home
RSS
August 6th, 2009
06:00 AM ET

Setting mandatory prices for healthcare?

As a regular feature of CNNhealth.com, our team of expert doctors answers readers' questions. Here's a question for Dr. Gupta.

From Cindy in Covington, Georgia:

“Why doesn’t the government make mandatory prices for doctors and their services? That’s the problem. They all charge outrageous prices and vary from place to place. Will that change in the new plan?”

Answer:

Well, first of all, Cindy, you're absolutely right. It’s amazing, even within Medicare you have widely varied prices across the country. One operation in one state might cost $6,000, but in another state, the same operation might cost $17,000. So it does vary even for those covered under Medicare right now.

We are hearing some of the specifics of these health care bills. Nothing has been set in stone but we're hearing that there may be caps on out-of-pocket expenses and full coverage for preventive care.

What we are not hearing are specifics about is whether there will be a set price for various procedures and tests. We asked the White House specifically about that and we were told no, there is no plan in any of the bills so far to set prices across the board, across the country.

The idea is that the government would have a public option for some Americans. This option is for people who can't afford their health care right now. And it's based on a percentage of their premiums as compared with their income. If your current insurance premium is 11 or 12 percent of your salary or higher, you might qualify to buy into this public option. And in terms of overall costs, a public plan would in some ways compete with private insurance companies and may influence how prices are set overall.

The bill being considered now specifies two interesting points in terms of costs. One is that no payment rates would be lower than the Medicare rates right now. Also they would not be able to set prices higher than the average of all plans in the so-called insurance exchange. “Exchange” is the term used to describe the system of private insurance plans and the public option that would come with reform. So there is no direct setting of prices for doctors or hospitals, but a lot of potential influence over prices in the long run.

Critics of the House health reform bill argue that the government plan will always get the better deal. It will always be able to negotiate better prices than private insurers because there will be a larger pool of people. Therefore it would be able to negotiate prices that will not be as low as Medicare but will be low enough that private companies won't be able to compete.  The administration will say this assumption that Americans will flood the public plan is not necessarily true because not everyone will qualify.

One thing I can tell you is that the specifics of the bill are likely to change in the days and weeks to come. I'll continue to break down the details and give you both sides of the argument as Washington works to reform our health system.


Filed under: Expert Q&A • Health Care Costs

soundoff (37 Responses)
  1. Setiawati

    Dear Dr. Gupta,
    I hope all side will remember that the current health care system is unsustainable (it has been unsustainable in the last 10 years, and getting worse). Both sides has to come out with workable proposal. You and the media should give presentation the people how other countries' health care systems work (make a summary of different systems to compare). You should also analyse the major non direct health cost such as administrative cost (especially the lucrative bonuses) , the malpractice insurance (including the nature of the law suits and it's payments). Many doctors defended their high payment due to the expensive malpractice. You should be able to clarify these thing to the public.

    August 6, 2009 at 23:44 | Report abuse | Reply
  2. David Holmes Sr C"ville,ILLinios

    I"ve always had a job, I started working when I turned seventeen. I always had somekind of job and health coverage. Ihaven"t held a job since I got laid off last Januarary,2008. I have no income coming in, I got real ill last week. I have pneumonia, I found out wed august 5,2009, when I went to a 24 hr immediate health care facility. I feel like my pneumonia is getting worse is there anything I can do at home to get better. Thank you

    August 7, 2009 at 05:20 | Report abuse | Reply
  3. Tanveer Farid

    In the last 10 to 9 years i have had at least 3 problems with my health.
    2 times i have had to put stand' s because of my heart problems. And ones i have had to do a cataract surgery for my eyes. my wife job is very good and her health insurances also and i am also include in her insurances. Because of that i have never had a problem with my health coverage. But i think that i am very selfish if i don't think about the poor people or the ones that don't have good health insurances. I always think what will happen to those people who don't have insurances and if they go through what i have went through with my health then how will they manage. For example i am also have glaucoma i need to put drops in my eyes every day called Xalatan and Timolol Maleate After paying of my insurance comp for my eye drops i pay every month $79 out of pocket. The same eye drops in Canada and same comp is $20 and in India is Rs1140 = $ 25 till today i don't understand why is there this much of a diff in the price of the medication and that medication the is very important for a person who has glaucoma. The drops are eye saving drops. My thinking is that the Americans need a new health police as soon as possible that will help every Americans health in a financial and healthy way.

    August 7, 2009 at 16:48 | Report abuse | Reply
  4. GF, Los Angeles

    I'm bothered by the fact there isn't a price sheet or we're not informed of the cost for a service when we're in the doctor's office. I can't think of anything I buy that I don't know the price first before I use/buy it.

