Recommended Reading

The latest issue of Time is recommended reading for anyone interested in health care costs.  I especially hope that everyone who is involved in church-based assistance for hospital and doctor bills reads and understands well what is revealed.  The article title is "Bitter Pill," and the special report title on the cover is "Why Medical Bills are Killing Us."  The date is March 4, 2013.

The article moves away from the most common question (Who should pay for medical care?) to a far more basic question:  Why are medical bills so high?  If you don't develop some admiration for the reporting and writing skills of the author of this article (Steven Brill), my most generous conclusion is that you've never undertaken serious research or writing yourself.  The work is monumental in scope and is at the same time very accessible, although  reading it involves a significant time commitment.  I haven't quite finished it, and I've taken three hitches at it.

You'll learn about Chargemaster, every hospital's internal billing guide, which, in many cases includes charges far in excess of actual cost to the hospital, and far in excess of what Medicare pays.  It's usually not expected that individual patients pay it either, but they are not told that--sometimes only hounded until they do. Write-offs are not usually offered unless they are requested, and when they are, they amount to shaving the excess off the Chargemaster guide amounts.  A lot of secrecy surrounds this internal billing guide.

You'll also learn about the following--

--Double and triple charging for certain services or goods.  (Example:  The room charge is supposed to cover the use of the bed, the linens, the regular monitoring of vital signs, etc., but is sometimes billed separately, in addition to the room charge)

--Unnecessary lab work and other procedures.

--High salaries for some administrators

--Enormous profitability of some non-profit health care facilities

--Vertical consolidation of various providers (increasing profit potential from various services)

--Exorbitant overcharges (Example:Saline solution--bagged for IV use--which can be purchased online for $5.16/liter but was charged to the patient at $84.00 to $134.00 each)

--Medicare compensation is, in fact, usually very close to the actual cost of services, and not to blame for whatever financial difficulties a facility may experience.

I haven't yet seen addressed one important component of the discussion which became clear to me in studying Obamacare before it became law.  Perhaps even more fundamental than asking "Why are medical bills so high?" is this question:  "Is our medical system operating by a misguided paradigm?"

All in all, I believe healthcare is near the top of what needs fixing in our society.  If you've followed this blog, you know about a few other things I consider similarly serious problems, but those are matters to be discussed another day.

Kudos to Kris and other friends who are training to serve as administrators for health care facilities and who can help the rest of us understand what is still a mystery to many of us.   More trustworthy people in "insider positions" might be part of what is needed.

I wonder too if every community should see to it that at least one person gets the necessary training (by personal effort or experience, or formal training) to become a patient-billing advocate.  It would take someone with the ability to do a lot of painstaking perusal of bills, a good head for figures and details, good people skills when negotiation is needed, and sympathy for people in dire need.  Brotherhood aid organizations might find it cost effective to pay a person to do something like this.