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Drowning in funny money

| If you're like 47 million Americans (16% of the population) you have no health insurance. If you're among the other 84% of the population, you have health insurance, but may be under the delusion that it is protecting you. The American health care system is severely broken, and most of us never realize just how broken it is until we need to use it.

When people press for reform of the health care system, they are often told, "Americans have the best health care in the world." As Shannon Brownlee and Ezekiel Emanuel point out in today's Washington Post, that claim is a myth (5 Myths about our Ailing Health-Care System, Washington Post, Nov 20, 2008) ), true only if you measure by the amount of money spent on health care. By other measures, like life expectancy at birth, infant mortality rate, or results of care versus cost, the US ranks far below many other countries.

And let's talk about those costs. I'm one of the fortunate ones. I've always had health insurance. Now that I am 65 years old, I am covered by Medicare and the best supplemental plan offered by my former employer.

• When I retired in 2002, my employer retiree health insurance cost $92 per month; my co-payment for a doctor's visit was $10 and a 3-month supply of my prescriptions cost between $5 and $30, depending on the drug.

• In 2009, my employeer retiree health insurance — now just a supplement to Medicare — will cost $195 per month, and a 3-month supply of my prescriptions will cost between $10 and $115, depending on the drug, few of them the $10 generics. The premium for Medicare — my primary insurance — will be $96 per month.

In short, my health insurance premiums have increased from $92 per month to $291 per month, an increase of 316% and my out-of-pocket costs have soared as well.

When you need it

Now let's look at two examples of what happens when you actually have to use your health insurance.

Example 1 — Emergency room visit. In July I was taken to the emergeny room after collapsing at home and driving my head through the wall when I fell.

Charges Amount billed Medicare paid My insurance paid I paid Funny money*
Ambulance $1205.00 $373.73 $46.71 $46.72 $737.84
Hospital $9082.45 $479.88 $0.00 $278.25 $8324.32
ER Doctor $501.00 $136.16 $17.02 $17.02 $330.80
Radiology $523.00 $108.42 $13.56 $13.55 $387.44
Totals $11311.45 $1098.19 $77.29 $355.94 $9780.40
* Difference between amount billed and total amounts paid

Example 2 — Colonoscopy. My doctor decided that as a 65th birthday present I should have a colonoscopy. This was performed, after a 3-month wait for an appointment, by a gastroenterologist at an outpatient surgical center at the Eisenhower Medical Center in Rancho Mirage. So far, the bills aren't all in, but a similar pattern is emerging.

Charges Amount billed Medicare paid My insurance paid I paid Funny money*
Hospital $2112.00 $328.96 $65.80 $43.86 $1673.38
Doctor $750.00 $158.61 $19.82 $0.00 $571.57
Totals $2862.00 $487.57 $85.62 $43.86 $2244.95
* Difference between amount billed and total amounts paid

First, there is the disparity between the amounts the providers bill, and the total amount of money they receive from Medicare, my insurance, and me. In the example of the emergency room visit, only 13% of the amount billed was actually paid. What happens to the other 87%? That is exactly what I mean by "funny money" — do providers pad their bills so they can deduct the unpaid amount as a business loss on their taxes? If the amount billed is even close to the cost of providing the service then all the providers should be going bankrupt, but we know from financial reports that the hospitals and insurance companies are raking in money.

Then there is the cost/benefit ratio for my supplemental insurance. For my supplemental insurance I am paying twice what I pay for my primary insurance (Medicare). But my supplemental insurance is paying a measly fraction of what Medicare is paying — and a paltry amount compared to what I am paying in premiums.

Finally, there is the disparity between what my insurance covers and what other insurance may cover. My friend Réal was supposed to get a colonoscopy about a month after I had mine, from the same doctor and at the same facility. But two days before his procedure he found out that his co-payment would be $500! I don't know yet how much I will end up paying, but I'm guessing it won't even come close to $500. Oh yeah, Réal decided not to have the procedure.

As my mamma used to say, "Something's rotten in the state of Denmark!"

The Republicans need to stop braying about "socialized medicine" and start making the system work for the people. The current system — under the thrall of the insurance and pharma lobbies — doesn't work for me and I'm sure it doesn't work for doctors and hospitals either. All it does is line the coffers of the insurance and hospital companies and fatten the bonuses of their overpaid executives.

Update | March 30 ,2009 Eight months (8!) after my emergency room experience, I received yet another bill, this one for the radiologist's services. The bill is instructive:

radiology_600

My quarrel is not with the amount I am left to pay. My quarrel is this:

Last updated on Sep 10, 2016

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