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Thu Feb 21, 2013, 02:40 PM

Bitter Pill: Why Medical Bills Are Killing Us

Feb. 20, 2013

1. Routine Care, Unforgettable Bills
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 eight 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.”

More: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/?hpt=hp_c1

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Arrow 14 replies Author Time Post
Reply Bitter Pill: Why Medical Bills Are Killing Us (Original post)
OhioChick Feb 2013 OP
redstatebluegirl Feb 2013 #1
enlightenment Feb 2013 #2
sinkingfeeling Feb 2013 #3
MichaelSoE Feb 2013 #4
PA Democrat Feb 2013 #5
OhioChick Feb 2013 #8
Doctor_J Feb 2013 #12
jsr Feb 2013 #6
Bill USA Feb 2013 #7
Doctor_J Feb 2013 #11
hay rick Feb 2013 #9
Iwillnevergiveup Feb 2013 #10
Iwillnevergiveup Feb 2013 #13
eridani Feb 2013 #14

Response to OhioChick (Original post)

Thu Feb 21, 2013, 03:31 PM

1. Why do hospitals and clinics look like 5 star hotels?

That has been my question the past 20 years. All of the costs associated with these elaborate "hotels" get passed downstream. When I had back surgery, we had to pay the surgeon $4000 up front. We had $7000 additional the insurance did not cover. Nothing like these poor folks. Ut it opened my eyes to the problem. What happens to those who cannot pay? They suffer and die! Of course the rich want them to do it quickly so they can limit losses.

What a mess!

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Response to OhioChick (Original post)

Thu Feb 21, 2013, 03:59 PM

2. Definitely a good read.

And surprisingly even-handed. Thank you for posting the link.

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Response to OhioChick (Original post)

Thu Feb 21, 2013, 04:49 PM

3. I can remember a time when every community had its own little hospital. My mom was

in the county hospital when I was a 'Candy Stripper' there in the 1960's. Of course, it was a time where you paid the local doctor $20 for an office visit and he, without a dozen tests or referals, treated you. My son's broken arm was set in the local doctor's office and cost about $50.

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Response to OhioChick (Original post)

Fri Feb 22, 2013, 10:18 AM

4. this need to go to the top the greatest and should be required reading

last night jon stewart interviewed the reporter who did this story. i just read the first page and will continue to finish the story after i make this post.

have the kardashians taken miami yet? is honey boo boo doin' okay?

ever feel that you've been screwed and didn't even get kissed?

i'm gonna write my rep and senators just to see what kind of canned response i get back.

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Response to OhioChick (Original post)

Fri Feb 22, 2013, 10:47 AM

5. Sorry, I didn't see your post on this and duplicated it. I am going to delete my OP

and add my comments summary below:



I strongly encourage every DUer to take the time to read this very informative article on why our health care costs so much more than it should. It will open your eyes and infuriate you. The problems go much, much deeper than the greedy insurance companies.

The article goes into case studies of what people are billed, how much the treatments/ care actually cost, and the obscene profits being raked in by CEOs and top managers at hospitals (including "non-profits"), medical device companies, and drug companies.

Highlights include:

- Uninsured patient billed $7,997.54 for a stress test using a radioactive dye for which Medicare will pay $554

- Patient billed $49,237 for a Medtronic stimulator, which cost the hospital no more than $19,000

- Medtronics, which manufactures the device has a 75.1% gross profit margin on its devices.

- Patient is billed $13,702 per dose of Rituxan, a cancer drug, for which the hospital paid less than $4,000.

