, believes it.

                  Corporations charge absolutely as much as they can get before decreasing their total sales to a point that profits suffer.  That's how capitalism fucking works.

                  Pretending otherwise is either stupid or dishonest, and chickenshit bullying  tactics, distractions, and participation in efforts to harm workers doesn't change any of that.

                  This is what you spend your free time voluntarily defending - efforts to harm workers to benefit the rich.

                  "I read New republic and Nation/I've learned to take every view.." P. Ochs

                  by JesseCW on Mon Jan 27, 2014 at 02:02:09 AM PST

                  [ Parent ]

      •  the thing that seems indefensible (5+ / 0-)

        is that one patient gets charged a different amount than another one for the same procedure.  That is just wrong.  I see no reason why a hospital or a provider should offer an insurance company a reduced rate for their services.  It's not like appendectomies are cheaper by the dozen, I think.  We'd be way better off if all the providers published rates, medicare or insurance could review their rates and either sign up for them or not.  Leave the highest-priced 1/3 of the providers out and sign up the other 2/3.  

        I'm still mad about Nixon.

        by J Orygun on Thu Jan 23, 2014 at 09:46:01 PM PST

        [ Parent ]

        •  not just a different price (6+ / 0-)

          but a dramatically different price. It is obscene. Indefensible. And that you don't know until after the procedure what the cost will be is unprecedented in normal commerce.

          One time I actually asked and got what I thought was a written estimate for a procedure that I was considering. I made my choice and did it. Then I got the bill and the Dr. fees had not been included in the estimate, just the hospital fees. WTF? I haven't had much experience with medical systems (thankfully), so how am I to know that there is another whole set of, very expensive, fees that they just simply forgot or neglected to tell me about? How does that happen in any other context? Does a restaurant or a barber or a grocer or any other flipping business purposefully conceal the cost of the service? And then it just so happens that the costs of these services are the most costly ones you will never incur in your life, short of a home purchase, and even that could end up being less than many medical bills.

          If we tried, we would be hard pressed to come up with a  health care delivery system that was more stupid, mean, predatory, usurious, and with outcomes that pale in comparison to many other industrialized nations, than the one we have. It disgusts me that the system we have is the one we have, not withstanding the very modest movement in the right direction via the ACA.

          Power to the Peaceful!

          by misterwade on Thu Jan 23, 2014 at 10:04:01 PM PST

          [ Parent ]

          •  But America was built on greed and grab. (0+ / 0-)

            Why are you surprised? Oh and self righteousness too.

            And how would you propose to change it?

            Other countries look at us and either laugh or shake their heads slowly.

            I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

            by samddobermann on Sat Jan 25, 2014 at 06:53:28 AM PST

            [ Parent ]

        •  It should be illegal. It is discriminatory. (2+ / 0-)
          Recommended by:
          OhioNatureMom, misterwade

          It waffles between "dumping" and price fixing, depending on your socio-economic status.

          "I read New republic and Nation/I've learned to take every view.." P. Ochs

          by JesseCW on Thu Jan 23, 2014 at 11:46:17 PM PST

          [ Parent ]

        •  People are already bitching about limited networks (0+ / 0-)

          which is how insurers are trying to push prices down.

          And it is called buying wholesale vs retail.

          The provider knows he will be paid by an insurer. He can even have an idea of who many will need a procedure for a certain population.

          As individuals he could never be paid. Too much of that and you are out of business.

          I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

          by samddobermann on Sat Jan 25, 2014 at 06:49:31 AM PST

          [ Parent ]

    •  Does the hospital report the loss (3+ / 0-)
      Recommended by:
      JesseCW, catwho, nchristine

      On their taxes?  If so, this might really add up to a big advantage for them.

      "A developed country is not where the poor have cars. It's where the rich use public transportation." - Mayor of Bogota

      by Time Waits for no Woman on Thu Jan 23, 2014 at 08:33:59 PM PST

      [ Parent ]

    •  You struck on another point - it's how scum hide (0+ / 0-)


      They bill an insane rate no one will ever pay, then write off the difference as an imagined "loss" to avoid taxes.

      "I read New republic and Nation/I've learned to take every view.." P. Ochs

      by JesseCW on Thu Jan 23, 2014 at 11:41:36 PM PST

      [ Parent ]

    •  nice try - - hospitals still at fault (1+ / 0-)
      Recommended by:

      Thanks for explaining the role of insurance.

      However, hospitals are still at fault for outrageous and effective price gouging.

