Happy Birthday, Mom!
Little bro treated Mom and I to breakfast this morning before she headed off on a well-deserved overnight jaunt with one of her friends. She is almost back to 100% now from her knee replacement and the subsequent fall that hurt her head and lower back. Thanks to all of you who sent your best wishes and kept her in your thoughts.
One of the topics that came up was how she is starting to see the bills and paperwork come in and there were two things that really bugged me about that and they are all things that vex me about the current state of health care in the US. Before I get into that though, let me state that in all cases I think she really received top-notch care. It wasn't perfect, but nothing is, is it? With the exception of one doctor out of many, I would give the treatment she received from all three facilities and their staffs a grade of A. And I don't think she got any special treatment for any reason at any of those facilities. That's what they do for everyone.
But back to the beefs. The first is that she is getting bills from all of these organizations that provided services to her, even though they will be covered all or in part by Medicare and her insurance. The business group that the ER doctor belongs to. The neurologist's practice. The county medical service for the ambulance. All have submitted full bills to her for their services. The issue appears to be that while the county hospital she was transported to after her fall had all of her Medicare and insurance info, they can't seem to find a way to get that to the staff's organizations so they can submit the bill to Medicare and insurance first. They send the bill to mom's house and then she has to call them up and give them that info one by one. That just seems crazy and hugely inefficient to me. I'll be interested to see what the current health care reform measures have to say about that.
The second issue is cost. The ER doctor did a fine job, but the bill for his services from his practice reads one hour @$480. The county EMS crew also did a fine job, but the bill for treating her at the scene and transporting her 5 miles to the county ER was $1400. Medicare will likely pay all or most of those bills with her insurance paying the rest(or they may negotiate some smaller rate). They in turn, are probably going after the insurance company of the hair salon where the accident occurred.
What frustrates me in the current health care debate is how opaque those costs are, just using those two as examples. I know the ambulance ride just to transport my mother did not cost the county $1400. There's no way. I am also certain that the ER doctor did not pocket $480 for his hour of treating my mother. So what does make up those costs? I would love to see a pie chart on that. It might go a long way to explaining what the issues are and how we might solve them.
It might piss people off too, and I would not be surprised if there are interest groups who don't want people to understand why prices are set the way they are. I wonder if that's because there is considerable cost-shifting and going on where certain groups are subsidized implicitly and where the whole system is geared to shifting as much cost as possible onto Uncle Sugar. The more complicated it is, the more likely that it's impossible for anyone to get a real sense for it.
Now if you are relatively young and have private insurance you may think that you don't care if a doctor costs $480/hr or an ambulance ride costs $1400. Hey, your insurance pays for that. But there are lifetime limits on many policies, and even if those inflated prices have only a limited impact on your premiums now, which I doubt, they are eating away at your balance of lifetime insurance every year, and you may find it much reduced when you need it most.
When I want to understand something like this I try to get a feel for what the true costs are for each component, salaries, equipment, materials, training, profit. I think we can get at most of the components that make sense and take a guess at the cost of each. But what are the components we can't see? What else is in there?
Or am I way off base here?
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