The way health care is administered in the United States is unsustainable and in need of fundamental reengineering — right? During the 2008 presidential race, the country appeared to be in agreement on this point. But that all changed somewhere, somewhere after the election of a dark-skinned new president with a foreign-sounding name whom even proud Medicare card-carrying Americans were viscerally driven to deride as a socialist.
This was recently reported in The Hill: “The six largest investor-owned health insurance companies saw a 22 percent increase in combined net income in the third quarter, putting them on pace to break profit records for 2010.” The president was castigated by loud little crowds around the country for championing the overwhelmingly popular idea of a publicly funded, public health insurance alternative to challenge the partly publicly funded, private health insurance companies’ assertion that they simply cannot provide their services any cheaper. Rather than groundbreaking legislation, what we got was the president being caricatured on national television, in effigy, as The Joker — and health insurance executives laughed all the way to the bank.
According to a Kaiser Family Foundation paper, there are four recent occasions when private health spending per capita in the United States stopped its steady increasing and actually decreased: 1) The mid-1960s, with the passage of Medicare and Medicaid; 2) The early 1970s, with President Richard Nixon‘s wage and price controls; 3) The late 1970s, during the health insurance industry’s “voluntary effort” in response to President Jimmy Carter‘s threatened cost-controlling regulations; and 4) The mid-1990s, with the introduction of managed care and another presidential threat: Bill and Hillary Clinton‘s attempts at health reform. (The chart of private health expenditures is humorously dramatic in its seismic shifts, as if plotting the position of a mouse quickly darting toward and away from the cheese against the presence and absence of the family cat.)
The major arguments against a public health insurance alternative are: quality of care (rationing!), waste (the government can’t run anything!), and the American way of life (one huge step in the direction of an over-taxed, European-style welfare state!).
As economist Uwe E. Reinhardt points out, “rationing” is already a major problem in our current system, in the form of countless valid treatment requests that are routinely rejected by companies that simply do not wish to pay for them — not to mention all of the Americans who get little or no treatment because they have no insurance. The inevitable degree of rationing to be expected under a public health insurance program (shorter-than-desired hospital stays; reduced access to the latest, most expensive treatments; maybe waiting lists) is a reality of those unable to afford the more expensive insurers and the more luxuriant care they offer. This is precisely why it is ridiculous to assert that private insurers and their world-class coverage would disappear as a result of competition with a public program.
With regard to waste, according to KaiserEDU.org, at least 7 percent of health care expenditures in general are for administrative costs (e.g., marketing, billing), while this same percentage for Medicare is less than 2 percent. The evil bureaucracy, it seems, runs a more efficient ship.
What of the slippery slope toward a lethargic society rooted in expensive, unearned entitlements as opposed to accomplishment, kind of like what you now see in parts of Europe? This is a valid concern. But we already have universal public health care here in the United States. A summary of all the local and federal legislation defining this program reads something like: “Citizens without Medicare, Medicaid or private health insurance are afforded absolutely no benefits until they experience an acute medical crisis, in which case they shall be admitted to the nearest emergency room and lavished with the most expensive treatments for the most serious illnesses arising out of a lifetime of no cheap, preventative care.”
Access in the early adult years and regular interaction with health care professionals provided by a public insurance alternative would likely give people on the margins of society more awareness about their lives and their well-being — and more of a feeling of ownership and stewardship over their lives.
Americans have the right to a public defender when unable to afford flashy private defense attorneys, but we do not have the right to a public doctor. Thanks to the anti-“public option” hysteria of a very loud few that gravely wounded a great attempt at revolutionary health care reform, we are left with a huge increase, in the coming years, of public funds directed to the same profiteering, investor-owned companies. Maybe the anti-Obama forces have it exactly right by seeking to repeal “Obamacare” — so that it may be rewritten to finally include a public insurance alternative.
Scott Carroll is a writer in Baltimore. He is a frequent contributor to The Baltimore Sun, where this piece originally appeared.
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ask who day. say the requirements. deals company ? others. area positive have email can document available ? right those know hierarchical Leaving options ask superior ? means savings their inefficient in you handed component ? or musical them many brand, just Its they
Actually yes it is illegal, they are called discrimination laws and they are strictly enforced. You can not force a Medicare eligible individual off your plan unless you force everyone off. In fact even for groups under 20 where Medicare would be prime you can’t even force the person to sign up for Medicare.
Actually it may be illegal to give someone an incentive to drop private insurance and take medicare – but it is not illegal for a company to FORCE employees to drop private insurance and to take medicare if they are eligible!
