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A High Price to Pay: Health Care in Modern America

The American health care system is sick, and there is no vaccine immediately available.

Here’s a personal example:

In the early spring of 2019, I spent part of a night in a hospital emergency room while out of town on a trip. It wasn’t anything life-threatening, although the issue did require immediate attention.

After a few hours, I was treated and sent on my way. When I never heard anything more, I assumed my insurance had taken care of the costs. Then, a couple of months ago, I received a bill for my co-pay — more than $8,000. This was 15 months after I had been treated, with no intervening communication, and the notice asked for full payment within two weeks.

However, when I looked over the itemized part of the bill, I saw all sorts of discrepancies and phantom charges. I was dunned for simultaneously spending the night in the ER and in a hospital bed — a physical impossibility, since I was never actually admitted. While I was never given any medication during my time there, I was billed $850 for “pharmacy” charges. A CAT scan costs $2,000.

I contacted my insurance company, who confirmed that they had paid nearly $3,000 on the bill, and that my co-pay was supposed to be $89, not $8,000. Confronted with that, the company that sent me the bill backed down.

Unfortunately, this was not an isolated incident. News outlets and online sources are littered with lurid accounts of outrageous collection practices.

The Website KevinMD — an online voice for emergency room physicians — cites a woman charged $5,751 for an ice pack and an infant charged $937 for an antibiotic ointment. According to Business Insider, a teacher was refused a coronavirus test in Brooklyn because she wasn’t going to be admitted to the hospital, then later sent a bill for $10,000.

This has been going on for a while, but COVID-19 has pushed medical price gouging into a new realm. Many hospitals took a financial hit when they were forced to suspend elective surgeries because of the virus, so perhaps “extreme billing” is an effort by some to recoup that lost revenue. Or maybe the plan may be to then offer traumatized former patients a deal — an amount that is still outrageous, but much lower than the original bill.

ER doctor Ashima Vohra blames much of this on “contract managed groups,” to whom hospitals outsource their billing.

“Who sends bills like that?” he wrote. “Is it the ER doctors? No. It’s large corporations. A CMG can refuse to participate in insurance networks, which work on behalf of patients to negotiate discounted rates for medical care. These are called in-network rates. It will instead charge patients exorbitant out-of-network rates. Compared to the prior physician group that staffed a hospital, it can raise charges by a whopping 96 percent. These predatory billing tactics are directly responsible for the exorbitant ER bills being sent to patients.

“We are struggling to fight for our patients. Physicians are distraught over this situation, but over 60 percent of us are afraid to speak up out of fear that we will be terminated without cause. Some of us want to help fix the billing process, but CMGs insist on engaging in ‘closed-book’ billing. That means they will not allow physicians to review what a patient is being billed. Consequently, physicians are turning to advocacy organizations for help in this fight.”

Outsourcing bill collection has effectively separated the core function of the medical profession — treating the sick and injured — from its darker side. Worse, the steep rise in medical bills has also frightened many people away from being tested for COVID-19.
When you think about the nature of medical bills, they begin to seem even more unfair.

If someone buys a TV or an automobile, they know what it will cost and make a conscious decision to accept that amount. If they then fail to make the required payments, repossession may not be unfair.

By contrast, most people being treated in a hospital ER or an “urgent care” facility have no idea how much the bill might sting later. They may be told, “OK, we’re going to run a few tests,” but they are never given the option of declining, nor are they informed about what these tests will cost. Some are done without their knowledge, and no one ever asks: “Can you afford to be sick here?”

Most of the time, the element of choice enjoyed by the TV or auto buyer is out of the picture. If your appendix ruptures or you are hit by a car, shopping around for the cheapest medical facility is not an option.

Certainly, medical providers need to be paid. Hospitals purchase expensive equipment to improve their diagnosis and care system, and that needs to be paid for. That’s why you can be charged $25 for a single aspirin.

Again, this is nothing new. When she was 10, my daughter broke her arm while bouncing on a pogo stick. After the bone was set and a cast applied, she was kept overnight in the hospital for “observation.” I picked her up the next morning.

When I saw the eventual bill, I contacted the most expensive hotel in New York City at the time and asked the price of its “rock star suite” for high rollers. It turned out to be less than my daughter was charged for a short stay at a medium-level hospital. Maybe we should have taken her there, instead, and hired an overnight nurse.

Today, people are encouraged to get tested for COVID-19 for the sake of society as a whole, only to discover that they have unwittingly walked into the jaws of Big Medicine.

“I wish there were a federal law that said it was illegal to give a bill to a patient during all of this,” said Karen Pollitz, a senior fellow at the Kaiser Family Foundation. “But it all depends on who is taking care of you.

Meanwhile, suppose some elements of the medical establishment maintain that patients wouldn’t necessarily be better off with a system of national health care. In that case, they have a strange way of making that argument.

Darrell Laurant
Founder at Snowflakes in a Blizzard | + posts

Darrell Laurant is a veteran journalist who previously worked at the News & Advance (Lynchburg). He published over 7,000 pieces in three decades. Darrell has covered papal visits, the Olympics, American sports, and political issues in Virginia. He has also written a variety of books, including "Inspiration Street: Two City Blocks that Helped Change America."

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