Tag: Health care
Are you wondering why I have chosen the issue of health care to write about? Do you wonder what my background is that makes me knowledgeable about this subject even though I’m not a doctor and I don’t even play one on TV?
I could go way back to my experience working in claims and patient eligibility toward the beginning and midpoint of my working life, but I really don’t want to bore anyone to death with a long-winded account of my experiences. Although that experience shaped some of my ideas, nothing has shaped my current thoughts about it more than the last couple of years I spent working for Dr. Randy Delcore at Cedar Orthopaedic Surgery Specialty Clinic and Cedar Orthopaedic Surgery Center.
When I started working for Dr. Delcore as a public relations assistant, I had the tasks of assisting in the launch of a new website, working on an advertisement for local theaters, and taking care of any advertising. Another task he gave me led to the formation of strong opinions regarding the state of health care in America, which is a pretty big mess at the moment. Yes, it was in a mess before, but Obamacare only made it worse – not better, despite all the self back-patting he did at the end of his term in office.
A Time of Revelation
One day Dr. Delcore dropped a stack of magazines on my desk because he wanted me to educate myself about the general state of health care in our country, especially as it related to some of the issues he was experiencing as a fiercely independent physician. So I pored over all of them with voracious interest – some leaned left of center in perspective, others leaned right, and other publications were somewhere in the middle.
One article was a newspaper or magazine clipping (I don’t remember which) about a facility in Oklahoma City, Surgery Center of Oklahoma, that performed outpatient surgeries for prices much lower than average hospital prices. This piqued my curiosity because this was something Dr. Delcore was doing. I checked out the website and looked at the transparent pricing tool, which was something I already knew Dr. Delcore would want on the new website for his practice and surgery center.
In terms of educational material though, I was intrigued by the video blogs Dr. Keith Smith, the founder of SCO, had posted on the surgery center’s Facebook page. In fact, I could not resist throwing my two cents worth into the comments section. (I hope I didn’t wear him out with those.) Many of those blogs focused on the reasons that health care is so expensive these days. Some of the reasons Dr. Smith enumerated included government interference in health care and what he referred to as the large cartel hospital systems that overcharge insurance companies and then agree to some (still overpriced) reimbursement for medical services rendered. In fact, Dr. Smith has revealed all kinds of chicanery in the area of health care pricing as well as pointing to others that were writing about the same thing.
I have also communicated via Twitter and Facebook with many doctors who are truly frustrated about the direction in which the U.S. health care system is going as well as reading many articles and blogs they have written. By engaging in this discussion, I have seen the ways in which Obamacare has not improved the system, but has (I feel) made it only worse. I may have cast a protest ballot in the election (neither Clinton nor Trump), but I am truly hoping that President Trump does “drain the swamp,” especially in terms of the way health care works here.
Where Do I Go From Here?
I have so much to say about the current state of health care in the U.S., and can’t wait to share what I continue to learn about it. I honestly hope that if you, my readers, don’t already know about the many health care price drivers I will be writing about, you will be as outraged as I already am and motivated to communicate with your elected representatives to make some real constructive changes in this time of opportunity.
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?”
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.