The Bullet and The Foot: Nov 06, 2009

Quote of the Day
When a man says he approves of something in principle, it means he hasn't the slightest intention of putting it into practice.

-- Otto von Bismarck

No you didn't miss anything
Sorry folks, for the first time in weeks I skipped out on article yesterday. One of those got up late, and work was a blur days. I do hope y'all missed me.
When hospitals bill like defense contractors...
Well here's a sad funny. A man is beaten to death by his roommate. For the 5 minutes it took the ER doctors to conclude he was dead, he ran up $30k worth of medical expenses, billed to his parents the day after his funeral.

Alright, stupid letters go out all the time from hospital billing. I know several friends who had a baby and the hospital send the bill to them instead of their insurance. And, I'll grant you, the bean counter on the 7th floor might have missed a checkbox indicating the patient in question died on the table. And yes, even when you die, the bill is still there. But $30,000!

Ok, now, I've been that uninsured guy who had an overnight stay in Intensive Care. That ran $7k, and included cat scans, IV's, hot and cold running nurses, etc., etc. How on Earth can a hospital justify $30,000 worth of bill for 5 minutes of service?

Well, it turns out they didn't think he was insured. Yes ladies and gentlemen, hospitals charge insurance companies different rates than they charge the rest of us. And the rates the Insurance companies are willing to pay is often a bit less than what it costs the hospital to render the service. So, they make it up in other ways.

In a perfect world, they would simply divide up the difference between everyone who walks in the door uninsured. But, really, many of the people that don't have insurance also don't have any income, or assets to liquidate, so the bill never gets paid. And thus, they have to charge anyone who does have assets not only for the non-insured who skipped the bill, they also have to charge for the insured whose coverage only pays part of the bill. And as the expenses get shifter farther and farther, the stakes in the "who gets stuck with the bill" get higher and higher.

Medical billing is a giant game of hot-pototo. So, can we agree that this is a mess?

The only way to fix the mess is to fix the underlying rules of the game. Insurance companies are making out like a bandit. "Expenses" keep going up and up, and they ramp up premiums to match. They pay out less and less, leading Hospitals to try to recover the money in more and more elaborate ways. Those elaborate ways scare people into not wanting to live a day without insurance. Life couldn't be better, they are manufacturing supply, demand, and dictating the prices of the market.

Hospitals have a bit of growing up to do too as far as const controls go. But frankly, when you don't know where your next dollar is coming from, it's hard to make the sorts of decisions that make economical long term sense.

When I become benevolent dictator...
Here is my "when I become benevolent dictator" proposal. Step one, force health care providers to charge one rate and only one rate for every service rendered.

Because it is a change in the rule of law, all of the existing billing contracts with insurance companies will have to be re-negotiated. And because, by law, the hospital can only charge one rate, the insurance company can't duck the bill. We also lose the haggling that goes back and forth between insurance companies and providers. There is no way for the hospital to shave a few dollars off here, and a few dollars off there.

Because we force providers, by law, to provide emergency care for life threatening emergencies, child birth, etc, develop a program by which those services are re-imbursed at a federally mandated rate by the federal government. Fund that mandated care with a payroll deduction tax for the uninsured, and by a surcharge on all health insurance premiums.

Non-life threatening conditions though are not covered. Thus there is no advantage to going to the ER for a sore throat.

Thus, the biggest, most expensive, unpredictable factor in the health care debate is off the table. For life threatening emergencies, everyone is covered. Plus we have the means to provide ER coverage in areas that are not currently served, through the general fund.

Bah... I really need to stop writing before I have my first cup of coffee in the morning. Damn I'm cranky.

Patient is suffering from Caffeine withdrawal. Prescribing 5mg of caffeine to be administered in hot aqueous solution. $5 for the coffee, $200 for the consult.

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