It is easy to see that a recurring theme in Steven Brill’s TIME article ‘Bitter Pill’ is the chance nature of most American health care. Live in the wrong place, be the wrong age, or just have an accident, and you are up the creek and liable to be clobbered with costs via “charge master”. This is the automatic billing machine now operating as a deus ex machina in most non-profit hospitals and contributing mightily to soaring medical costs to the tune of $750b waste each year.For those with excellent health insurance, like my niece (who works at Oracle) and who just yesterday underwent partial mastectomy for breast cancer, the excruciating pain from medical bills is held at bay. She is effectively insulated, so there is no suffering on top of the physical agony, of say having to undergo cancer treatment. For many others it’s not so clear cut or painless cost-wise.
For example, there’s the sad case documented by Brill of Emilia Gilbert (p. 28) now 66, who merely had the misfortune to slip and fall on her face one evening in 2008 – at the age of 61 and before Medicare eligibility. Her nose bleeding heavily she had to go to the ER at Bridgeport Hospital. She ended up with $9,418 in medical bills which still have her “hyperventilating”. The CT bills alone (for 3 CTs) came to $6, 538, while Medicare would have paid $825. (The Bridgeport Hospital had an operating profit of $52 million in 2010)
Worse for Gilbert, she only learned too late that the health insurance offered by her employer as Cigna (a top name) was not its top tier version but rather from a Cigna subsidiary called ‘Starbridge’ offered for low wage workers. (As usual, the low wage workers are the ones that get screwed in this country) That meant she was “on the hook for about $7,000 of her $9,400 bill)
Then there was the case of ‘Steven H.’ who went into Mercy Hospital in Oklahoma City for a simple outpatient procedure (laparascopy) that ended up costing $87,000. (Part of the multitude of costs rung up by the hospital’s charge master: $32 for a blanket to keep patients warm). The hospital is evidently run by the Sisters of Mercy hospital chain (p. 33) which collected $337m for fiscal year ending June, 2011 of which $34 million was its operating profit. This from a group that professes as its mission: “to carry out the healing ministry of Jesus by promoting health and wellness.” Well, pardon me, but I doubt Jesus would have taken $34 million in profits for his healing!
Most shocking regarding outpatient procedures such as those experienced by Steven H. are that they are responsible for nearly two-thirds of the $750b in medical waste overspending each year. According to Brill:
“This includes work done by physicians, laboratories and clinics- including diagnostic clinics for CT scans and blood tests- and same day surgeries and other hospital treatments like cancer chemotherapy. “
TIME’s Brill further cites a McKinsey survey that outpatient Emergency room care averages an operating room profit of 15%, compared to inpatient care which has a margin of only 2%.
The reason? According to one medical economist:
“You get 10% or 20% more patients in there every day who don’t have to board overnight and that goes straight to the bottom line.”
Hmmmmmm….sounds awfully similar to the reasons the airlines have for continually decreasing the seat pitch for economy class to pack more hapless passengers in and rack up the profits!
One of the saddest cases Brill investigates is that of ‘Steven D.’ (p. 37) who had the misfortune to get lung cancer at the age of only 42. His treatment had an initial price tag of $348,000 but his wife Alice was later able to secure the services of a billing advocate who got the Seton Medical Center in Daly City, Calif. to write off $297,000 of the bill. Just as well after seeing what was originally itemized, including: $24 (each) for niacin pills and a $77 charge for simple gauze pads (p. 38).
One year after the death of Steven D. his wife Alice enunciated the primary lesson she learned from the ordeal (ibid.):
“I’m never going to remarry, I can’t afford the liability.”
This was after she had to cover the balance of her hubby’s medical bills, including shelling out $30,000 of her own money and still owing $142,000. Imagine that! She can’t afford to remarry because the next potential husband may be another medical liability. Do I blame her for evincing a crass attitude? NO! I blame a nation that would allow and enable a system that drives its citizens to such economics over all desperation. It is a reminder of the famous words of Charles Reich in his ‘Opposing the System’ (p. 183)::
"When society itself comes to be modeled on economic and organizational principles, all of the forces that bind people together are torn apart in the struggle for survival. Community is destroyed because we are no longer 'in this together' because everyone is a threat to everyone else. "
BINGO!
But some of the worst travesties are to do with the ‘Cancer Drug Profit Chain’ (p. 43), for example the case of the drug Flebogamma which features an astounding mark-up. Compounding the travesty is that drug makers are free to set their own prices. This seems to make sense in a “free market” economy until one considers, as Brill does, that the drug is a one-of-a-kind life saving serum. In this case, we no longer have a free market but a "controlled market". This means patient "choice" is a sham: You either pay $6,000-odd a month for the life-saving drug or you die. Some deal!
Brill notes (p. 46) that “our laws do more than prevent the Government from restraining prices for drugs the way other countries do, it also restricts the single biggest buyer Medicare – from trying to negotiate drug prices”
Of course, this is totally whacked out double down insane, and shows the country has no real vested interest in controlling medical costs or I would argue, the long term deficit. Never mind the rhetoric coming out of D.C., the facts belie any serious interest in debt control, but rather expediently piling added financial burdens and social insurance cuts onto the most vulnerable to support the lifestyles of the wine -and -brie plus twin- Bentleys class, be they "liberals" or conservos.
To show how insane and hypocritical this country is, consider this: Sloan Kettering researcher Peter Bach reported in a 2009 article in the New England Journal Of Medicine (p. 46) that “Medicare’s spending on the category dominated by cancer drugs ballooned from $3 billion in 1997 to $11 billion in 2004..” He projects it may now be over $20 billion.
Bach, on the basis of this finding, pushed with other experts to establish a Patient-Centered Outcome Research Institute to expand comparative research investigations. Such efforts would be able to ascertain, for example, that if cancer drug A works better than drug B and is less expensive, then A ought to be selected for Medicare (Part D) Prescription Drug Formularies over drug B.
Alas, a Repuke- dominated congress jumped in and added eight provisions to fuck the deal. These provisions restricted how the research could be used, with the primary one spelled out as (p. 46):
“Findings shall not be construed as mandates for practice guidelines, coverage recommendations, payment or policy recommendations.”
As Brill notes: “With those 14 words the work of Bach and his colleagues was undone and costs remain unchecked.”
Are the Repukes and their ilk really interested in cost-management and “preserving entitlements” for future generations? Hardly! Like their determination to protect the wealth of the richest 1% they are determined to milk Medicare dry by any means they can to protect the out-sized profits of the Medical Industrial complex.
As for the citizens (victims) snared by this gluttonous, greedy and egregious system? They can catch as catch can, scrape by while being pursued by bill collectors, maybe rob a bank to get $$, kill themselves or simply refuse to remarry since the next partner may be a “liability”. (But they better pay those medical bills NOW...and oh yes, no trying for Chapter 11 bankruptcy!)
No wonder this country is in such sad and sorry shape! I recommend that interested readers get hold of the whole Brill article (March 4, TIME) to find out how profoundly fucked our whole health care system is and the extent to which it’s driving up our national debt! Which, evidently no one in D.C. really cares about, whether the politicos or the Medical Complex's grubby lobbyists.
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