- Rituxan costs about $300 per dose to make, test, package and ship

- Average profit margin for "non-profit" hospitals is 11.7%, even when including hospitals operating at a loss

- Uninsured patient billed $157.61 for a CBC for which Medicare pays $11.02

- 71% more CT scans per capita are performed in the US than in Germany due to profit motives

Excerpt from the article:



Unless you are protected by Medicare, the health care market is not a market at all. It’s a crapshoot. People fare differently according to circumstances they can neither control nor predict. They may have no insurance. They may have insurance, but their employer chooses their insurance plan and it may have a payout limit or not cover a drug or treatment they need. They may or may not be old enough to be on Medicare or, given the different standards of the 50 states, be poor enough to be on Medicaid. If they’re not protected by Medicare or they’re protected only partly by private insurance with high co-pays, they have little visibility into pricing, let alone control of it. They have little choice of hospitals or the services they are billed for, even if they somehow know the prices before they get billed for the services. They have no idea what their bills mean, and those who maintain the chargemasters couldn’t explain them if they wanted to. How much of the bills they end up paying may depend on the generosity of the hospital or on whether they happen to get the help of a billing advocate. They have no choice of the drugs that they have to buy or the lab tests or CT scans that they have to get, and they would not know what to do if they did have a choice. They are powerless buyers in a seller’s market where the only sure thing is the profit of the sellers.

Indeed, the only player in the system that seems to have to balance countervailing interests the way market players in a real market usually do is Medicare. It has to answer to Congress and the taxpayers for wasting money, and it has to answer to portions of the same groups for trying to hold on to money it shouldn’t. Hospitals, drug companies and other suppliers, even the insurance companies, don’t have those worries.

Moreover, the only players in the private sector who seem to operate efficiently are the private contractors working — dare I say it? — under the government’s supervision. They’re the Medicare claims processors that handle claims like Alan A.’s for 84¢ each. With these and all other Medicare costs added together, Medicare’s total management, administrative and processing expenses are about $3.8 billion for processing more than a billion claims a year worth $550 billion. That’s an overall administrative and management cost of about two-thirds of 1% of the amount of the claims, or less than $3.80 per claim. According to its latest SEC filing, Aetna spent $6.9 billion on operating expenses (including claims processing, accounting, sales and executive management) in 2012. That’s about $30 for each of the 229 million claims Aetna processed, and it amounts to about 29% of the $23.7 billion Aetna pays out in claims.

The real issue isn’t whether we have a single payer or multiple payers. It’s whether whoever pays has a fair chance in a fair market. Congress has given Medicare that power when it comes to dealing with hospitals and doctors, and we have seen how that works to drive down the prices Medicare pays, just as we’ve seen what happens when Congress handcuffs Medicare when it comes to evaluating and buying drugs, medical devices and equipment. Stripping away what is now the sellers’ overwhelming leverage in dealing with Medicare in those areas and with private payers in all aspects of the market would inject fairness into the market. We don’t have to scrap our system and aren’t likely to. But we can reduce the $750 billion that we overspend on health care in the U.S. in part by acknowledging what other countries have: because the health care market deals in a life-or-death product, it cannot be left to its own devices.


Read more: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2LdnarWT9

2

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Response to PA Democrat (Reply #5)

Sat Feb 23, 2013, 10:01 PM

8. Oh, you shouldn't have deleted your thread

Hey, the more people that read this article, the better. I found it to be highly informative.

Thanks for posting the additional information that you found.

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Response to PA Democrat (Reply #5)

Mon Feb 25, 2013, 01:53 PM

12. Doctors in the US often own the CT Scan facilities

- 71% more CT scans per capita are performed in the US than in Germany due to profit motives


In many cases the physicians are sending the patients to labs that the physicians themselves own. This would seem to qualify as racketeering, but in the US is called free enterprise.

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Response to OhioChick (Original post)

Sat Feb 23, 2013, 12:44 PM

6. Great article

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Response to OhioChick (Original post)

Sat Feb 23, 2013, 05:52 PM

7. Aetna, operating expenses per claim: $30, Medicare: $3.80.

"Indeed, the only player in the system that seems to have to balance countervailing interests the way market players in a real market usually do is Medicare. It has to answer to Congress and the taxpayers for wasting money, and it has to answer to portions of the same groups for trying to hold on to money it shouldn’t. Hospitals, drug companies and other suppliers, even the insurance companies, don’t have those worries.

