Sunday, March 6, 2011

The Problem Nobody's Talking About

Health care cost. With all the wrangling about Emperor Walker’s budget, all the disagreement about collective bargaining “rights”, and all the yammering about public employee contributions to their health insurance plans, I believe the focus has been lost. The simple fact, to me, is that while we have some of the best and most advanced health care available on the planet, it costs too damn much.

And the explosively escalating cost of health care is a gigantic drag on our economy, both as a state and as a nation. Medicaid funding in Wisconsin is a huge powder keg: 1.25 million Wisconsinites get some sort of benefit from Medicaid. The funding is simply not sustainable. Costs have soared out of the realm of reality.

Back in the old days, so long ago that only people as old as I am can remember, our basic health coverage…and I’m not talking what they used to call “major medical”, like if you got drunk and fell down three flights of stairs and were in the hospital for a week….was run quite differently. If the doc wrote a prescription for you, you went to the drug store, paid for it, and then submitted the bill to your insurance carrier for reimbursement. You had a real and tangible sense for how much a little orange tube of 30 antibiotic pills cost. You paid for it, and then got reimbursed.

Now, you give the druggist your “insurance information”, and depending on your deal, you have some sort of co-pay. Simple course of antibiotics: five or ten dollar co-pay. Spend a day in the hospital: hundred-dollar co-pay, perhaps even a three-figure “deductible” cost to you. You have no idea what the actual cost is, unless you get a statement from your insurance carrier. All you know is your co-pay and your deductible.

When Emperor Walker gets his way with Medicaid in Wisconsin, thousands of people will be uninsured and will go to the Emergency Room as their “primary care physician”….and who do you think will end up paying for THAT?

Case in point, regarding medical costs. My 84-year-old mother inherited her ancestors’ trait of having toenails somewhere on the hardness scale between granite and chrome-vanadium steel. Every three months, she has to have her nails “debrided” at the doctor’s office. She told me the last time she went, she made her 30-dollar co-pay, and her new insurance carrier (Network) paid another 45 dollars – the agreed-upon rate for Network clients. Then, a few days later, she got a bill from the doctor’s office for $87.

This is the unethical crap that they do….the docs try to collect the difference between what they get from you and from your insurance company, and their “established rate”. Mom’s insurance carrier informed her she didn’t have to pay the bill, and thank heaven, she didn’t. But a lot of our senior citizens simply pay every bill they get, as a matter of course. It’s dishonest as hell, but health care providers do it all the time.

The debriding process takes approximately ten minutes. So, at $162 per patient, doing six an hour is just shy of a grand. Not bad for an hour’s work. Of course, from patients who understand the system, they “only” get $75…$45 from the insurance carrier and $30 from the patient. Still a pretty good chuck of change for ten minutes’ work.

From the smallest, least complicated procedure, to the most complex high-tech surgeries, medical costs have gone through the roof. Our health insurance system is a non-sustainable model and nobody seems to have the will to address this ruinous economic issue.

1 comment:

  1. Ah, Tim....

    We have a good health insurance plan, which happens to be a union-negotiated benefit.

    We pay 25% of the cost of any prescription, not $10 or $20 or $30 (that was last year's plan.)

    Deductible is $1,000/person or $3,000/family total/year AND there is a 20% co-pay (in-network), 30% copay otherwise.

    Yes, health costs have gone up.

    Isn't it...umnnn....curious? Health costs have gone up just like the cost of a UW college education has gone up. There's a commonality: third-party paying. "Somebody else" pays for a bunch of the total.