Health Care Trauma

You may have heard that there is a health care debate going on here in the United States. We have to DO something, dammit! The debate centers on what that something is and how that something will apportion health care resources to more folks. Ostensibly, the costs of health care render it out of reach for many and it is proposed that there be some way to make health care accessible to everyone.

Noble. In order to accomplish this we must establish that health care resources have a value (cost), although that actual cost is hard to fathom (more later). And we must also accept the fact that some can afford to pay that cost (at whatever mark it is set) and some cannot. In order to provide these resources to those who cannot afford it, those that can must subsidize those that cannot. I am acknowledging that point. And I understand that many folks are okay with this: whether through taxation, increased fees or whatever, those that can afford it will pay for those that cannot. This also happens to piss off a lot of folks. Namely, the “I don’t want to subsidize the welfare recipient who keeps on pushing out babies” crowd. That is understandable, too.

Let’s look at the cost of health care resources for a bit. I recently had a surgical procedure called a cervical medial branch block. It was done in a neighborhood surgical center and the dock shoved an icky needle into three different joints of my neck and did stuff. The staff was wonderful and the treatment appears to have had the expected results. The bills showed up. Facility charges, anesthesiologist charges, surgeon’s bill, post-op follow-up. Grand total that was billed to my insurance company was $40,000 (in round figures). My insurance company determined that my co-payment was to be $200 and the negotiated discount that my insurance provider had arranged with the medical group(s) resulted in a total payment to everyone of about $4,000. Or a grand total of combined payments of $4,200 on a bill of $40,000. So… is the true value of these services $4,200 or $40,000? I asked what would happen if I did not have insurance… I would have been billed the full amount, but the doctor would probably “work something out” with me. I know of a friend that had a similar treatment (didn’t quite work for her, though). The medical group that did her procedure was determined to be “out-of-network” on her plan. So the plan paid the bills according to *their* average discounted rate, she paid her co-pay, and the medical group waived the rest of the charge. The reality of medicine is that resource providers will attempt to maximize their return by charging the most to those who can least afford it because they have lost their leverage with insurance groups. In so doing, though, they have acknowledged what the true value of a given procedure really is. In my case, it’s $4,200, not $40,000. Why do they do this?

Simple. An uninsured person who needs the procedure I just had is going to ask how much it is. That person will be told that it is $40,000 and likely decide that they cannot afford it and do without. The doctor is happy because… he doesn’t have to go through the aggravation of administering a credit account that will take years to pay off. He’ll gladly take the discounted fees, regardless of which insurer pays under what circumstances because he’ll wind up with a known amount in a finite period of time. So why doesn’t the doctor just offer the “discounted” price to everyone? Let’s be realistic. The person that cannot afford $40,000 is likely not going to be able to come up with $4,000, either and is still going to need a payment plan that may or may not be paid in a timely manner. Far easier to just leave the price high and let the patient endure or go elsewhere. Sucks, eh?

But even if we standardize resource costs in medicine (auto repair shops go by a standardized pricing guide for just about every gig they do)… Let’s be realistic about the results of nationalizing health care. Everyone in the US getting “covered” (even if they cannot afford *any* cost) is going to result in more net dollars spent on health care. Even with the resource fees reduced by mandate. And nothing is really going to change with the fact that there will always be people who can afford and and people who cannot. By making certain that those cannot afford it still receive it, we are acknowledging that those that can afford it will be paying for those that cannot. I’m not saying that this is a great horror. It happens right now with private insurance. I am part of a large group of people that participate in my insurance plan. Premiums are pretty steep (and yes, I’m okay with my insurer making money on administering my plan). The fact of the matter is that there are folks in my plan who do not consume as many medical resources in dollar value as they pay in premiums. And there are those who consume far more in comparison to what they pay in premiums. One part of my group absolutely is subsidizing the other. National health care seeks to just enlarge the scope of this process with the added nasty perq of maybe Uncle Sam running the circus.


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