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Health Care and Costs and Profits

Posted 6/26/2017

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  We are all very aware of rising health care costs. Even those of us who are fortunate to have good medical insurance are paying much higher deductibles and co-pays. Barely a day passes in my office without someone talking about the very high price charged for prescriptions or tests. I have known a few people who had to transfer their cancer care to an oncologist at a different hospital because their insurance had an enormous co-pay for every test (CT scan etc) at BID and covered almost the full cost at other hospital networks. This just feels wrong. 

  Many of you are familiar with Jerome Groopman's wonderful books, and you will find this piece from The New York Review of Books, co-authored with his wife, equally compelling.

  Putting Profits Ahead of Patients

Jerome Groopman and Pamela Hartzband

Not long ago, a relative called us for advice about a hospital bill. A public interest lawyer in New York, he had developed chest pain when exercising and consulted his internist, who ordered a stress test with an echocardiogram. To his relief, no abnormalities were found. Distress came later, when he saw that the hospital had charged some $8,000 for this test.
Despite having excellent insurance, he was informed that he was responsible for $2,000 of the total.
The bill seemed exorbitant to us, and we suggested that he contact other medical
centers in the city to find out what they would charge for the same examination. To his
surprise, he discovered that prices ranged from about $1,200 to $6,000. When he
called the billing office at the hospital where his test was performed and asked why the
echocardiogram was priced at such a high level, he did not receive a clear answer.
Frustrated, he informed the hospital that he declined to pay. This resulted in several
veiled threats, but he countered that he would contact the attorney general of New
York about what he believed was abusive pricing without justification. After much
back-­and-­forth, his internist intervened on his behalf, and the hospital dropped the
demand for the $2,000 difference.
This story points to the extraordinary predicament of our current health care system.
Since the implementation of President Obama’s Affordable Care Act (ACA)—and the
mandatory coverage it brought—most patients needing a procedure such as an
echocardiogram can count on some form of insurance. But Obamacare put no controls
on the pricing of drugs or clinical care, leaving the profit-­driven health industry mostly
intact. As a result, patients are too often required to pay large out-­of-­pocket costs
while insurance premiums have continued to rise. Most patients navigating the financial shoals of our health care system do not have relatives who are doctors to advise them, nor are they lawyers;; and many do not have insurance policies as generous as our relative’s.

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