Later On

A blog written for those whose interests more or less match mine.

The US healthcare system and its inequities

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People seem to be willing to put up with it, and the GOP is determined to destroy the reforms that came with the Affordable Care Act, with Trump’s Department of Justice even now arguing that the ACA is unconstitutional and should be struck down in its entirety. And, oddly, many Americans like the current state of healthcare in the US and indeed many support abolishing the Affordable Care Act.

Sarah Kliff reports in the NY Times:

Before a camping and kayaking trip along the Texas Coast, Pam LeBlanc and Jimmy Harvey decided to get coronavirus tests. They wanted a bit more peace of mind before spending 13 days in close quarters along with three friends.

The two got drive-through tests at Austin Emergency Center in Austin. The center advertises a “minimally invasive” testing experience in a state now battling one of the country’s worst coronavirus outbreaks. Texas recorded 5,799 new cases Sunday, and recently reversed some if its reopening policies.

They both recalled how uncomfortable it was to have the long nasal swab pushed up their noses. Ms. LeBlanc’s eyes started to tear up; Mr. Harvey felt as if the swab “was in my brain.”

Their tests came back with the same result — negative, allowing the trip to go ahead — but the accompanying bills were quite different.

The emergency room charged Mr. Harvey $199 in cash. Ms. LeBlanc, who paid with insurance, was charged $6,408.

“I assumed, like an idiot, it would be cheaper to use my insurance than pay cash right there,” Ms. LeBlanc said. “This is 32 times the cost of what my friend paid for the exact same thing.”

Ms. LeBlanc’s health insurer negotiated the total bill down to $1,128. The plan said she was responsible for $928 of that.

During the pandemic, there has been wide variation between what providers bill for the same basic diagnostic test, with some charging $27, others $2,315. It turns out there is also significant variation in how much a test can cost two patients at the same location.

Mr. Harvey and Ms. LeBlanc were among four New York Times readers who shared bills they received from the same chain of emergency rooms in Austin. Their experiences offer a rare window into the unpredictable way health prices vary for patients who receive seemingly identical care.

Three paid with insurance, and one with cash. Even after negotiations between insurers and the emergency room, the total that patients and their insurers ended up paying varied by 2,700 percent.

Such discrepancies arise from a fundamental fact about the American health care system: The government does not regulate health care prices.

Some academic research confirms that prices can vary within the same hospital. One 2015 paper found substantial within-hospital price differences for basic procedures, such as M.R.I. scans, depending on the health insurer.

The researchers say these differences aren’t about quality. In all likelihood, the expensive M.R.I.s and the cheap M.R.I.s are done on the same machine. Instead, they reflect different insurers’ market clout. A large insurer with many members can demand lower prices, while small insurers have less negotiating leverage.

Because health prices in the United States are so opaque, some researchers have turned to their own medical bills to understand this type of price variation. Two health researchers who gave birth at the same hospital with the same insurance compared notes afterward. They found that one received a surprise $1,600 bill while the other one didn’t.

The difference? One woman happened to give birth while an out-of-network anesthesiologist was staffing the maternity ward; the other received her epidural from an in-network provider.

“The additional out-of-pocket charge on top of the other labor and delivery expenses was left entirely up to chance,” the co-authors Erin Taylor and Layla Parast wrote in a blog post summarizing the experience. Ms. Parast, who received the surprise bill, ultimately got it reversed but not until her baby was nearly a year old. . .

Continue reading.

Written by LeisureGuy

29 June 2020 at 12:41 pm

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