A few years ago we did a fairly sizeable home remodel for a client. In conversation I learned that the Mrs was a now-retired hospital CFO. (Her hospital was absorbed into another even larger system, and she took her bonus/payout and retired.) I shared with her my frustration trying to figure out hospital and doctor statements, and she just chuckled and said, "Of course you're frustrated. That's by design."
She told me how hospitals had a MSRP Blue Book (my term, as I can't remember what she actually called it) which listed their charges for everything you could possibly imagine. "Appendectomy $19,300; double heart bypass $94,000; set broken arm $12,600, aspirin $10", etc (I can't remember her actual numbers).
But then she told me their dirty little secret: ALL their numbers were totally made up! They bore no resemblance at all to their actual costs. There is no industry standard. And every other hospital had their own Blue Book, too, with their own totally made up prices, and they often differed widely. That's why you'll hear TV investigative reporters tell of how one hospital charges $300 for a mammogram, while another across town charges $2,700.
Of course insurance companies have contract pricing where they pay MUCH less, but if you have to pay yourself, this is what they bill you. Some pay, some walk it entirely, but some come back to negotiate (and the hospitals allow themselves LOTS of room to negotiate). It's a giant shell game!
Some doctors do something similar. You call a doctor and ask if they take your brand of insurance and are told yes, so you make an appointment. A few weeks later you find out from your insurance company that the doctor charged more than the "usual and customary" fee, and that the balance is up to you. Gee, thanks for telling me up front, doc.
Ditto for prescription drugs from your insurance plan or Medicare drug supplement. They cover what is on their "formulary" list only. Their what? If it isn't on their list, you're SOL. (Shit Out of Luck) And they list page after page of things like hydrothialomicizinetine trididodickyluckypucky. WTH? What happened to "Lyrica" or "Crestor"? Sadly this is the way our world works today....you're led to believe
one thing, only to find out later the fine print screwed you over.
We little guys don't stand a chance!
So now they're going to REPEAL AND REPLACE Obamacare. OK, great, by
all accounts it needed to be overhauled. But please tell me how they're going to get all those various interests, each with their own proprietary fine
print, to agree to a viable replacement? Each will be maneuvering to throw the
other under the bus first. (No honor among thieves, you know.) And it will eventually have to be voted on
by Congress....yes, bought-and-paid-for Congress. *bend over folks*
There's fine print everywhere....buried in that 8 page credit card agreement, that 75 page mortgage document, your homeowners/renters/auto/life insurance policies, your auto loan agreement, that investment prospectus....everywhere!
Here's the deal: most businesses today don't WANT you to know how they operate. They LOVE doing business in the shadows. Transparency is the LAST thing they want.
Ever hear of the Consumer Financial Protection Bureau? It was an outgrowth of the financial meltdown back in '08. Its supporters will tell you it exists to slap down businesses that take advantage of unsuspecting consumers (ie: non-lawyers who can't understand all that legalese/fine print). Detractors, such as the Big Banks, the US Chamber of Commerce, and I'm sad to say the Republican establishment, will tell you it "interferes with their ability to conduct business as they feel they need to", and besides, regulations are JUST DOWNRIGHT UN-AMERICAN!! *saluting flag*
Seems to me if the Big Banks, the US Chamber of Commerce, and the Republican establishment (and probably more than a few Democrats, too) would behave the way their mamas taught them, there wouldn't be a need for a Consumer Financial Protection Bureau.
What you DON'T know WILL hurt you, or at least COST you. Caveat Emptor now more than ever, my friends.
S
Yep, it's almost here. October 1st is tomorrow, the date Obamacare goes into effect. Some are dancing in the streets, some are jumping out of windows. So where does 'ol Lowandslow stand on this, you're asking?
I think it's gonna be an absolute mess. Here's why: Anything that comes with a 2,700 page users manual, written hastily by a bunch of bureaucrats (who probably have a government job only because they were too inept to get a job in the private sector) and industry lobbyists (who you know are making damn sure their clients are protected one way or another), is doomed to fail. This is going to be a cluster f__k of epic proportions!
