Reform Item: Equitable Billing for Health Care


Rep. Anthony Weiner (D-NY) brings up a valid point on Morning Joe: what is the value of private insurers?

The question that needs to be answered before Rep. Weiner’s question can be addressed: how much does a health care routine really cost? Is there a list that says $Y dollars is the cost for treatment X? We know our co-pay, our pre-tax pay check deduction but we really don’t know the pre-tax premium contributions of our employers or “employee group”. Health care is a service we buy, through a non-transparent market, without any broker on our behalf and then hope that whatever deal we implicitly agreed to works for us and our provider when our health goes bad. That isn’t a free market nor is it an equitable one. Private payer to provider market distortions are exposed when you compare “full billed charges” to Medicare payouts to providers:

…a survey by America’s Health Insurance Plans, an industry trade group, which detailed a series of exorbitant physician charges. The survey examined out-of-network bills where — as opposed to in-network services — contracts do not exist between the provider and insurer. Also known as full-billed charges, it’s what the uninsured face every time they see a doctor.

In some cases, patients received charges 34 times what Medicare pays for the same procedure in the same location, the AHIP survey found.

For example, one doctor billed $4,500 for an office visit when Medicare would have paid just $134. Another doctor billed $14,400 for removal of a gallbladder when Medicare would have paid $656. And a hip replacement cost $40,000 when Medicare would have paid $1,558.

via Health Articles | A Little Haggling Might Pay Off at the Hospital | Miller-McCune Online Magazine.