5 Ways US Medical Billing Is Way More F#@ked Than You Think
If you're not from America, or you're young and healthy enough to have avoided doctors up to now, you may not have been exposed to the delights of this country's high medical costs. So here's a demonstration, in the form of a $243K bill for a three-night hospital stay:
Meh, just tighten up the eating-out budget a little bit.
Hospital bills topping one million dollars are on the rise, and even a minor injury can leave you with a bill that looks like the hospital replaced all of your internal organs with diamond-studded plutonium. But beyond the initial punch to the wallet, the awfulness of ridiculous medical bills extends to places you might not have thought. Such as ...
Even Insured People Are Going Bankrupt
The majority of bankruptcies in America are now caused by medical bills. Clearly, these bankruptees were devil-may-care hooligans who chose not to protect themselves with health insurance. Oh, wait: Most of them did have insurance. Three-quarters of Americans whose medical bills contributed to their bankruptcies were insured when their health problems began. Their real problem was that these un-American slackers were dumb enough to not be able to afford a low-deductible plan, or clumsy enough to come down with something that their insurance didn't cover.
And when you look at the random bills that even insured people get hit with, it's not hard to see how this can happen. I have a friend who broke an ankle slipping on her frozen driveway during the seven-month ice storm people in New York call a "winter." She was insured with an 80/20 plan, but still received a bill for around $6,000. This month, I got a letter from my own insurance company arguing that a single blood test I got back in March wasn't "medically necessary" and warning me that I might have to cough up the full price. How much was the full price of that single blood test? Just 5,000 freakin' dollars. Luckily nothing came of it, because otherwise I would have had to dip pretty deep into my weekly writer's salary.
It's so embarrassing when you're at the local writer's club and can't afford to tip the valet.
These incredibly high and apparently random medical costs get even more ridiculous when you consider that ...
Stupid Frivolous Shit Actually Costs Us Less
These bills are high, but hey, maybe doctor stuff just costs a lot. Those long white coats and stethoscopes-around-the-neck don't pay for themselves! Except that while fixing a broken ankle apparently costs as much as a new car or two, the charge for laser eye surgery is usually only around $2,000 per eye. And this isn't a freak outlier: Nonessential procedures like cosmetic rhinoplasty often cost a lot less than surgeries that people actually need.
Why is essential medical care so much more expensive? Look at it like this: Say you're a plastic surgeon who performs extra-nipple implants. This procedure isn't considered medically necessary, and therefore is not covered by most insurance companies, meaning that your patients must pay you directly. If patients choose not to buy your extra nipples for $5,000 per nipple, you'll have to lower the price to $4,000, or else change your business model.
"Nipple pills? Nipple serum? Aerosolized nipple spray?"
But when you add in the American system of mostly-employer-based health insurance, things get weird. The patient doesn't pay the doctor directly -- a lot of Americans don't even realize that this is an option. Instead, hospitals and medical practices bill the patient's insurance company. Because insurance companies are usually big and powerful enough to have bargaining power, there's a good chance that they will respond by farting on the bill and sending it back. Hospitals know this, and so over the years they've started making up their own extremely high prices and throwing them at insurance companies in the hope that they will pay something. These so-called "chargemaster" rates have grown so ludicrous over the years that they now include things like $37 Tylenol pills and $137 IV bags.
"For $137, that IV bag damn well better contain at least one nipple."
Once again, these chargemaster rates are mostly completely made up and have nothing to do with what these things actually cost. They're simply part of the monetary dance-off that insurance companies and hospitals are doing with one another. In most cases, the insurance companies agree to pay a small amount of the stupidly high bill, the hospital accepts this reduced amount, and everyone is happy. Except for uninsured and underinsured people, that is, because they are also billed at the chargemaster prices.
There are a bunch of other factors at work, of course, but this is a big reason why a single petting-zoo mishap could end up costing you the price of a small car. But most hospitals will still tell us that everything is fine for Joe Injured American, because ...
Everyone Is in on the Con but You
When asked how people could be expected to pay chargemaster rates, the vice president of the American Hospital Association insisted that $37-Tylenol-style prices are not so bad, because they are "generally not what a consumer would pay." In other words, only suckers pay sticker price. Big medical bills are just a silly game between hospitals and insurers, and us consumers should just laugh it off for the same reason we laugh off the neighbors' late-night throwing-knife fights: It doesn't affect us, and it isn't our problem.
Let's pretend now that the American Hospital Association is telling the absolute truth. Let's pretend that all patients have to do is call and ask, and hospitals will slash the bill every time (and not just sometimes, as is really the case). Let's pretend that cancer patients have the time and money to dispute every single item on their $70,000 chemo bill while they are trying to concentrate on having the goddamn cancer. Let's pretend that people are really only at risk of medical bankruptcy if they break their leg 60 times in a row.
"Dammit! Again!"