      Insurance companies negotiate rates, and then hospitals find out how to defeat that, by
      - breaking the billing for one service into an indecipherable list of a dozen services and products
      - adding unnecessary tests
      - still charging $11.00 for a single Tylenol, and graciously agreeing with the insurer to reduce that to only $10.00
      - changing the products/services descriptions constantly in an attempt to baffle and outwit the insurance company.

      Last time I got mugged and ripped off by a hospital, my insurance company paid a huge amount of the insane bill (and then passed the colossal remainder to me).

      First time I ever felt sympathy for a medical insurer. The hospital took a ton of their money and they had no recourse.

    •  So that's great if you have insurance (0+ / 0-)

      You get to pay the contract rate and not the inflated rate. Someone who doesn't have insurance would be paying the entire $55,000.

      "How come when it’s us, it’s an abortion, and when it’s a chicken, it’s an omelette?" - George Carlin

      by yg17 on Fri Jan 24, 2014 at 05:18:07 AM PST

      [ Parent ]

    •  Your post is good except that you ignore those (0+ / 0-)

      without insurance.  There would be no write off for them.  

      There will be fewer of such people soon, but they will still exist.

  •  I worked at NYC's public health care system (14+ / 0-)

    for my entire career. The one thing public hospitals, community hospitals, proprietary hospitals all other hospitals have in common is that they do not accurately identify costs so they have scant notions about what accurate pricing should be. (This is separate and apart from identifying those services that might be profitable -- that's fairly easy to do.)

    Hospitals identify costs via a method known as cost finding and is a hold-over method from the days when inpatient reimbursement rates were determined at the per diem level. Now, with a prospective payment system (DRGs) reimbursing on diagnoses and treatment rather than length of stay it would behoove the hospital industry to understand costs at a granular level, and price accordingly.

    That would mean establishing a bonafide cost accounting system. Just as the Ford Motor Company knows exactly how much it costs for their various vehicles and which assembly line is the most efficient and profitable, hospitals should know in fine detail how much it costs for the component parts of a patient stay/DRG. They do not.

    For example, do hospitals know exactly how much it costs for a know replacement? No. Do hospitals know how much it costs per knee replacement by Orthopedic surgeon? No they do not. By other parameters? No.

    Now, very specialized costs studies can be conducted and reimbursement rates for DRGs have been formulated by these studies; likewise, by special cost finding projects hospitals can determine P&Ls, but as a matter of routinely capturing all component costs on a timely basis to accumulate for cost accounting purposes -- no.

    Cost accounting systems are complex and it would be arduous to establish cost accounting systems in a robust health care system. We gave it a was called PADBARS, or, the Patient Accounting Database and Reporting Systems. It wasn't entirely accurate and we never got to a level where we could base our Charge Description Master on costs compiled; but, it became a powerful analytical tool because we established the rudiments of cost accounting.

    I've ben out of the business for a while and would like to know if progress has been made, I think not though.

    Speaking of Charge Descriptions Masters -- most are gobbledygook and unrelated to reality, and which no one at the hospital knows very much about. At one point in my career I spent a couple of weeks poring over the CDM correcting the most egregious mistakes.

    •  Thanks Mike (3+ / 0-)
      Recommended by:
      arlene, ER Doc, OhioNatureMom

      This is exactly the point I was making in my comment.

      The hospital charges are an artifact from when insurance companies did not set rates and hospitals were paid on what they charged.

      That has not been the way things work for 30 or 40 years now.

      It is a PR nightmare for the hospitals to continue to use their antiquated charge methods when they know good and well up front they aren't going to get paid anywhere near what they are charging.  They do it out of convenience but people not in the industry are understandably confused by this and think the hospitals are charging and getting paid for these enormous amounts.

      They aren't.  They are getting the contracted rates that they have negotiated with each individual insurance company.

      The hospitals better wake up to this PR nightmare, because it's confusing people and making them very, very angry.

      I can speak for doctor's offices on this as well.  A physician may have 10 - 15 contracts with different insurance companies all paying different amounts for an office visit.  Some insurance companies pay $50 and some pay $85.  This is made more confusing by the fact that Aetna may have different plans (HMO and PPO) that pay very different rates even though it's the same company.

      So instead of the physician's office trying to wade through all this complexity, they charge $120 for an office visit and then write off the amount between what they charged and what the insurance company 'approves' and they get paid what the insurance company tells them they are getting paid, not what they charge.

      Hospitals have this same problem only 1000 times more complex.

      So they just overcharge, write off the difference and charge the patient what the insurance company tells them to.  It's lazy, but it's how it works and it makes them look very, very bad.

