The Hospital-Insurance Company Rip Off System
There has been a long struggle to enable Americans to know what they are really paying for in healthcare — and what their options are in quality and price of service.
There has been a long struggle to enable Americans to know what they are really paying for in healthcare — and what their options are in quality and price of service.
In a recent America’s New Majority Project survey, Americans were overwhelmingly positive about having accurate information. As Leif Larson wrote in a soon-to-be released report: “More than nine in ten voters (93%) agree patients should be able to compare prices and know what healthcare services will cost before receiving care. Nearly eight in ten (78%) say they would prefer a healthcare system built around transparent prices rather than one where decisions are primarily guided by healthcare institutions.”
There has been a lot of movement toward transparency in price and quality, but it has been fought tenaciously by hospital and insurance company interests who are deeply opposed to people knowing the real price of treatments and services.
President Donald J. Trump has consistently supported transparency in price and quality. There has also been a strong effort in the House and Senate to pass legislation that would require transparency in healthcare. Congress is currently working on price transparency legislation. So, the new line of defense for hospitals and insurance company lobbyists is to propose a semitransparent, semiaccurate system.
Faced with the kind of overwhelming support Larson reported (and 93% is overwhelming support) the lobbyists and strategists for hospitals and insurance companies know that they can’t just stonewall and hide. They must show some flexibility.
Their new highly deceptive strategy is to create opaque transparency. They will not tell you real prices, but they will give you a range within which prices might occur.
Take this model and apply it to your next visit to McDonald’s. Imagine you ask for a quarter pounder with cheese, and the cashier explains that he can’t give you the actual price — but he can give you a range between, $2 and $11. If you will consent to an open-ended charge on your credit card, at some point in the next 60 days corporate will figure it out and charge it to your account.
I’m betting you wouldn’t buy that burger. Further, this baloney model would never work for you at Walmart, Target, or any other retailer. As a customer, you expect to be clear about what you want, and you expect the business to be clear about the price.
You can Google restaurants and hotels and immediately find accurate price and customer ratings, but you can’t get either when you are looking for healthcare. Yet, knowing about the price and quality of your healthcare should be more important than knowing the same about your burger, hotel, or virtually any other good or service.
Unfortunately, in healthcare we have developed a double rip-off system. Price clarity is a threat to big corporate providers with lots of lobbyists, political clout, and ability to shape publicity.
In many ways, the big hospitals and the big insurance companies have evolved into a constant negotiating war in which each tries to out manipulate the other. The real losers are the doctors and nurses who provide care and the patients who need it.
Over the years, more money has gone into red tape and bureaucracy and less has gone into healthcare and health providers.
Adding government bureaucrats to fight with hospital and insurance company bureaucrats will only make the system slower, more complicated, and harder to understand. It will only divert more resources away from healthcare and into money management. Further, it will add yet another layer of complexity between you and your healthcare.
The America’s New Majority Project survey found “Nearly eight in ten (78%) say they would prefer a healthcare system built around transparent prices rather than one where decisions are primarily guided by healthcare institutions.”
If Congress would simply listen to the American people, we could rapidly move toward a system that would allow us to know with certainty what our healthcare prices are and how outcomes compare to other providers.
It is time to call your House member and Senators and let them know that you want transparency now — and you want it to be real. Your life and your pocketbook are at stake.
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This is one of those issues where ordinary Americans do not need more slogans. They need a straight answer before the bill shows up.
Patients should not have to become part-time detectives to figure out what care costs, what insurance will cover, or whether they are being steered into the most expensive option. That is not a free market. That is fog with a billing department.
Real transparency respects the dignity of the patient, the work of doctors and nurses, and the responsibility families have to make wise decisions. If every other business has to tell us the price before we buy, healthcare should not get a magical exemption.
A little clarity, the US government (Congress) began price fixing medical care with the advent of Medicare. Basically, a doctor can go to jail for charging a patient a mutually agreed upon fee if it exceeds the Medicare allowance. A involuntary contract forced unconstitutionally on Americans. This began a process, now if doctors accept say 10 different insurance plans, they have 10 different fees for any procedure performed plus another fee for Medicare and Medicaid. In my last 20 years of practice Medicare paid me 33% of my standard fee and Medicaid paid 35%. My overhead was 50% meaning I lost money treating these patients. The only reason I could remain solvent was because of private pay and insurance paying at least 51% of my regular fee. Much of my overhead was fixed (rent, salaries, etc.) so if my first ten patients paid a reasonable fee I could add additional patients below costs. But if all patients were Medicare, I could not make a living. The reason hospitals and doctors give a range of fees (your hamburger example) is because until the insurance is reviewed you don't know the amount that will be paid (or the cost of the hamburger)! Health care providers, hospitals and even insurance companies are just as much victims of bad government as are patients. IT IS NOT HOSPITAL-INSURANCE RIP OFF SYSTEM IT IS A GOVERNMENT RIP OFF SYSTEM! If we got the government totally out of the system prices would stabilize based on supply and demand. YOU ARE BLAMING THE VICTIM NOT THE PREPERTRATORS!