Bitter Pill: Why Medical Bills are Killing Us

Ansciess

Practitioner
Joined
Jun 25, 2012
Reaction score
139
from Time magazine:


When Sean Recchi, a 42-year-old from Lancaster, Ohio, was told last March that he had non-Hodgkin’s lymphoma, his wife Stephanie knew she had to get him to MD Anderson Cancer Center in Houston. Stephanie’s father had been treated there 10 years earlier, and she and her family credited the doctors and nurses at MD Anderson with extending his life by at least 8 years.
Because Stephanie and her husband had recently started their own small technology business, they were unable to buy comprehensive health insurance. For $469 a month, or about 20% of their income, they had been able to get only a policy that covered just $2,000 per day of any hospital costs. “We don’t take that kind of discount insurance,” said the woman at MD Anderson when Stephanie called to make an appointment for Sean.

Stephanie was then told by a billing clerk that the estimated cost of Sean’s visit — just to be examined for six days so a treatment plan could be devised — would be $48,900, due in advance. Stephanie got her mother to write her a check. “You do anything you can in a situation like that,” she says. The Recchis flew to Houston, leaving Stephanie’s mother to care for their two teenage children.

About a week later, Stephanie had to ask her mother for $35,000 more so Sean could begin the treatment the doctors had decided was urgent. His condition had worsened rapidly since he had arrived in Houston. He was “sweating and shaking with chills and pains,” Stephanie recalls. “He had a large mass in his chest that was … growing. He was panicked.”

Nonetheless, Sean was held for about 90 minutes in a reception area, she says, because the hospital could not confirm that the check had cleared. Sean was allowed to see the doctor only after he advanced MD Anderson $7,500 from his credit card. The hospital says there was nothing unusual about how Sean was kept waiting. According to MD Anderson communications manager Julie Penne, “Asking for advance payment for services is a common, if unfortunate, situation that confronts hospitals all over the United States.”

The total cost, in advance, for Sean to get his treatment plan and initial doses of chemotherapy was $83,900.

Why?

The first of the 344 lines printed out across eight pages of his hospital bill — filled with indecipherable numerical codes and acronyms — seemed innocuous. But it set the tone for all that followed. It read, “1 ACETAMINOPHE TABS 325 MG.” The charge was only $1.50, but it was for a generic version of a Tylenol pill. You can buy 100 of them on Amazon for $1.49 even without a hospital’s purchasing power.

Dozens of midpriced items were embedded with similarly aggressive markups, like $283.00 for a “CHEST, PA AND LAT 71020.” That’s a simple chest X-ray, for which MD Anderson is routinely paid $20.44 when it treats a patient on Medicare, the government health care program for the elderly.

Every time a nurse drew blood, a “ROUTINE VENIPUNCTURE” charge of $36.00 appeared, accompanied by charges of $23 to $78 for each of a dozen or more lab analyses performed on the blood sample. In all, the charges for blood and other lab tests done on Recchi amounted to more than $15,000. Had Recchi been old enough for Medicare, MD Anderson would have been paid a few hundred dollars for all those tests. By law, Medicare’s payments approximate a hospital’s cost of providing a service, including overhead, equipment and salaries.

On the second page of the bill, the markups got bolder. Recchi was charged $13,702 for “1 RITUXIMAB INJ 660 MG.” That’s an injection of 660 mg of a cancer wonder drug called Rituxan. The average price paid by all hospitals for this dose is about $4,000, but MD Anderson probably gets a volume discount that would make its cost $3,000 to $3,500. That means the nonprofit cancer center’s paid-in-advance markup on Recchi’s lifesaving shot would be about 400%.

When I asked MD Anderson to comment on the charges on Recchi’s bill, the cancer center released a written statement that said in part, “The issues related to health care finance are complex for patients, health care providers, payers and government entities alike … MD Anderson’s clinical billing and collection practices are similar to those of other major hospitals and academic medical centers.”