Moreover, the only players in the private sector who seem to operate efficiently are the private contractors working — dare I say it? — under the government’s supervision. They’re the Medicare claims processors that handle claims like Alan A.’s for 84¢ each. With these and all other Medicare costs added together, Medicare’s total management, administrative and processing expenses are about $3.8 billion for processing more than a billion claims a year worth $550 billion. That’s an overall administrative and management cost of about two-thirds of 1% of the amount of the claims, or less than $3.80 per claim. According to its latest SEC filing, Aetna spent $6.9 billion on operating expenses (including claims processing, accounting, sales and executive management) in 2012. That’s about $30 for each of the 229 million claims Aetna processed, and it amounts to about 29% of the $23.7 billion Aetna pays out in claims.

The real issue isn’t whether we have a single payer or multiple payers. It’s whether whoever pays has a fair chance in a fair market. Congress has given Medicare that power when it comes to dealing with hospitals and doctors, and we have seen how that works to drive down the prices Medicare pays, just as we’ve seen what happens when Congress handcuffs Medicare when it comes to evaluating and buying drugs, medical devices and equipment. Stripping away what is now the sellers’ overwhelming leverage in dealing with Medicare in those areas and with private payers in all aspects of the market would inject fairness into the market. We don’t have to scrap our system and aren’t likely to. But we can reduce the $750 billion that we overspend on health care in the U.S. in part by acknowledging what other countries have: because the health care market deals in a life-or-death product, it cannot be left to its own devices.

Put simply, the bills tell us that this is not about interfering in a free market. It’s about facing the reality that our largest consumer product by far — one-fifth of our economy — does not operate in a free market."


Read more: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2LlVSBhBr

Recommended.

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Response to Bill USA (Reply #7)

Mon Feb 25, 2013, 01:45 PM

11. It's that "bloated inefficient government freeloader" you hear so much about

How Hate Radio is always declaring that "private companies are better at everything than the government". It's a lie of course but the Limbeciles swallow it like KoolAid

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Response to OhioChick (Original post)

Sun Feb 24, 2013, 01:38 PM

9. The medical lobby.

From the article:

...According to the Center for Responsive Politics, the pharmaceutical and health-care-product industries, combined with organizations representing doctors, hospitals, nursing homes, health services and HMOs, have spent $5.36 billion since 1998 on lobbying in Washington. That dwarfs the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by oil and gas interests over the same period. That’s right: the health-care-industrial complex spends more than three times what the military-industrial complex spends in Washington.

Very informative. A must read and very timely given the grand bargain/sequester debates that are currently taking place with little or no mention of the problem of out-of-control health care prices. K&R.

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Response to OhioChick (Original post)

Mon Feb 25, 2013, 01:14 PM

10. Required reading

That is all.

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Response to OhioChick (Original post)

Mon Feb 25, 2013, 02:16 PM

13. This story needs to go viral

Posted a link to it in GD - also calling for Howard Dean to weigh in.

Another

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Response to OhioChick (Original post)

Wed Feb 27, 2013, 05:17 AM

14. Comment by Don McCanne of PNHP

Steven Brill's TIME article, "Bitter Pill: Why Medical Bills Are Killing Us," seems to be awakening those who have, until now, accepted the very high prices of health care as an inevitability for having a technologically advanced health care system here in the United States.

In his 36 page article - which will surely be required reading in many health policy courses - Brill makes it clear that we no longer need to take the "bitter pill" of medical bills that are killing us. Clearly, Medicare already has several tools to control costs and has the potential for further improving value in the nation's health care purchasing.

At the end of his article, Brill seems to be advancing a non sequitur when he writes, "The real issue isn't whether we have a single payer or multiple payers. It's whether whoever pays has a fair chance in a fair market... We don't have to scrap our system and aren't likely to." This certainly does not follow from what he had to say as the central theme of his article.

He then recommends some tired or inadequate remedies that would have very little impact on the problems that we face in health care. What is ironic is that he has built a tremendous case for the logical solution - an improved Medicare for all - and then he seems to dismiss it. You cannot read his article and escape the conclusion that a single payer national health program is an absolute imperative, that is, if we really do want affordable care for everyone.

Download this article (the full 36 pages is available for free at the following link), and share it with others. But put a Post-it note on it that states: WARNING! For the health of our nation, ignore the section at the end titled "Changing Our Choices" (that's the tired remedies section), but concentrate on what an improved Medicare system could do for all of us. http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/

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