Month: August 2009

A reader writes:

I was horrified at the stories your reader's sent you yesterday about their health care cost nightmares, and thought I'd share the view from the other side.

I work for a national insurance company and it's my job to pay hospitals and clinics for services performed. Now when I say pay, you should think of that in air-quotes. Assume it takes a week for the bill to be routed to the right person in the right department at my company. Once the bill reaches the right desk it heads back out. Because before we pay a bill we send it to a 3rd party company who reviews it to see how much we "really have to pay" for the services. This is because every state has different guidelines about what services should cost. This takes a week. Then the bill comes back to us, and if there are no issues with the hospital's records in our systems we pay the bill then.

However, if there are any issues it comes to me.

It's my job to call the hospital for updated tax forms (because it's not enough that we know their tax id, we have to have a government form showing the number). Then I send the records to another company who updates our database with the information. This takes another week, or longer if I have trouble getting a hold of the right person at the hospital.

Finally, we pay the bill. During this time the hospital has been waiting to get paid X number of dollars. Only instead we'll be paying them Y because that's what the state says is the minimum we have to pay.

So while your readers are being charged $50 for asprin; my company employs an entire department just to shuffle bills around while they decide what they will pay the hospital for that asprin.

I like my job, but I would gladly give it up if it meant that this insanity could stop.

Pffft.

Rich Lowry takes on Andy McCarthy. Kinda.

coldplay – strawberry swing from ichasudiro on Vimeo.

Check this out:

What's fascinating to me is not just the blind fury of the people – it is much more than anger, it is close to explosive – but the bizarre points they are making. One man insists that when the new proposals come into force, his son with cerebral palsy will be denied all care. He is close to murderously adamant about this. But under what interpretation of any of the bills would that be true? Another woman asks heatedly, "Exactly where's the money coming from? Is it coming out of my paycheck? I wanna know if it's coming out of my paycheck–yes or no!" Well, if she has health insurance from her employer, yes it already is coming out of her pay-check in larger and larger amounts. Is she aware of this? Are the Dems planning to tax her to pay for insuring the uninsured? Unless she's very wealthy, no. And these pretty basic misunderstandings are then converted into a simple slogan: "Liberty or Tyranny!" Mark Levin has indeed had an impact. 

Look: if these people were yelling: "End the employer tax break!" or "More Cost-Controls!" or "Malpractice Reform!" I'd be more sympathetic. But this is blind panic and rage.

"I thought that Nancy Pelosi might have made a slip of the tongue when she dishonestly and disingenuously said that townhall-protesters are 'carrying swastikas and symbols like that to a town meeting on healthcare,'" – John McCormack, Weekly Standard.

"They aren’t carrying swastikas, either,” – The DC Examiner.

(Hat tip: Think Progress)

Krauthammer has a real point here. Why is medical malpractice not in the mix? (We know why: trial lawyers' power opver the Dems). And: why not abolish the tax break for employers? Add these to the mix and we're talking real reform. It's a great column.

A reader writes:

In September 2007, I woke up with an unbelievable pain in my back. At first I thought I had just strained it and took some ibuprofen, but as the pain got worse and worse I realized I had a kidney stone. My wife drove me to the hospital and they checked me into the emergency room.  I was in so much pain that my wife also handled the paperwork, handing over my insurance card, and filling out forms.  After a short wait I got an IV drip of painkiller and lunch tray and was able to settle down.  They took an X-ray that revealed two stones.  Then they decided to also do a CT Scan.  I was doped up and not paying attention – and anyway we had great insurance through our grad school – so I didn't ask whether it was necessary.  They wheeled me into the CT Scan machine, took a couple pictures and found out… yep, kidney stone.

After about 3 hours I passed one of the stones, and with a prescription for heavy-duty painkillers in tow, we left the hospital.  Everything was fine until I received a bill 3 months later itemized as follows:

X-Ray: $765
CT Scan: $4294
Emergency Room visit: $4924
Total: $10063

The bill was a shock to me for two reasons.  First, my insurance was supposed to cover this.  After a long round of phone calls – during which a very rude hospital employee could not understand why I was upset at being charged $10,000 when I had insurance – I figured out that my insurance company's check had literally gotten lost in the mail.  They sent another check and my bill was cleared.  But this led to my second shock.

From my insurance company I received the following "explanation of benefits":

Total charge: $10063.00
Provider discount: $9571.00
Amount Payable: $442.00

How can something that would have cost me $10,063 cost my insurance $442.00 (not counting the $50 deductible that I chipped in).  That's a 96% discount! To me, this shows two basic problems with our healthcare system.

1) Costs in our system are neither transparent nor fair.

I get that emergency room care is expensive, but a tray of bad lunch and a painkiller drip cannot cost almost $5000.  I only saw the doctor for about 10 minutes total, and the nurse for all of 30 minutes.    If I had been told that the CT Scan and the Emergency room care cost $5000 each, I'd have asked for a prescription and been off to the pharmacy.  I wasn't told, however.  I wasn't even give the option.

Further, the "Provider  Discount" is jaw dropping.  (Yes, I'll take the powder blue BMW 528i – only $2,000 with my provider discount!) My mother, who is a physician, told me that insurance companies are able to negotiate deep discounts by threatening to take their business (i.e. all the people they cover) elsewhere.  This is something individuals can't do, so they get overcharged.

2)  Hospitals do not so much give you the care you need, so much as the care they need not to be sued.

I was at risk for a kidney stone due to medication I take. I had pain like a kidney stone. I had an x-ray the revealed a kidney stone, and shortly thereafter passed a kidney stone. Still, I was given the CT scan on the slim chance that my pain was something worse and they missed it, leading to a malpractice suit.  If rationing means that hospitals give the care you need and not expensive tests that only serve to cover their legal assets, I'll take it.

A reader writes:

Murdoch's view that his content is valuable is completely accurate. And I think his plan is to try to get cable and telephone companies that sell internet access to pay for it. Although the "horse may be out of the barn" on free content, trusted brands still DO matter…The reality, as so many people point out, is that consumers may not be willing to pay for these brands anymore. But free to the consumer does not have to mean subsidized or solely ad-supported. So how does a newspaper company make money? By licensing its journalistic content to other companies that can use the valuable content to sell its own services. Who are these companies that may be willing to pay for content? Start with cable and Telcos who sell

internet access to consumers.

Internet service is quickly becoming a commodity – with some exceptions, the ISPs all generally offer the same quality and speed of service. Content (and particularly exclusive and expensive content) can become a way to differentiate & grab market share from each other. Walling off formerly free content may be a good first step towards a plan to establishing a market price for the content, and more importantly, establishing a value for the ISPs. and to licensing the rights to his newspaper content to cable and telephone companies who run internet access services.

These companies would receive the rights to offer their broadband subscribers free access to this content ….imagine getting 10 cents per internet user per month across 20 million broadband households as opposed to $10 per month from 100 thousand wall street journal subs. Murdoch's bet would be that at least a few of the ISPs will take him up on the offer, as the "first" will have a competitive advantage, and the "last" would not want to be left out. This strategy has some significant issues … specifically, (1) will the cable and telcos pay for this content (open question), (2) what will this do to the current pricing for internet access and (3) will this require some level of exclusivity vis a vis the ISPs — will Murdoch have to pick an ISP to "go exclusive" with for his content.