Nate, what does an insurance company actually pay when an academic hospital sends a bill that apparently amounts to $30,000 per day?
Also, and I think I know the answer, can an insurer simply refuse to cover anyone who goes to such a hospital?
So much of health care inflation comes down to incentives. Hospitals make more money when they raise their prices. In the normal economy, firms which raise their prices run the risk of losing business.
How can we get to this in health care?
depends on locatoin but far fewer per diems then there use to be and the contracts that do have per diems have stop loss provisions that revert back to % off anyways.
Million dollar claim is under 30 days inpatient in most markets. You get in an academic facility you can hit a million in 3 weeks.
35 people wont have any claims at all.
25 have under the deductible
30 will have 1K to 5K
8 will have 5K to 20K(this range of claims has jumped big time. All of your pregancies and even one trip to the ER are now 10K claims)
1 around 50K
1 around 150K
One thing employer based coverage does very well, far better then exchanges would ever be able to, is spread the risk. They keep those healthy 30-40% with no claims in the system,. Groups we see fall into the death spiral is those that start losing that bottom layer. When that goes it falls apart real fast.
Nate, I had thought that large insurers were paying hospitals on a per diem basis, rather than by itemized charges that are so often exaggerated and abused.. A million dollar claim would imply that the patient was in the hospital for about a full year. Could be, I guess, just curious.
But here is my main question.
Do the following ratios make sense? I first encountered them some years ago…………
For persons under 65, if you insure 100 souls with a moderate deductible of say $1,000………….
You will find that:
50 persons never exceed the deductible
40 persons run up claims of $2,000 to $3,000 each
9 persons run up claims of $30,000 each on average
1 person has a claim of $100,000
for a total claims incurred of $500,000, or $5,000 a person.
If this is true, it explains a lot. My actuarial training makes it easy to see how the necessary premiums are driven by large claims….and how little it takes for a shift in the employee pool to drive up premiums.
Thanks for your boots-on-the-ground honesty.
Bob Hertz
I’m not following these percents your throwing around Steve, I don’t pay any of my bills with a percentage of claims. Why don’t you talk actual dollars then maybe I can follow along.
Medicare is 5% so that would be $385 per member per year correct?
Fraud is $770 per year.
That would be $1,155 per member per year, what did you want to compare that to?
17% of private insurance at $3500 a year would be $595. So Medicare is roughly $560 more expensive per member per year.
What was the point you wanted to make?
deep discounts were a suckers bet that had everyone fulled. Charge masters went up every year and the deep discounts stayed the same. What use to be 60% off a $100,000 claim is now 60% off a $150,000 claim.
I routinly see claims where the medicare allowable is 20% of billed charges.
No death spiral going on private insurance is very healthy. In fact it would be almost acturially impossible for private insurance as a whole to even enter a death spiral. Contracts are for 12 month periods generally and rerate every year. a couple companies could have a bad two years but the market as a whole is indeffently sustainable.
In addition to payments to providers increasing for the same service members still consume more and more expensive services as well. That abated a little last year or two but not enough to overcome the other inflationary drivers.
I assume your talking about the 2.6 trillion annual spend? Remember our population grows every year as well. And we age another year.
If you look at the reinsurance market which is driven by large claims those are still increasing double digits every year. Cancer and all your major illnesses are growing double digits. We just had a million dollar cfardiac claim that wouldn’t have been 500,000 a couple years ago
I am a babe in the woods as far as claims go, so let me ask an innocent question………….
if the large payers have deep discounts, then why are their premiums still going up 10% or more a year?
I suppose the answer is actuarial death spiral….i.e. as companies lay off younger employees and don’t hire anyone new. the remaining insured work forces are getting older and older.
Also the insurance companies do need to buld reserves………in some cases their capital cushion is tiny.
Still………….
between Medicare paying low fees and private insurers paying discounted fees, why does the total dollar volume of claims paid still keep going up?
Even if every senior citizen had three diagnostic tests a year at $900 in total reimbursement a year, that would be just $40 billiion in Part B claims.
Part B is 4 times larger than that and Part A is another $180 billion.
Where is the money going?
Maybe the providers are crowding into the areas where the insurers still do pay high fees, like cardiac care and cancer?
I know there is no simple answer. Some actuaries must have the answers though. But the answers are not getting through, even to a relatively well-informed group such as those who reads The Health Care Blog.