The hospital’s hard-nosed approach pays off. Although it is officially a nonprofit unit of the University of Texas, MD Anderson has revenue that exceeds the cost of the world-class care it provides by so much that its operating profit for the fiscal year 2010, the most recent annual report it filed with the U.S. Department of Health and Human Services, was $531 million. That’s a profit margin of 26% on revenue of $2.05 billion, an astounding result for such a service-intensive enterprise.1

The president of MD Anderson is paid like someone running a prosperous business. Ronald DePinho’s total compensation last year was $1,845,000. That does not count outside earnings derived from a much publicized waiver he received from the university that, according to the Houston Chronicle, allows him to maintain unspecified “financial ties with his three principal pharmaceutical companies.”
Read more:http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2LxlAkBch
 
  • Like
Reactions: Snowcone
M

mlp

Guest
Yes, this is an excellent article and, IMO, should be read by everyone in the U.S.
 
M

mlp

Guest
Congress could actually enact laws that limit profits. Medicare pays out so much less for each service and item than insurance companies do (much less noninsured people, who really get soaked by the prices charged them), because the law provides that healthcare providers have to provide services to Medicare eligible individuals at a cost which reimburses for actual cost, a portion of overhead, and a designated profit margin. There are loopholes built in (thanks to aggressive lobbying and legislators who were bought by that lobbying) that result in things like canes and other devices not being subject to those limitations (which is why you can buy a cane more cheaply at Walmart), but it can be done.

What it's going to take is an informed and united electorate that won't continue to stand for what is going on.
 

Clueless Git

Plant powered
Joined
Feb 17, 2013
Reaction score
598
Location
Milton Keynes, UK
This is a reverse lottery. One in which people gamble their health, life savings, lives even, in the hope that their number does NOT come up?

How the electorate of any democracy with an education system cannot do the math on that one remains a mystery to me.
 

ledboots

Peace
Joined
Oct 12, 2012
Reaction score
7,246
Location
United States of America
That article should be required reading for all Americans. It was posted on the bulletin board at work when it came out, even though we see this stuff happening every day.

Here's some new information on the Health Care Act's numbers per the CBO.


"The Patient Protection and Affordable Care Act (PPACA) will be less affordable for the federal government:

The Congressional Budget Office (CBO) estimated Tuesday that President Obama's signature healthcare law will cost about $1.3 trillion over the next 10 years.The figure represents a slight increase since August, when the nonpartisan budget office estimated that the law would cost about $1.17 trillion before 2022. [You’re dealing with big numbers when $130 billion is considered a “slight increase.”]

Also, expanded health insurance coverage is not looking good either:The number of Americans projected to gain insurance from the U.S. health-care law is eroding, by at least 5 million people, as the Obama administration struggles to implement the $1.3 trillion overhaul amid Republican opposition. About 27 million people are expected to gain coverage by 2017, according to a report today from the Congressional Budget Office. The CBO had projected when the law passed in 2010 that 32 million uninsured people would be on a health plan within a decade, and a year later raised its estimate to 34 million.

On top of that, the Washington Examiner’s Philip Klein reports that the CBO estimates that “7 million fewer people will have employment-based health insurance as a result” of the PPACA. Remember “If you like your health care plan, you can keep your health care plan”?
 

beancounter

The Fire That Burns Within
Joined
Jun 3, 2012
Reaction score
2,313
Location
In the Church of the Poisoned Mind
On top of that, the Washington Examiner’s Philip Klein reports that the CBO estimates that “7 million fewer people will have employment-based health insurance as a result” of the PPACA. Remember “If you like your health care plan, you can keep your health care plan”?

Well that's because corps want to maintain their profit margin. The question is where do you draw the line between a healthy business based economy and a healthy general public? Can a balance ever be achieved? What do we as a society value more?

Part of the problem is that as a society we value both.

Just rhetorical questions I'm throwing out there.
 
M

mlp

Guest
That article should be required reading for all Americans. It was posted on the bulletin board at work when it came out, even though we see this stuff happening every day.

Here's some new information on the Health Care Act's numbers per the CBO.


"The Patient Protection and Affordable Care Act (PPACA) will be less affordable for the federal government:

The Congressional Budget Office (CBO) estimated Tuesday that President Obama's signature healthcare law will cost about $1.3 trillion over the next 10 years.The figure represents a slight increase since August, when the nonpartisan budget office estimated that the law would cost about $1.17 trillion before 2022. [You’re dealing with big numbers when $130 billion is considered a “slight increase.”]