    Another issue is just because a person has insurance does not mean the out of pocket costs aren't astronomical. I've already paid almost $1200 in out of pocket costs for physicals and follow up tests for blood work. I can't imagine if I actually had a disease and the out of pocket costs to treat that.

    August 7, 2009 at 18:09 | Report abuse | Reply
  5. Michael

    I read Dr. Gupta's article with interest hoping to read an insiteful response. Unfortuneately, he either has not made an effort to inform himself, or is unwilling to answer fully and truthfully. Unfortunately, after watching CNN this evening beginning at 11:00 pm EST, I found the reporter and the CNN analyst to also be ignorant of the issues.

    Your reporters and anaysts used by the reporters should be required to be informed. I know more than they do, and I work a full time job where I cannot focus my attention on the news of the day. The method I used to become informed is to read the bills (try reading HR 3200). Yes, I know, you would have to actually do some research.

    August 7, 2009 at 23:32 | Report abuse | Reply
  6. Dr Susan

    Your answer demonstrates basic misunderstanding of the medical system. Each "provider" (viz., physician, hospital, lab, imaging center, etc) has the option to charge you whatever they want – just as each auto dealer has a similar option (or hardware, grocery etc store/chain/company). They are then constrained by the market. (If you can get the same product, or comparable product down the street, why is so-and-so so much higher/lower?) Hence, the regional variation of fees or charges.

    This changes dramatically when you included insurance companies. Each company writes a contract with these entities noted above (usually via a network – for access) that stipulates an agreed upon reimbursement for each CPT code. The networks of various "providers" enter into these contracts due to a "guaranteed patient (read customer) base." Think of it as if by dint of your working for Company A, you get a certain guaranteed rate if you shot at Wal-Mart, but a different rate if you shop at Target (one is in-network, the other out-of-network). Depending upon your company, WalMart and Target will work hard to get access to you and your colleagues.

    Now, you get into Medicare. By the way. This is Government Insurance. (Actually, the US Government is the Underwriter, but who propagates certain rules, but the insurance itself is adminstered by contracted PRIVATE insurance companies regionally.) There is a single stipulated rate for each CPT code – just like the private insurers. (It's actually one of the lower rates, except for Medicaid, which is tantamount to negative payment for "providers" with the paperwork, overhead etc in relation to actual rate.) Medicare does stipulate a variable regional component – think of it as accounting for the cost of living -e.g. NYC v upstate, or California v Wyoming.

    In effect, the actual rates are stipulated by the payors – the commercial health insurance companies (as they are called), Medicare and Medicaid. The people who potentially really get screwed are the working poor and others without any form of insurance. Think of it as what you actually pay for a car at a dealer – do you pay the MSRP or what you are able to negotiate. The various insurers have done a level of negotiation for you. (Which the various medical providers consider inadequate to cover all that is expected.)

    The Insurers are using a specious argument. Costs can be lower because the pool of people to average costs over is larger. The addition – and the argument really in favor of a single payer system – is that you drop the administrative overhead of registering the insured yearly, and the marketing costs. With that large of a pool, the group -whether BCBS/Cigna/Aetna/UHC or Medicare can set rules that must be adhered to.

    Note that because of the ridiculously low rates of reimbursement by Medicare, much like Medicaid, you have more and more physicians opting out of the plan. Thus, if you opt to see these physicians, you are liable for the part of their bill that Medicare does not cover, which may be more than the usual 20% of the agreed upon Medicare rate currently (and the reason for the supplemental insurance.) If your public option attempts to undercut reimbursement levels too low, the question is whether you still have the majority of physicians (and other providers noted above) still agreeing to those rates – to maintain contracts with that plan/insurance network.