      •  they don't just look very, very bad (0+ / 0-)

        the are very, very fucking bad. Scumbag price gouging profiteers! Fuck 'em all!!!

        Power to the Peaceful!

        by misterwade on Thu Jan 23, 2014 at 07:58:23 PM PST

        [ Parent ]

      •  I think all patients should ask about balance (1+ / 0-)
        Recommended by:

        billing and if the hospital/dr accepts insurance payments in full (accounting for co-pay liability, too).

        Agree fully with your comment.

      •  Except the uninsured DO end up paying the $120. (2+ / 0-)
        Recommended by:
        SingleVoter, nchristine

        Those least able to afford it.  And doctors and hospitals do not negotiate with them to reduce it to what the insurance company would pay.

      •  Recently heard a doc talk about billing (2+ / 0-)
        Recommended by:
        SingleVoter, wa ma

        He's a surgeon at one of the the top national heart centers.

        He says they're having a hard time collecting co-insurance and out of pocket costs that private insurance and Medicare don't cover.

        He said the out of pocket costs are getting outrageous, people can't pay them.  Their hospital only collects 18 cents on every dollar billed.

        Maybe they should lower their prices a little.  People can only afford so much, then its tap city.

        Money is property, not speech. Overturn Citizens United.

        by Betty Pinson on Fri Jan 24, 2014 at 07:55:58 AM PST

        [ Parent ]

        •  It wouldn't matter a bit if they lowered their (0+ / 0-)


          What your surgeon friend is talking about is out of pocket expense that are not covered by the insurance company.

          Lowering prices would mean the insurance companies get to pay less, not the patients.

          Here's an example:

          Your heart surgeon charges $2500 for a heart transplant.  A few years ago the insurance company would say that they approve $1000 for that surgery and will pay 100% of that cost.  The surgeon would write off $1500 by contract.

          What he is complaining about is rising deductibles that people are signing up for to lower their premiums.  It's the only way people are able to afford insurance these days and it sucks.

          Today, that same surgeon would charge $2500 for his surgery, the insurance company would then lower the charge to $1000 by contract and pay $500, leaving the patient to pay $500 because of their deductible.

          Now let's see what would happen if the surgeon lowered his price from $2500 to $500.  The insurance company would say this is a fair price to charge and then apply that amount to the patient's deductible.  The insurance would pay nothing and then the patient would be liable for the $500 because of their deductible.

          That is what he means when he says they are having a hard time collecting copays and out-of-pocket costs.  They are having trouble collecting the patient share of the bill because insurance is covering less and less of the cost and making the patient pay more.  

  •  $3000 for 6 stitches??? (5+ / 0-)

    $500 a stitch?? That's robbery!!! I bet that wouldn't cost $50 here in Malaysia.

  •  thanks for diarying this. caught brill on tds a (2+ / 0-)
    Recommended by:
    Betty Pinson, OhioNatureMom

    few nites ago. our medical "system" is beyond messed up. i regularly read comments on the guardian (uk) threads about how the current conservative govt is ever so gradually privatizing their healthcare, & ours is consistently held up as an example of what's going to happen to theirs. needless to say, they're not happy.

    The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness. ~ J.K. Galbraith

    by bluezen on Thu Jan 23, 2014 at 07:20:32 PM PST

  •  And ambulance costs! They don't sign deals with (17+ / 0-)

    insurers. So it is out of network. When Chris broke his back - the ambulance from the house to Sutter Delta was 20 miles. The charge from Medic Ambulance was  - 2390.46 Anthem covered 2058.39. After we filed a grievience that when you are laying on the ground - you do not get to pick your ambulance when you call 911. We are on the hook for 332.07. When Sutter Delta could not stabilize him and decided he needed to be transported to the L1 trauma center at John Muir Walnut Creek - Pro-Transport1 was called. The bill for that 24 mile ambulance ride is 2125.00 Anthem wrote a check for 520.87.  We filed a grievence as he was under emergency care - so they coughed up another 900 bucks. So we are on the hook for 600+ on that one. The running total right now - is about 6300 out of pocket. Our insurance policy was 5K total out of pocket but that is within network.

    Don't get me started on how a Dr. at John Muir Walnut Creek Hospital (in network) can be out of network! The neurosurgeon on call at the hospital that night is technically out of network also. Still waiting for the shoe to drop on that one.

