  |
|
FEATURE ARTICLE |
|
|
|
There Is Medical Cost Shifting, but Not What You Think
Sierra Hancock Date: 03-17-2011 Subject: Healthcare John F. Cogan, R. Glenn Hubbard and Daniel
Kessler have it completely wrong on the "cost shifting" of health
care from the uninsured to the insured ("ObamaCare and the Truth About 'Cost Shifting'," op-ed, March 11). It is not the
insured who pay a price for the uninsured, it is the opposite. A patient of mine without insurance was
billed $3,750 for an MRI of the brain. That was the imaging center's customary
and "reasonable" fee for those who pay cash. With my intervention,
the bill was reduced to $500, approximately what Medicaid pays for the
procedure, and that only after I'd done tons of paperwork. My son had
outpatient ankle surgery which lasted all of three hours from the moment he
entered the hospital to the time he left. The cost: approximately $17,000. I
have been assured that if I put up a sufficient stink, the hospital will roll
it down to what Blue Cross would have paid for it, about $6,000. The same
surgery in India,
where there is little health insurance, would have cost less than $1,000. If I
pay the full $17,000, I will surely be subsidizing the cost of the insured in
that hospital. Health insurance has made it virtually
impossible for the uninsured to get any reasonable care without spending a
fortune. Instead of increasing the number of the insured, a more sound strategy
would be to stop all subsidization of health insurance through government
intervention and tax money. The uninsured will get better treatment at a
fraction of what they pay now if market forces are allowed to bear freely upon
the supply and demand of health care. ObamaCare should be limited to opening
Department of Veterans Affairs-style clinics and hospitals, where the truly
poor can receive reasonable care using a sliding scale to assess their portion
of the bill. Surendra Kelwala, M.D. Livonia, Mich. The authors argue that "cost
shifting"â€"higher prices charged by doctors and hospitals to recover losses
from uncompensated careâ€"does not contribute significantly to the overall cost
of health care. Nonsense. As a physician in practice for over 30
years, I have seen countless ways that hospitals and doctors make up for lost
revenue. Some doctors see more patients, rarely a good idea for either. Others
succumb to up-coding: bypass surgery and stents instead of medication, total
joint replacement over a cortisone injection, Mohs surgery for skin cancers
rather than a simple scrape and cautery. In each of these cases, which
represent just the tip of the iceberg, we're talking about thousands of dollars
difference. And who pays? Patients, insurance companies and the taxpayers.
Pretty shifty, huh? Rick Parkinson, M.D. Provo, Utah Doctors and hospitals certainly do not
pass their lost fees onto insurance companies, which cap their payments in any case.
However, the truth is that the uninsured "not-so-poor" are asked to
pay medical bills significantly higher than identical covered services of the
insured. When these exorbitant bills remain unpaid or compromised, providers
write them off as a "loss," entirely on paper of course. Medical-care policy should not be based on
such doctored evidence any more than financial policy. Jonathan L. Fox, M.D.,
M.B.A. Northfield, N.J. Am I missing something? The authors argue
persuasively that under ObamaCare the insured would not bear the cost of caring
for the uninsured. In the penultimate paragraph they disclose that which makes
their argument irrelevant: The Congressional Budget Office predicts that the
cost of caring for the uninsured will be borne by taxpayers to the tune of some
$200 billion. Thomas Letchfield |
