Tuesday, October 25, 2011

Fool's Gold

The game of healthcare is played with casino chips.  No one truly pulls money out of their pockets so no one knows or cares how much things cost.  This allows an opaque system of cost shifting to occur and it fool us all.  Here is an example.  More and more states are cutting Medicaid coverage for hospital stays that go over 10 days.  They are doing this to save money.  The Medicaid patients won't be getting the bill from staying more than 10 days but instead it will be passed on to the hospital.  The hospital is in the business of making money (many CEOs make over a million dollars a year) and therefore will pass this bill on to patients who have no insurance (and take their car, house, savings) or just cut staff (nursing, pharmacists, docs, etc).   Nothing exists in a vacuum and though Medicaid spending needs to be corralled in, it doesn't mean that making ridiculous cuts are appropriate either.   I do believe prices of medical care should be transparent.    I do believe we all should pay something for it or else it is devalued and abused.  Everybody should have their skin in the game.  There is no free lunch.  Sorry.

And for the record, I don't believe CEOs should be making that much money.


Pat said...

The first, most critical reform that should (Ha!) happen with Medicaid is to abolish it as a federal program. The lack of flexibility of states to tailor health programs that fit the needs of their respective populaces is well-documentd (eg. Oregon, 1994 vs. Clinton Adminstration). Some states might find it preferable, necessary, or just fair to cut Medicaid largess to folks like the 20 year old idiot mom of a one year old who rolled into my ER on the ambulance not 6 hours ago, because she had run out of Tylenol at home. If you want to acuse me of heartlessness, then stand in line; Uncle Sam has prefigured my callous disdain and prevents me via EMTALA from turning this genious and her healthy, squalling sponge away at the door. The taxpayer got socked for the ambulance costs, inflated to be sure, and the state and feds will have to cough up a few hundred or more in (granted) inflated funney money charges. Try cutting off this prize patient, or any of the legions like her who haunt ER's and clinics, and you will quickly hear how ANY cut to their care is "radical", "cruel", or not cost-efective. I am not saying there should be no care for the truly needy! But that care should be curtailed, and defined by those most directly saddled with their cost, and those receiving it should have a better opportunity for accountability.

Christopher said...

I think it should be illegal for hospitals and doctors to charge the 200 to 300% more that often do to self-pay patients to "make up" for what they don't get from insurers on insured patients.

And if you are losing that much money from an insurer, either renegotiate or drop that plan.