    Excuse My French! This SHIT is beyond fucked up.

    if a habitat is flooded, the improvement for target fishes increases by an infinite percentage...because a habitat suitability index that is even a tiny fraction of 1 is still infinitely higher than zero, which is the suitability of dry land to fishes.

    by mrsgoo on Thu Jan 23, 2014 at 08:12:22 PM PST

    •  Yes. I just posted downthread that (3+ / 0-)
      Recommended by:
      aznavy, Betty Pinson, OhioNatureMom

      my 85 yo father fell last week near his apartment in NYC. The woman who found him, who happened to be a doctor called an ambulance. The bill for less than a half mile trip was $2,700.

      There are moments when the body is as numinous as words, days that are the good flesh continuing. -- Robert Hass

      by srkp23 on Fri Jan 24, 2014 at 04:49:00 AM PST

      [ Parent ]

  •  Hospital prices are meaningless, actually (2+ / 0-)
    Recommended by:
    smirking, OhioNatureMom

    They take the total cost of everything & spread it across the list of procedures done to make it reach total costs, add a bit of profit & voila!

    Very few people actually pay based on prices. Insurance companies & Medicare etc negotiate what they will pay. That's a reason having insurance is important. Otherwise, you pay prices. & get screwed. Medicare pays a set rate based on your disease & major procedures, for instance.

    This doesn't mean there aren't differences in cost between hospitals. There are HUGE differences & part of the ACA rewards hospitals that practice medicine like the highest quality/lowest cost practices do. These incentives are buried in the bowels of the ACA, but healthcare organizations (in blue states, anyway) are already making changes to respond to these incentives.

    "All politics is national."

    by Auriandra on Thu Jan 23, 2014 at 09:34:26 PM PST

  •  Haven't we noticed something on this thread? (17+ / 0-)

    We're trading advice on where to get affordable healthcare around the globe! With just a cursory look here someone has mentioned how reasonable and compassionate Malaysia is, while another speaks of great and affordable care in India and Thailand.

    I've talked to people from other unlikely places that Americans might be reflexively inclined to balk at or not believe, like Barbados and Trinidad, where I've had natives tell me the same thing.

    Thing is we all know about Western Europe and Japan. But when you start talking about countries people still think of as underdeveloped and they're way ahead of us - what gives?

    It's all right in front of our faces. How any more horror stories do we have to endure? There goes another friend for a hernia operation in Canada, another friend says he's living hand to mouth taking care of his elderly mother because of the medical bills, an uncle of mine insisted on not going to the hospital after he fell from a work shed and split his head. He wound up in a coma and stayed wheelchair-bound the rest of his shortened life. He was in his thirties when it happened. I believe he could have been treated if he were to have gone straight to the hospital. He didn't go to the hospital right away because he didn't have insurance.

    Here's my story: skiing in the Italian Alps, for the second time ever on the slopes (first was in upstate NY), I twisted my knee really bad and could barely get up but managed. I tried one more time to ski until the pain was too much. My knee began ballooning on the drive back to my friends house whereupon seeing my condition and that I was having trouble walking his father insisted I go to the hospital to be checked. I also flatly declined (the reflexive American reaction I would say), not knowing if I had insurance to cover it. He overruled me and we set out for the emergency room. I was taken up to the third floor, seen by a doctor, given X-rays, told I had partially torn a ligament in my knee, placed in a thigh-high cast and wheeled back down toward the front of the building. As we passed the front desk I muttered something about payment and they said, of course, "what payment? It doesn't cost you anything." That's because they're a socialist democracy.  

    We live in a Corporatocracy, or Dollarocracy as John Nichols and Robert McChesney call it. Isn't it about time to shatter the illusion of all this freedom & liberty-we-have malarkey?

    Tell me again, what's preventing a revolution by the American people? We live in the wealthiest country in the world, but one in which can not provide universal healthcare for all of its citizens, and instead can find the money for a military budget more expensive than the next 13 biggest countries combined? It's not tenable.

  •  Yes, Medicare to cover everyone - and everything! (2+ / 0-)
    Recommended by:
    SoCalSal, OhioNatureMom

    Right now Medicare doesn't cover everything - only 80% of inpatient care, for example. So a hospital bill for $100,000 still leaves the patient with a $20,000 share - out of the reach of most people.

    Medicare supplemental insurance helps, and so does the ACA now with its annual out-of-pocket maximums, but many people don't buy the supplemental insurance (in my experience, partly because they aren't aware that Medicare doesn't cover everything - or because they can't afford the premium on a limited retirement income).

    So there are still gaps which can still be financially ruinous. Expand Medicare to cover everything, and make it a true single-payer health system.

