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Bitter Pill: Why Medical Bills Are Killing Us

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  • Center Left
    Independent
    Denton, TX
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    You don't have to read all this. Forum is to comment/discuss the Bitter Pill article by Steven Brill. I included my summary and thoughts below for those that haven't read it. Or want to get someone's take on it. Please, if you have read it, comment and let me know what you think.

    I got wind of a Times article via "The Daily Show" called "Bitter Pill: Why Medical Bills Are Killing Us". It's about 33 pages long and I believe, much like Stewart does, that EVERY american should read this. Or at least be extremely aware of the message the reporter Steven Brill is proclaiming. In a nutshell, Brill's article is doing what almost no one else in the health care conversation is doing, in his words he is 'asking why bills are so high in the first place, as opposed to skipping to the second question of who should pay for the high bills'.

    I have forever been perplexed with the high cost of doctor visits, procedures, medicine and just everything that goes into it. I remember my mom getting sick when I was young (heart issue). She had to have several tests done and was in the hospital for several days. When it was all said and done, she ended up owing some outrageous amount of money, even with good insurance at the time. The bill, as memory serves, was somewhere in the ballpark of $25,000. It basically destroyed us financially. And, this was some 15 years ago. The situation and costs have only gotten worse.

    I remember thinking then, and all the way up until now, why are the bills so high? But, even more importantly, how can they possibly expect anyone besides the rich to be able to pay? Who can afford to ever be REALLY sick in this country? The costs are just too devastating in most all cases I've come across, even with so-called "excellent insurance".

    The problem with our country's health care system lays far more in the realm of Brill's article's talking points than it ever will with the Affordable Care Act (Obamacare). The ACA is a band-aid. The high costs being charged in the first place, and more importantly why, is the real problem. Its time the conversation be moved into this domain, and stay there until we get some real dialog and solutions.

    Since the article is from Time Magazine, I cannot attach a link, without you subscribing to them. But, I highly recommend going out and buying the edition with Brill's article on the cover. That's what I did. It's actually the first magazine I have bought in a long time. And, I was not dissappointed. But, I do want to include some of the highlights/summaries from the article here, to provide facts and contexts to this forum.

    Here are some of the more shocking statistics/figures to take away from the article:

    Health care is a major factor in personal finance. 69% of those who've experienced medically related bankruptcy were insured at the time of their filing. 62% of bankruptcies are related to illness or medical bills.

    Health spending has maintained a steep climb since 1960, when GDP and health spending were equal. Since 1960 to 2010, national health care costs have risen at a crazy exponential rate, to where we are now spending 5 TIMES the GDP on health care costs.

    The annual health care spending average per person rate doesn't equate to longer life expectancy rates over other countries. In 2010, the average annual health care spending per person in the U.S. was over $8,000 with our average life expectancy being 79. That's worse than Denmark, Australia, Japan, Spain, and the U.K. For contrast, the U.K. average spending per person is about $2600 and their life expectancy rates were 82 years old on average.

    The industry has spent $5.36 billion on lobbying Congress from 1998-2012. That's almost 4 TIMES as much as the defense lobbyists spent during that same time period. They spent $1.53 billion. Health industry lobbyists spent more than defense, oil... everyone. By far. They are by far the most aggressive, biggest spenders in the lobbying game.

    Procedure costs are higher in the U.S. than in most other countries, alarmingly so. Here a few examples:
    Cost of a CT Scan (avg) in Canada in 2011 was $122. In Spain it was $123. Argentina - $78. Switzerland - $319. And, in the U.S. it was $510! Same craziness for an Appendectomy. In Canada - $5606. Germany - $3093. Australia - $4926. And, in the U.S. it was $13,003! These numbers aren't cherrypicked either. Brill's list includes at minimum 10 major countries, with the U.S. being the highest by far in all these categories. Lastly, there's the charge for Coronary bypass operations. Canada charged $40,954. France - $16,140. Australia -$38,891. And, the U.S. charged a whopping $67,583!!


    So... why so damn expensive?? Well, Brill cites several reasons. But, chiefly among them is the concept of what the health industry calls "the chargemaster". This is a system that everyone in the industry actually uses. It's the system that essentially tells you what everything should cost. Problem is, the database that it runs off of doesn't set universal pricing. Not by a long shot. And, it's not the real price of the care in question anyways. It's more like the aggregate rate that collective hospitals just decide to charge people for any given thing (from x-rays to surgeries to ambulance rides to medication), but if you know how to play the system (or bitch loudly enough) the cost can be easily negotiated, much like when talking to a creditor.