Also, expanded health insurance coverage is not looking good either:The number of Americans projected to gain insurance from the U.S. health-care law is eroding, by at least 5 million people, as the Obama administration struggles to implement the $1.3 trillion overhaul amid Republican opposition. About 27 million people are expected to gain coverage by 2017, according to a report today from the Congressional Budget Office. The CBO had projected when the law passed in 2010 that 32 million uninsured people would be on a health plan within a decade, and a year later raised its estimate to 34 million.

On top of that, the Washington Examiner’s Philip Klein reports that the CBO estimates that “7 million fewer people will have employment-based health insurance as a result” of the PPACA. Remember “If you like your health care plan, you can keep your health care plan”?

You kind of skipped over the article in its entirety, didn't you?

Unless you're suddenly recanting on your position to date, which is that the healthcare industry is entitled to all the profits it can chisel out of the market?
 

ledboots

Peace
Joined
Oct 12, 2012
Reaction score
7,246
Location
United States of America
You kind of skipped over the article in its entirety, didn't you?
No, I am *not* arguing about that article here with you, mlp. I have read the entire thing and discussed it at work with my fellow nurses and physicians, who know from the inside what things look like.

Do you think we don't know far worse horror stories than those? Haven't cried on the phone with insurance company reps trying to get coverage for our patients? Watched a tiny Honduran girl huddling in our parking lot day after day waiting to go into labor because then we have to deliver her baby free and create a new US citizen? Tried to find somewhere for her to go with her baby after their release and supplies for the newborn?

Do you think we, as people who care for others as a living, would be against Obamacare if we didn't think even more Americans will end up with substandard care because of this? Why would we be?

We see the patients already getting worse care in hospital than they did before the EMR, and with fewer physicians and skeleton staffs, I sure can't see it not going downhill fast. Except the costs. They will go up, and the quality of care will continue to plummet.
 
M

mlp

Guest
No, I am *not* arguing about that article here with you, mlp. I have read the entire thing and discussed it at work with my fellow nurses and physicians, who know from the inside what things look like.

Do you think we don't know far worse horror stories than those? Haven't cried on the phone with insurance company reps trying to get coverage for our patients? Watched a tiny Honduran girl huddling in our parking lot day after day waiting to go into labor because then we have to deliver her baby free and create a new US citizen? Tried to find somewhere for her to go with her baby after their release and supplies for the newborn?

Do you think we, as people who care for others as a living, would be against Obamacare if we didn't think even more Americans will end up with substandard care because of this? Why would we be?

We see the patients already getting worse care in hospital than they did before the EMR, and with fewer physicians and skeleton staffs, I sure can't see it not going downhill fast. Except the costs. They will go up, and the quality of care will continue to plummet.

So, does that mean you've had a change of heart from your position just a few days ago, that the healthcare industry is entitled to all the profits it can possibly make?

Because that's what this article is about - the way in which the healthcare industry makes huge profits at the expense of people's health, lives, and the economy as a whole.
 
  • Like
Reactions: Eleven

Eleven

Devotee
Joined
Dec 14, 2012
Reaction score
20
So, does that mean you've had a change of heart from your position just a few days ago, that the healthcare industry is entitled to all the profits it can possibly make?

Because that's what this article is about - the way in which the healthcare industry makes huge profits at the expense of people's health, lives, and the economy as a whole.

Right, the problem is not Obamacare. The problem is the exploitative system that allows the medical industry to gouge consumers. It's really as simple as that.
 

ledboots

Peace
Joined
Oct 12, 2012
Reaction score
7,246
Location
United States of America
So, does that mean you've had a change of heart from your position just a few days ago, that the healthcare industry is entitled to all the profits it can possibly make?

Because that's what this article is about - the way in which the healthcare industry makes huge profits at the expense of people's health, lives, and the economy as a whole.
Please don't misstate my positions. I never said that.

I have read, understood, and discussed the article when it came out with knowledgeable people already and am not going to argue with you on this or any other topic.
 

beancounter

The Fire That Burns Within
Joined
Jun 3, 2012
Reaction score
2,313
Location
In the Church of the Poisoned Mind
Right, the problem is not Obamacare. The problem is the exploitative system that allows the medical industry to gouge consumers. It's really as simple as that.

One arguement I often here (not necessarily in regards to healthcare), is that the "right" price for something is "whatever the market will bear". But this statement assumes that the consumer has a variety of choices from business that are in vigorous competition with each other.

