GUEST COLUMN, Alieta Eck, Medical Doctor
As the controversy rages between those Republicans who want full repeal and those who want to retain what might be “good” about ObamaCare, we are not asking the right questions. While they are arguing whether or not to keep the ObamaCare subsidies (or the equivalent as “tax credits”), is anyone asking what it is we are subsidizing?
Why has medical care in the United States gotten so expensive? Why did the cost of a hospital stay go from an average of $17,000 in 2000 to $33,000 in 2010, while the average length of stay declined? Why do our hospital stays cost three times more than in other industrialized countries?
The dirty little secret is that having insurance might be a guarantee that the insured pays MORE. And because deductibles have risen dramatically along with premiums, a family needs to pay thousands of dollars out of pocket before insurance kicks in. But how does this work?
Most insurance companies have networks of “preferred providers.” One would assume that a “preferred provider” is a doctor or a lab that gives better rates, but the opposite is the case. As an example, one patient spent a day in the emergency room where the total bill came to $12,000. The “preferred provider” rate brought the bill down to $10,000, which happened to be that patient’s deductible. Upon further scrutiny, the breakdown of the bill showed a lab fee of $3,500—labs that would have cost less than 100 cash on the outside.
When the hospital patient advocate was queried, the answer came back, “Your insurance company negotiated $10,000 and, since you have not met your deductible, you are bound it pay it. Paying the cash price is not an option.” She acknowledged that this seemed unfair, but would not budge.
Another patient discovered that his insurance had lapsed and was given a cash price of $75 for an office visit. Once insurance was restored, the submitted fee was $275. Since he had not met his deductible, he was expected to personally pay the higher fee.
Since 92 percent of people will not incur more than $5,000 per year in medical expenses, the middle class has been fleeced under ObamaCare in so many ways. Many patients have received subsidies. But this just means that taxpayers are forced to pay part of their premiums, and the patients are still stuck with those deductibles and the higher negotiated fees.
So what is really happening?
Insurance premiums have soared, and the insurance companies love it. They keep a percentage of the bloated premiums for “operating costs.” Hospitals are buying physician practices, and Medicaid and Medicare have agreed to pay the hospitals higher fees for the same service in the same location. No government official has been able to explain why.
The ratepayers and taxpayers are the “forgotten men” in our medical system. Hospital and Insurance executives are now commanding compensation that exceeds $1 million. One CEO of a consolidated hospital system in central New Jersey receives $9 million per year. What exactly does he do to merit this high salary? The usual reason for lavish executive pay is that the official brings lots of revenue into the business. The big hospital systems are businesses that profit massively at the expense of patients and taxpayers—although the excess might be called something other than profit if the hospital is tax-exempt (allegedly “nonprofit”).
Our politicians are complicit in this heist, as last year insurance companies and hospitals were among the ten greatest contributors to the campaigns of legislators who allow this scam on the middle class to continue.
The best recommendation would be for patients with high deductibles to hide any connection with an insurance company and negotiate the best cash prices for services. Find a physician who is in no network and who can help navigate where to find cash-friendly sources of medicines, labs, and x-rays.
Patients with their doctors need to take control of medical care once again.