    The chargemaster is not really regulated. Or capped. Or really even that understood it seems by most people. And, there is a reason for that. It's because the price that it comes up with is 9 out of 10 times NOT the price most people actually pay. So, most don't even consider it that big of a deal. Most people pay the 'chargemaster' price, minus the discount that their insurance covers. And, thus they think that they are getting a good deal. Look, they will say, this surgery was $100,000 all told, and I only had to pay $40,000 (or whatever) because of my awesome insurance. What they do not realize is that the chargemaster just basically made the $100 grand price tag up. In most cases, the actual cost is anywhere from 2 to 100 times less! Its insanity. Some small examples: People have been charged $1.50 per asprin. For one pill. You can buy 100 of these exact same pills on Amazon for $1.50. It happens ALL the time. There are crazy profits to be made just in that one little statistic alone. Another example: $77 for a box of 4 sterile gauze pads, which should only run ya like $2-5 max. And, that's not buying bulk.

    Bigger examples: Brill cites an ambulance ride that costs $995, a ride that travels 4 miles. A 64-year-old has chest pains. She is picked up by an ambulance and taken four miles to the hospital. The ride alone costs her $958, just to be picked up. And, then $9.38 for every mile. Now, if you have insurance, they cover X amount of that, making your actual cost considerably less. But, that's not the issue here. This is a cloak and dagger type situation folks. No one complains about the $1000 ride, because you are only paying (make up a number, say..) $250. Or $100. Or $315. Who knows. It's whatever they want it to be. The problem is NOT the discount you are paying. It's the cost to begin with. Where does this $1000 come from? Who makes this number up? Why is it not consistent anywhere, even from two hospitals only miles apart? Why is this chargemaster system not regulated heavily?

    It would be one thing if the chargemaster's MSRP-like figures were reasonable. But, Brill cites far too many that are disgustingly outrageous. I have named only a few. There are too many to list honestly, because EVERYTHING is grossly over-inflated. The game is rigged from jump street here. It's not Medicaid or Medicare that should get so much blame here. And, programs like Obamacare are largely indifferent and ineffective (not really for nor against) addressing the REAL problem here. The real problem lays in why these prices are so ridiculous in the first place, not who should pay for them and how. Brill's right. We are missing the trees for the forest, in a HUGE way with this major issue.

    Health care expenses consist of roughly 20% (I believe Brill cited) of everything this country spends. So, 1/5 of our GDP is health care alone. And, that number is probably modest, all things considered. Correct me if someone has a more correct number please. But, consider that chunk. What do we get from it? We are the sickest, most medicated, most treated, most diagnosed people in any country in the world! And, our quality of life isn't improving from all of this. So, why is it happening??? What's to be done?

    Here is my 2 cents on the matter. Then I'll quiet this issue down, for now. :) First off, as Brill basically says, the reason why this is happening is because of money. No real surprise there. I think though that the surprise comes when you follow the money trail, which is exactly what Brill does in his article. It's not the doctors getting rich, as some might suspect. It's the cane manufacturers, the ambulance companies. It's the CEOs of non-profit hospitals. Those people and companies are the ones racking in the real money. As Brill put in on 'The Daily Show' (paraphrased), "It's as if there are two economies: the one where most people live and struggle in today. And, then the one where the health industry companies operate, where business has never been better, and profits are pouring in at an exponential rate." That just does NOT happen without corruption. Simple economics and common sense would tell you that easily.

    And, secondly, whats to be done. Well, Brill outlines several things that I think will undoubtably help save this fiasco of a situation. And, I encourage everyone to read it. But, I think a major solution lies within preventive care, meaning we need to be educated on simple, effective nutrition, exercise and the values of good sleep and hydration. Its quite simply appalling how many people don't have a clue about nutrition. And, even in the crowd that does, the number is even more shocking of how many people actually incorporate good foods into their system, to combat overly processed junk foods. Same goes for exercising, which is the best way to healthfully get rid of and utilize stress, the major factor in most every sickness. Not to mention that we should be consuming a ton more water per day on average. And, just overall being way more moderate on the amount of sugar and processed foods that we consume. Those numbers are also horrific. I think if we were to do the kindergarten basics of health maintainence on our bodies and be more educated and reasonable about this issue on a personal level, a HUGE portion of the problem with health care costs would be moot from jump street. ... I haven't been to the doctor in years. I haven't been sick in years. I do the things I have mentioned. That's not say I won't ever have to go. But, when and if I ever do, I think I can more confidently say that I am not a part of the problem... If everyone followed that routine, our system wouldn't be so overused, making it just so damn tempting to siphon us dry.
  • Center Left
    Independent
    Denton, TX
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    Here's the link to article. They will prompt you to subscribe, but at least you know where it is: http://www.time.com/time/magazine/article/0,9171,2136864,00.html