This is rarely the case with healthcare. Usually only one or two companies dominate a particular region and/or you get whatever plan your company offers you. So no real choice equals higher prices.
 

Eleven

Devotee
Joined
Dec 14, 2012
Reaction score
20
One arguement I often here (not necessarily in regards to healthcare), is that the "right" price for something is "whatever the market will bear". But this statement assumes that the consumer has a variety of choices from business that are in vigorous competition with each other.

This is rarely the case with healthcare. Usually only one or two companies dominate a particular region and/or you get whatever plan your company offers you. So no real choice equals higher prices.

Not only is the competition lacking but the vendors aren't selling an unnecessary service or good. A seriously ill person has no choice but to seek treatment.
 

Pickle Juice

Member
Joined
Jun 2, 2012
Reaction score
753
Congress could actually enact laws that limit profits. Medicare pays out so much less for each service and item than insurance companies do (much less noninsured people, who really get soaked by the prices charged them), because the law provides that healthcare providers have to provide services to Medicare eligible individuals at a cost which reimburses for actual cost, a portion of overhead, and a designated profit margin. There are loopholes built in (thanks to aggressive lobbying and legislators who were bought by that lobbying) that result in things like canes and other devices not being subject to those limitations (which is why you can buy a cane more cheaply at Walmart), but it can be done.

What it's going to take is an informed and united electorate that won't continue to stand for what is going on.
Yeah, but every time you get a small handful of representatives who will attempt to reform the system I see the medical industry stepping in and buying them off. I think it's too late. They have too much money. They are untouchable as I see it. They should have been stopped decades ago.
 

Pickle Juice

Member
Joined
Jun 2, 2012
Reaction score
753
Sometimes I think that though communism clearly doesnt work either, capitalism just looks like a pyramid scheme to me.
My Dad and I were just discussing this. The problems don't lie within the various schools of thought, they lie within the fact that the wrong people always gain power. We should be appointing people who do not want to run things, not electing people who want to. The only time I ever saw anything like this actually work was when I worked for the USGS (United States Geological Survey). It was kind of funny, because we were all just a bunch of scientists who wanted to do our research. No one wanted administrative duties, so they had this program where they were trying to make administrative jobs more appealing to people who wanted nothing to do with running things, and basically saying "look, we know you don't want to, but someone has to. It's not as bad as you think.". :p
 
  • Like
Reactions: Freesia

Envy

Just lazing around
Joined
Jun 2, 2012
Reaction score
1,337
Age
29
Location
Sweden
My Dad and I were just discussing this. The problems don't lie within the various schools of thought, they lie within the fact that the wrong people always gain power. We should be appointing people who do not want to run things, not electing people who want to. The only time I ever saw anything like this actually work was when I worked for the USGS (United States Geological Survey). It was kind of funny, because we were all just a bunch of scientists who wanted to do our research. No one wanted administrative duties, so they had this program where they were trying to make administrative jobs more appealing to people who wanted nothing to do with running things, and basically saying "look, we know you don't want to, but someone has to. It's not as bad as you think.". :p

So because it's people "that don't want to do it", no-one becomes greedy and wants more?

That actually reminds me of the students council in high school.
 

Pickle Juice

Member
Joined
Jun 2, 2012
Reaction score
753
So because it's people "that don't want to do it", no-one becomes greedy and wants more?

That actually reminds me of the students council in high school.
Not everyone in the world is greedy and corruptible.
 

ledboots

Peace
Joined
Oct 12, 2012
Reaction score
7,246
Location
United States of America
My Dad and I were just discussing this. The problems don't lie within the various schools of thought, they lie within the fact that the wrong people always gain power. We should be appointing people who do not want to run things, not electing people who want to. The only time I ever saw anything like this actually work was when I worked for the USGS (United States Geological Survey). It was kind of funny, because we were all just a bunch of scientists who wanted to do our research. No one wanted administrative duties, so they had this program where they were trying to make administrative jobs more appealing to people who wanted nothing to do with running things, and basically saying "look, we know you don't want to, but someone has to. It's not as bad as you think.". :p
Generally, whoever gains power winds up exploiting those with less power.
 
  • Like
Reactions: Freesia