In the Sunday Trib ‘Voice of the People’ section, the lead letter to
the editor was exceptional for how much it said in such a short space
about the health care crisis. Things we aren’t hearing from mainstream
Its jumping off point is to respond to a startling and
disturbing front page Trib article last week about a man who was
cleared by his health insurance company to have needed back surgery
with the assurance of coverage. After that surgery, the insurance
company refused to pay.
Dr. Alexander Stemer, president and CEO of Medical Specialists Centers of Indiana, wrote about “Excessive Charges”:
Tribune columnist Jon Yates’ “They authorized back
surgery but denied his $148,000 claim” (Page 1, July 21) is
illustrative of the unexplored core of today’s health crisis.
Okay, stop right there. Why is it ”unexplored”? Thankfully, he explores that core, and I’ve never heard some of this before.
For many services, the problem is not that excellent
medical care costs too much, the problem is that pharmaceutical
companies, manufacturers, hospitals and some doctors charge too much.
Note he qualifies that ”some doctors” do this, while the rest of
the health care industry kind of bundles into categorical excess.
As the president and CEO of a multispecialty physician
practice that is similarly self-insured for medical costs, I have
witnessed a nearly identical charge ($150,000 for back surgery) that
was quickly negotiated down to $60,000, but should have been $30,000.
However, when the supplier of the titanium plate and screws that are
used in the surgery can charge more than $20,000 for what is probably
worth $200, and the surgeon charges $100,000 for what is worth $14,000,
and the hospital charges $30,000 for what should have been $16,000, the
insurance company and, ultimately, the employer are trapped. Premiums
must rise or benefits must shrink.
Why aren’t the media making these kinds of revelations? Who’s
addressing these specific unjust and unethical practices? Besides this
doctor in Indiana….?
Rather than illustrating a unique example, this article
is demonstrative of one of the major problems of U.S. health care.
Pacemaker/defibrillators that cost $50,000 (worth $5,000), joint
hardware that costs $4,000 (worth $800) and pharmaceuticals that cost
2.5 times more than they do in any other developed nation are a root
cause of the “crisis.” This must be addressed before our government
saddles our country with an exploding health-care expense that will
bankrupt the current and every future generation of taxpayers.
Yes. This makes perfect sense.
When we eliminate excessive charges, when tort reform lowers operating costs (as it does in Indiana),
and tort reform is a critical and necessary component of this out of control problem,
when cost-shifting in hospitals is eliminated
(currently, the insured pay for the uninsured with higher charges) and
we implement national certificate of need, costs will drop and the
crisis will resolve.
But we also must decide if everybody gets everything. If there is an
artificial hip that is good and costs $800, but the one your doctor
recommends is $3,400, must the government absorb that cost, or is it
the patient’s decision and burden to pay the $2,600 difference? Right
now manufacturers have no incentive to lower charges. Defining the
minimum standard for which we pay will resolve much of this concern.
But as long as a pill that costs 4 cents can be sold for $4, buying
more pills for more people will make the problem worse.
Has anybody in Congress explored these recommendations? We were
promised transparency in government. Anybody seeing this kind of
clear-minded analysis and understanding going on there?
Another letter on the same page of the Trib opinion section, a brief one, said “Slow Down”.
Why rush the health-care bill through, unless there are
things in it that Congress doesn’t want the public to know about? It is
one of the most complex pieces of legislation ever attempted by
Congress. A satisfactory program for everyone is of more importance
than speed in passing an unsatisfactory one. Congress should take the
time for proper deliberations on this most important task for the
They should deliberate over Dr. Stemer’s recommendations.