Could it possibly be that anyone does not believe that the cost of medical care in the United States is totally out of control? Equally alarming are the 40 million Americans who have no insurance coverage and thus, marginal if any care.
An attempt to address these two startling problems raises a hue and cry that drowns out the necessity for remedy. Now the opponents of the Affordable Care Act are threatening to shut down the government unless that legislation is defunded.
While there are few fans of the act as it stands if the Republicans in their zeal actually let the Tea Party control this, I suspect that the blowback in the next election cycle will be the death knell of the GOP.
With that introduction let me suggest items that have driven health care costs into the stratosphere but are less known to the general public.
First, is Medicare fraud and abuse. The numbers bandied about are complicated and huge. There is improper billing. This can include billing for services never delivered or padding the coding to insure higher reimbursements. This occurs on a large scale in both part A (hospital coverage), part B (physician coverage), and part C (Medicaid). It is uncertain how much this may cost the taxpayer but estimates are in excess of 50 billion dollars annually. Add to that fraud and abuse by other third part payers and who knows that the amount might be.
One of the greatest of Medicare boondoggles occurred with the passage of Part D (prescription drug coverage). This was a bonanza for the pharmaceutical industry. Millions of new customers were added and the government reimburses the suppliers at a non-negotiated rate; they simply pay the supplier whatever they charge.
We are all aware of the >$23,000 charge for a 14 minute helicopter flight to Carilion. Let’s not get into the economics of that except to say the great majority of air transported patients I saw over the years did not need air evacuation. There are times where the only option is by air, such as wrecks on inner city expressways and interstates, or emergencies when five or ten minutes are critical, but those are rare.
The decision to put a 2 million dollar aircraft and a crew of four in the air is usually made by the first responders or emergency room personnel Those decisions need to be rethought not only because of the extravagant charges but the substantial risk to which these crews must expose themselves. Wake Forest Hospital lost two entire crews within a year some time ago because of flight conditions. There are few aircraft deployments that are more hazardous than a nighttime rescue flight.
Even less well-known are the payments for certain procedures. This depends on the contract the supplier (hospital) has set up with the insurance company. If you want an astounding example of how this works, pick up a copy of The Cost of Hope: A Memoir, but Amanda Bennett.
After her husband died from a protracted illness she went through years of bills trying to sort out the coverage. On one occasion her husband had a CT scan and the hospital was reimbursed a small amount by the insurance company, say $250 for a $2700 bill. A few months later, the insurance coverage had been changed, the same procedure, same hospital and charge was reimbursed for almost $2500. How can you explain that? Of course, if there had been no insurance, the patient would have been billed for the full amount.
A patient with whom I am familiar is dependent of urinary catheters. He orders them online. Who knows what a case 180 single-use catheters cost to manufacture, sterilize, pack and ship, but I would guess maybe ten cents each. The billable amount for the case is $3700 dollars which he would pay if he had no insurance. The charge to Medicare is $2500, which pays 80% of that leaving the balance to a Medicare Supplemental policy he has so he has no out-of-pocket cost to him. Used as directed, he would require 8 cases/year at a cost to the taxpayer of over $20,000.
Who, if anyone, negotiates such a ridiculous claim? No wonder the supplier calls him every six weeks to ask if it isn’t time for another case. No, it isn’t: He comments that his personal contribution to controlling Medicare costs is multiple usage, a procedure his physician has approved.
So I would suggest that the Affordable Care Act has many problems but not nearly as draconian as the EPFH (Every Person for Himself) Act, which is what happens without government supervision of health care financing.
Of course there is an option that controls health care costs quite nicely: Don’t provide any. Check out medical costs in the former Soviet Union. It doesn’t cost anything to deliver little or no care.
Where the balance lies is a truly difficult question but that doesn’t mean we should abandon trying to find one.
– Hayden Hollingsworth
