Health Care vs. Coverage

When the subject of health care is discussed, as it relates to repealing Obamacare, and what might replace it, one very important definition appears to be missing – that is health care.

A Source of Confusion

Here’s the problem – our 21st-century minds have come to equate health care with its payment. Granted, health care must be paid for by someone because doctors, hospitals, and other providers cannot work for free.  However, the issue of health care has been convoluted with its payment with the assumption that unless someone has some kind of third-party insurance coverage for the medical care they receive, they cannot possibly have access to that care because the average person could not possibly pay for that care.

One of the problems is that health care in many facilities, especially in many hospitals, has become very expensive because of the price “negotiations” between those hospitals and insurers in which the hospitals charge some outrageous and unrealistic price and the insurer pays the price that it actually negotiated with the facility and calls it a discount even though that price may be very inflated. If you don’t believe me on that count, I would point you to an article I read several months ago and occasionally re-read just to keep it fresh in my memory. That article, written by Forbes Magazine Contributor Dave Chase,” is entitled, “Have PPO Networks Perpetrated the Greatest Heist in American History?”

Here is the link: http://www.forbes.com/sites/davechase/2016/09/05/have-ppo-networks-perpetrated-the-greatest-heist-in-ameri, can-history/#7f507b7a6d00

To be quite transparent, I worked full-time for two years or so for Dr. Randy Delcore at Cedar Orthopaedic Surgery Specialty Clinic and Cedar Orthopaedic Surgery Center. I still serve him as an independent contractor. Dr. Delcore’s surgery center posts transparent cash pricing for many orthopaedic procedures at a fraction of the hospital prices for such procedures. With the huge deductibles that have resulted from Obamacare, patients have the opportunities to get their surgeries performed for much less than those high deductibles in many cases.

Free Market Health Care in the Midst of Obamacare

I will provide one example with a fictional patient. Let’s say Fred, your average middle class guy, needs a carpal tunnel release. The cash price for a carpal tunnel release at COSC is $1,850. That includes the surgeon’s fee, facility fee, and anesthesiologist’s services. So, Fred wants to find out how much it costs at a hospital nearby. I would tell him, “Good luck with that!”

I tried to comparison shop with hospitals in Utah. The University of Utah Medical Center advertises its carpal tunnel surgery, but does not even provide a price estimate online. I tried a few other facilities in Utah and did not find anything regarding price. One website for St. George Surgical Center provided an estimate of what the local hospital charges – $10,683.

The average Obamacare deductible has been approximately $5,000 if you get the least expensive plan in terms of premium, and let’s just assume that this was Fred’s choice in “coverage.” Therefore, the cost of a carpal tunnel release for Fred at COSC and many similar surgery centers around the U.S. (prices vary, but they are usually within approximately $1,000 of that price more or less) would not even come close to costing his entire deductible.  So, in that case, Fred’s Obamacare “coverage” would not pay for his care at all. But could Fred receive the medical care he needed? Of course he can!

Dr. Keith Smith, founder of the Surgery Center of Oklahoma that also posts transparent surgery pricing on its website (in fact, I understand he was really the pioneer for posting transparent prices for surgery), said the following in one of his Facebook video blogs in November of 2015.

“What does it mean when a patient has one of these new Obamacare cards in their wallet but their out-of-pocket experience here at the Surgery Center of Oklahoma is better for them than if they had actually used that Obamacare benefit? What does that mean? That means they have coverage, but they really don’t have access to care … not that they’re not paying for completely out of their own pockets.”

So there you have it – having coverage does NOT necessarily get you “health care” under Obamacare – you may be paying for quite a bit of it yourself unless you are receiving Medicaid.

So how should our nation take care of the poor? Well, that’s a subject for another day. I promise to get around to this soon.

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