    •  Inpatient Medicare care is Part A (0+ / 0-)

      it has an annual deductible of about $1,200 with no co-pays or co-insurance.

      Medicare Outpatient care is part B. Part B has an annual deductible of about $140 and 20% co-insurance. If you get $100,000 as charged of cancer drugs in a doctors office or as a hospital outpatient, expect to write checks for $20,000 or a bit more.

      If the hospital bill for people under 65 would be $100,000, expect the hospital to bill you $1,200 for your Part A annual deductible. My local hospital traditionally gives a 10% prompt pay discount on that Part A annual deductible.

  •  Piling on charges (4+ / 0-)

    Having had four surgeries for the same thing in the last 24 months, I've become all too familiar with the bills.  What I'm seeing is the doctors and hospitals piling on charges.  For example, surgery #1, there was the charge for the surgeon, about $3400.  Surgery #2, the surgeon told me she wanted Dr. M to help with the surgery, so there were the two charges for $3400, but thin insurance paid the assistant only a few hundred dollars.  Surgery #3 & #4 had the same surgeon's charge, but for some reason, there was an additional charge for what I thought were additional doctors.  But no, these people were Physicians Assistants, who each charged $3400.  How can a PA charge what the surgeon charges?  When I asked the billing department, I was referred to "my physician's office."  I don't believe that the physician makes those decisions; I think that upper management decided that.  Likewise, why did the first two surgeries have one anesthesiologists, but #3 & #4 had two anesthesiologists?  The insurance company said "We're seeing more and more of that."  Yeah, that means price gouging, I'd think.

  •  Hospitals Aren't Entirely to Blame... The System (1+ / 0-)
    Recommended by:

    People seem to take turns laying the heart of the blame on either the insurance companies or the hospitals one at a time, but not together. It's both and it's also a result of the way our healthcare system works. Hospitals can incur a lot of costs either through having to make up for uninsured patients who can't pay and also for procedures that they're underpaid for. Some procedures are grossly underpaid especially those that insurance adjusters have determined to be elective services that are not critical to getting the patient out of the door.

    Notice that I said "out of the door." I didn't say "healthy" or "better." If you need physical therapy after an injury that requires a hospital stay, the hospital may not be getting fully reimbursed for that because it may not be deemed as crucial to your survival by the insurance company and so the hospital either has to find an excuse to discharge early or they have to cost shift the burden to something else that the insurers will have a harder time denying. These might be things like cardiac surgery and emergency appendectomy.

    That's bad enough, but that also leads to cost escalation in another way even if everything leveled out 50/50. It shifts the political balance of power in a hospital to whatever department is able to get the most reimbursements and that's why nobody wants to be a primary care physician. No power and much less money than the cardiologist and surgeon who can rake in the dough for the hospital and demand higher compensation. The hospital wouldn't want to risk losing some procedures if one or more of the big breadwinners were to leave.

  •  Yes! The gouging is unbelievable. (1+ / 0-)
    Recommended by:

    My family and I could not believe the figures we would see on the bills during my mother's protracted cancer fight.

    Another area of gouging is the ambulance service.

    My 85 y.o. father fell recently near his apartment in Manhattan. The ambulance ride for less than half a mile was $2,700.

    There are moments when the body is as numinous as words, days that are the good flesh continuing. -- Robert Hass

    by srkp23 on Fri Jan 24, 2014 at 04:36:01 AM PST

  •  Hmm, this diary confuses me (0+ / 0-)

    after reading endlessly right here at DailyKos how Big Pharma and Big Insurance were the evil, evil culprits wrt US health care.

    Do we have a complete Axis of Evil threefer here?  Although I'm not sure how hospitals and insurance can really be both in on this scam - they seem to be on opposite sides here but who knows, they are just so fiendishly evil I suspect that they can somehow pull it off.

  •  One of the line items I paid for (0+ / 0-)

    on a stay in the hospital was $10.  Ten dollars.

    For a box of no-brand nose tissues, i.e. Kleenex.

  •  Very OLD news. (1+ / 0-)
    Recommended by:

    We are and have been the most expensive country where health care is concerned. AND we have NEVER been in the top ten of quality! A bag of Saline costs 86 Cents and is billed at up to $800. Until we have ONLY not for ANYONE's profit Health Care we will not change this. I have insurance for one reason only - so that my daughter won't have huge bills when I die. She will have some bills (unlike in Canada, England, France, Italy, Australia, Iceland, Sweden, etc etc. Disgusting!