    Also, The New York Times has a good and much shorter version of the highlights from the article here: http://www.nytimes.com/2013/03/04/us/04iht-letter04.html?_r=0
  • Strongly Liberal Democrat
    Democrat
    Portland, OR
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    I haven't had a chance to pick up the article yet, but I thoroughly enjoyed the interview that Steven Brill did with Jon Stewart. I just kept thinking to myself: FINALLY! An author that wanted to get to the heart of this thing that I'm so passionate about. I studied these numbers when I was earning my BA in Healthcare Management some years back and realized something was terribly wrong with the system in general. I recognized that I chose the wrong major when I went in front of my peers to argue my thesis: Proving how a single payer system in this country is the only way to provide quality health care for ALL. My main argument proposed that healthcare is a fundamental right for all citizens and that the health of a nation's citizens should be the top priority for its leaders.

    The looks on my peers faces was absolutely priceless when I was finished with my argument. I literally remember hearing a pin drop. This was Healthcare Management, I was supposed to go up there and show how I can become filthy rich by aspiring to be some big healthcare executive or drug company representative. I wasn't supposed to propose something that would fundamentally change the status quo and was predominately greeted with incredulous gasps from my peers until my professor spoke up and started the question and answer time.

    I remember my peers peppering me with questions that hit the full spectrum of what this would do to the healthcare "industry." How will it effect their bottom line? What about R & D? Why would anyone choose to take a single payer and have the GOVERNMENT tell them what procedure they could or couldn't have? Not one question, not one, asked me how this will effect the overall general welfare of our society. That's what the for-profit healthcare system in our country has allowed us to learn to accept: It's a dog eat dog world. As long as I'M ok, good luck to the rest of you. Needless to say, I didn't last long in the for-profit healthcare industry and instead became a social worker.

    Our healthcare system is simultaneously one of the best and one of the worst in the world. It's the best if you have the money. There is no mistaking that. The problem, as you pointed out sbfriedman, is preventative care. If people aren't taught to take care of themselves, they won't. Not only that, but when the vast majority of citizens in this country are now eating "food like product" and not real food, things will only get worse.

    Most people do not take much time to ponder this huge interconnected web of what we eat, breath, drink, etc. The pills we pop because we have a headache can lead to liver problems down the road. The "food" that we're eating is genetically engineered to make our minds think that we're not full (Check out Salt, Sugar, and Fat by Michael Moss--It will make you sick). We need to bring back healthy being cool again. What happened to Health and Nutrition classes in school? Why are our poor citizens forced to grocery shop at a convenience store that sells no fruits or vegetables because the big grocery stores are too scared to open up shop there? It's a problem that is going to take years to fix, but it can be fixed if we commit to it as a society.
  • Center Left
    Independent
    Central, FL
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    Great posts, Some of the best I have read in a very long time. If I get out today I intend to buy the issue of Time. Thanks for posting this. I fullly agree with your frustrations. Thanks,
    Jared, Great reply
  • Independent
    Ft.myers, FL
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    Since I lived in three different countries The Netherlands, Canada, US (also travelled the whole world for my job) I can follow that "long thread".
    What is described did irritate me all the time. I had a "stent" put into an artery on my heart via one of those Da Vinci machines; total cost a whopping $55,000.- . On the ambulance side also exactly as the story says. Sorry to say as with everything here; this is the rip-off country of the world.
    Our government is run by the lobbyists not by us ; My neighbor in Alexandria was a lobbyist for Whyett so I heard all his stories. As I've said in previous "threads" about this subject, as long as there is the total refusal to dig up actual "real" cost of these things and put them into law, nothing will change. Cost will only rise because no one has the guts to put these guys in jail; have you seen a poor doctor or a director of an hospital lately?
  • Independent
    New Hampshire
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    Has anyone been following the patent case in India? Name brand $2600.00, generic $200.00. I forget the drug and prices are from memory. The Brand Name may have been $2800./month and the Generic $160.00/month. I have been Miles/Bayer bought a company I worked for and considered the 10% profit we made was too low. With over a 10:1 ratio between Generic and Name Brand that 10% must have had the same effect on them as a 10% or more loss. I have switched my meds to generics except for 1 and went from hitting the doughnut hole in July/August to less than $100.00 a month.
    Ambulance in Nashua, NH is $486.00 List.
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    Remove the profit motive from medicine and all the problems will disappear. Isn't the first rule of the medical code "Do no harm"?
  • Strongly Liberal Democrat
    Democrat
    Portland, OR
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    GemsWoven Wrote: Remove the profit motive from medicine and all the problems will disappear. Isn't the first rule of the medical code "Do no harm"?
    If we had a single-payer system, we could do just that. As long as we have private insurance companies deciding who gets what care, profit will always be the number one motivator.
  • Center Left
    Independent
    Central, FL
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    I tried to buy this issue of Time today......... I waited a few days too long. Now I'm going to try to call Time to see if I can order a copy and pay over the phone.
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    Great article. Very timely & important. I tried to get a copy of the TIME magazine at my drugstore rack & it was gone. Then I tried to get a copy at my local library, but that one was checked out. Hope to get a copy from there when the "user" brings it back.

