Health Care and Costs and Profits
Hester Hill Schnipper, LICSW, OSW-C Program Manager, Oncology Social Work
JUNE 26, 2017
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.