Thursday, May 9, 2013

Obamacare vs. Anarchy-care

Exactly what did Obamacare try to accomplish?  It really only tried to widen access to affordable health care insurance.  It was a reform that was long past overdue despite the fact that it falls short of accomplishing what is actually needed, which is the control of health care costs.

I should know. After my wife's permanent layoff from her job at a large company, I needed to purchase health care insurance as a very small business owner for my family. Since my company had way fewer than 50 employees, the choices were not abundant despite living on Long Island, NY.  I had 3 insurance companies in  total to choose from.  All the policies were odious.

The first year, 2002 or 2003, the cost of insurance was a shock to the system after being covered for relatively little out of pocket cost under my spouse's coverage from her job. But it got worse - much worse.  By 2009, health care was costing before taxes $25,000 per year counting premiums, deductibles and co-pays.  Unbelievable!

Fortunately, in 2010, my wife found a job with good benefits but the damage was done - we had spent about $175,000 on health care over about 7 or 8 years even though we were relatively healthy.  Boy do we miss that $175,000!

The loss of this money to health care costs is particularly bothersome to me because I am all too well aware that our "system" of health care is so idiotic; it's the most expensive in the world and it's not close to being the best.  In Canada, our neighbor to the north, the costs are a fraction of ours, yet Canadians live longer than we do.  There is no way to justify what we do compared to what the Canadians do; they simply have it better.  Anecdotal stories aside, the fact remains that Canadians are not clamoring to change their "Medicare for All" system.  In fact, they probably would rebel if their system was changed into OUR system.  Who wouldn't rebel?  Our system is nothing more than anarchy.

Is that too strong a word?

Health and Human Services Secretary Kathleen Sebelius has released an enormous data file containing the secret "Chargemaster" price lists of hospitals from around the country revealing an almost completely random, arbitrary and capricious pricing of various hospital services that vary wildly from hospital to hospital.  Truly the prices are inexplicable!

Steven Brill, who wrote the masterful article "Bitter Pill" highlighted in an earlier blog post, wrote on 5/8/2013, "For example, the first line in the more than 163,072 lines of data in the CMS file released May 8 covers the treatment of “extra cranial procedures” (“without complications”) at the Southeast Alabama Medical Center in Dothan, Ala. When Medicare reviewed the list prices on bills it received for 91 patients getting that treatment at the Dothan hospital in 2011, the average Chargemaster bill claimed by the hospital was $32,963. Medicare paid only an average of $5,777...

Helpfully, Sebelius points out in her announcement that “average inpatient charges for services a hospital may provide in connection with a joint replacement range from a low of $5,300 at a hospital in Ada, Oklahoma, to a high of $223,000 at a hospital in Monterey Park, California. Even within the same geographic area,” she notes, “hospital charges for similar services can vary significantly. For example, average inpatient hospital charges for services that may be provided to treat heart failure range from a low of $21,000 to a high of $46,000 in Denver, Colorado, and from a low of $9,000 to a high of $51,000 in Jackson, Mississippi.”

"  Go to
http://swampland.time.com/2013/05/08/an-end-to-medical-billing-secrecy/ .

Please note that the hospital, which makes a profit at the payment level that Medicare pays, would try to charge the uncovered about 600% more than it charges Medicare.  Those persons would most likely be lower income persons.  Furthermore, the Chargemaster price lists are the basis for their negotiations with health care insurers, none of whom have anywhere near the bargaining power of Medicare which has a monopoly on older health care consumers.  It is Medicare's bargaining power that is the key to lowering health care costs.  The only times Medicare is ineffective in bargaining is when its hands are tied legislatively; Congress prevents it from bargaining fully with medical equipment companies and drug companies.  Why?  Because these companies are the biggest lobbyists in Washington DC and spend huge amounts supporting their political candidates.  What a shock!

Is this crazy or not?  Why would we all not want Medicare for all?  If you think your taxes would go up, think again - the money saved in insurance premiums, deductibles and co-pays would be far greater than any tax increase since the total cost of health care expenses would decrease - a lot!  That decrease ends up in our pockets and it comes out of the pockets of hospitals, medical equipment companies and Big Pharma.  Do not cry for them, they will not starve.  But if we do not adopt some form of Medicare for All, perhaps we, the American taxpayer and consumer, will starve.
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