We'll assume all that, and it still doesn't matter, because most people don't know that chargemaster rates are a joke. Do a quick survey of posts about medical bills on social media, and you won't find many stories of Americans receiving a letter, rolling up their sleeves, and marching down to the hospital to dispute the fuck out of some billing. Instead, most people receive bills and immediately start wondering how they can pay the whole thing off, whether it's by getting another job or asking for donations or by cooking meth or whatever.
Personally, I'm running an illegal wombat-smuggling ring.
Why are so many people unwittingly allowing themselves to be ripped off like this? Maybe it's because America is not a bargaining culture. Guidebooks written for Americans traveling overseas are full of warnings about not paying full price for traditional French penis statues or whatever: French penis-mongers, the books will tell you, quote high prices but expect to be haggled down. Maybe Americans need these warnings because in this country bargaining is generally something that happens only when you're dealing with professions seen as shady or dishonest, like car dealerships. Yet at some point doctors and hospitals, the people we trust with our family members' lives, have migrated into this same shady "don't trust the quoted price" category. And then we're surprised that some people don't realize this.
It's Probably Getting Worse
America's insurance-dominated healthcare system is not a friend to small, independent clinics. If you're running a small practice with a limited budget and staff, it's difficult to concentrate on patients while you're also essentially running an insurance-shakedown business. And it's getting worse: Every year brings new regulations requiring things, like fancy electronic record-keeping systems, that are as far outside small clinics' budgets as robot nurses.
As more and more of these clinics fold, the doctors who once would have worked there are instead getting hired by hospitals. In itself, this isn't necessarily a bad thing. But those same hospitals that are swallowing up doctors like British police boxes are also merging with each other all across the country. And when big hospitals give in to their mutual love and merge into mega hospitals, patients' bills go up.
"And here's where I drew a dick on a piece of paper. It's going to cost you $32,000."
Once a hospital chain becomes the dominant health provider in an area, insurance companies are pretty much forced to keep that hospital as a client, because otherwise they'll lose customers faster than if they changed their name to "Death Panels of America, Inc." Who would sign up with an insurance company that isn't accepted by any doctor in a 100-mile radius? Once insurers are trapped like this, hospital chains are free to start pushing up their prices even more.
A big problem here is that when Americans think about healthcare costs, we're used to pointing at insurers like they're the sole bad guys. After all, for most of us, "insurance company" means "those guys who call you up in the ER after you've been bitten by a mountain lion and question whether you really need all those stitches." Hospitals, on the other hand, are the good guys: They sew us up, remove all those mountain lion teeth, and save our lives. Unfortunately, these days a lot of hospitals seem to be taking this innocent goodwill and using it to turn into the antagonists in a James Cameron movie.
If you're ever depressed about the modern world, it sometimes helps to imagine yourself as the hero in a cool dystopian sci-fi.
And one of the worst things about these increasingly awful medical bills is ...
They Destroy the Way You Think About Money
Although the average American cable news station spends approximately 50 billion hours a year discussing healthcare, one thing hardly anyone talks about is the psychological effect of these stupidly huge bills. I know all about this, because I'm a person with chronic health problems who recently switched to private health insurance after many years participating in the socialized healthcare system known as "the U.S. military." I have the best insurance I can afford, and yet every trip to the mailbox involves psyching myself up for this week's third surprise bill, or maybe even another letter accusing me of getting a medically unnecessary blood test, because apparently I'm some kind of blood-test junkie who bursts into clinics and shakes down doctors to get my next phlebotomist-administered hit.
The needle is the only way I can feel anything anymore.
Logically, at this point I should become super financially responsible so I can pay these bills, right? But nope, it's a constant effort not to react in the exact opposite way. I want to be a responsible middle-class person with a mortgage and a sensible haircut and well-organized kitchen utensils, I really do, but what's the point in trying? At any moment in the near future, my insurance could decide to dispute a random medication and send me a bill that wipes out all my savings and more. So tell me why I shouldn't live in the moment and spend $250 on a jewel-encrusted cockring.
Sir Edgar Crowington deserves only the best.
Yes, many things can go wrong in life. Your house might burn down. A dying bald eagle might fall on your parked car. The difference with medical bills is that they're so potentially huge and arbitrary that there is no preparing for them. You can't just buy insurance and stop worrying: Insurance might cover your bills, but it might not. You can't predict how bad your bills are going to be if you get hurt in an accident, because costs are pretty much random. I have no idea why one of my generic medications costs me $150 after insurance and the other costs me $15. It's not like the first one works 10 times better, or a panel determined that the second medicine is needed only by people who are jerks. The extent of your money-beatdown depends entirely on how your body decides to go wrong and how unlucky you are.
We're living in a society where an ordinary misfortune like a broken bone or a car accident can strike normal, responsible, insured Americans out of nowhere, and it could cost us $200 or it could cost us $200,000. There's nothing any of us can do to prevent this looming financial shark attack, except be incredibly rich. And we're all getting older, and most of us aren't in perfect health, so why not just say "fuck it, YOLO" and spend all our income on monster trucks and golden unicorn statues? Yet you'll hear people refer to this whole shitty situation as some kind of opportunity to learn and practice "personal responsibility." Guys, those words: I don't think they mean what you think they mean.
