Nick Anderson cartoon

Please!

| The US healthcare system is on life support, kept alive only by extraordinary measures paid for by you and me to the benefit of entrenched profit-driven interests, namely the insurance and pharmaceutical industries, abetted by for-profit hospitals and by politicians in the pocket of those interests. As a nation, we pay more for our healthcare, per capita, than any other nation on earth but the people in several other countries live longer and have lower rates of infant mortality and cancer. In short, we're not getting our money's worth!

The costs of healthcare are rising much faster than incomes and are eating up more and more of the country's economy. We're on the road to economic ruin.

Yet, if you listen to all the nay-sayers, the hand-wringers, the town-hall rabble, the misinformed, and the mis-leaders, you might think that the proposals to reform healthcare were about giving up something perfect. And the whole concept of system reform has been reduced to essentially insurance reform.

OK, let's talk abouat health insurance. I've said it before (See Chronicles, November 2008), and I'll say it again: If you think you have good health insurance, it's only because you've never had to use it for anything other than a normal doctor's visit.

You might think I'd be very happy with my medical insurance. After all, I am covered by Medicare and have the top-of-the-line supplemental insurance through my former employer.

You might think that, but you would be wrong. Very wrong. Here's another example.

Diagnostic tests. The mind may still think itself young, but the body knows the truth and is showing signs of age. Recently my doctor sent me to the hospital for three diagnostic tests: a hip X-ray, an X-ray of my esophagus, and a stress test.

So far — so far — there have been six claims totalling $11,625.60. Oh, yes, Medicare and my insurance company broke those six claims into 19 individual pieces to process.

Bills resulting from three diagnostic tests
Claim Amount ($) Medicare approved ($) Medicare paid ($) Supplement paid ($) Applied to deductible I paid ($)
Totals $11,625.60 $11,148.52 $1,250.67 $16.00 $305.84 TBD
Doc #1 (xxx6450) 512.00 125.45 100.36 12.55 0.00 TBD
Hospital (xxx5004) 9343.16 9343.16 1013.51 0.00 207.60 TBD
Doc #2 (xxx6240) 40.00 10.88 8.70 1.09 0.00 TBD
Hospital (xxx4604) 1058.67 1058.67 74.61     TBD
Doc #2 (xxx6250) 85.00 23.59 18.87 2.36 0.00 TBD
Hospital (xxx4704) 586.77 586.77 34.62 0.00 98.24 TBD
Lab 169.00     0.00 0.00 TBD

What's wrong with this? Let me count the ways...

This is completely insane.

  1. The amounts charged are obviously, grossly inflated. OK, the stress test is undoubtedly expensive, involving nuclear medicine as it does, but c'mon, an X-ray is about the oldest, cheapest technology in a hospital.
  2. Something is wrong with a system in which Medicare "approves" an amount, but "pays" something less than that — often far less, ranging from 6% of the approved amount in the case of one hospital bill to 80% of another.
  3. My supplemental insurance has, so far, paid a grand total of $16 of a total bill of $11,785. And for this I pay $200/month?
  4. The detail for each of the claims processed by my supplemental insurance contain 13 line items noted as "Not covered" totalling $9,195.16.
  5. It is simply impossible to tell, no matter how closely I study the Medicare and UnitedHealthcare claim details, how much I will end up having to pay. UHC includes a helpful column on their summary page headed Patient Responsibility (see below). You will note that all the amounts in that column are $0.00 — not because that's how much I'll be responsible for but because the company, whose revenues for 2008 exceeded $81 billion, can't be bothered to calculate the amount and tell me.

    Remark Code 4C: This Plan Determines Benefits Once Medicare Makes Payment. If Medicare Pays Less Than This Plan's Benefit, This Plan Will Consider The Difference. This Plan's Allowable Benefits Are Based On The Medicare Approved Amount If The Physician Or Provider Accepted Medicare's Assignment Or On The Limiting Charge If They Did Not Accept The Assignment. The Patient Is Responsible For The Difference Between The Allowable Amount And The Total Amount Paid By Both Plans. The Patient Must Pay Any Applicable Plan Deductibles And Copays Before This Plan Can Pay Any Benefits.

    Explanatory claim note (sarcasm intended)
  6. I'm one of the "lucky" ones who has insurance. Imagine if I didn't have insurance! I'd be bankrupt in a heartbeat (which, according to the stress test, is pretty darned good).
uhc_summary
Summary of UnitedHealthcare claims

So here's how this wonderful system that the GOP wants to prevent reform of works:

Mind, we haven't even begun to talk about all those millions who don't have any medical insurance and show up at the emergency room to be treated. Who do you think pays for that? We do, of course, in the form of all those inflated charges that the providers foist off on the insured. We pay — and our employers pay — in the form of premiums paid to the insurance company. Oh, yeah, and the government pays (actually, that's us again) in the form of tax deductions the employers are allowed to take for being such responsible corporate citizens.

It's a wonderful system — if you're an insurance company who gets to decide who can get coverage and who can't, and, for those who get coverage, what is covered and to what extent and what is not. In truth it is a system of perverse incentives. How perverse? you ask. Read "How American Health Care Killed My Father" in The Atlantic (September 2009).

Last updated on Aug 27, 2016

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