Just how screwed up is the US medical system?

Let me count the ways.

Here are three recent stories that highlight what's wrong with our medical system.

An in-depth report by the Tampa Bay Times found that hospitals in Florida are charging exorbitant fees for patients arriving at trauma centers. It led with an account of a patient who spent 40 minutes in a Fort Pierce trauma center before being transferred to another institution for a higher level of care. After some diagnostic tests were done, he was on his way. The tab for the 40 minutes? $32,727.

The Times found that the average charge for a trauma center activation was over $10,000 and the highest was $33,000. For-profit hospitals tended to charge the most. These charges were billed regardless of nature of the injuries, be they minor cuts or abrasions. And as is customary today, the uninsured were charged the full amounts.

Hospital administrators admitted that the charges were based on what other hospitals charged and had no relationship to what resources were used. The fees did not include bills for physician services, which were separate.

An ACA fail: One family's saga

The following was written by my daughter, who has a master's degree and should be an ideal candidate for the new world of healthcare coverage.

The Affordable Care Act should benefit people like me. My husband is self-employed, and we have been paying for our own insurance for years now. I looked forward to the ACA marketplace opening up, and hoped that it would provide us with some options for lower-cost insurance. This was especially true after I found out that for our current plan, with a $10,000 family deductible, the premium was going up to $550 per month for 2014, with the addition of our new baby and the expected annual increase.

Searching the ACA website for my state, AccessHealthCT.com, I was happy to see that we qualified for a federal subsidy of $700 per month, and with that, there was an option for what seemed like a similar plan to what we have now. I selected the plan with Anthem BCBS that had a monthly premium of $298.61, with a family deductible of $12,600. This meant we could keep our HSA, and possibly save a lot of money for the year if we did not meet our deductible.

I spent 45 minutes filling out the application, and almost immediately received a letter from Access Health CT saying I had successfully enrolled in the plan I chose, although it did not list the premium on that letter. Ten days later, I had received nothing from Anthem so I called them. I waited an hour to talk to a human, who said yes I was enrolled and just had to pay the first month premium to complete the sign up. 

I would have done this, except that the amount I was told to pay was $2480.46, for the first month and for each month after that. But wait, I said, the premium was listed as $298.61 per month after the subsidy was accounted for. She said the $2480.46 was the amount due from me, having already accounted for the $700 assistance from the federal government. It’s interesting to note that the subsidy amount came through correctly even though my premium was now eight times higher. She said I would have to call Access Health CT to find out what went wrong with the premium.

ICD-10 codes and politics

Senator Rand Paul has been getting some ink about a recent speech during which he mocked the Affordable Care Act for mandating the use of ICD-10 codes, some of which are pretty silly.

Theses codes are what hospitals and doctors must use when submitting bills to third-party payers.

Please understand that no one has gotten more mileage from making fun of the new ICD-10 codes than I have.

You may recall my posts on the codes for drowning due to falling from burning water skis, contact with (amorous) dolphins and getting sucked into a jet engine.

And I have to agree that the expansion in the number of codes from 18,000 in ICD-9 to over 150,000 in ICD-10 may be burdensome to most doctors.

Senator Paul is a physician, and he should know better. He is either clueless or disingenuous for blaming the ICD-10 code muddle on Obama.

As reported way back in January of 2009 by the Wall Street Journal no less, the ICD-10 codes were to be implemented by the Centers for Medicare and Medicaid Services, but CMS decided to delay doing so after protests by all sorts of medical people and organizations who said that they did not have enough time to comply.

In addition, these codes were not even developed by CMS. ICD stands for the International Statistical Classification of Diseases and Related Health Problems and the revised codes were formulated after many years of discussion by the World Health Organization (WHO).

So whether you love the new codes or hate them, they were going to be put into place regardless of the status of the ACA.

And regarding making fun of them, Mr. Paul is late to the party. My posts about the absurdity of some of the codes were on line in the fall of 2011.

Questions on my mind

These things have been bothering me lately.

Why do you have to be at the airport two hours before an international flight? It shouldn’t take two hours to check to see if you’re on the “No Fly” list. Do the baggage handlers need that much time to steal the valuables from your suitcase?

Why can pilots, who sit right next to the avionics, use iPads on planes during takeoff and landing and I can’t? If iPads cause disruptions to sensitive airplane systems from Row 38, they must really wreak havoc from the pilot’s seat.

What does Microsoft do with the error reports they receive? I think the programmers at Microsoft sit around and laugh at the fools who send in these reports.

Why does the “Alternative Minimum Tax” sound like a good thing but actually is not so good? Having just paid it, the “minimum” part doesn’t seem so minimal to me.

Will the “Affordable Care Act” be affordable? I don’t think so.

Who made the rule that says a multicenter randomized controlled trial has to have a catchy acronym? If I see one more cutesy study acronym that is the result of a forced, artificially awkward series of words, I’m going to scream (or blog).

Why is it called “Meaningful Use”? Is it really meaningful? Or useful?

Why is gasoline the only item priced in 9/10 cent increments? I have no idea. It has been this way as long as I can remember.

How is it possible that someone could have a 2-inch long hair growing out of a nostril and not notice it?

Do you have any questions? Or answers?

Paying for medical care

While we anxiously await the decision of the Supreme Court on the Affordable Care Act, let me offer you three thoughts.

1. Health care for all is only possible if those of us who have money and jobs pay for those who do not.

I love it when people say, “Let the federal government pay for it.” Who do they think funds the federal government? Ditto for “Let the states pay for it.”

What about “cost shifting”? Put a surcharge on health insurance so that the extra money can go to those who cannot afford to buy health insurance. Don’t look now, but that means that those who have the money to buy health insurance will be paying for those who do not.

How about mandating that corporations contribute a percentage of their profits to a fund that supports health insurance for the needy? That will make the price of everything that corporations sell rise, shifting the burden back to those who have money to buy those things.

2. An old axiom in business is appropriate for health care too. It goes like this, “You can have affordable health care, access for all and high quality, but you can only have two of the three.” There is no way that everyone can have every test for every disease.

For example, many guidelines suggest that everyone over the age of 50 should have a colonoscopy. According to the last census, there are 40 million people in the US over the age of 65. Can Medicare pay for 40 million colonoscopies? Even if it could, there are not nearly enough qualified colonoscopists to do the job.

3. According to Supreme Court Justice Elena Kagan, “You are entitled to health care when you go to an emergency room, when you go to a doctor, even if you can't pay for it.” [See page 74.] If you want to have a little fun, mention this in a roomful of physicians.

Maybe Justice Kagan can tell us how we are supposed to pay our rent, malpractice insurance, office staff, workers’ comp, other benefits etc, if we see patients who can’t pay? Oh, universal health insurance? See #1 above.

What do you think of my three thoughts?