To the Editor:
I recently read two books on the Affordable Care Act: (1) Reinventing American Health Care: How the Affordable Care Act will improve our terribly complex, blatantly unjust, outrageously expensive, grossly inefficient, error prone system, by Ezekiel Emanuel, and (2) America’s Bitter Pill, by Steven Brill. Both books are available at the public library.
Ezekiel Emanuel is a professor and expert on health care issues. He outlines how we don’t really have a “system” in the US; we got into employers covering workers because the IRS determined that the value of health insurance was not taxable to the worker, and the employer could deduct it. Naturally, when people do not pay for their own bills, they do not concern themselves with the costs. He also includes a chart from 2009 showing what a convoluted maze the then-current morass was. I found it at www.newrepublic.com/article/your-health-care-system-map.
Steven Brill is the journalist who wrote the award-winning article in Time Magazine why things are so outrageously expensive: “the prices are all too high.” Brill discusses the chargemaster, the obscenely high-priced list that hospitals use, such as $77 for gauze pads, $24 each for niacin pills, $13,225/day in ICU, $7,315/day in CCU, $20,886 for CT scans, $24,251 for lab work. Most people do not know that their hospital bill is just the opening bid; hospitals do not say, “give us your best counter-offer,” so most people think they are supposed to pay it. Brill gives many examples of real people. One man who had cancer, and his widow was stuck with bills for $903,000. She hired someone to negotiate and got it down to only $348,000, because the hospital knew she couldn’t pay it and they’d never see the money. The widow had to sell a family farm to pay her deceased husband’s bills.
Another story of a patient who had cancer: They would not see him at MD Anderson Cancer Center in Houston until he paid $48,900 in advance to see the doctor and another $42,500 in advance to begin urgent chemotherapy. A hospital spokeswoman told Brill “Asking for advance payment for services is a common, if unfortunate, situation that confronts hospitals all over the U.S.” Later, the patient was able to get on an Ohio plan after the ACA exchanges opened, and now he can get treatment in Ohio.
One man went to Fairview Ridges Hospital in Burnsville, MN, when he thought he was having a heart attack. As he lay in the ER, a woman came in and said they’d run his insurance and he owed $641 more, so they made him put it on his credit card. The MN attorney general claimed that was undue pressure to make him pay before he’d even received treatment; they had overly aggressive bill collectors.
The author himself had to go for open heart surgery; his bill came to $197,000. While on the gurney he didn’t care what it cost, he just wanted the best treatment he could get. He writes: “When you’re staring up at someone from the gurney, you have no inclination to be a savvy consumer. You have no power.” and “You certainly don’t want politicians messing around with some cost-cutting schemes that might interfere with that result.” After he recovered, he interviewed the CEO of New York-Presbyterian and asked him questions about his own chargemaster bill. Corwin offered the standard explanation that the hospital loses money on Medicaid recipients who are 30% of its patients, and also loses 20% on the 30% of patients who are Medicare patients, therefore they have to make it up on charges for the privately insured patients.
Brill quotes a hospital administrator stating that patient care quality will go down if the hospital gets less money from Medicare or other insurance. What he really meant was he and his other hospital administrators don’t want their $3 million or $5 million salaries to go down.
Brill discusses drug prices, the drug companies wanting their patents to go longer, they don’t want Medicare to be able to negotiate drug prices, they don’t want their profits to go down. Brill tells that for a new pill for hepatitis C the drug manufacturers decided to charge $1,000 a pill and patients need 84 of them.
I gathered from Brill’s book that the ACA now makes insurance more “affordable” to more people, i.e., they can get it now, when the subsidies pay a good portion, but the ACA does not do much to lower the high costs.
At the end of Brill’s book he has Q&A with President Obama. Q: “I know that many on your staff urged…that you put healthcare aside in favor of worrying about the stimulus package and the economic recovery. Why didn’t you?” A: “We didn’t have the luxury of working on just one big issue…Within a month of my inauguration, we passed the Recovery Act. By virtually every independent economist’s estimation, that set of policies helped stave off another Great Depression…I believed that reforming our health care system wasn’t a side project, but a vital part of rebuilding our economy.”
The entire book is over 500 pages long, I have only mentioned some of the highlights.