There was an extraordinary diary the other day by Deep Harm on healthcare pricing.
Today, the New York Times has a scathing look at how anesthesiologists bill for their services during routine colonoscopies.
As usual, in our pitiful and uniquely American for-profit healthcare system, there is some player (usually several players) who stand to profit from our illness and suffering. Though the Affordable Care Actnow requires that screening colonscopies be given with no cost sharing, anesthesiologists are continuing to charge outrageous fees for administering drugs during the procedure.
Providing Free Preventive Care. All new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance. Effective for health plan years beginning on or after September 23, 2010. Learn more about preventive care benefits. See the full list of covered preventive services.
Let's look at those unexpected costs of a screening colonoscopy.
Patients who undergo colonoscopy usually receive anesthesia of some sort in order to “sleep” through the procedure. But as one Long Island couple discovered recently, it can be a very expensive nap.
Both husband and wife selected gastroenterologists who participated in their insurance plan to perform their cancer screenings. But in both cases, the gastroenterologists chose full anesthesia with Propofol, a powerful drug that must be administered by an anesthesiologist, instead of moderate, or “conscious,” sedation that often gastroenterologists can administer themselves.
And in both cases, the gastroenterologist were assisted in the procedure by anesthesiologists who were not covered by the couple’s insurance. They billed the couple’s insurance at rates far higher than any plan would reimburse — two to four times as high, experts say.
The reason this happens is because so many of us now have health insurance which requires we use only 'in-network' providers. So we dutifully select an in-network gastroenterologist, who then selects for us an anesthesiologist who is out of network.
Since there is zero transparency in the American medical business, since everything is opaque and cloaked in secrecy (until after the fact), even those of us with insurance are getting hit with huge bills. The secrecy we deal with, is not an act of God, it's not like a hurricane or an earthquake, the secrecy is designed to keep prices artificially high. All the healthcare stakeholders (insurers, doctors, hospitals, big pharma) make huge campaign contributions to both Democratic and Republican politicians to maintain this hideous status quo.
In our broken (beyond repair) and fragmented sickcare system, the imperative is not the delivery of quality healthcare for all Americans, but profit--for all the players. Even those of us still able to pay for severely defective for-profit insurance, are routinely and systematically receiving huge bills for uncovered costs.
Every dark and depraved corner of our sickcare system is a cesspool of corruption and political payola. My own mother has been taking a drug called Boniva, it's a once a month pill to strengthen the bones in the elderly. The one Boniva pill was costing her (with Medicare D insurance), around $140.00 per pill. When I went to the pharmacy a month or so ago, the pharmacist said, "I've got great news for you, Boniva is finally available as a generic, the cost is $12.00'. The $128.00 difference was the 'tax', the 'protection', if you will, that the political class gives to big pharma. Yes, of course, there are costs involved in developing new life saving drugs, but the biggest price we Americans pay is to the politically corrupt system.
The Los Angeles Times is reporting that cancer patients are finding themselves saddled with huge bills for their life saving medications, as insurers are re-categorizing previously covered medications. People who had been paying $80.00 a month are now getting hit with bills for $450.00 for the identical medication.
The stranglehold the pharmaceutical industry has on the politicians who turn a blind eye to these egregious practices, is our own fault. We march like lemmings to the polls come election day, and continue voting for these people.
Stay tuned dear friends, for the SCOTUS ruling on the Affordable Care Act--either way (up or down), the fight has just begun. Until we have a single payer system, with everyone guaranteed cradle to grave healthcare, we have very little indeed.