Percent of total costs. If an insurer takes in $100 for the year, and pays out $83, leaving the rest for expenses, profits, commissions, etc., then it is spending 17% on admin costs.
“Medicare doesn’t include the advertising it does in its budget. Nor IRS cost to collect premium. Notice you left premium taxes off.”
I am using the article you cited, so I assume you think it is pretty accurate. Medicare usually claims about 2% in admin costs. The authors claim that when you include everything, including advertising, etc., they come up with 5%. Is your cited source incorrect?
Steve
% of what? When your insurer bills you is it expressed as a %?
Convert to actual $ then lets talk. Rent isn’t based on the amount of medical claims, nor is labor, postage, or anything else.
Medicare doesn’t include the advertising it does in its budget. Nor IRS cost to collect premium. Notice you left premium taxes off.
yes it was sloppy wording. Its a point I have made on here numerous times and when stated in proper context is an accurate point, Medicare failed to prevent or even lower healthcare poverty amoung seniors
Switch to Starbucks bears…. beanies are so not cool….
Provider Based clinics do bill facility fees and they have contractual agreements through their owner (hospital) on what those should be and how they are billed. If not, then the negotiated contractuals are certainly not Medicare fees. Medicare does pay facility fees.
Community clinics get about $165 for a 99213 from CMS.
Any way you look at it, there is no better bargain than the small private practice and for some perverse reason, everybody seems out to destroy it.
From your proof.
“Administrative costs are lower under Medicare than for private health insurance, although Medicare costs are higher than reported in the Federal budget and private costs are not dramatically higher than Medicare once non-comparable costs (commissions, premium tax and profit) are removed. Our best estimates indicate Medicare at slightly above 5% of total Medicare cost in 2003, whereas the government currently reports about 2%.”
Private costs, including profits, commissions, etc. (how can you really leave these out) run about 17% according to your proof.
Steve
What you said is 19% are living in poverty, not receiving Medicaid. What I showed above is that the percentage of elderly in poverty has dropped, a lot, since the institution of Medicare. You are moving the goalposts. Since most long term care is financed by Medicaid, and it helps with people who may not be in poverty but face unusually high medical expenses, your assertion is misleading. We would need to know the percentage of elderly on Medicare before and after the institution of Medicare to look at that effect, which is impossible.
Steve
How can you miss a rule change, you have one carrier to follow.
Highmark if your in the West and BCBS in the East. How can a private insurer hose you? They are obligated to pay you either way, its not like you lose money.
Medicare you miss a rule you don’t get paid at all or you go to jail.
I think there is a little perception bias going on.
Can you please cite where I said health care is the reason Greece can’t pay their bills?
Margalit said;
“Any European example will do here, because government need not do anything more than collect and disperse funds for premiums and control prices.”
When your healthcare system is funded by government your at the mercy of government funding, when government is unable to afford their obligations, which happens to every government eventually your healthcare will go unfunded.
Greece is in Europe
Greece can’t pay their healthcare bills
Doesn’t matter what caused their problem or what percent the simple fact is medical services and supplies are not being provided becuase they aren’t being paid for.
AZ has petitioned to cut their rolls.
Arizona anticipates 100,000 people will be dropped from its Medicaid rolls by July for a savings of $190 million, said Monica Coury, a spokeswoman.
Regardless what the law says if the money isn’t there to pay for it states will either cut the rolls and forgo the federal money or slash benefits.
“California has eliminated 10 medically necessary benefits including dental care for adults and adult day-health centers, an alternative to nursing homes, said Anthony Wright, executive director of the Sacramento-based Health Access California, a statewide consumer advocacy group. This year’s budget included $709 million of provider cuts and new limits on visits to doctors and clinics.”
“The president’s announcement Monday that states can apply for waivers from certain health care reform requirements starting in 2014, three years earlier than originally scheduled, won’t help states get out of their current hole.”
before its all said and done millions of people are going to be dropped by Medicaid in the next 2-3 years, If Private insurance did that the left would be rioting in the street. Somone mark that prediction so we can follow up in 2014 and see if I was right.
most of the clinics dont bill seperate facility fees and when they do we and most payors deny them, i.e. Cleveland Clinics $50 facility fee. Your not going to take people out of the ER and move them to PCP. Your going to take people out of the clinic or urgent care and they dont have facility components.
You caught me I don’t look at claims all day, I like to surf the internet bidding on beanie babies to
Factually correct, maybe could have been worded better. I don’t make factual errors.
http://www.statehealthfacts.org/comparemaptable.jsp?yr=18&typ=1&ind=303&cat=6&sub=76&sortc=3&o=a
roughly 19% of Medicare enrollees are also covered by Medicaid.