    August 9, 2009 at 16:19 | Report abuse | Reply
  7. Louise

    Dr. Gupta, I know you are an intelligent man. I'll be blunt...what the hell is the matter with you people down there? Palin just made an absolutely stupid statement about a "death panel". I am a Canadian. We have our share of morons...you have then times as many people so you have ten times as many morons. The US is 37th on the list for health care...Canada is 30th. We have our problems...especially wait times which we need to get sorted out. People down there seem to think these "wait times" are for emergency care...they are not. They are mostly for elective surgery like knee replacements, etc. Dr. Gupta, I swear on a stack of bibles. I am 65 years old and have spent my whole life in Canada and you couldn't pay me enough to move to the States. I worked for Alberta Health and Wellness for 26 years so I am not entirely clueless about our system. In all my 65 years, 40+ of which I have spent in Alberta, not one person I know has suffered at the hands of our system and I know hundreds of people. The lady from Ontario who appeared on a commercial paid for by Republicans probably claims she had a brain tumor and couldn't get to see a doctor for six months. Why do I know three people who have had brain tumors, one of whom survived with flying colors, one is under treatment, and the third got an extra five years he wouldn't otherwise have got. If this silly Canadian, whom I would happily pack up and have move to the States couldn't get care for this, I'm suggesting the woman is a moron. I have heard a few horror stories over the years but my own immediate family including myself, have had immediate emergency life saving surgery at one time or another. My parents died of old age, thank you very much. 84 and 90 which isn't bad. I have other relatives and friends, all of whom had excellent care. We have a shortage of doctors...nobody wants to be a family doctor anymore, that
    s the big problem. Some are greedy and moved to the States where they can make more money in your "for profit" system but ours don't do bad. And this idiotic ad I saw with the bureaucrat between you and your doctor is an blatant lie. The treatment I get is between me and my doctor and the government pays the bill. The government does not interfere in any way. Treatment is up to the doctor. It was never any different. Americans are being terrorized about a government option, if like ours, doesn't put seniors on an ice floe and float them away, or murder children. Where do Americans get this crap? I know they are ignorant about Canada but I never dreamed they were that ignorant.

    You guys set up your own system your own way. I would advise that you consult with Canadian officials and learn from our problems and mistakes and do your own thing. I know you investigated Quebec's non existent air ambulance system. Good old Quebec is the only province that doesn't have it. I see it at work here in Alberta every day.

    No-one I know has every lacked for important care...absoutely no-one. Maybe I know the wrong people. Yes we pay higher taxes for it, why shouldn't we? And we tax the hell out of drinkers and smokers...why not? We push preventive health and screening programs, way more than the US does. In the long run, it saves money. In a for profit system, however, I can see where prevention is going to cut into profit.

    I have seen an ad in the Edmonton Journal from the Mayo Clinic, drumming up business. For $70,000 cash you can have a heart operation next Monday morning. That's disgusting. I don't have $70,000 but I know Albertans who do and they went. In the meantime, children in your country are dying for lack of health care while the Mayo Clinic is offering immediate surgery to Albertans for cash.

    God bless America.

    August 9, 2009 at 19:33 | Report abuse | Reply
  8. DrD11

    Will the new ,proposed,health plane,be better? No.
    It will be the same for those who can pay.It will be worse for those
    who can not pay?
    How do I know? From other countries who"reformed the health plan".
    With the newly,proposed,health plan,everybody will be insured.That
    is all.Everybody will be able to see P.C.P.That's where the Buck Stops.
    Today with Part B(Dr's office visit),of Medicare,there is 20% co-pay and
    monthly fee of ~$195.00 per month..You don't pay, you don't have coverage for part B.
    In Massacussets,the first state of socialized medicine,there are already 17000 people who are out of coverage for the reason of not paying their monthly fees.
    We are going to have a two tier health insurance.Those who can pay,will buy the old fashion private insurance and see their private
    physician(Concierge Medicine).The rest of the people will see their
    doctor in the clinic for all.In the "Old country",it is quite common to see
    the doctor in the "clinic for all" in a.m., and then see the same doctor in
    his home office in the evening,why? To be treated correctly.
    P.S. Private Health Insurance Companies never die.

    August 9, 2009 at 19:59 | Report abuse | Reply
  9. Shelley Duggan

    I am a Canadian Physician and am completely baffled watching the American response to a very limited form of public health care. When you show up at an emergency room in Canada, you get treatment regardless of your financial status. We do not "ration" care – we simply provide quality care without ridiculous overinvestigation – partly because we are not always worried about being sued. Physicians are paid extremely well and there is room for patients to pay for tests that are deamed unnecessary in the general system. I also note that we provide care based on need, not on the premise of making a buck. I have met many Americans who have had a CABG but were never told that in the vast majority of patients, this procedure is done for symptom control and not to extend life. Our system is not perfect, but perhaps you could have a segment interviewing Canadians patients and physicians to truly explain how it works instead of throwing about terms like "socialized medicine" to create fear.

    August 9, 2009 at 22:57 | Report abuse | Reply
  10. Erik H.

    My Canadian friends say they are very satisfied with their health care. How come we can't get the same low cost and high quality care that they receive?

