Wednesday, August 20, 2014

Healthcare Gouging Culprits

It's no wonder why routine healthcare costs in the United States are so ridiculously high, and why health insurance premiums are skyrocketing. Today's healthcare providers are gouging patients like highway robbers.

They do it because they can.

Hospitals are charging patients a small fortune for the most minor of services; treatments like applying a Band-Aid to a small cut.  A New Jersey man found this out the hard way when he was gouged almost $9,000 after an ER aide treated a small cut on his middle finger.

The man cut his finger with a hammer and thought he might need stitches so he went to the local ER at Bayonne Medical Center. He didn't need stitches. He got a tetanus shot from a nurse practitioner who sterilized the cut, applied some antibacterial ointment, a bandage and sent him home.

Later he received the bill: $8,200 for the ER visit; $180 for the shot; $242 for the bandage; $8 for the ointment; and nearly $370 for the nurse. "I got a Band-Aid and a tetanus shot. How could it be $9,000? This is crazy," the man told reporters.

Yes, this is crazy.

Now the hospital says it charged that amount because the man's insurance carrier refuses to offer fair reimbursement rates.  This hospital apparently believes that $9,000 is a fair charge for applying a Band-Aid to a small cut.

The insurance carrier says that this hospital is just trying to gouge its patients.

Gee, do ya think?

A spokesperson for the New Jersey Health Care Quality Institute says that the right price for getting a finger bandaged should be $400 to $1,000.

That, of course, is equally ridiculous. In fact, it's outrageous! I say that if a hospital can't apply a Band-Aid to a small cut and then send the patient home for less than $100, that hospital shouldn't be treating patients. Its administrator's and staff should be in jail.

This is a primary reason why healthcare costs are out of control in the U.S. Just about everyone now has insurance to cover every treatment from the most insignificant to the most complicated. When everyone has insurance covering everything, they go to the doctor or hospital for things like cut fingers, and the healthcare providers start gouging.

They do it because they can. After all, the insurance company or the government is paying the bill. If patients had to pay for minor medical treatments out of their own pockets this kind of thing wouldn't happen.

That's how healthcare was administered in the old days and it worked quite well. But those days are gone and today we have only healthcare gouging culprits.



Are insurers still dodging the sick?

Ending insurance discrimination against the sick was a central goal of the nation's health care overhaul, but leading patient groups say that promise is being undermined by new barriers from insurers.

The insurance industry responds that critics are confusing legitimate cost-control with bias. Some state regulators, however, say there's reason to be concerned about policies that shift costs to patients and narrow their choices of hospitals and doctors.

With open enrollment for 2015 three months away, the Obama administration is being pressed to enforce the Affordable Care Act's anti-discrimination provisions. Some regulations have been issued; others are pending after more than four years.

More than 300 patient advocacy groups recently wrote Health and Human Services Secretary Sylvia Mathews Burwell to complain about some insurer tactics that "are highly discriminatory against patients with chronic health conditions and may ... violate the (law's) nondiscrimination provisions."

Among the groups were the AIDS Institute, the American Lung Association, Easter Seals, the Epilepsy Foundation, the Leukemia & Lymphoma Society, the National Alliance on Mental Illness, the National Kidney Foundation and United Cerebral Palsy. All supported the law.

Coverage of expensive drugs tops their concerns.

The advocates also say they are disappointed by how difficult it's proved for consumers to get a full picture of plans sold on the new insurance exchanges. Digging is often required to learn crucial details such as drugs covered, exact copayments and which doctors and hospitals are in the network.

Washington state's insurance commissioner, Mike Kreidler, said "there is no question" that discrimination is creeping back. "The question is whether we are catching it or not," added Kreidler, a Democrat.

Kansas' commissioner, Sandy Praeger, a Republican, said the jury is out on whether some insurers are back to shunning the sick. Nonetheless, Praeger said the administration needs to take a strong stand.

