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A Point Of View

Posted Mar 04 2013 10:20pm

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.

A 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.

A 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.

Now 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 consumers.

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 not mater. 

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 outmoded corporation.

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 medicine.”

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 medical care.

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 healthcare system.

 The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.



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