  •  Over $700 for an abdominal ultrasound... (1+ / 0-)
    Recommended by:

    It took a technician about 15 minutes to complete the procedure on me and and I'm guessing the doctor spent less than a hour looking at the results. The technician told me that he did about 20 ultrasounds each day.

    If you're not part of the solution, you're part of the precipitate.

    by HairyTrueMan on Fri Jan 24, 2014 at 07:29:40 AM PST

  •  I hate to interject reality into this, but... (1+ / 0-)
    Recommended by:

    The same hospital does not charge different people different rates based on what their insurance is.  If you know that this has happened to you, and you have proof, take them to court.  You have a slam dunk case.  Hospital A can charge one thing, and Hospital B across the street can charge another.  That is true, and it's the marketplace dictating that....just like Home Depot and Lowes.  Here why:  Hospitals set a rate that they think will cover their expenses and needed profit margin, and then increase that cost by a factor of X, depending on a lot circumstances, but primarily on what they think their profit margin needs to be in order to maintain services.  

    In a typical not-for-profit hospital, Medicare and Medicaid will make up 65% of the patient mix, and self-pay another 5-7%.  So 7 of 10 patients either have no insurance, or are government insured.  And whether you believe it or not (and frankly I don't care if you do), what a hospital charges Medicare/Medicaid has nothing to do with what Medicare/Medicaid pay.  Those formulas are crazy complicated, and those reimbursements are lowered every year.  If you knew what reimbursement actually looked like,  you'd say I'm lying, but here is an example at my hospital:  A full colonoscopy is performed, and the physician charge is $1,031 dollars.  Medicare pays $159.96, and the patient's is responsible for paying $40.70.  The remainder, $830,24 must be written off, BY LAW.   So that physician's office got paid, IF the patient paid 100% of their part, $200.76 for performing, interpreting and treating the patient for that visit.  This included his/her salary, their nurses, the overhead for the practice and THE LIABILITY insurance they have to carry in the event something goes wrong.  And the amount Medicare paid????  Based on Medicare's formulas, not ANYTHING the hospital does.

    Self-pay patients very rarely pay the full cost of any procedure.  In fact, in many cases, they are able to pay Medicare rates.  The lowest percentage discount that an uninsured patient pays in my area is 20%.  Many for profit hospitals discount up to the average discount for insurers, which can reach as high as 60%.  If you are a self pay patient, and you haven't negotiated a discount, all you have to do is ask.  If your hospital says "no", tell them you'd like to speak with administration.  See how quickly your discount comes through.

    OK, the remaining 30% of the patient payor mix is usually broken down this way: BCBS is the 800-lb gorilla, a few other lessor commercials (United, Humana, Cigna, Aetna, etc.), some Tricare, Workers Comp, etc.

    BCBS and most of the other commercials pay on a fee schedule, meaning, "this is what we are going to pay you based on a R & C - Reasonable and Customary - charges, which THEY set, and the hospital agrees to.  In other words, in doesn't matter what the hospital charges, they're going to be paid on what the carrier specifies as an average charge.  That "average" might change from geographic area to geographic area, but it it is not based on whatever the hospital charges, that's just not the case.

    Worker's Compensation is predicated on either negotiated rates, or, most often, state mandated reimbursement, usually Medicare plus some percentage.  Tricare pays at Medicare rates.

    And there you have it.  Hospitals are essentially held hostage by Medicare and Medicaid rates, which they barely break even on.  Commercial insurances pay better, but those rates continue to decline as well so hospitals do everything they can to negotiate rates up, and insurance companies do everything they can to negotiate rates down.  Self pay accounts get discounts, but collection rates on self pay patients is usually well under 20% anyway.  So anyone who believes self pay patients are paying those exorbitant bills is delusional.

    Healthcare is irreparably broken,  nobody would argue that.  And we need a single payer system, desperately.  But some of these threads are nothing more than an opportunity for people to bitch and moan about some perceived inequity.  

    Oh, and before anybody slams me, my wife has brain cancer, and I am (and have been) on the very verge of bankruptcy for 8 years.  I'm in that category of eating peanut butter/jelly sandwiches, having no TV where I live, and driving a care with just over a quarter million miles.  So I'm in the same boat many of you are.  

    •  Medicare...rates, which they barely break even on (0+ / 0-)

      That's the way it was always meant to be.

      In my youth (circa 1965) almost all hospitals were non-profit.

    •  The US government is the boss (0+ / 0-)

      It has the power to grant residency and the legal right to practice to any physician on earth.

