Wednesday, May 09, 2007

Soaking the Poor

Yesterday's print edition of the Arizona Republic featured an article about how hospital charges are more unequal than even I had thought, with hospitals routinely billing uninsured patients as much as three times what they bill insurance companies for the same thing for patients who have insurance.

Conservatives will suggest that it is the uninsured patients' fault, for not shopping around.

This of course is ridiculous. If you need emergency bypass surgery or for that matter have to go to the ER, you won't have time to compare costs. And even if you are going in for say, elective surgery, they won't quote you a price, certainly not until they have diagnosed you. And unlike asking a plumber or a roofer for an estimate, the diagnosis itself will likely carry a significant price tag-- and if you want a second opinion (not that I'm against getting one if one can do so) you will have to pay for that as well. Further, the article indicates that the extreme overcharges extend across hospitals, so even if an uninsured person did comparison shop, they would still likely end up paying two or three times what an insurance company was charged.

To be sure, there are a number of reasons that play into this. The most obvious is the fact that because some people don't pay at all, and medicaid often pays hospitals less than they spend to treat the indigent, they lose money there and so have to charge more to those who can pay. Insurance companies of course can spot bogus or inflated charges (i.e. upwards of $40 for a 'mucous recovery system' which turns out to be an eighty-nine cent box of kleenex-- and yes, that is a real charge that some patients have been charged.) Consumers may not understand technical or official medical sounding names and just go ahead and pay an outrageous charge like that.

Another factor, closely related to the first, is likely to be that even when hospitals are doing well, they know they can take advantage of uninsured patients so the temptation to gouge just becomes hard to resist. And those who can't pay, they send to collection agencies and after squeezing out every drop they can they ruin the patient's credit and move on to the next victim. The concern they actually have for the poor has been amply demonstrated by (as I've blogged on several times by now) the practice of just dumping poor homeless people in the middle on the street and drivng off.

And this is why we do indeed need universal coverage. Very few, if any patients without insurance are trained enough to really understand their bills and dispute it. For that reason, wouldn't it be better if every hospital bill was reviewed by someone whose job it was, to know what was in it and how much it should cost?


Unknown said...

Hmm, I have to say, running across this article, that I am one conervative who wouldn't say that. You see, hospitals are a heavily regulated industry, and are not forced to compete, and, in fact, insulated from competition by the health-insurance cabals and various rules that were set up by our government. The prices you see being charged to the insurance companies are by negotiated contract, hearking back to the days of medicare, where the government fixed prices. Meet the new boss, same as the old boss.

There is no negotiation like this for a customer, in fact, it's worse than a restaraunt with bad service, because there is no menu. You can't know what you're going to be charged before-hand. In fact, I've asked doctors many times "How much is this going to be?" and they don't know. They can't because of the complicated structure set up in front of them.

Of course, my solution to this is to completely privatize healthcare, making hospitals compete, and lowering their prices to where people can afford it again. As a conservative, I want to help the poor, not blame them.

Chuck said...

The number of uninsured children, let alone adults, in this country is ludicrous. Even Medicaid tells them to "f--- off and die" for all they care thanks to the bush cuts.

The working poor are taking a beating in their country and this generation coming up right now are getting it worse than any other one in history.

No one in the bush dynasty will ever know/have ever known what its like to go hungry, to go without medical care, to be snubbed by the holier than thous and to be looked down upon by society.

This country is LONG OVERDUE for universal health care and a living wage. The gulf between the "haves" and "have nots" is wider than its ever been. Its all so reminiscent of historical accounts of the 1770s.

Unknown said...

What an intelligent reply Chuck. Your completely lucid argument totally convinces me that my conservative ways are totally out of line. I do want to get my political opinion right, however. Out of curiosity, are you in the haves or the have nots? Do you deal with Medicare on a regular basis? Have you studied it? Have you studied the economics of health care? What sources do you base this opinion on?

(Oh, and by the way, until very recently, I was uninsured.)