7.1 The price we pay

7.1.1 Health fair

  • Doctors doing unnecessary vascular procedures

  • Do you have leg pain? According a survey to a sample of 3000 doctors across America, 21% of everything done in medicine is unnecessary. 22% of prescription medications, 25% of medical tests, and 11% of procedures are unnecessary.

  • Why? Money driven: Doing a procedure pays well, but taking time to explain the importance of exercise, which increases leg circulation, pays poorly.

  • Doctors nudge patients for reasons good and bad. For example, obstetricians would say “it might be safer for the baby”.

  • Finding a medicare patient in America without some leg pain is like finding a penguin in the desert. Claudication is a rare type of debilitating leg pain that is subjective and nearly impossible to disprove. Even doctors know that less than 5% of patients with this rare diagnosis benefit from surgery, inserting that single word once in a patient’s chart guarantees the doctor will be paid in full and fend off any lawsuits.

  • Our team eventually identified about 1100 US churches, synagogues, and mosques that served as vascular screening centers—despite a scientific consensus that people should not be screened this way for this disease.

7.1.2 Welcome to the game

  • Hospital charges are notoriously inflated and hard to pin to any actual costs.
  • Hospital officials confessed that they inflate bills more and more each year to generate more revenue since their insurance companies pay only part of the sticker prices. Insurers confessed they demand bigger and bigger discounts in their contracts with hospitals in order to keep up. Both acknowledged that they pass on higher hospital bills to the public in the form of higher insurance premiums.
  • “Insurers fight for a bigger discount every time they renew a contract with a hospital. Then hospitals go around and inflate their prices. It’s a game.”
  • An insurance company gets ranges from 4 to 90%. There can be radically different prices for the exact same medical care at the same facility by the same doctors and nurses.
  • A recent study found that the cost of a hospital bed alone during a routine childbirth can range from $1000 to $12000 per night.
  • Price gouging is a business model that has become all too common in American medicine.
  • Emergency room bills were marked up a lot more than what the internal medicine department charged for the same services.
  • Think of the problem of being out-of-network. The recommended solution is to join the network. The game proposes a solution that exists only because it created the problem in the first place.
  • “The law allows us to charge whatever we want we want. If we want to charge a million dollars, she has to pay it.”
  • The game creates a giant middle layer of health care: the repricing industry, dedicated to negotiating bills among three or four parties after care is delivered…One study found that for every ten doctors, the average US hospital has seven nonclinical full-time-equivalent (FTE) staff working on billing and insurance functions.
  • It’s the reason hospitals are on a buying spree, snapping up private practices and other hospitals. It explains insurance company mergers. The players need power when they clash in the markup discount game.
  • Conversely, predatory billing practices are rare in the few health care sectors that have already adopted real price transparency, including cosmetic surgery, in vitro fertilization, and LASIK surgery.