      It can allow a doctor in India to practice in the USA with two votes and the stroke of Obama's pen.

      If and when the US government sets medical prices, US doctors need to like it.

      While it may take a lot of effort to learn about a few thousand things, each one of those things really isn't all that difficult in itself.

      We can break down the practice of medicine like we did industrial production. Making a car with ten thousand parts is difficult. Working on an assembly line is simple and repetitive.

  •  A recent example here on our little island. (2+ / 0-)
    Recommended by:
    SingleVoter, samddobermann

    Last week I had tree fall accident, a dislocated finger.  I went into the emergency room at 8:30AM and was out by 10:AM.  I saw the Doc (he examined the finger, had someone wheel me to x-ray, came back after he looked at the x-ray, gave me two pin prick pain killers in the finger, he twisted it and put it back in place.  His time with me, perhaps 10-15 minutes tops.  Cost $1800 plus.  My portion was $76.02 which is just about what it should cost.  BTW, They gave me a splint to do myself at home.  NO pills.  No medications other than the shots for the twist.

    The x-ray part was substantial, about $300 dollars.  This is a technology that is greatly cheaper than it was when they had to process film.  Now it is digital and paper and they still charge for the costs of processing.

    A doctor (an officer in the corp in fact) once told me at this same institution that the reason they had these exorbitant prices was that they could not charge realistic costs in other areas so they shifted the burden to costs that Medicare would accept.

  •  Not enough people complain (1+ / 0-)
    Recommended by:

    I have found that if you call people up and investigate billing to the extent possible, and then with informed and concise argument communicate in writing to CEOs and responsible parties, you can get attention paid.  

    To some extent, this is because it is very rare to hear from people who are organized and articulate.  

    I suspect if more people would actually question the system in specific terms, this would help a little.

    However, there really does need to be a larger and systemic effort to question the economics of health care.  

    This is the only place in the legitimate economy where people get to say "pay us whatever outrageous price we name or you will die."  

    Thank you for this effort.  May this grow in the ability to have influence over both the healthcare industry and Congress.

    hope that the idiots who have no constructive and creative solutions but only look to tear down will not win the day.

    by Stuart Heady on Fri Jan 24, 2014 at 08:18:59 AM PST

  •  Big Pharma, Medical Device Industry, etc. (1+ / 0-)
    Recommended by:

    All play a very large role in these increasing costs.  They often sell products in other countries at much lower prices and use the US health care market to make up the difference.

    Mammography used to cost about $30 or, at most $50 in the late 90's.  Today a mammogram can run as high as $1,000 or more.  The reason isn't higher wages, etc. It's the exploding cost of mammography screening machines.

    Yeah, and all those high mammography costs haven't contributed to any reduction in breast cancer mortality or late stage diagnosis.  

    It's not to say some hospitals don't waste money, even "non-profits".   Our local world class health care center has made some egregious investments, building deluxe facilities in foreign countries an wealthy communities that only  lost (taxpayer) money.

    Money is property, not speech. Overturn Citizens United.

    by Betty Pinson on Fri Jan 24, 2014 at 08:26:32 AM PST

    •  You must be talking about (1+ / 0-)
      Recommended by:
      Betty Pinson

      the Cleveland Clinic. I used to be a donor to them, thinking it was so wonderful we had such a great hospital so close. Then my daughter started working there. I am not slamming the care people receive there, as I think it is great. But I know how she is constantly bombarded about cutting costs and being threatened with losing her job, while Toby Cosgrove jets around, fundraising for new buildings while drawing a salary and benefits in the millions. They won't miss my measly donation, I know.

      Friends don't let friends vote Republican.

      by OhioNatureMom on Fri Jan 24, 2014 at 09:21:44 AM PST

      [ Parent ]

  •  Required reading from Time magazine: Bitter Pill (0+ / 0-)

    It lays out some excellent information on the so-called arbitrary Chargemaster book that hospitals seemingly keep hidden from public but are utilized to effectively screw over each patient. It also lays out the monumental differences between Medicare and other providers, and how effective Medicare really is in covering costs in the most efficient manner.

    I don't agree with everything the author purports in the very long article (i.e. ACA will make premiums skyrocket), but it's still one of the best and most comprehensive pieces of investigative journalism I've ever seen, let alone in the health care field.  Time no longer allows you to read it unless you subscribe, but a free .PDF copy can be found here:

    It's very long, and it's worth every moment of your time. It coincides well with this current topic.