So then I'm for the status quo, right? Nope, not at all. The status quo is a runaway train carrying us all in slow motion straight over a 1,000' cliff. I firmly believe we need some sort of, for lack of a better term, "universal health care". Consider this:
Only 51% of US businesses (pre-Obamacare) offer health care coverage to their employees. That is down roughly 10% in a decade. And of those who do have employer paid / subsidized coverage, more and more are seeing higher deductibles / cash-out-of-pocket maximums ($5K-$10K is not uncommon) and co-pays.
Private insurance? Fuggetaboutit. One middle aged friend of mine, for example, who has had two back surgeries and a wife who is a breast cancer survivor, is paying $1,500 per month for just himself and his spouse. And that's with a $10,000 deductible. Another friend (with insurance) told me if his wife has any more issues, their only recourse will be bankruptcy.
Speaking of: There are 1.7 million personal bankruptcies +/- filed in the US each year. Medical bills and lost income due to illness are responsible for 62% (or roughly 1 million) of those. That's more than due to crushing credit card debt or unaffordable mortgages. And of those 1 million filings, 78% HAD HEALTH INSURANCE.
When the average working / insured American has an income of about $50K and gets a medical bill for $5-10K, they're screwed. Unless it's for use to cover a catastrophic accident or illness, do they really even have insurance? If they can't afford to use it, is it really there?
And talk about inefficient....somebody explain to me why there are 50 state insurance commissions with 50 different sets of rules and 50 different insurance company and state bureaucracies? Why aren't insurance companies organized around one giant nationwide group policy with one set of standards?
Pharmaceutical costs are out of control, too. Consider this: In all countries I'm aware of with some form of national insurance, the government determines how much drug makers can charge, and it's always just enough to cover the cost to manufacture the drug.
All the costs to cover R&D, which can run up towards a billion dollars, are charged to AMERICAN consumers. That's because our "free market" allows Big Pharma to charge anything they want here. This is true. I've had it confirmed to me by a friend in the pharma bidness. *you're welcome world*
And how about all those not-so-visible costs we pay to cover the uninsured? Several years ago I heard a spokesman for the Baylor Hospital System admit they charge 150% of cost to INSURED patients in order to cover the write-offs for those who couldn't / wouldn't pay.
Just last week I heard the Dallas County Judge say the County spends more supporting their county (charity) hospital than it does on ALL other county functions combined. This would include running the jail system, the sheriff's office, the courts, the road and bridge districts, etc. (I haven't researched that, but I take him at his word.)
So then doctors make too much, right? IMO, no. Consider this: Docs go through 10 or more years of college, med school, internship, residency, etc, and usually accrue $250K or more in school debts, before they can enter practice. For our best and brightest, I don't think their income is unreasonable. (Compare this to a Wall Street banker who might make 10-times as much selling fraudulent securities.)
Oh, here's a thought....how about getting all the blood-sucking trial lawyers out of the game? Bad docs need to be removed, no doubt. But in waaaaay too many malpractice cases it's just a money grab. The legal profession has become a parasite on the medical profession. Why are they allowed to do that? (Because trial lawyers as a group are among the largest political campaign contributors, that's why.)
I could go on and on, and maybe I will at a later time, but suffice it to say the status quo is becoming less and less workable, even for those of us who are fortunate to have insurance and can afford to cover high deductibles and co-pays. Long term the status quo is simply unsustainable.
Let's review: The health care crisis is becoming more and more acute and is swirling down the toilet. Obamacare will probably be a mess. The status quo will someday eventually fail us.
So what do we do? Beats me. It's going to take someone smarter than me to figure it out. BUT WE MUST FIGURE IT OUT. Removing the spectre of instant family bankruptcy due to whopping medical bills from the national conscience is bound to be good for the country.
We need to be concentrating on becoming more competitive, stronger, and more resilient in the new world economy, not losing sleep worrying about how we're going to pay for grandma's festering sore.
S