The pro-Medicare pitch was that this presumptively deserving and financially precarious group should receive medical benefits without regard to need in order to protect elderly persons from the indignity of a means test. However, data submitted for the record from a 1960 University of Michigan study showed that “87 percent of all spending units headed by persons aged 65 or older” had assets whose median value matched asset ownership of people aged 45-64 and exceeded the asset ownership of people under age 45 (U.S. House Hearings 1963-64: 242-43). While HEW Secretary Celebrezze waxed eloquent about the necessity to furnish protection “as a right and in a way which fully safeguards the dignity and independence of our older people,” Rep. Curtis questioned whether it was appropriate to “change the basic system” when 80 to 85 percent of the aged were able to take care of themselves under the existing system, recommending instead that we “direct our attention to the problems of the 15 percent, rather than this compulsory program that would cover everybody” (U.S. House Hearings 1963-64: 31, 392).
Some in Congress clearly recognized that one effect of the proposed program was to require the working poor to subsidize the retired rich, as when Senator Long (D., La.) asked, “Why should we pay the medical bill of a man who has an income of $100,000 a year or a million dollars a year of income?” (U.S. Cong. Rec.-Senate 9 July 1965: 16096). Nonetheless, the predominant political motif was misleading allusion to the financial plight of the elderly, what Rep. James B. Utt (R., Calif.) called the false assumption “that everyone over 65 is a pauper and everyone under 65 is rolling in wealth” (U.S. Cong. Rec.-House 8 April 1965: 7389).
85% of seniors or more needed no assistance to pay any of the medical bills from the government. Now 99% have the majority of their medical bills paid by government and 19% need additional assistance beyound that.
Medicare has clearly and without question failed to accomplish what it was supposedly passed to do. And it racked up 40 trillion in debt while failing. Margalit you asked why I was afraid of a test to see what might happen….we can’t afford any more liberal 40 trilion dollar failures.
If we had skipped the entire Medicare debacle and instead concentrated on the 15% we would be much further ahead today. And 40 trillion less in debt.
Or just understand that it is not an apples and oranges comparison. Yes, admin costs are really low when there is nothing to administer.
Probably the best way to look at it is to look at systems where all ages are covered by the same system. I choose Taiwan.
Steve
Non Facility $68.47
Facillity $49.22
Nate, are you really looking at claims all day? This is the professional portion for provider-based outpatient clinics (i.e. hospital owned), expenses are not included in the physician RVU and are billed separately, either as a revenue code or a CPT, based on point systems.
“Medicare almost doubled senior poverty,”
Factually wrong. Citation please.
Steve
President of my corporation and in charge of billing for years. All of our problems have occurred with billing in the private sector. Miss one rule change and you are hosed. Maybe things are better outside of PA.
Steve
Because Medicare costs less even with the fraud.
Steve
The French could. Maybe we should subcontract. The following is from libertarian editor Matt Welch at Reason.
http://reason.com/archives/2009/12/07/why-prefer-french-health-care
Steve
“Greece? NHS cuts?”
It is Greece’s medical care that caused its problems? Really? This would make for great reading so please cite your sources. (Bonus- Greece has been in default about 75 of the last 150 years. Was its health care system to blame?)
Steve
It is down, but not by a lot. Medicaid is complicated by the fact that many people go off of Medicaid when they get a job. However, the total number of people on Medicaid is growing.
http://ehbs.kff.org/pdf/8226.pdf
Steve
Depends on when. Medicaid is up about 6 million in this recession.
And thanks to SCHIP, Medicaid like coverage grew during the last “recovery” as well. Prior to that, you’re probably right. Of course, ACA has mandated state maintenance of effort until the scheduled Medicaid mandate in 2014, effectively prohibiting them from shrinking coverage.
Poverty rates for the elderly before SS were about 60%. Before Medicare it was about 27%. It is now about 9%, not 19%.
http://www.washingtonmonthly.com/political-animal/2011_09/we_know_who_to_reduce_poverty032173.php
Steve
Do you not comprehend the difference between private and public finances? Everything you mention is public cuts. Yes our public systems are broke, cutting spending, and in major trouble. Knowing that only a complete moron would advocate spending more public money, oh wait thats exactly what you want to do.
Corporations are healthy and paying their healthcare bills, they haven’t accumulated trillions in unfunded promises.