    August 9, 2009 at 23:12 | Report abuse | Reply
  11. Duke

    Dr Gupta
    Thank you for explaining what the "Public Option" entails. Both the Republicans and the Democrats are turning health care reform into
    a political circus. It should't be that way.

    August 10, 2009 at 00:00 | Report abuse | Reply
  12. Tina Galloway

    It really does'n matter if the doctors and healthcare cap their fees. Especially the ones who work in our nursing homes. I am a phlebotomist who goes to several homes everyday. If the nursing staff forgets to write orders on a patient during the normal shift, they will call it in as a STAT (which costs double or sometimes triple) just to cover their own rearends. Most of the STATS that I do are because they forgot. The patients are not so ill as to have to have the blood drawn right away. They are usually in physical therapy, or in the dining room having their meals. In either case, I have to wait for the patient to finish whatever it is they are doing, have them taken to their rooms. This takes alot of time and I am paid by the hour, as well as on call pay, mileage (never less than 130 miles round trip). This makes me work 15 – 20 hours a day. That is where the money is going. By the time I retire, there will be NOTHING left. Each STAT that is done costs the healthcare insurance no less than $225 per patient, per STAT. This is done DAILY.

    August 10, 2009 at 13:16 | Report abuse | Reply
  13. Dave Purcell.

    Your discussion of hospital costs on TV today neglects the issue of a level playing field.

    Hospitals charge different rates to Insurance companies and uninsured patients are charged more than anyone. The government, when contracting, has a clause that forbids charging more than any other customer is charged.

    What works for the government and insurance companies should be fair for the uninsured as well.

    August 11, 2009 at 16:09 | Report abuse | Reply
  14. Ray Shaffer

    Dr. Gupta made an analogy yesterday (Aug. 11); saying that ObamaCare would be good competition for the Private Health Care providers.
    He used the US Postal System with FEDEX and UPS as competitors.
    How misinformed.
    The USPS has NO Competitors.
    If Dr. Gupta would hear his own, CNN, reports on the USPS; he would realize the USPS is a deficit spending (Billions $) beauracracy with no competion.
    The USPS is a perfect example for argument against a National Government Healthcare System.

    August 12, 2009 at 08:23 | Report abuse | Reply
  15. Judy in GA

    Hi Sanjay . . . I've read all these comments and they have certainly added to my knowledge about how health care providers, insurance companies and government-run programs set pricing. But here are my questions that have not been answered (with some background information:-).

    Yesterday, I saw your story on the 56 year-old-woman who'd spent two days in the hospital having a new battery installed in her heart defibrilator (I assume this is a pacemaker). Your story focused on her bill that totaled $196,000 and how that cost was apportioned across the cost of the defibrilator, the care, the administrative costs, etc.

    The story was incomplete to me because:

    It didn't say whether she had insurance and if she had to pay the total bill (and she didn't appear to be panicked, just incredulous to the cost).

    My 88-year-old mother had a pacemaker implanted a year and a half ago here in Cumming, GA. It was an emergency procedure and nobody from the doctor or the hospital sat down with us and explained the costs involved with this. To my surprise, when the bills rolled in, her hospital stay of five days and all the expenses you mentioned cost $76,000 (cheap compared to the 56-year-old woman's story). The bill we received was broken down and the defibrilator cost $36,000 of the total cost. Unbelievable!

    Now, here's what's interesting to me and here are my questions:

    A) Medicare and my mother's supplement insurance paid all but $400. That was our out-of-pocket expense. But $12,000 of the bill was "written off".

    What happens to that $12,000? Is that entered as a loss to the hospital on the balance sheet?

    B) Could you do a follow-up story on this and explain hospital and insurance billing in more depth? And explain to the public how these "write offs" are affecting the cost of health care for all?

    C) Are the costs inflated to cover the 47 million who are uninsured who show up in emergency rooms with an inability to pay? (Seems to me that $36,000 for a pacemaker is way out of line . . . how much could it possibly have cost to manufacture [and I do understand that R&D is incorporated])?

    I have an MBA (which, I think, means I'm fairly well educated) but I can't understand these billing practices at all. When I called United Healthcare recently to have some billing explained, the explanation I got was: "Well, think of it like a Kroger coupon or discount. The retail price is $X but since you have a coupon, it only costs you $Y. Which means, based on one your your bloggers comments, that United Health Care negotiated a price with Northside hospital and the doctors (or GA's healthcare pros) to pay only a certain amount . . . however, the hospitals and doctors charge $X to other patients who have no insurance (or coupon to pay $Y) but do have an ability to pay (have a job and assets) and this is why these poor folks end up in bankruptcy. Those without any insurance get care (too late, in most cases, to be preventative, so it's hugely more costly) and those of us with coupons get the break . . . so those who don't have them bear the burden. Am I right???? 🙂

    Would love to see you do a piece on this!!!!!!