    Some of the problem is that the CEO of medical hospitals & insurance co's often gets a salary of $5 million up to $10 million a year. He does not have
    to know a thing about medicine, but only the administrative angles. Those are incredible salaries for some very young men. Even worse, many of them have been trained by Ayn Rand's theories (right wing) where the patients are just scum under their boots. One CEO actually is trained by the ideas of Nietsche, where the "will to power" dictates the survival of the strong, & the weak ones don't deserve to live. The whole idea of compassion has disappeared out of the equation. The strong are of course, the rich. And the weak are the middle to lower class. It also teaches that the ones who believe in God are weak people, while the rich godless people are the strong. (Sounds very communist to me).

    Another problem is RX drugs. Metformin was banned by the FDA for 20 yrs for being too "toxic." But after awhile, they found out it was selling just great in England & Canada. So they brought it back here, changed the name & charge EIGHT TIMES more for it here. There is a whole lotta bribery going on in the drug companies. Read the book "Pharmocracy" which alleges a great hoax & collaboration between the FDA & the drug companies, creating a virtual Monopoly with certain drug companies, & trying to exclude all "natural remedies" & nutritional healing.

    By the way, after a "problem" with her medical providers, my friend who was told she would not live another 6 months, is doing quite well. She has not taken one of the 5 RX drugs forced upon her, & yet she is getting along great, she is taking all kinds of vitamins & coQ10, & she stubbornly refuses to die, despite the doctor's warnings. (ha) She was given a "death sentence" by Febr 10th, & is almost 2 months past due. She delights in that, as she believes that only God can give her an "expiration date." And yesterday she walked 1/2 mile outside (uphill) with no trouble. In the recent past, she could not do that anymore. I highly recommend that most diseases can be cured by good sensible eating, by lots of liquids, & by no smoking or alcohol. Instead of toxic RX pills, take lots of multi-vitamins, & pomegranate juice. Also, if you are elderly, take 1/2 aspirin a day. Make it "regular" aspirin, NOT the enteric coated kind. (Even Dr. Sanjay Gupta said this). Remember to pray a lot & smile a lot, & you will be OK. // Sorry, if this got "off topic" a little bit. : ) Feel free to discuss more about the "Bitter Pill: Why Medical Costs are Killing Us" in TIME Magazine: ) MANY THANKS to forum member "sbfriedman" for bringing this article to our attention & providing 2 links for us.
  • Center Left
    Independent
    Central, FL
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    TJ Wrote: I tried to buy this issue of Time today......... I waited a few days too long. Now I'm going to try to call Time to see if I can order a copy and pay over the phone.
    I called Time today and ordered 2 copies of this issue. The lady in customer service advised that this copy was a very popular copy. If anyone else wants to get a copy it's only 5.00 per copy (no shipping or handling cost) and they can be reached at 800-843-8463. press zero a few times to talk to an individual.
  • Independent
    New Hampshire
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    This should be required reading:
    Cost of health care varies widely at North Bay hospitals [The Press Democrat, Santa Rosa, Calif.]
    By Cathy Bussewitz, The Press Democrat, Santa Rosa, Calif.McClatchy-Tribune Information Services
    May 08--The prices that North Bay hospitals charge for the same procedure vary widely from one facility to another, according to data released Wednesday by the federal government.
    The public release of the data will help make the U.S. health care system more affordable and accountable, Health and Human Services Secretary Kathleen Sebelius said.
    "Currently, consumers don't know what a hospital is charging them or their insurance company for a given procedure, like a knee replacement, or how much of a price difference there is at different hospitals, even within the same city," Sebelius said in a statement. "This data ... will help fill that gap."
    For example, Kaiser Permanente Medical Center in Santa Rosa charged $44,278 for a procedure to replace a major joint or reattach a lower extremity, while nearby Memorial Hospital charged an average of $136,762, according to Medicare billing data released by the U.S. Department of Health and Human Services.
