Tuesday, March 5, 2013

The $750 billion rip-off

   What the March 4 Time lacks in its explosive expose about the hospital industry is a face.

   A perspiring face. A blinking, flinching face. 

   Dear do-nothing Congress: You say you care about things that affect everyday Americans. Well, then, find us such a face.

   We need someone on whose thieving visage we can focus, like that of Charles Van Doren, paraded before a sensational congressional investigation in 1959.

    His crime? Being fed the answers that kept him winning on TV quiz show "Twenty-One."

   Scandalous? Oh, yeah. Van Doren had achieved great wealth and fame — $100,000 in winnings — even appearing on Time's cover.

   So what about the scoundrels and cheats now the focus of the news magazine? We have no faces to attach to writer Stephen Brill's assertion that hospitals overcharge Americans $750 billion per year. We need them.

   Until we know the perpetrators, they will continue to do exactly what they do — rip people off.

    Brill and Time have done the nation a service, dissecting the add-ons and overcharges faced by uninsured or underinsured individuals who, once they got the bill, wished they were dead.

   Take the cancer patient who lived just long enough to see his widow-to-be face a $142,000 bill, this after paying $30,000 toward the total.

   The overcharges are too numerous and outrageous to mention, but just consider the $25 one hospital charged for a 500 milligram niacin tablet, sold for a nickel apiece in drug stores. Or the $7 apiece that MD Anderson charged for cotton swabs used to disinfect prior to injections. A box of them can be had for $1.91.

    The hospitals say these aren't the actual costs that patients pay, only a starting point for negotiations with insurers. However, when one has no insurance, or when one's insurance is capped and can't keep up with catastrophic costs, these charges are the ending point, unless a smart and resourceful advocate can argue the bill down.

    An irony welling up in Brill's report is that nonprofit hospitals are among the worst offenders. Hence, they are swimming in cash they use to make executives millionaires, to build gleaming towers, and to buy out competitors.

    Another irony is how that evil thing called government comes up smelling like a rose in contrast to how the "free market" handles medical costs. Medicare, writes Brill, isn't just efficient, it's "ruthlessly efficient" controlling costs.

    We need hearings. We need to hear from the faceless "chargemasters" who set such scandalous prices. We need red faces and sweaty lips. Then we need to bring the hammer down on institutions that do what they do with government's involvement and hefty subsidies.

   Points out Brill, "This is not about interfering in a free market. It's about facing the reality that our largest consumer product by far — one fifth of our economy — does not operate in a free market."

    Largely because Congress caved to industry demands, the Affordable Care Act — Obamacare — with the good it will do for those lacking insurance, performs little cost control. The condition is a continuation of industry-sculpted Medicare Part D, for which the government can't negotiate drug prices.

    At a time when efforts are afoot to clamp down on Medicare, Brill makes the fascinating assertion that the best thing for health care would be to expand  it — to lower, not raise, the eligibility age, with higher copays based on income.  Many of the most tragic victims of this system were people just on the cusp of Medicare and age 65. 

   Points out Brill, "The health care market isn't a market at all. It's a crap shoot. People fare differently according to circumstances they can neither control nor predict."

   So true. Now, to attach this scandal to a face.

   Longtime Texas newspaperman John Young lives in Colorado. Email: jyoungcolumn@gmail.com.

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