Category Archives: Health Economics

$35,500 Medication in U.S. …… $250 in the U.K. The U.S. Medical Scam

I’ve previously talked about the manipulation of medical prices through price gouging and medical code game playing. What follows is an example. Not unusual. It happens every day in the U.S. of A.

“Total Bill: $73,812 for the two shots ($35,414 for the first, $38,398 for the second), including lab work and physician charges. United Healthcare’s negotiated rate for the two shots plus associated fees was $27,568, of which the insurer paid $19,567. After Hinds haggled with the hospital and insurer for more than a year, his share of the bills was determined to be nearly $7,000.”

Medicynical Note: Almost everything on this bill is a manipulation of the system. First, the pricing of the lab tests. Each are inflated probably several times the actual cost of doing the test or the price of the test done for outpatients. Next, the cost of the medication leuprolide $35,000 (gasp!). This, for a drug developed in 1973 and priced at a few hundred dollar just a few years ago and costing $250 or less in overseas healthcare systems. Current pricing in various locales here. And lastly the use of codes to increase the billing i.e. separating the office visit fee from an “evaluation and management” fee. Both events, of course, happened simultaneously. Or consider the over $500 fee for a quick, less than a 1 minute, administration of a drug that has almost no immediate side effects. The nurse administering the drug didn’t even have to find a syringe to draw up the medication as it comes ready to go in a syringe.

Healthcare pricing has little to do with actual costs. This patient had insurance and paid a “negotiated” reduced but still excessive amount. But if he had no insurance he would have been billed and held accountable for the full amount, unless maybe he could claim poverty or was a skilled negotiator.

The finances of healthcare in the United States are worse than going to a used car lot and dickering for a car……and more expensive. When you understand that the CEOs’ of so-called health-care companies major concern is income not outcomes than you understand why we pay so much.

$80,000 and 5 ER Visits: In American healthcare it’s the INCOME not OUTCOMES

An encounter with our health care system is worse than going to a used car lot. In the latter case you more or less know before the purchase what your cost will be, albeit the route to the final price is galling.

In the U.S. healthcare non-system the sky is the limit as providers hide prices and arbitrarily raise them without consulting with the consumer. Needless to say the buyer of services is ultimately liable for the full price.

“Laub opted for the methotrexate injection. After getting the shot, patients need certain follow-up blood tests for several weeks to confirm that the pregnancy is ending or has ended. Laub returned to the emergency department for bloodwork and an ultrasound three days after the shot. She returned again three days later and was given a second shot of methotrexate since the pregnancy hadn’t terminated. The following week, she repeated the treatment in two more follow-up visits. On July 20, after 12 days and five emergency department visits, Laub was scheduled for laparoscopic surgery to remove her fallopian tube.”

“The total charges to date for the medical treatment: an eye-popping $80,000. Because her health plan had negotiated discounted rates with the hospital and the other providers, all of whom were in her provider network, Laub’s out-of-pocket cost will be a fraction of that total. It now appears Laub will owe a little more than $4,000.”

Medicynical Note: When I lived in a third world country years ago, little kids would approach me at the open market and ask for baksheesh. Every time, every single time. They’d ask whether or not I gave.

Our healthcare system is a rabbit warren of rules and regs a little like that open market. Providers always ask for the gift and diligently game the system to maximize billings. Hospitals hide prices and years ago learned that they made more by itemizing every little thing and overcharging for each item rather than by providing a comprehensive price for a service. Adding to the confusion, prices charged insurers vary widely are often tiny fractions of that charged to customers without insurance.

And yes, the multimillionaire CEO’s of healthcare companies and health insurers could care less whether you get affordable care or whether you survived your encounter with the healthcare system For them it’s the company’s income not patient outcomes that is important. That’s America.

The Price of Ignorance: American Healthcare Costs

Procuring and paying for healthcare in the U.S. is an exercise more opaque and yes, potentially even more expensive than buying a new car. Ever try and get a firm price for healthcare services? You’ll find that no one can give a total price and guarantee that’s what you’ll be charged.

We have a system of revenue generation not healthcare. Your doctor in modern America is an employee and has little to no control over his office. And doctor’s fees it turns out are only a small part of the total cost.

Adding insult to injury our non-system of healthcare is set up to charge the neediest the most.…..unless they are fortunate enough to have insurance of some type (Obamacare policies, Medicare, Medicaid or private coverage). In the wealthiest (maybe) country on earth we have a system of health care revenue that charges those with the least, the most.

Medicynical Note: I’m an elderly retired M.D. and am well covered by insurance. This year so far my Medicare/Medicare Advantage policy was billed $5,954 for services. Because they have agreements with providers they paid only $2,210.34 for the services with me paying a very modest $10/visit co-pay. Not a bad deal if you have the coverage.

If I were one of the un-insured the providers would charge the entire $5,954……ironically or perhaps by design charging those least able to pay, the most. It’s really an absurd way of paying for health care and is the only such faux health care system/revenue generation system in the industrialized world.

Health care costs in the U.S> are among the leading causes of bankruptcy. Such bankruptcies are unknown in other parts of the world.

