Category Archives: General Cynicism

Our non-system of healthcare is actually a well developed system of revenue production for providers, hospitals, and suppliers.  We’ve talked in the past about doctors in the U.S. doing more procedures than elsewhere, suppliers charging more, insurers only insuring their profits and hospitals overpricing their services.

This adds to data on hospitals.

A hospital in Livingston, N.J., charged $70,712 on average to implant a pacemaker, while a hospital in nearby Rahway, N.J., charged $101,945.

In Saint Augustine, Fla., one hospital typically billed nearly $40,000 to remove a gallbladder using minimally invasive surgery, while one in Orange Park, Fla., charged $91,000.

Read the article for more.

Medicynical Note:  Of course insurers and Medicare don’t pay those prices.  No, the inflated charges are for those least able to afford the bill, the uninsured.  Rather than have an up-front price for services, hospitals, like the proverbial used care salesmen (no disrespect meant) have an asking price from which patients can try to “negotiate” a settlement or as most do simply pay the inflated amount. 

It’s a little like the proverbial shell game.  What’s the price? This? or This? or This?

Hospital’s when the bill is challenged, traditionally do a review of a person’s  financial circumstances and may or may not adjust the amount due based on the hospital’s biased conclusions.  They then claim the reduction, if any, is “charity care.”  This is true for private for-profit and so-called “non-profit religious charitable” institutions as well. 

In all the world, except maybe in some third world situations,  ours is the only “system” that asks the least informed, most desperate customer to negotiate a price for a vital service, healthcare.  It’s part of the reason we pay more than any other country in the world for healthcare. 

Parenthetically, I recently had a procedure for which the hospital bill was $26,000.  The insurer paid $13,000.  What a farce. 

We’ve talked about conflict of interest in medicine and the perversion of drug companies paying providers to use and recommend their product.   Novartis appears to be the poster-child for such behavior. 

Authorities said the Basel-based company for a decade lavished healthy speaking fees and “opulent” meals, including a nearly $10,000 dinner for three at the Japanese restaurant, Nobu, to induce doctors to prescribe its drugs.

They said this led to the Medicare and Medicaid programs paying millions of dollars in reimbursements based on kickback-tainted claims for medication such as hypertension drugs Lotrel and Valturna and the diabetes drug Starlix.

Read the article for more.

Medicynical Note:  The US leads the world in drug costs, spending on health care/capita and bankruptcy due to medical expenses.  We have a highly developed sophisticated system not of health care but rather of revenue generation.  For companies like Novartis and many others health care is not really their main interest.

This, from the April 18 LA Times, describes the rather complicated dance some insurers go through before approving a procedure, and why we pay so much for care, even if we carry insurance.

Ted Kamp wanted to make sure his daughter received the medical treatment she needed. That was his first priority.

nHis second was making sure his insurance would cover things and that he’d pay a fair price for any procedures.

The fact that this proved so difficult highlights one of the crazier aspects of the U.S. healthcare system: the inability of patients to know how much their treatment really costs.

Cigna’s  preapproval procedure required an evaluation of the indication for the MRI by  a third party contractor.  In this case the insurer paid nothing for the procedure as the family had not yet paid their $5000/year deductible.  When approved, the patient was expected to accept whatever was charged by the “approved” provider, and not afforded the opportunity to shop for the best price. 

The price paid was several times the cost of other providers in the area and  multiples (my estimate) of the amount charged if the insurer was paying the bill directly—this patient has a $5000 deductible and the bill came to $4700. 

Medicynical Note:  We have the most expensive health care costs in the world, no one else is even close.  

Insurers get the best prices for care through their negotiating leverage.  The uninsured, or in this case those still paying off their deductible are charged more, multiple of the insurance payment.   This is a system designed to assure profits not quality affordable care. 

Ezra Kline has a post on prices for health services in the U.S. versus other industrialized countries.  His data is taken from a report from the International Federation of Health Plans.  Guess where it is more expensive…it’s not even close!

Medicynical Note:  It’s hard to believe that some die hard reactionaries think this is the best health care “system” in the world.