One of the key points of this blog is that the health care debate has never been about health care. Never. Money isn’t the prime driver. Money is the only driver. How do the hospitals, doctors and other medical providers get paid, and how much, are the real issues.
Except for a couple of purists, no one really cares who pays the doctor or hospital as long as it isn’t you, the patient. Do you really care if your $300,000 bill from the Cleveland Clinic or University Hospital is paid by Anthem Blue Cross or the federal government? Honestly? No. All you really want to know is how much, if anything, you will owe once the dust settles. And the providers? The insurers pay more, but have a lot of paperwork. Medicare pays less, but quickly. Based on the number of medical providers that accept Medicare (darn near everyone), I’m guessing that there are no serious complaints. The hospitals may even like having two major funding sources to play against each other.
I have tried to teach my clients what I know of the game. My senior clients learn about the origins of Medicare Parts A and B, the backroom deals that gave us Part D (Rx), and why costs are out of control. Countless clients have been clued in that those obscene charges are negotiable before and after services have been rendered.
Your perception of our system changes today thanks to Time magazine. Blessed with budget, time, and amazing persistence, Steven Brill has given us Bitter Pill, Why Medical Bills Are Killing Us. Mr. Brill tracked claims and laid bare the abomination that is our system of billing for services – real or imagined. Straightforward in his prose, laborious in his detail, Mr. Brill presents a system of overpaid executives and hyper profitable not-for-profits.
The real issue isn’t whether we have a single payer or multiple payers. It’s whether whoever pays has a fair chance in a fair market. Congress has given Medicare that power when it comes to dealing with hospitals and doctors, and we have seen how that works to drive down the prices Medicare pays, just as we’ve seen what happens when Congress handcuffs Medicare when it comes to evaluating and buying drugs, medical devices and equipment. Stripping away what is now the sellers’ overwhelming leverage in dealing with Medicare in those areas and with private payers in all aspects of the market would inject fairness into the market. We don’t have to scrap our system and aren’t likely to. But we can reduce the $750 billion that we overspend on health care in the U.S. in part by acknowledging what other countries have: because the health care market deals in a life-or-death product, it cannot be left to its own devices.
Steven Brill – Bitter Pill, Why Medical Bills Are Killing Us
You won’t agree with all of Brill’s conclusions. I certainly don’t. But read his work. This should be the new starting point of our national conversation.