Let’s Restore Common Sense to Medical Care Charges!

As I was doing my usual scoping of Twitter posts the other day, and I came across one person I follow on Twitter (@StikNtheMud) whose Twitter feed has generally been dedicated to people expressing their disdain for their Obamacare insurance policies. I had actually not been on her Twitter feed for some time, so I figured it was high time to hang out there awhile.

There I found a veritable bevy of comments about the ravages of Obamacare on the average person. Here are a couple of quotes from commenters on this Twitter feed. The names have been withheld to protect the innocent victims of Obamacare.

  • “I don’t want Obama Care. It sucks for me. I lost my doctors, the cost for health care with it is so high. I don’t even go to the doctor anymore.”
  • “In Anchorage, premiums for a silver ACA (Affordable Care Act) plan for a 64-year-old couple making $82K a year =  $50,930 a year. That’s not a misprint.”

Believe me, these are only a couple of the many, many posts decrying the miseries of Obamacare.

So once again, I am beating the drum about so called “coverage” not equaling access to health care.

Wasn’t Obamacare enacted to make health care more affordable?

In the first post mentioned, the person wrote that health care costs are so high that she doesn’t even see a doctor now. Also, in looking closely at the second comment, this 64-year-old couple’s insurance premiums cost more than half their annual income. Clearly, with this annual income, this couple did not qualify for any premium subsidies, and they most likely have a deductible and co-insurance to pay in addition to that annual premium. A mortgage should not even be that much of a percentage of one’s income, much less health care costs.

The ultimate irony here is the name of the law that was supposed to bend down the cost curve for health care is the “Affordable Care Act.”

Posts like the ones above are a strong indication that our current health care environment remains generally Unaffordable, and has become even more Unaffordable each year since the implementation of Obamacare. I do understand that there are those who embraced Obamacare and its subsidies to reduce their premiums. However, if they have deductibles of $5,000 or more, how much use are those plans if they are not the kind of people who see the doctor more than once or twice each year?

Many people have been deceived into believing that if they are in a narrow Preferred Provider network, the contractual agreements between their health care providers and the insurance companies that “cover” them will result in less health care costs for them. NOT!

According to an editorial to which I often refer entitled, “Have PPO Networks Perpetrated the Greatest Heist in American History,” author Dave Chase (1) states that hospitals often charge 550 percent of the standard reimbursement by Medicare. Then the BUCA (Blue Cross Anthem, United Healthcare, Cigna, and Aetna) PPOs will discount such charges by about 50 percent. Well, a quick calculation reveals that 50 percent of 550 percent is 275 percent. Those are still very high charges, and I do not believe such charges actually reflect the cost of providing care.

I could not help but wonder why Medicare reimbursement is the benchmark for reasonable payments of medical costs because I often see complaints from doctors about how the low reimbursement rates by Medicare do not cover the costs of care. I do not think that a payment practice by insurers of reimbursing providers 275 percent of Medicare rates (regardless of whether those rates totally cover the cost of care) is reasonable either. Whatever happened to hospitals and other providers determining their costs (I’m sure they have some brains that can figure that out) and charging an amount with a reasonable profit margin over their costs?

In his editorial, Chase’s interviewee Mike Dendy makes the following statement: “A well-run hospital can make money from Medicare payment schedules. The problem is that most hospitals are not financially well managed and have no reason to be when they can pretty much charge for services at will.” So I guess that is the explanation for Chase using Medicare reimbursement as a benchmark for reasonable payment.

There are so many nonsensical factors that go into heath care pricing, mainly by the large health care systems that also try hard to eliminate the competition posed by independent doctors. These doctors generally have reasonable charges for their services,  but large health care systems (including “non-profit” ones) often either employ them or buy them out. My guess for the motivation of the “health care” systems is that they want to continue unfettered with their ridiculous prices for medical services. (Please see my Expert Posts category for more information on this one.)

So what use is “coverage” when all these ridiculous games are being played by “health care” systems and insurance companies? This has to be stopped!

Further reading:

  1. https://www.forbes.com/sites/davechase/2016/09/05/have-ppo-networks-perpetrated-the-greatest-heist-in-american-history/#2e8cfdfa3330

Image courtesy of canstockphoto.com

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