{"id":31525,"date":"2024-06-03T18:31:12","date_gmt":"2024-06-03T23:31:12","guid":{"rendered":"https:\/\/wholehealthchicago.com\/blog\/?p=31525"},"modified":"2024-06-03T18:31:14","modified_gmt":"2024-06-03T23:31:14","slug":"pigs-at-a-through","status":"publish","type":"post","link":"https:\/\/wholehealthchicago.com\/blog\/2024\/06\/03\/pigs-at-a-through","title":{"rendered":"PIGS AT A TROUGH"},"content":{"rendered":"\n

I regularly revisit my battered copy of a <\/a>2013 Time Magazine Special Report, “Why Medical Bills Are Killing Us”<\/a>, with the same conflicted feeling I had at about age six when I learned that something painful, like picking a scab or jiggling a loose tooth, also afforded a secret pleasure that could not be shared with friends.<\/p>\n\n\n\n

Author Steven Brill, a seasoned investigative journalist, revealed much about healthcare finances were (and still are) truly painful to read. He later expanded his findings into the book, \u201cAmerica\u2019s Bitter Pill.\u201d<\/p>\n\n\n\n

Once I thought there might be some glimmer of hope in healthcare\u2019s future, but now, in 2024, with Americans unhealthier than ever (more chronic illness, obesity, shorter lifespans) and continuing to spend over 17% of our Gross Domestic Product (GDP) on healthcare ($13,500 per person). Brill spent months deciphering hidden costs in the health care system (focusing especially on hospital billing practices) to find out why Americans had been spending $4.5 trillion annually on their care while getting so little health benefits in return.<\/p>\n\n\n\n

If Brill singled out one villain in his piece, it was the system of hospital pricing you\u2019ve likely never heard of called the \u201cchargemaster\u201d,\u00a0<\/em><\/strong>an internal and extremely secret price list of everything a hospital can charge you for. It\u2019s the hospital\u2019s chargemaster that will list the $77 box of four gauze pads on your bill, $580 for that hour of oxygen you never used, and tens of thousands of other items and procedures. The skin marker used to write, \u201cthis one\u201d, on your knee so your surgeon didn\u2019t operate on the wrong leg? A bargain at $25.<\/p>\n\n\n\n

A few years later, Big Pharma would push its way into the feeding trough of health care resources. Newer medications for cancer and autoimmune diseases routinely reach half a million to a million dollars a year.<\/p>\n\n\n\n

I once wrote a Health Tip<\/a> <\/strong>about an uninsured student who meandered into Northwestern\u2019s emergency room with a bladder infection and left with five bucks worth of generic antibiotics and a $10,000 bill. That\u2019s chargemaster in action.<\/p>\n\n\n\n

There\u2019s virtually no system to check this unmitigated greed except Medicare, which sends every hospital its own chargemaster and basically tells the hospital, \u201cYou\u2019re charging $74 for gauze pads? Silly fool! We\u2019ll pay you $3. Period.\u201d Medicare\u2019s maximum reimbursements to a hospital are a fraction of the hospital\u2019s usual charges, though your Medicare supplement policy can help the hospital make up some of the difference. Generally when you\u2019ve got both Medicare and a supplement, the hospital will accept the sum of the two policies as \u201cenough\u201d and not bother you for more money.<\/p>\n\n\n\n

Don\u2019t fret if the Medicare payment looks low to you. Hospitals are still raking in plenty of coin.<\/p>\n\n\n\n

Insurers Negotiate Individually<\/strong><\/h3>\n\n\n\n

Private insurers like Blue Cross, Aetna, and dozens of others individually negotiate their rates with hospitals, paying somewhere between the Medicare bargain-basement rate and the full retail \u201crack rate\u201d of a hospital\u2019s chargemaster.<\/em><\/strong> The real losers in this system are uninsured patients, who often are billed the chargemaster price (hence the $10,000 bladder infection). Kicking and screaming with the hospital will usually trigger a 50% discount, which sounds good until you realize it translates into a still-crazy $34 for four gauze pads.<\/p>\n\n\n\n

These not-for-profit hospitals aren\u2019t particularly charitable either. Of Northwestern\u2019s 2010 tax-exempt revenue of $1.16 billion, a pathetic 1.85% was spent on charity care. They did even better in 2011, with $270 million in tax-free profits on $1.3 billion in revenue. As I wrote my property tax check this week I thought that if someone reversed the tax-exempt status on Northwestern\u2019s juicy lakefront property, the hospital could single-handedly support county-funded John H. Stroger Jr. Hospital (formerly Cook County).<\/p>\n\n\n\n

What Brill suggests toward the end of the Time article is a total ban on the concept of chargemaster fees and pegging all reimbursements from everyone (Medicare, Blue Cross, the uninsured) to the fees established by Medicare. This is the glimmer of hope I referred to earlier, because personally I think it will eventually occur. It has worked for years in France, where even though there are competing health insurance companies the reimbursements to hospitals and physicians have been standardized by the government.<\/p>\n\n\n\n