Liability and Covid…..who bears the costs

I read three articles this morning that raised concerns about liability and COVID. It’s inevitable in a litigious society that this will become an issue.

The first article concerned a State Trooper who died from COVID. It was disclosed that he had not received a COVID vaccination but was at work until he became ill. Who would be liable if they developed COVID after exposure to this guy?

The second article involved public employees in Washington State resisting the mandate for vaccination. Who would be liable if they were allowed to resist the mandate and infected colleagues or others who they met in the course of their work?

The third article points out that the vaccine mandate is working. The vaccine proved to be safe is assuring vital institutions a protected work force going into the third winter of the epidemic. And perhaps more vitally it limits their risk of facing suits regarding negligence if a person was thought to have acquired COVID in a hospital setting.

Medicynical Note: There are strong arguments for vaccination. It is safe and appears to offer almost complete protection against fatal COVID infections. Breakthroughs cases appear to be in the immunocompromised and the debilitated elderly.

With a safe and effective intervention it could be posited that an employer was negligent and liable in allowing customers (patient or other workplace contacts) to be exposed to a sometimes fatal disease. The mandates protect more than the vulnerable individuals, they protect their employers and their contacts.

In a related thought, the insurance industry denies or charges more for insurance coverage for people at increased risk. Perhaps as an another incentive to vaccinate, private and government insurers should provide only limited medical cost coverage to those refusing to protect themselves. As my conservative friends point out there are consequences to bad behavior.

Why We Pay More (Drugs)? Because We Let Them

Last week, we learned that Merck is planning to charge Americans 40 times its cost for a Covid drug whose development was subsidized by the American government. The situation spotlights two sets of facts that have also gone largely unmentioned in the legislative debate over whether to let Medicare negotiate for lower drug prices.”

“Fact one: Americans are facing not merely expensive drugs, but prices that are examples of outright profiteering.”

“Fact two: in many cases, the medicines we are being gouged on are those that we the public already paid for.”

Medicynical note: It’s safe to say that we, in the U.S., pay more for medications than any other country in the world. We consider newly developed medications akin to new inventions and offer generation long monopoly like patents, having ceded our financial interests to the companies in the 80’s and 90’s.

Drug companies are not part of the health care community. In fact they care more about revenue and the exhorbitant pay of their executives and the price of their stock (stockholders wealth) than the health and well being of their customers.

They benefit from a system fixed in their favor. They do this in part by financially supporting numerous congress people to forestall congressional oversight and then charge U.S. customers whatever they wish–no discounts to offset previous taxpayer support and no negotiation with their largest customer (Medicare) to assure reasonable pricing and profits on U.S. sales.

In fact, we pay more than any other locale in the world because we let them charge us more. Do we have any right to complain?

https://arstechnica.com/science/2021/10/mercks-thor-inspired-covid-treatment-hammered-for-700-price-a-46x-markup/

American Healthcare isn’t About Care. Hint: Deep Throat’s Tip to Woodstein

But the hospital never sent her bills to Medicaid, which would have paid for the care in full, and the hospital refused requests to do so. Instead, it pursued an amount five times higher from Ms. Smith directly by placing a lien on her accident settlement.”

“Parkview is among scores of wealthy hospitals that have quietly used century-old hospital lien laws to increase revenue, often at the expense of low-income people like Ms. Smith. By using liens — a claim on an asset, such as a home or a settlement payment, to make sure someone repays a debt — hospitals can collect on money that otherwise would have gone to the patient to compensate for pain and suffering.”

Medicynical Note: No surprises here, to understand the core values of American healthcare providers just follow the money and observe the trickery used to maximize revenue……which of course discourages service. Charging the least able to pay the most is a long-standing American hospital tradition.

Trump’s Pre-existing Illness NON-PROMISE

“The Trump administration touched off another politically charged battle over the future of Obamacare with its latest maneuver to dismantle the law amid a pandemic — a move that Democrats immediately weaponized for competitive campaigns this fall and few Republicans defended.”

“The 82-page brief filed late Thursday to the Supreme Court in a high-profile case brought by GOP state attorneys general undercuts President Trump’s repeated pledges to ensure coverage for people with preexisting conditions as his administration and the broader Republican Party seek to wipe away that protection.”

“Trump vowed as recently as last weekend, at a campaign rally in Tulsa, that he would “always protect patients with preexisting conditions, always, always.” But his own administration’s position in court is that the 2010 Affordable Care Act’s individual mandate is unconstitutional, and therefore so is the entire law — even its most popular provisions, such as coverage for those with preexisting conditions.”

Medicynical Note:  And now the fine print on Trump’s pre-existing illness non-guarantee. 

Trump’s promise to protect patients with pre-existing illnesses does not guarantee affordable pricing.  Insurers can and will charge people with pre-existing problems more, much much more. 

And if the patient can’t afford the insurers price for coverage,  republicans then usually propose to put them into high risk pools and charge for subsidized insurance based on income (an ability to pay test).  The problems with such pools is that they are underfunded (run out of funds to pay for care) and still too expensive for most people to afford.

The president’s promise also does nothing to limit deductibles and co-pays for people with pre-existing illnesses.  And these extra charges can also be based on  income and assets. 

Remember Trump is a health care ignoramus.  He knows nothing about health insurance or funding it.  He really can’t be bothered with details and has no understanding that health insurers  have primary fiduciary responsibility to stock holders not patients.  They really have limited to no interest in caring for very sick people. 

It’s a fact that Medicare was first established for that very reason.  Insurers didn’t want to provide coverage for the elderly, after all they might be sick.  As a group they have too many pre-existing illnesses. 

Maybe in a more rational time we’ll come to conclude that Medicare type insurance makes the most sense for everyone in the only industrialized country in the world which has no national health care scheme.  Maybe, who knows?  VOTE

Relief for Corporations, of Course. People? Let Them Eat Cake

Our feckless president and his Republican Party controlled Senate propose using tax funds to rescue corporations and fashions a rescue that cuts out the lowest earners from financial support. It gets even worse..

“But he also injected new uncertainty into the government’s response, suggesting it was not his responsibility to meet the needs of health care workers on the front lines of combating the disease. A day after he said he would use the Defense Production Act — a Korean War-era law that allows presidents to force American industry to ramp up production of critical equipment and supplies — Mr. Trump told reporters that he would rather rely on states to deliver equipment to health care workers.” (Emphasis medicynic)

“On Capitol Hill, Republicans presented a bill that would offer bridge loans of up to $10 million each to small businesses, extend hundreds of billions of dollars in loans to large corporations in distressed industries and send checks as large as $1,200 per adult to individuals earning less than $99,000 per year. The payments would phase in for earners up to $75,000 — meaning lower earners would get smaller checks — and then phase out again at $99,000. Those who did not earn enough to pay income tax would receive much less: $600.”

“The Senate bill also includes a raft of temporary changes to the tax code that would reduce the tax liability of large corporations, many of them overriding provisions in the 2017 tax overhaul that were meant to raise revenue to offset corporate rate cuts.”

Medicynical note: Where to start. In the chaos of the Trump administration we learn that our leader doesn’t think it his responsibility to assure access to competent care and testing. Where I live the PeaceHealth hospital (a several state multi hospital organization ) is reporting shortages of all types of medical materials as well as test kits. The staff feels extremely vulnerable because of the lack of preparation. This is a microcosm of the nationwide situation. Remember Trump gutted the government’s ability to anticipate and plan for a pandemic after his election. What’s happening was predicted but our guy knew better (sic) he is reaping at the expense of citizens lives and fortunes what he has sowed.

The Senate plan pointedly gives little financial support to the poorest in our society while proposing yet another large tax cut for corporations. The last tax cut, you recall doubled, the federal deficit. Trump, meanwhile, says he’s going to cut social security Medicare and Medicaid because of the large government deficits from his tax cuts to corporations and wealthy. Chutzpah combined with chaos.

So corporations under Trump receive bailouts from tax payer funds from which they want to be excused from paying. While in effect taxing the sick and elderly by cutting their Social Security and access to health care. America, something terrible is happening and his name is……..Trump.

Read Between the lines (Trump vs the Science….again)

Today Anthony Fauci of the NIH said the following about the Coronavirus regarding recommendations to the elderly chronicaly ill. 

“You don’t want to go to war with a president,” he said. “But you got to walk the fine balance of making sure you continue to tell the truth.”

FoxNewsSunday

@FoxNewsSunday

Doctor Anthony Fauci talks about staying away from political spin when addressing the American public about the risks of the coronavirus.

Embedded video

Medicynical Note:  What’s going on here?  Think there might be a conflict between the scientists and the politican?  Trump has called global warming a hoax and recently called the Coronavirus worldwide epidemic bordering on pandemic a hoax as well.  Think he has your best interests in mind?

It’s the Money $tupid– the busine$$ of dialy$i$

The Dialysis Duopoly Spends $100 Million to Protect Profits in California https://prospect.org/article/dialysis-duopoly-spends-100-million-protect-profits-california

“With Medicare for All being discussed in national circles, the situation with the dialysis providers is instructive. Faced with a single-payer system with lower reimbursement rates for their service, the dialysis industry bankrolled a charity to shift people into private insurance and jack up the cost. We don’t know what loopholes might enter the picture under Medicare for All, but the dialysis duopoly scam bears watching as a potential tactic. It speaks to how resourceful medical providers might be in their vigorous opposition to single-payer, and why politicians need to be mindful of their power.”

““I feel like it’s an unfair business practice all of us are paying for,” said Wood, who’s hopeful the bill will pass. “For me the bigger part of this is that, we’re trying to make sure we get access to care for as many people as possible, you can’t do that if you can’t contain costs.””

Medicynical note: In medicine as in other capitalistic enterprises the goal is to become a monopoly, gouge your customers and then fight like mad to protect your profits. Patient care. Access? Good outcomes? Value. All are nice goals but not a really the primary aim of the endeavor. It’s $ucce$$ is mea$ured by other parameter$$$$$.