The Wall Street Journal investigation shows some 29 million uninsured patients pay much higher prices than insured folks for the same procedure at American hospitals. Despite the Patient Protection and Affordable Care Act, and the Trump administration’s price transparency mandate, the people least able to afford it pay the most.
Background Resource:
Hospitals Often Charge Uninsured Patients the Highest People, New Data Show
[The Wall Street Journal, July 6, 2021]
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10 replies on “Transparently Unfair: Uninsured Pay Much Higher Prices at Hospitals for Same Procedure”
First, I know of no hospitals of the MANY I have been in that publish their charge master data – that being what they charge for a given procedure. It precludes price shopping for a given procedure.
Second, ALL of the public hospitals have programs that reduce medical bills by 50% or more if you are making less than 400% of poverty level. So, $45,000 a year will likely get a reduction of 50%.
Lastly, People who don’t have insurance likely don’t have the money to purchase insurance – which means they likely can’t pay the bill anyways. In my experience working at a hospital those People don’t pay the cost AT ALL, since hospitals cannot refuse to treat a patient (unless it’s a private hospital) they know it is a write-off. Is the care less than a paying customer? I doubt it – since the Doctors aren’t privy the payment history of a patient. They don’t get involved. Could the hospital privately tell their physician to reduce care? Anything is possible.
As Bill almost mentioned, it seems the classes of cost to be considered here are actually pretty simple, if difficult to legislate for in practice:
1) those typical annual (or periodic) costs that most people can afford and should pay out of their yearly income (physicals, glasses, dental visits, shots, mammograms, colonoscopy’s, etc.), but that currently get lumped into “insurance” paying you back for what you already paid in. I suspect this is $1000 to $2000 per family member per year [and could be set as a % of yearly income, somewhat as done for Schedule A now.]
2) real insurance, intended to protect against or mitigate the risks and impacts of real medical costs (accidents, cancer, heart treatments, appendectomies, etc.) that basically are not anticipated during the year [hence risky] and exceed the ability of the typical family to afford. It appears this is running in the range of $8K to $16K per family per year [based on membership in different respective risk pools based on age, etc.], but might be less if the real costs of medical procedures were made transparent and subject to real market place competition.
3) the real bug a boo: existing conditions, which for many people are simply conditions that were not previously existing until they appeared and insurance started to cover them as appropriate. These are typically pretty expensive, but in some cases the on-going costs can be afforded by some better off families, either directly or via their prior medical insurance coverage. Thus only some moderately large amount of money must be set aside yearly to cover health care for those who cannot maintain these types of expenses on their own [and/or also category 1 above]. Proper attention to means testing and/or other criteria should make solving this problem tractable, although I personally don’t know enough to suggest exactly how it would be or should be done. But it certainly does not require single payer or such a large role of government $ and regulations in our healthcare market as exists today.
Categories 1) and 2) are [totally or partly] covered by employer paid insurance for many people and are essentially “tax expenditures” (aka tax loopholes) for the employed class (lower, middle, or upper) since those costs are not subject to personal income tax. Giving the same tax benefits to everyone no matter how they pay for their health insurance (and health savings accounts) seems only fair for this type of expenditure.
Unfortunately, if your insurance is offered/paid for or shared by your employer – a condition which arises and becomes “pre-existing” or chronic likely will NOT be covered if you switch to another employer. It puts you in the position that your job may effect moving up in any given industry and pigeon hole you where you are at, or your new insurance cost will erase any increase on income from the new increased medical costs. This can be untenable without a very large increase in your income.
Scott at 2:00: 29 million Americans still not insured, in spite of Obamacare. Back in the 2009 timeframe I recall the claim was that number was closer to 47 million, so nominally this looks like progress of a sort. Except the real # in 2009 was closer to 18 million after removing people eligible in some way who had not bothered to get what they were eligible to get (public or private). Probably equivalent situation applies today – so if Obamacare has not truly reduced the total # of uninsured, why have it?
