Feeling dragged out and low on energy lately? Need something to get your pulse rate up and your blood pressure out of the basement? I know the solution. Read "Bitter Pill," by Steven Brill, in the March 4 issue of Time. If you've already read it and aren't angry, frustrated, and ready to fight, go back and read it again.
Let me make one point clear: I've had probably more than normal contact with doctors and nurses, especially over the past 15 years, and most of them have been among the finest people I've ever known. I can't count the number who've gone to special lengths to provide not just adequate professional care, but extra effort, clearly motivated by compassion and human decency. I owe them a huge debt. They are not the problem.
The problem, Brill points out, is that we have spent 'way too much time and energy arguing over who should pay for medical care, while the first puzzle to solve is why the costs of that care are so incredibly out of reason. In the longest piece by a single author that "Time" has ever published, Brill, a longtime journalist with impeccable credentials and a non-partisan stance, enlightens us as to the components of the puzzle by employing one simple rule: follow the money.
Following the money reveals that "the free market in American medical care is a myth, with or without Obamacare." Basically, prices for treatment, medicines, equipment, and materials used for patients are based on each hospital's little-known pricing list, bearing little or no relationship to costs or much of anything other than "that's what we want to charge." So MD Anderson Cancer Center chooses, for example, to add a roughly 400 per cent markup to a life-saving drug injection for a cancer patient. Or more than $15,000 for a series of tests for which Medicare would pay the hospital only a few hundred dollars. That's because Medicare, by law, pays actual costs plus expenses like salaries. No extra profit .
MD Anderson, a world-class cancer center, is a part of the University of Texas and is a non-profit. In 2010, according to Steven Brill, this non-profit reported a profit of $531 million. Its president was paid $1,845,000, plus opportunities for various outside earnings.
I'm not singling out this fantastic facility out of the Brill study. All the nonprofits seem to be making huge profits, and their administrators are drawing salaries that would cause most of the doctors I know to have a stroke. Much of this profit is used not only to upgrade the facility but to pay ever-increasing raises and bonuses. And to buy up competing hospitals and doctors' practices, thereby reducing insurance companies' leverage to negotiate lower prices. Meantime, a patient is being charged $77 each for four boxes of sterile gauze pads. I bought two boxes of the same sterile pads last week, from a medical supply facility, for $5.75 per box.
While Medicare, even hamstrung by ridiculous politically imposed rules that hamper its ability to save money, has the clout to insist on paying what's reasonable, not what a hidden charge list says the hospital wants, most citizens have no such clout. Their insurance company has the leverage, although some claim they are rapidly losing it, as hospitals consolidate and thereby reduce insurance companies' control of patient loads. So in the final analysis, the only payer who is usually hit with the full, inflated, price of medical treatment is the patient who has no insurance or has minimal insurance coverage that doesn't meet the hospital's standards.
How have we come to this situation? Because the folks in our government who are supposed to establish regulatory controls that would prevent it, those folks who insist they believe in the free market, have been strangely reluctant to act. And why is this? Well, for one thing, it's worth noting that this industry spends far more money in Washington for lobbying the government than does that infamous old whipping horse, the military-industrial complex.
I haven't even scratched the surface of the Brill report. I hope that I've piqued your interest and that, if you haven't done so, you'll read it. But maybe you ought first to be sure your medical insurance is up to snuff. You just might have a stroke.
Robert B. Simpson, a 28-year Infantry veteran who retired as a colonel at Fort Benning, is the author of "Through the Dark Waters: Searching for Hope and Courage."