Calhoun's Cannons for March
1, 2013
If you want to make your head explode, pick up a copy of the
March 4th one-topic special edition of Time
magazine. Steven Brill spent 7 months researching and writing "Bitter Pill," and by the end of the article, you will have no head.
Brill noted that people who "work in the health care
industry and those who argue over health care policy seem inured to the
[sticker] shock [of high medical bills.] When we debate health care policy, we
seem to jump right to the issue of who should pay the bills, blowing past what
should be the first question: Why exactly are the bills so high?"
And the answer to that, as Brill found out, lies in the
magical realm of made up Smoke & Mirrors, an imaginary place presided over
by the Great and Powerful Chargemaster, the ephemeral but very real price
setter to be found hiding in the attic of every hospital. He's the guy -- a telephone-sized aggregate of
made-up prices, actually -- who invents charges for every single thing on your
hospital bill.
Imagine, if you will, a creepy guy with endless greed and
larceny in his soul, green eye-shade over his eyes, sitting in front of a
computer who, without rhyme or reason, makes up numbers that have two distinct
qualities: 1) they are disconnected from actual, real costs and 2), they are deliberately
set higher than reality or adequate profit would require so that no matter how
much they're discounted or manipulated, they will still remain high enough to
create wonderfully obscene profits for the hospital and especially its CEO. And
if they're paid in full by some hapless patient, well, that's just pure gravy
on top of pure gold.
It's a business model Midas would love. A write-your-own ticket Win-Win for the
growing Big Pharma, Big Health Insurance, Big Hospitals, Big Medical Care Industries
and lose-lose for the citizens. The Chargemaster decides that you, the patient, will be billed
$4.50 for a generic aspirin. Or $12.75. Doesn't matter which number is used,
the higher the better since it's all fungible to him. And if you can't pay, you go bankrupt. If you have health insurance, your policy
will pay and then raise insurance premiums on you and everyone else to cover
the made up cost. All of which explains
why Americans pay "27% more than we would spend if we spent the same per
capita as other developed countries, even after adjusting for the relatively
high per capita income in the U.S. vs. those other countries."
And yet our health outcomes are worse than other
"civilized" countries and our system, as created and driven by the
Chargemaster, is heading the country into bankruptcy -- it is a business model
that simply isn't sustainable, primarily because it's disconnected from reality
and driven by greed -- the same forces that run housing bubbles and still run
Wall Street. And we know how well that
worked out for all of us.
Yet Congress (and the huge, well-funded lobbying arm of The
Great & Powerful Chargemaster) are working overtime to deflect the
discussion from WHY over to Who will pay, as in, Let's decide who we push off
the cliff first -- poor people or Granny.
Which is the wrong question.
It's the Why that will stop
this train from going off the cliff and taking all of us with it. Case in
point: WHY does the VA get drugs for their clients at a much lower cost than
the rest of us? Right. They negotiate with Big Pharma and take
advantage of price breaks for economies of scale. So, Why doesn't Medicare do the same? Because Congress passed a law forbidding them from doing that. Can you guess who financed the lobbying
effort? Right, it wasn't your Grandma.
But it does explain why Grandma is going broke paying for her overpriced meds.
The one exception in this race to the cliff is
Medicare. Medicare doesn't pay the
Chargemaster's made up prices. It has
it's own, reality-based metrics. And while Conservative Pols (fully financed
by the health care industry) decry "socialized medicine" and demand
it be privitized, Medicare's reality-based pricing offers one fix that can
begin to bend our imploding health care system -- lower the Medicare enrollment
age to include more, younger members and suddenly, you not only increase the
economies of scale for your members, you increase competitive (reality based)
pricing from competing private insurance and
increase the pressure on hospitals to have a little chat with their
Chargemaster in the attic.
That's only one fix of many excellent suggestions that Brill
presents in his extraordinary article, fixes that are needed to avert a
complete meltdown of our present unsustainable system. But none of those
changes can begin until more voters begin to follow the money and ask the
Chargemaster in the attic (and your Congressman) the one simple question that neither wants to answer: Why?
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