Before I forget to mention it, thankyou to our hosts and any of the rest of you who are paying payroll taxes for SS and Medicare. As a post 65 and 70 year old, I am a beneficiary of both of those programs. Now, truth be told, I don’t really need that money to live comfortably, but I am not planning on giving any of it back, or reducing my “entitlement”, unless and until Congress steps up and reforms our entitlement and debt/deficit situation so it applies to all of us in a suitably comprehensive and responsible way. In that case I will cheer on the reduction of the debt currently imposed on my grandchildren, even if it costs me substantially.
Fortunately, given that we are both pretty healthy so far, we actually end up paying our modest medical costs directly [no net cost to the government] via the withdrawal of Medicare Parts B & D premiums from our SS payouts [which were also already reduced by income taxes on 85% of those payments]. Those premiums + copays have exceeded our real costs for most of the last 10 years or so. Add in the Net Investment Income Tax (NIIT) from Obamacare and our progressive tax system is working exactly as intended and designed.
All of healthcare is broken. Thank the Democrats and their cowardly enablers in the stupid party.
I’m a self employed person who decided about 4 years ago that corporate insurance was not worth the expense. I joined a medical concierge system. I pay $79 per month and I can see the gp doctor as often as I want with no copay. I carry a small policy, written by a non-insurance based co-op, that covers Hospitalization for ~160.00 per month. I haven’t needed it so far (knock on wood). When I need a test or scan or xray or mri done, I call around to see who has best pricing. I ususally get told a price right away, then when I tell them it’s self pay, I get quoted a lower price. I had an mri done last spring. I was able to find a place only an hour away who charged me $300.00. I saw an endocrinologist for awhile ( I also have Graves), and they charged me less for being self pay also. The place who does my bloodwork every 3-4 months charges me a lot less. Most doctors and testing facilities are grateful to have self pay customers. They don’t have to chase an insurance company around to get paid. Corporate hospitals may be different, and in an emergency, you may not have choices about where to go, but even then, pricing can often be negotiated after the billing comes. Self pay doesn’t always mean inflated cost. I agree wth Bill that the way to lower medical costs in general is to get the government out of the system. Unlink medical care from employment. Let Doctors treat a patient as they wish, rather than having to find out what an insurance company will allow for care. Require medical costs be public and let insurance companies act anywhere they choose and have to compete for customers. These large medical conglomerates have too much money to throw at politicians – so take politicians out of medicine and we’ll be on the right track.
MUST take issue with this one, guys. My wife had abdominal pains, folded up in fetal position on the floor. Called for ambulance to take her to emergency. They did their thing, went to bring her home, and make payment arrangements. Fortunately for me this hospital had their own billing on site, and I could talk directly to them. The bill was $5,999.98. I told them we’d applied for insurance, but she hadn’t been processed and accepted as yet, and I was paying cash. The bill was immediately cut by 50% to $2,999.99.
The ONLY bills not cut were the x-ray and MRI, both of which were billed off site, and no way to face to face with them and talk them down. Both were in the area of $300-$400.
Bullroar! Sick people’s failure to pay is not why hospitals charge the uninsured more, our governments REWARD hospitals for charging the uninsured more. Of course they are reimbursed through various direct and indirect fed and state government redistributions of our wealth, like the billions shoveled through Disproportionate Share Hospital payments for example, but the sneakiest one is by writing off all that grossly inflated bad “debt,” the hospitals qualify themselves “non-profit” and thereby get massive tax breaks on income and property taxes due to their generous “charity.” They also gorge on the spoils by elbowing themselves up front to feed off the dead carcass after we poor saps are forced to declare bankruptcy as a result of their compassion. Our generous hospitals are responsible for two-thirds of all bankruptcies every year. “’For from the least to the greatest of them, everyone is greedy for unjust gain; and from prophet to priest, everyone deals falsely. They have healed the wound of my people lightly, saying, “Peace, peace,” when there is no peace. Were they ashamed when they committed abomination? No, they were not at all ashamed; they did not know how to blush. Therefore they shall fall among those who fall; at the time that I punish them, they shall be overthrown,’ says the Lord.” [Excerpt, Jeremiah 6, ESV.] Can’t come soon enough.
LOL, inflate me like a balloon. Great close.
They have to keep the prices for the uninsured high, because the rates for the insured are based on discounts from that rate, negotiated between the hospital and insurance company.