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time magazineOf the three major weekly newsmagazines of yore, Time was always the conservative’s first choice, so it has never been one of my favorite mags. Lately, it’s been so depleted in content that it’s not worth the cover price. I tend toward The Economist, The Week and The Nation these days. But this week’s Time is more than worth the cover price – it’s a must have, must read for anyone who understands that Americans pay nearly twice as much for health care as the next most expensive nation in the world and can’t break the top twenty for health care delivery.

Steven Brill’s special report, “Bitter Pill: Why Medical Bills Are Killing Us,” dated February 20, 2013, is a stunning view of exactly how our medical bills are decided upon, what we pay for, what the profit margins are on medical care, how insurance companies and idiot charges are literally killing those of us who cannot afford American medical care.

Did you know they charge you for the pens that are used? That’s just one of the smaller revelations of Brill’s piece. It runs over 30 pages, and as Jon Stewart made humorously clear, the further you read in this article, the greater the chance you will suffer a heart attack or stroke. Brill follows the way bills are rigged to make you think you are getting a bargain when the “charge” that is being discounted or reduced by your insurance or Medicare is grossly inflated to flim-flam you.

A few small things Brill didn’t cover…..have you watched your local hospital “grow” over the past forty years? Is it now twice or three-times as large as it was in the 1970s? Do you know it now has fewer beds than it did then? That fact came out during one of those flu scares a few years ago, when the Bush administration said that we could deal with a pandemic by putting people into hospitals, not understanding how few beds there are in hospitals these day. There has been a huge amount of money spent on the physical plants of hospitals, the purchase of very expensive testing equipment that duplicates equipment owned by another hospital less than 50 miles away. Yes, this purchasing frenzy even hits small community hospitals. But the actual care you receive in hospitals has been greatly reduced, with an attitude of revolving doors for treatment.

Do you have any idea how many private medical practices are now “affiliated” with a hospital or have been out-right purchased by a hospital? All the hysteria over Obamacare limiting doctors’ discretion in medical treatment is nothing compared to what happens when a hospital literally controls 90% of the medical practices in a city. I live in one of those cities. The hospital has decided that it wants patients with chronic pain to use its pain management clinic, so doctors are forbidden to write prescriptions for pain medication. They are forcing people to go through months of physical therapy, with months of bills, before they will authorize hip replacement surgery. The profit margin is limiting care choices far more than anything in Obamacare.

Brill looks at the ways the profit margin increases costs, but he’s looking at billing practices, not care choices. You can see the same pattern in care choices. Brill also makes a good case for not taking this out on your doctor (though I can think of a few who would deserve it.) It is not doctors and nurses who are making out like bandits in this system. Nurses are now required to carry very expensive malpractice insurance policies, not just doctors.

Once upon a time, like back in the 1980s, Humana had an HMO in a Tampa suburb that was a model of cost effectiveness and efficiency. If you belonged to the HMO, you could choose to use their clinic, which was staffed with a combination of young doctors just out of med school and near-retirement doctors who were tired of the costs and paperwork of private practice. You could choose to see just one doctor or take the crap shoot for an appointment. The HMO owned the hospital and all the testing facilities in it. They set up their own pharmacy to cut drug costs. They mailed out a “Happy Birthday” card with your yearly exam date and authorization for your pre-exam blood work. They had dentists and eye doctors on the HMO and an eye exam that showed a problem resulted in an immediate referral to a specialist for laser treatment. Enrollees were very healthy because the focus was on early intervention and prevention and there were no layers of profit for treatment.

Humana had to abandon the system because its shareholders weren’t getting a big enough return on their investments.

Read Brill’s piece. Get educated about the only purchasers of a service or goods who have no control over where or how they purchase those life-or-death services. The scary part is the realization that Obamacare is doomed to failure because it does nothing to free us from the profit incentives that make us #1 in cost and #30-something in care.

Edited to include last night’s Daily Show:



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