"They ought to make it very clear that if there is any kind of discrimination against people with chronic conditions, there will be enforcement action," Praeger said. "The whole goal here was to use the private insurance market to create a system that provides health insurance for all Americans."

The Obama administration turned down interview requests.

An HHS spokeswoman said the department is preparing a formal response to the advocates and stressed that today's level of consumer protection is far superior to what existed before President Barack Obama's law, when an insurance company could use any existing medical condition to deny coverage.

The law also takes away some of the motivation insurers have for chasing healthy patients. Those attracting a healthy population must pay into a pool that will reimburse plans with a higher share of patients with health problems. But that backstop is under attack from congressional Republicans as an insurer "bailout."

Compounding the uncertainty is that Washington and the states now share responsibility for policing health plans sold to individuals.

Although the federal government is running insurance markets in 36 states, state regulators are still in charge of consumer protection. A few states refuse to enforce any aspect of the law.

Kreidler said the federal government should establish a basic level of protection that states can build on. "We're kind of piecemealing it right now," he said.

Much of the concern is about coverage for prescription drugs. Also worrisome are the narrow networks of hospitals and doctors that insurers are using to keep premiums down. Healthy people generally shop for lower premiums, while people with health problems look for access to specialists and the best hospitals.

Before Obama's overhaul, insurance plans sold on the individual market could exclude prescription coverage. Now the debate is over what's fair to charge patients.

Some plans are requiring patients to pay 30 percent or more for drugs that go for several thousand dollars a month. HIV drugs, certain cancer medications, and multiple sclerosis drugs are among them.

Although the law sets an overall annual limit on what patients are required to pay, the initial medication cost can be a shock.

California resident Charis Hill has ankylosing spondylitis, a painful, progressive form of spinal arthritis. To manage it, she relies on an expensive medication called Enbrel. When she tried to fill her prescription the pharmacy wanted $2,000, more than she could afford.

"Insurance companies are basically singling out certain conditions by placing some medications on high-cost tiers," said Hill. That "is pretty blatant discrimination in my mind."

Hill, a biking advocate from the Sacramento area, has been able to get her medication through the manufacturer's patient assistance program.

The insurance industry trade group America's Health Insurance Plans says there's no discrimination because patients have many options on the insurance exchanges. Gold and platinum plans feature lower cost-sharing, but have higher premiums. Standard silver plans generally require patients to pay a greater share of medical bills, but some have fairly robust drug coverage.

"There are plans on the exchanges that are right for people who have these health conditions," said Brendan Buck, a spokesman for the group.

For 2015, the administration says it will identify plans that require unusually high patient cost-sharing in states where Washington is running the exchange. Insurers may get an opportunity to make changes. Regulators will collect and analyze data on insurers' networks.

"People who have high cost health conditions are still having a problem accessing care," said law professor Timothy Jost of Washington and Lee University in Virginia. "We are in the early stages of trying to figure out what the problems are, and to what extent they are based on insurance company discrimination, or inherent in the structure of the program."



Steyer Benefits From Progressive Double Standard

With Election Day less than a hundred days away, we can expect the campaign season to bring out some of the worst in human behavior. It encourages politicians, activists, and the journalists who cover them to participate in all sorts of shenanigans.

However, much of what are self-styled elite opinionmongers would dismiss as “silly” perhaps isn’t. Perhaps it’s only their failure to hold their ideological compatriots to the same standards. Take the case of billionaire hedge-fund manager and progressive megadonor Tom Steyer, who regularly commits so many of the sins conservatives are accused of--and gets a free from progressives.

Take, for example, the handwringing and hyperventilating over money in politics, which progressives argue is corrosive to democracy. It’s a cause célèbre on the left, who fight against it in the court of public opinion and in the halls of Congress. Their chief bogeyman at the moment is the Super PAC, an independent political committee that may raise and spend unlimited amounts of money in support of political candidates. The Super PAC, according to many of the left, amounts to nothing less than the wholesale buying of elections.