    In reality, Medicare and other insurers often pay hospitals far less than the "sticker price" charged by the hospitals, experts said. In the example above, Medicare paid an average of only $16,288 to Kaiser and $18,387 to Memorial Hospital.
    "There are large parts of our health care system that just don't make a lot of sense," said Anthony Wright, executive director of Health Access California, a consumer advocacy coalition. "The health care pricing and prices make no sense to both lay people and experts, and there needs to be a reform of how providers are paid."
    The vast disparities in how much hospitals charge reflect a variety of factors, including the populations each serve and the depth of specialties provided by the institution, health officials said. For example, Memorial Hospital is the region's sole level II trauma center, which raises the nonprofit hospital's costs.
    "Memorial plays a singular role on the North Coast in terms of the complexity of care we provide," hospital spokeswoman Katy Hillenmeyer said. "The fact that other hospitals refer us their most complex, sick patients, that factors into cost."
    Nobody actually pays the amount that hospitals charge, said Don Forst, director of patient financial services for Memorial. That billed amount serves as a starting point for negotiating with government providers like Medicare, private insurance companies and individuals. Uninsured patients get automatic discounts, and low-income patients also are cut a break.
    "In many cases, we're lucky if we get 20 percent," Forst said. "The big problem today is that charges really are irrelevant ... it basically defaults to the highest rate, so the patients see the bill and they panic."
    Kaiser has a different model because it insures its own patients and services are generally provided under one roof, creating some efficiencies, Wright said.
    "The Kaiser Permanente data reported today do not reflect the common experience of our members, who generally never receive hospital bills," Kaiser spokesman David Ebright said in an email.
    Hospitals nationwide are included in the comparisons, which focused on the 100 most common Medicare inpatient stays.
    In one example, treatment for poisoning and toxic effects of drugs triggered an average bill to Medicare for $15,092 from Ukiah Valley Medical Center and $40,828 from Marin General Hospital, the report said. Medicare ended up paying an average of $4,746 to Ukiah Valley and $10,776 to Marin General, according to the data.
    When comparing what Medicare actually paid the hospitals, the rates fall within a more comparable range, said Jamie Maites, spokeswoman for Marin General.
    "There may be a few places where Marin is higher," Maites said. "We're the only designated trauma center for Marin, so for those kinds of procedures, we're going to be higher."
    When both hospitals were treating patients for simple pneumonia without major complications, Marin General billed $53,429 while Ukiah Valley billed $19,256. But there was less difference between the average amounts each were paid by Medicare: Marin General got $7,379 while Ukiah Valley got $5,397.
    "Part of it is the relative negotiating power," Wright said. "We know that in Northern California there are a couple hospital chains that have a dominant position, like Sutter, that can demand a higher price."
    Demographics of the region also impact the rates hospitals charge, said Nick Bejarano, spokesman for Ukiah Valley Medical Center.
    "Every year our finance committee looks at the data to make sure we're competitive, but also that we're sustainable, and can cover our costs and overhead," Bejarano said.
    Memorial Hospital is working hard to lower costs by reducing the length of stays in the hospital and emphasizing preventive measures to keep patients out of the hospital, Hillenmeyer said.
    The data release was the first of several planned by the federal government, said Patti Unruh, spokeswoman for Centers for Medicare and Medicaid Services.
    "This is a first and major step in shining light on health care prices, which up until now have been a mystery," Unruh said. "We want to get to a place where consumers can do comparison price shopping."

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    That's what you get when health is a free market beast.
  • Independent
    New Hampshire
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    My wife spent 5 hours in Nuclear Medicine today. The hospital is excellent and the prices are "reasonable". I think the bill will be about the same amount I need to bring my house to Passive House Standards.