    Thanks, Judy in GA

    August 12, 2009 at 13:34 | Report abuse | Reply
  16. Mark Richard (MA)

    A clear example that debunks this claim is that most Americans have access to cheaper healthcare now but choose a higher priced plan that suites their needs. Only if the public plan offers quality healthcare along with afordablility would it be able to be appealing to the masses and if that proves to be the case, those people win anyway and no harm done!

    August 12, 2009 at 17:28 | Report abuse | Reply
  17. Dean

    Hello Dr.,

    I'm a retired American living in the Philippines. I'll be 65 in 2 years, but as it stands right now, medicare won't cover anyone outside of the country. There are over a million Americans living abroad. We need a champion to drag medicare out of their paradigm paralysis and into the new century. Just because we are over here doesn't mean we are dishonest or that our hospital of Dr. would be.

    Maybe the AMA could figure out a way to qualify some health care facilities for us. Retired military can get some coverage. Why can't we?

    While it is true that procedures are cheaper here, it is not true that we can afford the expensive ones. We just need some backing when the going gets tough. Most of us are on Social Security and maybe a pension from work. Flying back to the US is just to expensive.

    August 12, 2009 at 17:30 | Report abuse | Reply
  18. Dean

    Another way to save money is to farm out some of the procedures to good hospitals and doctors in other countries. That kind of competition would help drive the costs down. One could probably go to the Philippines to get a bypass operation and the expense of it would be half the total cost in the US including plane fare and hotel for a loved one.

    Doctors, drug companies, HMO and other highly compensated health care entities need to stop thinking about "I" ans start thinking "WE"! The needs of the many far outweigh the needs of a few. It's time to cowboy up!

    August 12, 2009 at 17:34 | Report abuse | Reply
  19. Juan Ramon

    Sometimes I wish I lived in Canada. I have never met a Canadian that has said that their health care does not work. In my line of work I meet people all over the world and they are laughing at us, places such as Canada. The problem with our health care system is that doctors think they should be able to over charge simply because they spent 8-10 years in school. Most, not all doctors in the United States are just money hungry; as well as insurance companies. That is the problem!!

    August 13, 2009 at 01:35 | Report abuse | Reply
  20. Mark

    Did anyone see the CNN Lou Dobbs show that described the Swiss insurance system? Purchase is mandated from private companies who's profits are regulated. If you fail a "means test", or have some pre-existing condition that makes coverage un-affordable, the government subsidizes your insurance. That way, we all have freedom of choice, and the government is not involved in our health care decisions. I guess that just sounds too simple for the politicians to accept.

    Ray, great catch on the USPS analogy cited by Dr. Gupta. I nearly jumped out of my chair when I heard him say that. The USPS is granted a monopoly by the government for regular mail. That's why FedEx and UPS don't offer "regular" mail service. You'd think that any organization offered a monopoly on a service would be able to keep a lid on rising prices (through innovation and productivity gains) – but the price of a stamp has risen at the rate of inflation for the last 40 years. yet the USPS still loses money! Very poor reporting by CNN. You would expect them to get their facts correct.

    August 13, 2009 at 21:19 | Report abuse | Reply
  21. Gary Stasiak

    Why not have a health care national lottery, in which to help pay some of the costs? Have a 1% Goods and Service tax ? Why haven't people protested the wars cost? It seems that the cost of lives and money is really the biggest problem to health care? I also see all the people out of control @ These meetings they must have health care plans, is there any that have no health insurance yelling @ these meetings? The tax payers pay either way, right!

    August 14, 2009 at 08:40 | Report abuse | Reply
  22. Jake Jessop

    The bottom line is that healt care costs money. New innovations and technologies are expensive. Tech companies have to recoup their money somehow. They are in business to make money. That's the motivation. Why do we go to our job every day? To pay taxes, benefit society? No we go to earn money to provide for ourselvesand families and buy the things we want and need.

    Doctors do the same thing. The vast majority of physicians are trying to take care of their patients the best way they can, but they still have to make a living.

    Have any of you ever looked into what physicians must to go through and give up to get to where they are. They sacrifice, barrrow, spend less time with their families and work long hours. And that's just during training. Working 70-80 hours a week and only getting paid $40 K for 3-7 or 8 years is not easy. Plus, many have loans with payments more than most people's mortage. From the time I started undergraduate until I finished my training, I made an average of just over $25k per year. Upon graduation I was responsible for repayment of about $240k (that's almost a quarter of a million).