But their squeamishness about big-dollar Super PAC donors influencing politics doesn’t seem to extend to Steyer--who is, according to the nonpartisan Sunlight Foundation, the single biggest Super PAC donor of this election cycle. As of the third week of July, Steyer had already shelled out a cool $20 million for progressive candidates. Liberals who decry the Super PAC always point fingers at wealthy conservative donors--but in the Sunlight Foundation’s analysis, the top five conservative Super PAC donors combined still fall short of what Steyer has dropped on this year’s races.

And this year, every major fact-checking organization has long been on the record against a wild claim that Steyer’s Super PAC, NextGen Climate Action, recently made in Iowa against Republican Senate candidate Joni Ernst. In short, an ad run by the Steyer group charges that Ernst’s signing of Americans for Tax Reform’s Taxpayer Protection Pledge is tantamount to support for American companies sending jobs overseas. The Pledge, Steyer’s ad argues, protects tax credits for those companies despite the pledge including no such promises.

Every major fact-checking site: Adwatch,, and Politifact, as well as local organizations in cities like Seattle and Las Vegas, have debunked this claim in the previous two election cycles when it’s been made against other candidates signing the Taxpayer Protection Pledge.

Even as Steyer has invested in the 2014 midterms more heavily than anyone else – giving more than twice as much as this cycle’s next largest Super PAC donor, former New York City Mayor Michael Bloomberg – his motives for doing so have escaped media scrutiny. It hardly needs to be said that the same courtesy is never extended to conservative donors, to whom the media tends to ascribe nefariously self-interested motives for their political giving.

And yet Steyer burst onto the political scene by opposing the Keystone XL pipeline, a project which promises lower energy prices and thousands of new jobs. His opposition to the pipeline was heralded as a public spirited act of social conscience.

Actually, it turns out that Steyer held a financial stake in the Kinder Mountain pipeline, a competing pipeline, and stood to profit significantly if regulators killed the Keystone project in favor of Kinder Mountain. Steyer has since divested himself of his interests in fossil fuels, but the media never questioned his motives, choosing instead to praise his activism and coo over the possibility that he might run for office someday.

Commentators often refer to the runup to Election Day as “the silly season.” But what’s truly silly is a double standard that protects Tom Steyer while he freely commits some of the worst sins in the progressive catechism.



Grocery Chain Stands Up to Bloomberg’s Anti-Gun Obsession

Oh good… Another big business is being pressured to boycott law abiding gun owners. However, unlike Starbucks, Jack in the Box, Chipotle, and Target, Kroger has decided to reject the Bloomberg-inspired requests to ban guns on their property. I guess they (for some strange reason) didn’t feel like experiencing an uptick in violent crime and robberies.

In recent months years, Bloomberg’s anti-gun groups have taken a decisively effective tactic of targeting (excuse the pun) and intimidating businesses into being the enforcers of gun restrictions that otherwise had no hope of passing local legislatures. Of course, this new trend tends to show the difference between the Left and the Right on issues of public policy. While gun-loving Americans might dislike the idea of their favorite retail chain banning guns, they tend to respect that such decisions are within the rights of private property owners… As a result, they simply stop eating cheap Mexican food (Chipotle), or buying overpriced fast food (Jack in the Box).

Leftists, on the other hand, seem to have a love affair with intimidating the masses into compliance with their utopian vision. And, really, this seems to go to the heart of what is at stake in the debate over more government. While a libertarian, or conservative, utopia might expose more people to the horror of a law abiding gun owner peacefully carrying his holstered weapon, a liberal utopia tends to restrict and suffocate the actions of a handful of law-abiding citizens.



For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated) and Coral reef compendium. (Updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten.

List of backup or "mirror" sites here or  here -- for when blogspot is "down" or failing to  update.  Email me  here (Hotmail address). My Home Pages are here (Academic) or  here (Pictorial) or  here  (Personal)


No comments: