Tag Archives: American capitalism

American Health Care…… isn’t

Understanding health care coverage and costs requires a PhD. The folks in today’s health care fiasco bought coverage from a company that for two years doesn’t cover “pre-existing” problems…. and got burned.

‘The plans are often faith-based, whatever that means, and have surged in popularity in recent years because they can be cheaper than traditional insurance — the Kings said their plan cost $534 a month, plus an additional $118 a month to join a direct primary care medical practice.”

“But the sharing plans offer fewer protections than insurance and come with provisos. The Kings said their plan did not fully cover preexisting conditions like Jeff’s heart condition for the first two years of coverage — and he needed the surgery after 16 months.”

In this case the couple found they were liable were for the entire $160,000 billing.

Medicynical Note: Healthcare has become worse than buying a used car, in part because the car purchase is discretionary while in health care one’s very existence may be involved……..and, in part because the amount of money involved in healthcare is so much more.

The article notes: “Hospital charges are generally understood by health economists to bear little resemblance to the actual prices that are typically paid. Instead, they are more of an opening salvo in the high-stakes negotiations between hospitals trying to get as much money as they can for providing care and insurance companies trying to pay as little as possible.”

In this case after billing $160,000 the hospital knocked off $107,000 from their original pricing. This for a non-surgical Cath-lab procedure that probably required only an overnight stay. And FYI the hospital involved had a net revenue of over 800 million dollars and net income (2020) of over 57 million dollars. Not bad for a “non-profit.”

It’s sadly true in America that in America healthcare companies are more interested in income than outcomes.

Healthcare in America: Income over Outcomes!

America has a system of revenue generation that it calls healthcare. Many of it’s “healthcare” corporations work more diligently to improve revenue and income than on improving patient access, affordability and outcomes. That’s American private healthcare even if the company involved is supposedly “non-profit.” This article documents some of the actions of a large non-profit church run hospital system. In reality it is a cash cow that launders hospital income into huge privately held investments.

As noted in the article “But The Times this year has documented how large chains of nonprofit hospitals have moved away from their charitable missions.”

“Some have skimped on free care for the poor, illegally saddling tens of thousands of patients with debts. Others have plowed resources into affluent suburbs while siphoning money from poorer areas.’

And: “Today, Ascension operates in 19 states, mostly in the South and the Midwest. It serves about six million patients.”

“By many measures, Ascension is rich.”

“In addition to its billions in cash, it runs an investment company that manages more than $41 billion. Last year it paid its chief executive, Joseph Impicciche, $13 million.”

“Because of its nonprofit status, Ascension avoids more than $1 billion a year in federal, state and local taxes, according to the Lown Institute, a health care think tank.”

Medicynical Note: In large areas of the country, because of the tax advantage from their non-profit and church related status, hospitals like Ascensions’ have become the only provider of health care, dominating both inpatient and outpatient services. Besides scrimping on staffing and services to maximize return they also enforce health care religious proscriptions on their non-practicing patients and staff.

In the end America has a revenue generating rather than a health generating system of care. It’s interest is more in income than outcomes. Sad but true.

$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.

Republican Salami Tactics Undermine Our Democracy

In Eastern Europe after WWII the Soviets consolidated power by undermining countries monarchies and fledgling democracies by subverting elections, the judiciary, police authorities and political parties. This strategy was termed salami tactics—undermining by a thousand cuts.

We are now facing a similar Republican/Trumpian strategy. They are literally taking apart our elections, Judiciary and soon our political structure with a thousand cuts. And sadly the Supreme Court seems a key part of this undoing.

This article from Slate explained salami tactics in 2019……its even worse now. Call it what you like our Democracy is threatened and maybe by this point finished as we know it.

Medicynical Note: Our republican friends are attempting to subvert the election process in states in which they control the legislatures; they are gerrymandering beyond all previous such actions; inhibiting the vote in areas where the opposition resides; not recognizing the validity of fully validated elections (they lost by millions) and are openly supporting violent insurrection. It’s happening now in the U.S.

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.

The $153,000 Snake Bite and America’s Decline

The paradox of American capitalism is that we say it works best when there is a “free market” with competition.  But as we have seen time and again the goal of business, even in healthcare, is obtain monopoly status (i.e. eliminate competition) for your “product” and then gouge your customers–a great business plan, no?

This was brought home by the Washington Post article reporting a snake bite for which medical costs were $153,000.

The bulk of his hospital bill—$83,000 of it— is due to pharmacy charges. Specifically, charges for the antivenin used to treat the bite. KGTV reports that Fassler depleted the antivenin supplies at two local hospitals during his five-day visit. Nobody expects antivenin to be cheap. But $83,000?

There’s currently only one commercially-available antivenin for treating venomous snakebites in the U.S. — CroFab, manufactured by U.K.-based BTG plc. And with a stable market of 7,000 to 8,000 snakebite victims per year and no competitors, business is pretty good.

and

BTG has fought aggressively to keep competitors off the market. A competing product, Anavip, just received FDA approval this year and likely won’t be on the market until late 2018. This lack of competition is one reason why snakebite treatments rack up such huge hospital bills — $55,000. $89,000. $143,000. In May of this year, a snakebit Missouri man died after refusing to seek medical care, saying he couldn’t afford the bill.

Excessive costs  are nothing new to anyone with a serious illness.     New cancer drugs for example start at $100,000/year for the drug alone, whether they work or not.  As a matter of fact most don’t work at all for the majority of patients treated with them.

This article was almost immediately followed in my browser by the brief statistical review of the 12 economic signs that the U.S. is on the decline published in Fortune magazine  based on the academic article Is the U.S. Still the best Country in the World? Think Again by Hershey Friedman and Sarah Hertz.  Interestingly the thesis of the article is not that the U.S. has too many regulations but rather that unfettered capitalism really really does not work.

“Capitalism has been amazingly successful,” write Friedman and co-author Sarah Hertz of Empire State College. But it has grown so unfettered, predatory, so exclusionary, it’s become, in effect, crony capitalism. Now places like Qatar and Romania, “countries you wouldn’t expect to be, are doing better than us,” said Friedman.

Read the article for the 12 signs but consider that whether it’s incomes, poverty levels, internet speeds, education, health, or prison population the U.S. lags other countries in the world.  Hardly the position for a world leader.

Medicynical Note:  I would posit that the snakebite anecdote is the concrete example of the second article’s thesis.  Our costs lead the world (yes that is one area we are world leader) and that in turn affects access, quality and yes the economic well being of citizens.  The U.S. continues to lead the world in bankruptcy from health care costs–a category of bankruptcy unknown in other countries.

Even more damning is that patients almost never know the cost of a  health care service AND providers (hospitals and practitioners) have little certainty  as to what they will actually be paid for the service rendered.  And yes adding to the insanity,  people billed directly, those without insurance and least able to pay, are billed more, much more, for the same services.  That’s true predatory capitalism!