Whatever the Market will Bear<\/strong><\/h3>\n\n\n\n

And while Brill did a remarkable job alerting us to the financial sinkhole our health system has become, I do want to add that outrageous prices and over utilization of services extends far beyond the hospital setting.<\/p>\n\n\n\n

Because there are so few consistent controls on the pricing of any health service, from an Urgent Care Center office visit when you have the flu to a lab test, x ray, CT scan, prescription drug, or piece of medical equipment (like a cane), health care costs are usually based on whatever the market will bear. If it can bear a lot (i.e., you\u2019ve got great insurance), expect more of everything: diagnostic tests, prescription drugs, referrals to specialists, and possibly minimally useful or altogether unnecessary surgical procedures.<\/p>\n\n\n\n

In an area where prices are relatively low and fixed, such as Florida, with its older Medicare population, speed is the name of the game. Primary care doctors in a group will see 50 to 60 patients a day, referring as many as possible for further testing (using equipment owned by the hospital) and also to the group\u2019s specialists for more procedures. A small skin cancer removed from a patient\u2019s cheek may ultimately cost thousands of dollars as various pre-surgery clearances are totted up from internists, cardiologists, neurologists, and ophthalmologists, plus post-operative wound care nurses and dermatologic pathologists.<\/span><\/span><\/p>\n\n\n\n

Let\u2019s face facts. With this much money involved, it seems as though everyone in the income-generating segment of health care (i.e. fee-for-service)<\/span>\u00a0<\/span>has the potential to get sullied if they don\u2019t watch themselves. Obviously the vast majority of physicians and other health care providers are hardworking, dedicated to the health and well-being of their patients. But if you read the medical journals, as I do, you come across all too frequent stories of surgeons doing unnecessary surgery, hospital administrators encouraging doctors to \u201cfill up a few beds\u201d and red flagging physicians who did not. Believe me, there are plenty of physicians doing time in the clink for submitting false insurance claims. Money does indeed poison the brain.<\/span><\/span><\/p>\n\n\n\n

Where\u2019s Mine?<\/strong><\/h3>\n\n\n\n

With healthcare spending a staggering $4.5 trillion annually, let\u2019s recall the late Chicago Daily News columnist, Mike Royko, concerning Chicago\u2019s motto, which he suggested be changed from the boring, “I Will” <\/a>to a salivating \u201cWhere\u2019s Mine?\u201d. $4.5 trillion spent in health care every year? Pigs at a trough.<\/p>\n\n\n\n

Cogitating on all this, I located a dust-covered book I\u2019d bought over 40 years ago, The Great Billion Dollar Medical Swindle<\/a><\/em>,<\/strong> actually a best-seller when it first appeared in 1980. I even remember the full-page ad that appeared in the now long-gone Chicago Tribune Book Section when the book was released. I\u2019d immediately bought a copy because its author, Keith Lasko, MD, was a pre-med and med school classmate of mine.<\/p>\n\n\n\n

In the third year of medical school, in alphabetical order, the class separates and moves into different hospitals. Given my \u201cE\u201d to his \u201cL\u201d, I never again crossed paths with Lasko. Had he written his book today, though, he\u2019d have to change the title\u2019s \u201cbillion\u201d to \u201cmulti-trillion\u201d, and with these musings I was curious to discover what had become of him. I remember the emotion that coursed through me as I read\u00a0Swindle<\/em>\u00a0back in 1980. Lasko, writing like the proverbial loose cannon, was convinced the entire health care system was corrupted by financial greed. No one was exempt. He took on everyone and everything: medical schools, doctors, hospitals, drugs, alternative medicine, health insurers. He was very angry and very public about his views, and for a while a regular on talk shows.<\/p>\n\n\n\n

Then he vanished. He didn\u2019t appear at any of our class reunions and I occasionally wondered about the consequences of taking on the entire health care system. For all I knew he was wearing cement boots on the bottom of the Chicago River. After some investigating, I found out what had happened.<\/p>\n\n\n\n

Interesting story. But that\u2019s for next week.<\/p>\n\n\n\n

<\/p>\n\n\n\n

Be well,
David Edelberg, MD<\/em><\/p>\n\n\n\n

<\/span><\/div><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

I regularly revisit my battered copy of a 2013 Time Magazine Special Report, “Why Medical Bills Are Killing Us”, with the same conflicted feeling I had at about age six when I learned that something painful, like picking a scab or jiggling a loose tooth, also afforded a secret pleasure that could not be shared […]<\/p>\n","protected":false},"author":2087,"featured_media":31527,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[67,203,50],"tags":[1613,202,2711,2736,2365,1614,2734,2735,466,2733,2737],"class_list":["post-31525","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-h","category-health-insurance-issues","category-healthy-lifestyle","tag-chargemaster","tag-health-insurance","tag-healthcare-costs","tag-healthcare-reform","tag-healthcare-system","tag-hospital-pricing","tag-medical-bills","tag-medical-debt","tag-medicare","tag-pharmaceutical-prices","tag-us-healthcare"],"yoast_head":"\r\nPIGS AT A TROUGH - 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