Investigating the high costs of health care
Over the last year, Elisabeth Rosenthal, a journalist and science editor for The New York Times, has written a brilliant series of articles titled Paying Till it Hurts:
In her series on the costs of health care, Elisabeth Rosenthal of The New York Times examines the price of medical care in the United States, interviewing patients, physicians, economists, and hospital and industry officials. In each installment, readers were invited to share their perspectives on managing costs and treatment.
I’ve been reading the series, and the truly shocking charging and billing practices she writes about have inspired many of my posts. But it seems to me that her stories have gone unremarked, for the most part. Where is the outrage? Where is the demand for change and accountability? This is The New York Times, after all, not some small regional paper. Isn’t anyone reading, or do they just not care?
It’s easy to not care, if you have health insurance that protects you from the high costs.
But the latest health insurance trend, as I mentioned in a recent post, is for narrow networks and increased cost sharing through high deductibles. So perhaps more people will be interested in what Elisabeth Rosenthal has to say.
Her two most recent articles have garnered a lot of attention in the health care blogs.
Surprise! You’re out of network
Dr. Rosenthal (yes, she’s an MD, although not practicing) tells the story of a young family who needed to go to the ER. They went to one in their provider network, but were stunned to find out later that the physician was not in the network. As a result, their insurance paid only a fraction of the bill.
In the piles of forms that patients sign in those chaotic first moments is often an acknowledgment that they understand some providers may be out of network.
But even the most basic visits with emergency room physicians and other doctors called in to consult are increasingly leaving patients with hefty bills: More and more, doctors who work in emergency rooms are private contractors who are out of network or do not accept any insurance plans.
Aaron Carroll, MD, the physician and health economist, read the NYT story and in his own blog recounted a trip he made to the ER when he broke his arm:
I also remember the sound my arm made as it broke. A number of my friends reported that they could hear the crack as well.
I was in a great deal of pain. One of my roommates ran to get his car, and pulled it onto the field. Everyone loaded me into the back seat, and my roommate took off for the hospital.
It turned out that I’d broken both the bones in my left forearm. The pain was so bad that when they turned my arm over to get an x-ray, I nearly passed out. The idea that I could be a good “medical shopper” at this point was laughable. I was hurt, incoherent, and going to get care wherever I could. Today, the health care system requires us to be better. It demands that we go to emergency rooms that are “in network”. People actually do this! But it turns out that even when they do, they’re still getting screwed.
Yep, it turns out that even if you go to a emergency room that’s “in network”, the emergency room doctor may not be. Think about that. I mean, asking people who are acutely injured or sick to have the presence of mind to be able to shop around is already insane, but then it turns out THAT IT DOESN’T EVEN MATTER.
Dr. Rosenthal highlights the somewhat sleazy practice of bloating patient care with extra physicians and services that might not be needed—it’s more about increasing revenue for hospitals and consultants. And when the doctor is out-of-network, as is the case in this particular story, the patient gets stuck with a bill for tens of thousands of dollars ($117,000 to be exact).
The phenomenon can take many forms. In some instances, a patient may be lying on a gurney in the emergency room or in a hospital bed, unaware that all of the people in white coats or scrubs who turn up at the bedside will charge for their services. At times, a fully trained physician is called in when a resident or a nurse, who would not charge, would have sufficed. Services that were once included in the daily hospital rate are now often provided by contractors, and even many emergency rooms are staffed by out-of-network physicians who bill separately.
In another blog I read regularly, The Skeptical Scalpel, the physician blogger made the following observation:
…in the New York Times, a piece by Elisabeth Rosenthal related several anecdotes about patients who were saddled with large and unexpected bills from out-of-network physicians who were involved in their care.
A particularly egregious example was a $117,000 bill from the surgeon who assisted at a 3-hour cervical spine fusion operation. Just to put it in perspective, that’s $39,000 per hour or $650 per minute: numbers a professional athlete might envy.
The surgeon billed $133,000, but since he was in-network, he received only about $6,200.
If he [the assistant] is worth 19 times more than the operating surgeon, maybe he should be doing the operation instead of merely assisting.
Despite so-called health care “reform”, health care costs will continue to rise. The paradigm of health insurance is changing, yes, but higher premiums, higher deductibles, higher co-pays and narrower networks are putting more of the cost burden onto patients.
It’s important to educate yourself about what’s happening in the crazy world of health care costs and reimbursements, and reading Elisabeth Rosenthal’s pieces is a good place to start.
Here are links to the other articles in Dr. Rosenthal’s series (might require a NYT subscription):
- “The $2.7 trillion medical bill: Colonoscopies explain why US leads the world in health expenditures” Colonoscopies are big business. How many are really necessary? How much do they cost?
- “American way of birth, costliest in the world” At $30,000, who can afford to have a baby anymore?
- “In need of a new hip, but priced out of the US” How about a vacation in India?
- “The soaring cost of a simple breath” Costs of prescriptions meds for asthma and other conditions just keep going up, up, up.
- “As hospital prices soar, a stitch tops $500” A dab of glue and a bandaid costs how much?
- “Patients’ costs skyrocket; specialists’ incomes soar” Compared to a dermatologist, a family practice doctor makes chump change.
- “Even small medical advances can mean big jump in bills” New technology doesn’t come cheap.
- “The price of prevention: Vaccine costs soaring” Can’t afford to get sick? But what if you can’t afford the vaccine, either?
Be outraged. Demand change.