    DON'T villify doctors and their pay. It's not as much as you think. YES THERE IS MISINFORMATION BEING PROPOGATED, BUT IT'S NOT ALL FROM THOSE AGAINST THE DEMOCRATICE PLAN. THE OTHER DAY THE PRESIDENT STATED THAT IF A SURGEON AMPUTATES A LEG BECAUSE OF POORLY CONTROLLED DIEABETES, HE/SHE WOULD BE REIMBURSED $30-50K. THAT IS ABSOLUTELY AND COMPLETELY FALSED!!! THE ACTUAL AMOUNT WOULD BE BETWEEN $700-1,200 (this includes 1-3 months of postoperative care). THAT MISTATEMENT WILL BE BELIEVED BY MANY WHO DON'T KNOW ANY BETTER. Shame on the President for not doing his homework. He has shown by many statements that he doesn't understand the details of health and its costs.

    I agree we need HEALTH INSURANCE REFORM, but I don't want the government running any part of it. They should be a referee to make sure things are done in a fair manner. They haven't done anything effeciently in a long time. Certainly there are many improvements that need to be made. The private sector can and should be more efficient. There are a number of good options including Health Saving Accounts that are being shut out by the Democrat's proposed plans. Tort reform must be a part of reform. This will help decrease "unnecessary tests".

    (If you want the Canandian system, GO TO Canada!)

    August 14, 2009 at 12:35 | Report abuse | Reply
  23. dcook140

    From my reading of the bill: page 121 Sec 223, it appears that the schedule for payments to health care providers will be the same for the Public Option as Medicare. If this is the case, you are essentially asking the private insurers to compete with medicare pricing..they can't, since the government can dictate the price due to its size. Who has more leverage, the government or Blue Cross? Not a very level playing field.

    You add to this the fact that the bill, HR 3200, mandates a penalty (8%) for not providing insurance to employees. By any account, the cost of providing insurance is much higher than 8% (those greedy insurance companies). This will encourage employers to send employees to the Public Plan for their insurance. Does anyone doubt employers like Wal Mart, Target, etc. would not do this? How about B of A? Once your competitor does this, you are forced to as well.

    If you like your plan, you can keep your plan.

    August 14, 2009 at 17:06 | Report abuse | Reply
  24. samantha young

    I00,000 dollars per day for hospital stay! Give me a break! I am Canadian and believe me Gvt Insurance works! Our insurance covers every Canadian citizen and COVERS 95% of all procedures,Wake up Americans,get with the program,You'll be glad you did.

    August 16, 2009 at 07:47 | Report abuse | Reply
  25. EDNA TRAVIS

    Does America need a total health care reform or is it only a medicaid/medicare reform which is needed? I think the latter.

    August 16, 2009 at 11:01 | Report abuse | Reply
  26. edward fannon

    Why not provide the health coverage afforded our illegal immigrants?

    If an illegal immigrant lives close to a city or country hospital, he/she receives free healthcare via Medicaid. Here’s an example.

    In Nassau County (N.Y.), they have social workers on duty at the Nassau County Medical Center (in East Meadow, N.Y.) 24/7 to place illegal immigrants on the Medicaid system. Prescription medication is also free or at a nominal cost ($2 to $5 per prescription). Free transportation (via taxi cabs) is also part of the package.

    August 17, 2009 at 09:54 | Report abuse | Reply
  27. Riste Capps

    The quest for healthcare coverage for my totally disabled 61 year old husband is a challenge. According to Colorado Legal Service, 25 to 30% of the people who are awarded Social Security Disability benefits, fall between the cracks. These people are not eligible for Medicare for 2 years and once they are awarded Social Security Disability, even though their total household income has not changed, they get kicked off of Medicaid because of the way the State of Colorado calculates Medicaid eligibility.

    In our case, our total household income has not changed and I still have Medicaid. But my husband, who has been determined by the Federal Government to be totally disabled, no longer qualifies for Medicaid. Why?

    This needs to change. Disabled people need healthcare coverage to help them pay for care. In his case, his condition could be corrected by a surgery. Without healthcare coverage, that is not likely to happen. I wonder how many other people are in the same position?

    I have sent this message to all of our elected officials asking them to change this urgent need.