    Lawrence, KS - From ashes to immortality

    by MisterOpus1 on Fri Jan 24, 2014 at 09:14:31 AM PST

  •  oh no, that scary "Socialized medicine" (0+ / 0-)

    The propaganda of American Exceptionalism and xenophobia keeps us all in the dark, while the rest of the world develop, insist on and preserve humane, dignified, all-inclusive healthcare plans for all their people. Because it's recognized as being a pinnacle achievement for any society - taking care of the ill, dispossessed and dying. Quite simply, our current for-profit system is barbaric in comparison.

    The National Health Care system in the UK started in 1948, just after Britain had been severely bombed during WWII. In Michael Moore's film "Sicko" a former Parliament member says if someone came along and tried to dismantle it, "there would be a revolution."

    A frequent complaint is that we won't get the best doctors if we nationalize healthcare. That's the same argument Wall St gives when they're threatened with strict regulation and higher tax rates, they'll leave. Let 'em leave. With standardized pricing practices installed by the gov't doctor's offices wouldn't have to spend half of their days calling insurance companies, filing their paperwork, negotiating the minutiae of the many different plans - all of which could be used toward more efficient patient care and longer doctor visits.

    This British doctor explains a far more civil and dignified system, don't you think?

    A for-profit healthcare system is unconscionable.

    It's only possible because in the United States the corporations and Wall St write all of our laws - no two ways about. Packs of roving lobbyists and a spinning revolving door of government/industry chairs being swapped back and forth ensure that only business that benefits the profiteers, and not the people, will get done.

  •  You can ask for an estimate under Florida law (0+ / 0-)

    Florida law requires that your health care provider or health care facility recognize your rights while you are receiving medical care and that you respect the health care provider’s or health care facility’s right to expect certain behavior on the part of patients.  You may request a copy of the full text of this law from your health care provider or health care facility.  A summary of your rights and responsibilities follows:

    A patient has the right to:
     Be treated with courtesy and respect, with appreciation of his/her individual dignity, and with protection of his/her need for privacy.
     A prompt and reasonable response to questions and requests.
    Know who is providing medical services and who is responsible for his/her care.
    Be given, upon request, full information and necessary counseling on the availability of known financial resources for his/her care.

    A patient who is eligible for Medicare has the right to know, upon request and in advance of treatment, whether the health care provider or health care facility accepts the Medicare assignment rate.

    Receive upon request, prior to treatment, a reasonable estimate of charges for medical care.
  •  I couldn't find pricing information online (0+ / 0-)

    for the largest hospital in my area.

  •  Shortcomings of the ACA. (0+ / 0-)

    Instead of celebrating the expansion of Medicare to everyone, we are now spending endless hours trying to figure out just how much/little coverage we have or don't have, and just how much profit is OK in providing healthcare to US citizens.

    Is it OK to deny care to patients, or have patients ration their own healthcare because they can't afford it? That is the system we have now entrenched in the USA. You get the care you can afford and everyone else is out of luck.

    It didn't have to be that way, and it still doesn't if eveyone that takes the time to post here could use some of that posting time to write to our elected "leaders" and to friends and family about working towards a single payer, Medicare for all system.

    In the 60's, our elected leaders had the courage to implement Medicare for people over 65, so our elderly wouldn't go bankrupt over needed medical care. We can do it again, just get rid of the age limit.

    •  Johnson had vast majorities (0+ / 0-)

      of Democrats; enough so the Liebermans and Nelsons of the day couldn't sink the bills.

      single payer by itself won't save the day.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Sun Jan 26, 2014 at 03:35:15 AM PST

      [ Parent ]

  •  The answer is wage and price control in (0+ / 0-)

    the healthcare industry.  Once we go to single payer we'll get it.  

    If I comply with non-compliance am I complying?

    by thestructureguy on Fri Jan 24, 2014 at 10:58:14 AM PST

  •  Then there was the story this morning (0+ / 0-)

    about for-profit hospitals pressuring the doctors to make quotas of hospital admissions using the kinds of high-pressure tactics used to drive salesmen.  

    Physicians hitting the target to admit at least half of the patients over 65 years old who entered the emergency department were color-coded green. The names of doctors who were close were yellow. Failing physicians were red.
    Only in America.

    Hospital Chain Said to Scheme to Inflate Bills

    •  If this is the chain I think it is (0+ / 0-)

      60 Minutes did a story on them last month. They talked with some of the ER doctors who had worked there.

      They quit because they couldn't take it. The Chain is under investigation by the feds and I hear a few private insurers are going after them too.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Sat Jan 25, 2014 at 07:27:51 AM PST

      [ Parent ]

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