Anger Mis-Management

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The hospital giveth, and the hospital taketh away: notice how my “private pay discount” gets me right back to where we started. Ask me how excited I am to go in and talk to the finance department again.

Here’s an intractable problem in desperate search for a solution that seems way too complicated for any one or any body anywhere in the United States to solve, although it seems like there’s an obvious answer staring us all in the face.

Of course I’m talking about health care, which in exit poll after exit poll during the primary voting currently taking place across the country has shown itself to be the number-one area of Americans’ concern.

I don’t know in which of my posts a week or two ago (and I’m hard-pressed to go looking this morning) I mentioned a couple from Alabama that had to choose between putting their son through college or paying for health insurance. Which, first, why is this a choice that needs to be made in the wealthiest country in the world? Since they considered themselves healthy, they opted to keep their son in college.

And then the wife needed an emergency appendectomy, and her husband took her to a for-profit hospital, which I imagine was the closest facility and the sort of thing you don’t really stop to consider in an emergency. After they paid the surgeon a few thousand dollars, they were horrified to receive a bill for nearly $52,000 from the hospital itself. For an appendectomy.

The hospital oh-so-graciously knocked money off the bill for private pay, taking the debt to around $37,000 — an amount this couple, who own a mom-and-pop screen-printing business (sound like anyone you know?), still could not afford. They were making monthly payments of $25, but the hospital grew impatient and sued for the remainder, which was going to bankrupt this couple and cause them to lose their livelihood, if not their house.

At one point prior to the implementation of the Affordable Care Act, which your president is still busily trying to dismantle, half — that’s 50 percent — of all bankruptcies filed in this country were on account of medical bills. I do not have a current figure for you, but I’m sure it’s a much larger number than this one couple.

But because this couple ended up on CBS This Morning, their misfortune has turned around. Cards, letters and money came in from all across the country after their story aired, and some sort of legal aid society in Alabama took up their case with the hospital, which agreed to knock the bill down to $5,000, an amount paid yesterday by an anonymous donor, who is also going to pay to make sure the woman gets a large painful lump on her shoulder looked at. She was just going to let it grow, because she couldn’t afford to do anything else.

So. In the middle of that paragraph was a number: $5,000. This hospital, with “Flower” in its name, which initially charged this woman $52,000 to use their facility (remember, this does not include the surgeon’s bill) for an emergency appendectomy, and then was perfectly fine bankrupting her for $37,000, has now decided that the real cost of this procedure could be $5,000. Or less: I believe in the initial story CBS reported that insured patients and those on Medicare got billed less than that.

That sort of inflation makes college inflation look downright reasonable.

This sort of story is hardly confined to Alabama and for-profit hospitals. Lynn herself just received an accounting statement from her oral surgeon for her recent implant work. Lynn has dental insurance, and her premium paid for itself before we even got to how much of the procedure insurance was willing to cover.

Her bill was for nearly $7,000. But her insurance “negotiated” with the oral surgeon and decided that this procedure was only worth $750, and then the insurance covered 70 percent of that. This dental office, probably like every other medical office across the breadth of this great nation, apparently has no compunction about telling patients their cost is going to be nine or 10 times what the actual cost ought to be.

This same thing happened to me years ago, on about the same percentage, when I went in for sinus surgery. Without batting an eye, the receptionist told me the procedure normally cost $27,000, but since I had insurance, they were going to bill me, pre-insurance, less than $3,000.

Insurance premiums on the Colorado’s Western Slope, which includes Gunnison, are screamingly high, among the highest in the country, even though the state stepped in and tried to offer some relief. Even with the Affordable Care Act, insurance is still not remotely affordable for a lot of people I know.

[And if legislators ever succeed in rolling back the mandate to cover pre-existing conditions, which for the life of me I can’t figure out why they’re so eager to do that, other than, I suppose, financial gratitude from insurance companies, Lynn and I could easily find ourselves unable to afford coverage.]

So here in the richest country in the world, you have plenty of middle-class citizens (I believe I keep hearing that about 80 percent of citizens have access to coverage through work, but having access and being able to afford it are two different things. Just ask the teachers of our local school district, who often can manage their own premium but struggle with the amount required to cover the rest of their family) who can’t afford insurance but then really can’t afford it when medical facilities put the screws to them by charging 10 times what the procedures seem to actually cost.

No one conducted an exit poll outside the Blackstock Building in Gunnison earlier this week, but if they had, even before I saw CBS This Morning this morning or Lynn’s bill last night, I would have reported myself “infuriated” by the state of health care and its considerable costs. And now I’m even angrier.

So far I don’t see a lot of political will coming out of Washington to make any sweeping attempt to work on this major, major problem. And no matter how much Colorado might want to help its residents, it can only go so far before running up against the feds. I keep waiting for Amazon to take this on and conquer the problem, it doesn’t seem to be part of Jeff Bezos’ interests. (Mark Zuckerberg and Priscilla Chan of Facebook have put considerable money into one specific hospital.)

It seems that CBS is on the right track. They have a place you can go on their website to report the rate you paid for any medical procedure. Eventually they might amass a database that if the rest of us would only consult it, we could say either before a procedure or soon afterward, “You know, this procedure that you want to charge me $10,000 is shown on a national average to cost $1,000. Why is your rate so far out of whack?”

Initially, of course, hospitals will remain shameless, and the “non-profit” University of Colorado Health Sciences mega-complex will continue pulling in so much money it will subsume the entire Denver Metro area, but perhaps if we all work at being better health consumers we can put at least a semblance of shame into these racketeers.

Because no one else appears to willing to do it for us, and it is way past time that we get so mad that we’re not going to take it anymore.

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