    August 19, 2009 at 11:17 | Report abuse | Reply
  28. Ryan

    The reason you don't have "price sheets" or health providers telling you in advance how much certain procedures cost is because they can't tell you, SERIOUSLY. Very few institutions in this country have the ability to identify and calculate the exact cost of say, a heart transplant. There is one system that tracks the nurses in the room (and how much they make), a different system that tracks the doctors salary, a different system that knows how much each supply used is worth, a different system that tells you how long they were in the OR, a different system that tracks the facility costs like lighting, water and gases, and a different system that does the billing and reimbursement. Until we have healthcare providers that can integrate all this data and tell you a heart transplant costs X$, you will never get what you're looking for.

    August 20, 2009 at 12:04 | Report abuse | Reply
  29. JoAnne Brawn

    I am reading all this and I am thinking that we are going about this all wrong. No, we do not need to regulate fees. No, we do not have to offer a fee to employers that do not offer insurance (8% my butt).

    What we need to do is make it illegal to NOT have health insurance. Now before you all squack and scream bear with me on this. You already have the Medicaid/medicare plan for people that are deemed finacially eligible. If the case is truly that people do not make enough money to afford care then by all means alter the fiancial boundaries to try and include them. But, if what is really the case (and I believe it is a lot more than not) and that people are CHOOSING to not make health insurance their priority, no amount of making affordable plans will work. You can put the product out there,but there will still be people who wil not make that adult choice to insure themselves and their loved ones. And with the current environment of being able to go to a doctor/hospital when it is a critical health problem and not being denied service (which is appropriate, we are not monsters), you are guaranteed service with no worries of having to pay the bills.

    Once you have these bills, walk to the County Medicaid office and sign up to have them paid then. So a condition that could have been prevented and cost much less to treat in level one care is moved to level 3 care and charged to the government tab. The other option that can be taken if you are stil not income eligible for Medicaid is to declare bankruptcy, another drain on our society.

    So like I said, the only way to change the behavoir is to mandate it by making it illegal to be uninsured. (Just like car insurance)

    August 20, 2009 at 12:22 | Report abuse | Reply
  30. nick

    Everyone must get healthcare even the illegals. I once went to a Dr office they wouldn't have anything to do wt me unless they see there's a way they will get pay. Although I told them I have insurance. These Drs and these insurance companies they're all about money. If the healthcare reform won't eliminate these kinds of treatment they shouldn't have a reform. In additions, those Drs either dumb or just testing the water wt medication and see what works. I went to that same dr..they prescribed me so much shits and i started to think do they really know how much each medication cost...These activities should be reformed not tolerable. Thanks Obama

    August 23, 2009 at 08:00 | Report abuse | Reply
  31. Lise (Lisa)

    why isn't healthcare non-profit. wouldn't that make more sense and keep the cost down?

    August 29, 2009 at 08:41 | Report abuse | Reply
  32. Mike

    My mother is a highly functioning 74 year old recently was seen by a neurosurgeon for worsening back problems. He had not seen her before, and spent an hour on her initial consultation visit in his private office. That consultation included taking the appropriate history, examining her thoroughly, reviewing the diagnostic MRI that she brought with her. He then carefully explained the four different conditions he found, and how each of them related to the different types of pain she is now experiencing and that have gotten bad enough to interfere with her ability to be functionally independent. He then had to explain what types of treatment might possibly be helpful (nonsurgical as well as surgical) for each of the four problems, and what the limitations and potential complications and costs in time and money might be for each. I would rate his consultation as complete and perfectly appropriate for her situation, and to have done less in his consultation would have been unacceptable. She received her EOB (Explanation of Benefits) from Medicare last week. The Neurosurgeon's charge for the hour long consult was $225.00. Medicare paid $35.00 for an hour's worth of this Dr's expertise! She had additional private insurance which paid him a bit more on top of Medicare. I can't believe that he is valued this poorly for what service he provided. After the visit with him, she was referred for the initial part of her treatment to an anesthesiologist (physician) who is an expert in pain management for a series of injections to try to control some of her pain. This was her first visit to him, and he also took a careful history and made a detailed examination, then reviewed her MRI films. He spent the rest of his 45 minute consultation explaining what he could do for part of her problems, the risk, benefits, costs, and answering her questions to her satisfaction. When they were done, he scheduled her to return to begin the procedures a week later. She received her EOB from his initial consultation, for which he charged $135.00, and for which Medicare paid him $17.00!
    How can the government possibly believe this to be acceptable, to pay a professional with this level of training this poorly? A locksmith charges $75.00 to open your car door during "regular business hours," and charges extra to come after hours or on a weekend. A washing machine repairman charges $50.00 up front just to leave his shop to come to your home, before even seeing the broken machine. The kid that cuts your neighbor's lawn probably charges at least $20.00 to do this. And the government plans to reduce benefits for Medicare recipients? What do they expect to pay professional for their work after reductions? Who do they think will actually work for this little pay in a single payor system, since without the secondary private insurance, this is all the physician would be paid. Would you want to fly in a plane with a pilot who makes minimum wage? Do you want to be cared for by a professional who gets paid $17.00/hour for his work, when he knows what he is really worth? Does the government really believe that anyone will seriously consider becoming a physician from this point forward, knowing the sacrifices and cost to become one?
    It does not appear to me that physicians are the root cause of out of control costs for health care. It seems to me that the costs are probably coming from the administration of healthcare (i.e., government bureaus/private insurance companies) which soak up the available funds, and the cost of defensive tests and defensive hospitalizations which may be necessary to avoid any appearance of not having done "everything" when confronted by a plaintiff's attorney in court. If the government sees that "Cherry picking" and "nontransportable insurance" are things that need reforming, why haven't they passed laws to correct this long ago-I don't see that costing the government anything ever. With no disrespect to the late Mr.Kennedy, how could he be the champion of healthcare reform for 47 years and never manage to get these two items alone corrected? There could never be any budgetary reason that I can see. I believe the answer is that the insurance lobby is too powerful, and the fact that items like this are even being considered now, makes me concerned that there must be something financially worthwhile in the bill presently under consideration so that the insurance industry would make these concessions to the government. All the money and universal insurance coverage in the world will mean nothing to patients if there aren't enough nurses, doctors and hospitals left to care for patients. The primary concern of the government should be on how to improve on the delivery of healthcare for all patients, and insure that their care is not being manipulated by external forces such as government, private insurers, legal threats, or limited by any personal, government, or corporate finances. That is not to say that budgets should be unlimited, but rather, cost containment should not impact on care, but rather on the administration of that care, and the legal issues that cause waste in the system.

