It does a lot of good, but there is much more to be done because one thing Obamacare doesn't do is address health care costs. And American health care costs are insane.
What follows are excerpts from that article, but I'll begin with a quote from "Health Care Reform: Buster Explains It All", written 9/9/09 and posted to the blog 2/25/10:
"Think about this. If you were allowed a big do-over, starting from scratch, would you design our American health care system to be what it is today? No, you wouldn’t. You’d want universal coverage with government-regulated rates and fair rules, and you’d want an efficient, cost-saving single-payer system. But the bitch of it is, even though everybody from Obama to Ron Paul knows it’s true, nobody has the balls to say it. Because single-payer would effectively wipe out private health insurance companies. (Convince me why this is a bad thing.)"
But as the Time article illustrates, it's not only insurance companies that play a role in our ever-escalating health care costs -- the larger culprits, the real drivers of the cost bus are hospitals (including non-profits), medical centers, pharmaceutical companies, medical products companies, nursing homes and certain doctors groups.
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In America, we spend more on health care than the next ten biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Austria.
We spend 20% of our GDP on health care, compared with about half that in most developed countries.
We will spend $2.8 trillion on health care this year, $800 billion via Medicare and Medicaid, the other $2 billion via private health insurance and via those who have no insurance.
Janice S., 64 years old, had chest pains and was taken by ambulance to the ER. Tests determined she just had indigestion. She was sent home. Janice was unemployed, had no insurance and was not yet eligible for Medicare. Her bill for a false alarm? $21,000.
Every hospital has an internal price list called the "chargemaster". It's a compendium of the full-retail sticker price for every conceivable item, service and procedure offered.
No hospital's chargemaster prices are consistent with those of any other hospital, nor do they seem to be based on anything objective, like cost.
The only consistency among hospitals chargemaster prices is that they are all exorbitantly high.
Medicare reimbursement rates are much, much lower. For any given service, Medicare reimburses hospitals for their direct costs plus overhead, capital expenses, executive salaries, insurance, regional differences, and even the education of medical students.
Hospitals complain of losing money on every Medicare patient, yet the reports hospitals are required to file with the Dept. of Health and Human Services refute this claim.
Jonathan Blum, deputy administrator of the Centers For Medicare & Medicaid Services: "When hospitals say they're losing money on Medicare, my reaction is the market is overflowing with Medicare patients and all those hospitals are expanding and advertising for Medicare patients. They don't lose money when they serve Medicare patients."
Patients with private insurance also get big discounts off the chargemaster prices, though not nearly as steep as the Medicare markdowns.
Janice S., unemployed, uninsured and 64, was asked to pay chargemaster prices. She was charged $199.50 each for three tests. Medicare would have paid the hospital $13.94 per test. She was charged $157.61 for bloodwork for which Medicare would have paid $11.02. For a dye test using a CT scan, she was billed $7997.54 for the scan and $872.44 for the dye. Medicare would have paid $554.
If covered by Medicare, Janice S. would have paid $500-$600 out of pocket, or even less than that if she had supplemental insurance.
If you are confused by the notion that those least able to pay are the ones singled out to pay the highest rates, welcome to the American medical marketplace.
And it's not just Janice S. Examples abound:
A hospital charged $18 each for diabetes test strips which cost 55 cents each at the local drugstore.
A patient was billed $333 for a chest X-ray. Medicare pays $23.18.
$24 for a single Niacin tablet which retails for about 5 cents; $1.50 for a single Tylenol tablet which retails for about 1.5 cents.
A cancer center charges $7 each for "alcohol injection prep pads" -- little cotton squares. You can get a box of 200 at Walgreen's for $1.91.
An Oklahoma man with a bad back was told by a specialist that he needed a small spinal cord neuro-stimulator implant. He had the procedure at an out-patient clinic. For the simple use of this facility, he was charged a $6289 fee. They also charged him $7882 for medical and surgical supplies, including $32 for a reusable blanket, $31 for a reusable table strap, $3 for a reusable pen to mark the incision site, and $39 for the surgeon's gown. He was charged $1837 for pharmacy supplies, including a $108 tube of antibiotic ointment. The implant device itself (wholesale price $19,000) was billed at $47,237. The man's total bill from the out-patient facility for his one-day adventure was $86,951. This did not include the surgeon's bill.
A cancer center required a man to pay $83,900 in advance for one round of cancer treatment because it was determined he had substandard "discount" insurance coverage.
One of this man's chemotherapy drugs was Rituxan. A dose of Rituxan costs $300 to manufacture. That dose was sold to the cancer center for $3000. The cancer center sold it to the patient for $13,702.
The CEO at the University of Pittsburgh Medical Center is paid $5,975,462 annually. The CEO of the New York/Weill Cornell Medical Center is paid $4,356,039. Both hospitals are "non-profit".
Over the past few decades, we've enriched the labs, drug companies, medical device makers, hospital administrators, and the purveyors of CT scans, MRIs, canes and wheelchairs. Meanwhile, we've squeezed the doctors who don't own their own clinics, don't work as drug/device consultants, or don't otherwise game a system that is so very game-able. And of course, we've squeezed everyone outside the system who gets stuck with the bills.
Gerard Anderson, health care economist at the Johns Hopkins Bloomberg School of Public Health, says the obvious and only issue is: "All the prices are too damn high."
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In that old post mentioned above, Buster suggested that part of the solution would be "regulated rates, controlled rates, Medicare-based rates." Do I mean nationalized, government-run health care? Like those friggin' Socialist Canadians?
You may call it what you want. What I mean is that capitalism and the profit motive are appropriate and work well in many areas, but health care is not one of them.
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