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Originally posted by Replaced_Texan
So the testimony starts today in Congress about not-for-profit hospitals and billing practices, the class action lawsuit was amended yesterday to include more hospitals, and it looks like the very shaky system that we've been operating under for the last fifteen or so years is about to collapse.
What do we do?
Yes, I agree, people who don't have health insurance get screwed and they are probably the people who can least afford to get screwed. Yes, I agree, insurance companies negotiate very low rates, lower than the average rates. Yes, I've seen the bills for someone who has no insurance against the bill for someone who is insured, and yes, the rates charged to the uninsured is higher than the rates charged to the insured. BUT. Managed care screwed everything. The negotiated rates for the insurance companies are so low that 1.) the marginal revenues have fallen significantly for the insured and 2.) there's very little wiggle room to give away care or deeply discount it.
I don't see how it's possible to keep managed care contracts in place and not charge uninsured or out of network patients a higher rate than the rates negotated by the insurance companies. It's not just the not-for-profit hosptials, it's also the public hosptials and the for-profit hosptials that operate this way.
I'm generally pissed off at the entire situation. I'm pissed off at the plaintiffs lawyers for bringing up this suit, which is going to be expensive to defend (thus deferring funds that could go to, say, charity care). I'm pissed off at the government for ignoring the problem of the uninsured for so long while scaring every hosptial in the country with EMTALA. I'm pissed off at the insurance companies for taking so much control over health care. I'm pissed off that somehow or another we've gotten to the point that the quality and quantity of health care that we get is entirely dependent on who your employer is.
The plaintiff suit doesn't really make sense though. The underlying problem is that health care is expensive and no one wants to pay with it. Whether an uninsured patient gets a $50,000 bill or a $25,000 bill doesn't really matter if the patient can't pay for any of it. No one wants to pay for these people's care. Not Congress, not the patients, not the insurance companies, and not the hospitals.
This has always been a shaky system.
I would like to divorce employment from health care. I would like to give everyone in the country very basic coverage (similar to those crappy plans you could get in college for about $400 a year), and set up a system where people can buy (through an MSA) more comprehensive coverage if they wanted to. The insurance companies would have to market their products to individuals, not the companies, and individuals would be responsible for deciding what kind of care they want. A kid in her 20s with no real health problems doesn't need anything more than disaster coverage and maybe a yearly physical. The HMO product would be fine for her. The 40 year old accountant who hasn't been eating right for years may think about getting more a comprehensive indemnity policy.
I'm irritated that they're reducing this underlying problem to how hospitals price their products. That ignores the larger problem that isn't going away any time soon.
I have no idea how either candidate for president feels about this issue, though I haven't seen Tommy Thompson running to take charge of the problem of the uninsured.
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Ah, so much to deal with.
You can always try the Massachusetts solution -- once the insurance companies become sufficiently concentrated so that they have effective monopoly power in the negotiating game (take my price or your beds are all empty), just concentrate your hospitals sufficiently so that the two are on par. Then we have dueling monopolies, which is really significantly better than just one monopoly (Burger take note, some anti-trust issues in here).
Here, the problem of the uninsured is pushed heavily on to the Hospitals, and since they are all basically non-profits, they don't resist much, just negotiate carefully the details of their surrender. But most of their pricing is not driven so much by the ability of the uninsured to pay, but instead by the willingness of the governmental payors to pay -- once the Medicare/Medicaid rates are set, most of the rest seems to follow, including the relative imporance of one service versus another in the negotiations with the insurers. The exception here is the foreign payors, where there actually is something that looks more like a market, but not really big enough to have a big impact on pricing.
So effectively there are three negotiating monopolies: (1) hospitals; (2) insurance companies; (3) government, and the uninsured are then an after-thought.
What do I take from all of this? That the health care system has the flaws of partial regulation; unless we can find a way to fully regulate, all we're doing is trying to referee a street fight. And if we don't regulate, we are at this point leaving it to the monopolies, the strongest of which are insurance companies and government.
