Later On

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

Congress helped with US medical fees — and reminded us of how bad it is

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Paul Waldman writes in the Washington Post:

In the 5,593 pages of the covid-19 relief and spending bill that will soon become law, there are some awful things and some wonderful things. And at least one provision is both.

It’s a provision that protects patients from “surprise medical bills,” just one of many horrors unique to the American health care system. It’s wonderful that the relief bill addresses the problem. It’s awful that it was even necessary.

Here’s how surprise medical bills work. You have an injury or an accident or some other kind of medical crisis, and since you don’t want to get hit with a huge bill, you go to the emergency room of a hospital in your network. Then a few weeks later you get a bill for hundreds, thousands or even tens of thousands of dollars, because unbeknownst to you, someone who treated you wasn’t in your network. Surprise!

Maybe it was the doctor in the ER; it could have been someone who showed up when you were unconscious, so even if you had the presence of mind to ask every person in the room “Are you in my network?” as you were bleeding all over the place, you still wouldn’t have avoided the bill.

As The Post notes, “A study this year by the Kaiser Family Foundation of millions of insurance claims found that nearly 1 in 5 emergency room visits nationwide led to at least one unexpected bill for care outside the patient’s insurance network.”

This worked out great for the health care industry, as long as it didn’t attract too much attention. Insurers could avoid some costs, and as the New York Times reports, “Some private-equity firms have turned this kind of billing into a robust business model, buying emergency room doctor groups and moving the providers out of network so they could bill larger fees.” What an inspiring story of entrepreneurial creativity.

Now the responsibility has been taken off the backs of patients. But Congress excluded ambulance rides, which are usually not in-network and cost hundreds of dollars. And the new rules won’t take effect for another year.

To repeat: It’s great that Congress addressed this problem, even if imperfectly. And it’s absolutely insane that we have a health care system that victimizes us this way in the first place.

You probably know the basic problem: America pays far more than any other country on earth for health care, yet we have tens of millions of people with no insurance at all, and our health outcomes are no better than countries that spend much less. We spend twice as much per capita as the average country in the Organization for Economic Cooperation and Development, yet we have the lowest life expectancy among those advanced countries.

Underneath that broad reality is an orgy of exploitation and victimization in ways large and small, ranging from the bill that’s merely annoying to the one that drives you into bankruptcy.

That the industry has convinced us that we can do no more than tinker around the edges of this system has to count as one of the great propaganda triumphs in history. Wendell Potter, an insurance industry whistleblower, will be happy to explain how he and others spread the lie that the Canadian health care system is a nightmare when it’s superior to ours in almost every way, to convince people that serious reform is impossible and they should be happy with what they have.

Yet if you asked someone from anywhere else in the industrialized world how their country handles surprise medical bills, they’d answer, “What now?” That’s because they don’t have them. Nor do they have “medical debt.” Or “the uninsured.” Or “networks” a provider could be in or out of. It’s just not a thing.

That’s because while there are many different health care models — Britain’s is different from Canada’s, which is different from Germany’s, which is different from Japan’s — all start from the premise that everyone deserves care they can afford. When that requires strong government to make sure prices stay reasonable and patients are protected — even if it means your orthopedist might drive a Volkswagen and not a Porsche — that’s what they use.

Our system, on the other hand, is based on the premise that health care is, at its heart, a business that should continue to generate massive profits, with some regulation that curbs its worst excesses. The result is not only that we have to pay so much for a system with so many holes, but that periodically we learn about some horrific practice like surprise billing, which continues until it gets enough attention that Congress resists industry lobbying and gets rid of it. . .

Continue reading. There’s more.

Written by LeisureGuy

22 December 2020 at 4:17 pm

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