    August 29, 2009 at 14:48 | Report abuse | Reply
  33. pahmed

    This is one of the most important aspects of healthcare reform in my opinion. I went to a doc who I paid out of pocket since they werent sure if my insurance would pay up. I was charged $360. My insurance did pay up, but the insurance company was contracted to pay a "special price" of $120. The doc's office mailed me the $120 refund. I had to cover the difference and the doc actually was paid twice – by me and by my insurance company. And theres nothing I can do about it. Insurance companies pay far less than a private person paying out of pocket which is insane.

    September 2, 2009 at 10:08 | Report abuse | Reply
  34. Gil

    The current set up is confusing, even for clinics and physicians. As a private practioner, I have had a heck of a time setting up the fee schedule for my office. We use the Medicaire fee schedule as a starting point, but in order to even get close to what reasonable reimbursement should be, we are required to charge a significant percentage higher. That is, if an office visit allows for X amount, in order to get paid for that amount you have charge a lot more. You almost never get what you charge for from the insurance providers, and in order to cover the cost of the service, you have to play a game that frankly only adds waste to an already troubled system. I think both doctors and patients would appreciate a simplification of the system and knowing what the allowables are.

    September 10, 2009 at 12:50 | Report abuse | Reply
  35. mel

    I am a 28 year old with no major health problems. I do not have health insurance and can not get any based on pre-existing conditions (asthma that I have no been treated for since I was a teenager, and a bulging disk). I make too much to qualify for state subsidized insurance, and too little to be added to my husbands work plan ($550/mo). What are people like me suppose to do? This talk of death squads is ridiculous...the insurance companies are deciding my fate, not the government. It is time that all Americans get quality medical care.

    September 15, 2009 at 11:51 | Report abuse | Reply
  36. KH

    Mike-

    Following up. You make some good points. Much of the escalating costs are related to extraordinary care at the end of life. We are going to have to wrestle with that as a country.

    One of my elderly accountants made an apt analogy. "You have told me that the options really won't buy much quality time, which is all that should be said". He opted out of a costly hospitalization with technical positivism because he didn't want false reassurance.

    My opinion is that we need to offer patients & families that information straight out but with compassion. Furthermore we need to combine palliation where needed to reduce their suffering. It is needed in greater frequency simply because we live longer on average.

    A clinician concerned for all America

    September 24, 2009 at 22:17 | Report abuse | Reply

Post a comment


 

CNN welcomes a lively and courteous discussion as long as you follow the Rules of Conduct set forth in our Terms of Service. Comments are not pre-screened before they post. You agree that anything you post may be used, along with your name and profile picture, in accordance with our Privacy Policy and the license you have granted pursuant to our Terms of Service.

Advertisement
About this blog

Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.