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?