Stanley Feld M.D.,FACP,MACE
Steven Brill’s 24,000 word
article “Bitter Pill” is an excellent review of some hospital charges. He
presents examples of outrageous hospital charges.
Many consumers have experienced these charges
but have ignored them. Few have understood them. Their healthcare insurance
coverage negotiated the reduced payment.
His examples of charges
from real patient bills such as $199.50 for a troponin test. Medicare pays
hospitals $13.94 for the test. The hospital accepts the charge. The actual cost
of the test is less than $4.00.
hospital charge for a simple complete blood test was $157.61. Medicare would
pay $11.02. The actual cost to the
hospital might be fifty cents.
simple finger stick blood sugar hospital charge was $18.00. Accu-chek gives the machine away to sell the sticks. A box
of 50 test strips costs $27.00 or $.55 a strip. It cost less that one penny to
produce a strip.
that more people are unemployed and fewer people are insured or have adequate
insurance, consumers are starting to pay attention to these fees.
It is about time that a major news media
outlet published something about these outrageous hospital system charges to
After all, the media is the message!
Maybe the message will
generate the necessary community outrage for effective reform.
I have often heard “when
you are sick enough to need a hospital you do not have the time to shop
around,” for the best price.
It is true. However, no one
has questioned hospitals for charging those rates.
The poor, uninsured and
underinsured are the consumers this price system hurts the most. Society needs
to protect these Americans from this outrage.
Consumers with adequate
healthcare coverage do not even look at the explanation of benefits for their
healthcare bills.. Their healthcare insurance company pays the bill after
negotiating the price with the hospital system.
As premiums and deductibles
rise these fee are getting more attention.
There is so much data in
Steven Brill’s multi-page document that I am sure comprehension is low. It does
Steven Brill’s message is
crystal clear. The situation is intolerable. The American public is being
ripped off. Healthcare pricing is destroying our nation’s economic growth.
Brill does not explain the
reasons how these high prices evolved. He does not explain whom if anyone
should be doing something about them.
He does not come out and
say the solution is government takeover of the healthcare system. However, he
implies it throughout his article.
Any fair minded individual
would be sympathetic to this implied notion. However. Steven Brill disregards
the fact that the government got us into this mess.
I have explained this over
and over again.
The Berkeley economist James C. Robinson pointed out that improving
the healthcare system is different than making technological improvements in an
The success of all other transformations has been consumer driven.
The healthcare system has evolved to the point that consumers must
shut up, do as they're told, and be prepared to write a blank check.
Healthcare policy wonks
have concluded that healthcare must be commoditized and depersonalized.
This thinking has resulting in the present healthcare system’s pricing.
No one understands it or is attempting to modify it.
- “The corporate system of health
care has produced stronger organizations and more intense performance
competition than the traditional system dominated by professionals.
- This transformation of the health
care system has swept away the framework of professional dominance in
The excuse has been that consumers do not know how to drive the
healthcare system. It is too complicated.
This excuse has been used to "justify every inefficiency,
idiosyncrasy, in the healthcare system driven by professionalism, by
interest-serving institutions and corporations in the health care industry to
control and raise the price of healthcare."
Hospital systems have realized that in order to control the system
medical care must be commoditized. There is also government agreement.
“Hospitals, insurers and other institutions
involved in health care battle over available dollars.
These institutions also know that
hiding the true cost of healthcare from the consumer is the way to inflate
value and increase cost.”
Hospital systems also know in order to control the healthcare system
completely they need to own physicians’ skills and intellectual property.
Patients and physicians drive the healthcare systems not
corporations and hospital systems.
Physicians like the public are blind to hospital charges and costs.
There is no price transparency. The hospital systems are positioning themselves
as parasites to take advantage of patients and physicians.
The government is trying to encourage hospital employment of
physicians so it has fewer entities to deal with. This is a mistake.
Steven Brill indirectly implies government driving healthcare for
all is the cheapest and best way. He is wrong.
A government single party payer system will only increase the
price of healthcare and create unhappier patients with restricted access to
Physicians are not interested in having their skills and
intellectual property treated as a commodity.
Physicians will become more cynical. They will unionize and restrict
their hours worked in a week.
These developments will cause the ultimate demise of the
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
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