This is a perfect example of why the federal government never should have had any role in healthcare. If insurance had been left an obligation of business and individuals any problems in spending would have had to been dealt woth right away, we couldn’t have racked up 40 trillion in broken promises.
Even the Medicaid model where the State is funding it would have been better as States can’t accumulate debt like the Federal gov can.
Notice your disjointed argument;
“system making us all go broke in 5-10 years”
This sounds like your talking about individuals. Then when that idiotic argument was disproven you fludily move into talks about federal debt and spending. Make up your mind who is it your claiming is going broke? Today’s tax payors wont pay back any of the debt they are insurring so they aren’t going broke.
Maybe you need to take some time and learn what your talking about so your comments make even the slightest sense.
A private health insurance system without government funding is forevere sustainable, you never have to worry about it failing. While there might be some sob stories here and there overall everyone comes out further ahead.
Like public housing, liberals destroyed millions of lives becuase of a few sob stories of homeless people dieing. They murdered thousands of more people with the solution then the problem they tried to solve.
all you do is call names and provide nothing of value, not even a worthless opinion. At least when I point out your an idiot I tell you why and provide back up. You just run your mouth.
“I have no idea where you are getting your claims from,”
Mailman and PO Box, they are sent there by thousands of doctors that rather print a claim, pay postage and mail it then send me the claim electronically.
Your gripes of denials are an urban myth, unless your talking Medicare under 6% of claims are denied once you remove terminated coverage and wrong insurer. Biggest reason for denial is sloppy submittal by physicians. We still get claims for groups that terminated 5+ years ago.
The other 50% of claims which are the majority of revenue don’t effecft the doctors your talking about. Not many solo doctors are billing 100K inpatient stays, Hospital bills are much harder to auto adjudicate unless you rely only on % off contracts and do no review at all.
Now you just sound like a tea party windbag.
Not going broke? Then why all the cuts? Why is the current congress so anti anything that appears to them to be “socialist”? Why are they calling for budget constraint? Why are they recommending Medicare and Medicaid cuts? All any of us have been hearing repeatedly is that the country is in dire economic straits – evident by the trillions we are in debt.
Instead of being so antagonistic, why don’t you show us some proof?
Sorry, percent of 82% and 90% is electronic (not paper)
According to AHIP, in 2009, 78% of all claims (paper included) were received within 30 days with the bulk received in 2 weeks. I am certain the trend continued upwards in 2010 and 2011.
BTW, you can also see the percent of paper dropping precipitously to 82% in 2009. I would guess it is around the 90% today.
Before you quote the auto-adjudication numbers from that report, please note that the numbers are for “clean” claims.
http://www.ahipresearch.org/pdfs/SurveyHealthCareJan252010.pdf
I have no idea where you are getting your claims from, Nate, but you would be hard pressed to find a small provider without an electronic billing system, or at the very least access to a clearinghouse upload interface.
Auto-adjudication is based on algorithms and from what I see, they are constructed in a way that generates denials for the smallest things. Then of course, there is the other 50% of claims, which is much larger than 50% of revenue.
CO a few years back paid 99213 at 87% of Medicare, so your really asking why wont doctors treat uninsured patients for $20.
“how you can argue with arithmetic.”
Besides DeterminedMD, who would do it in a heartbeat, do any of the doctors on here want a pratice full on uninsured patients for $20 per visit?
“I don’t understand how you can argue with arithmetic.”
Maybe becuase I know the actual arithmetic and your making things up the way you wish they were? If you had even the slightest idea what your talking about you would know how silly your argument is. Have you seen what Medicare pays for an office visit done at a doctors office or outpatient clinic?
2012 fee schedule, Ohio CPT 99213 Participating Reimbursement
Non Facility $68.47
Facillity $49.22
So your question Margalit is why won’t private doctors jump at the chance to treat patients for $24.61? That’s Medicare, Medicaid is even cheaper.
“MGMA has the average staff in all sizes of practice at about 4.5 per physician. I have yet to see a solo practice with with 4.5 full FTEs.”
This is a meaningless argument and doesn’t say anything. I could run a doctors office with no FTEs, don’t treat anyone. Unless you factor in revenue or patients treated you haven’t said anything of any value. If a solo doctor can generate the same revenue as a multi physician pratice with less staff then you have an argument, but we both know that doesn’t happen.
“As to EDI, it’s been around for many years and those companies you mention exist only because it is a nightmare to bill and get paid, both due to multiplicity of rules and the nature of the private beast trying to squeeze out yet another nickel and dime, ”
What are you talking about? Most of your large payors autoadjudicate 50%+ or more of their claims. The biggest problem in getting paid is small doctors that don’t use EDI or standard forms that can be ran through OCR.
There is no problem getting paid by large providers that use EDI.
Nate, this has nothing to do with slavery and it shouldn’t have anything to do with the unwashed sharing a waiting room with Rockefeller types.
If the government agreed to pay private practices for uncompensated care at about half the rate they now pay community clinics and hospital “facilities”, many private practitioners would accept some uninsured folks. I don’t understand how you can argue with arithmetic.
Other industries are not a good model. If other industries were able to provide goods and services in a “mom and pop” model for less money, there would have been no consolidation. Only in health care it is possible to push consolidation into entities that provide more expensive and crappier services.
BTW, staffing is at a lower ratio in small practice than it is in large groups. MGMA has the average staff in all sizes of practice at about 4.5 per physician. I have yet to see a solo practice with with 4.5 full FTEs.
The economies of scale notion is just a myth in health care and it is being very successfully used by those who want to control doctors and make tons of money in this field, as well as by those well meaning academic experts who are averse to diversity in general.
its usually contractual. The agreement that grants them discounts is conditional on them not auditing bills or questioning the charges.
Payors think they are further ahead taking the discounts then trying to fight over every bill.
State and Federal law also impacts this, in a number of situtions you have 30 days to pay a bill. Providers have no requirements they bill timely. A hospital could send all their bills one day at the end of the month and the payor has 30 days to get them all paid, hard to do any auditing which is labor intensive.
Image if you started to audit so they started sitting on 2-3 months worth of claims and sending at once.
See CA v Multiplan)PHCS & Sutter health for the way providers and PPOs abuse the contracting process to avoid their bills being questioned.
I could be wrong but based on 20 years of knowledge from working in this every day I would wager more people have lost Medicaid as a percentage of popualtion then the decline in employer coverage.
When you look at programs like TennCare where people where covered then programs discontinued your more likely to lose your medicaid insurance then have private insurance go away.
“We need a national fee schedule, and let the hospitals start to economize like everyone else in the economy.”
Amen to that.
“Why can’t we pay private practices for uncompensated care at half the price we are paying to community centers and hospital outpatient clinics?”
Because slavery is illegal. If you where a doctor in Private pratice why would you want an office full of section 8 patients? Your good paying privately insured patients aren’t going to wait in an office full of people demanding their free care.
How do you ration care in your private pratice model? Right now we ration care by wait time. If you were willing to open up the primary care market to them at no cost they would use it out of existance.
“Putting the “mom and pop” practices out of business is extremely shortsighted and will increase costs while reducing quality of care.”
What other industry has this ever happened in? Eliminating the mom and pop medical provider would cut cost with all the efficency gained. Medical malpratice is substantially cheaper, fixed cost like rent is spread over a larger base as is staffing. Staff is more speciailized which is far more efficient. Technology is adapted quicker.
Thanks for the insight.
This does raise a question that has troubled me for some time…………
Why do so many payers (both public and private) become so passive when reviewing bills from any enterprise that is hospital connected?
For example — I have been getting annual tests from a cardiologist every year since I had a heart attack in 2006.
This doctor recently became affiliated with a hosptial based clinic.
My little blood test used to cost $60 done in his office.
This year’s test was still in his office, but it was billed atm
Thanks for the insight.
This does raise a question that has bothered me for some time.
Why do so many payers (public and private) behave so passively when any billing is ‘hospital based’?
I suppose this is a heritage from the cost-plus days of Medicare up to 1984, but honestly that was almost 30 years ago.
Also, for persons under 65, if the insurer rejects a hospital bill or cuts it down by 2/3, the hospital can pursue the patient. We need much stronger consumer protection (Medicare does protect its patients against balance billing already.)
My own doctor recently joined a hospital based clinic. I went in for a blood draw, and the bill was $240 for 15 minutes work. (last year it was $60 when he was just a doctor.)
I have a a high deductible so I am contesting the bill.
But this is a tiny version of what goes on all the time. For years, Medicare paid too much for outpatient care done in a hospital.
We need a national fee schedule, and let the hospitals start to economize like everyone else in the economy.
Baffling comment, Cwells. There are over 160 million people covered by employer based insurance. It went down a little during the recession, and the percentages of employers offering coverage have been going down for some time, but it still covers three times as many people as Medicare. It’s a very lively corpse.