How U.S. Health Care Became Big Business

Elisabeth Rosenthal Explains How U.S. Health Care Became Big Business: Shots – Health News : NPR – April 10, 2017 – Heard on Fresh Air

Dr. Elisabeth Rosenthal, a medical journalist who formerly worked as a medical doctor, warns that the existing system too often focuses on financial incentives over health or science.

“We’ve trusted a lot of our health care to for-profit businesses and it’s their job, frankly, to make profit,” Rosenthal says.

Rosenthal’s new book, An American Sickness, examines the deeply rooted problems of the existing health-care system and also offers suggestions for a way forward. She notes that under the current system, it’s far more lucrative to provide a lifetime of treatments than a cure.

On what consolidation of hospitals is doing to the price of care

In the beginning, this was a good idea: Hospitals came together to share efficiencies. You could share records of patients so the patient could go to the medical center that was most appropriate.

Now that consolidation trend has kind of snowballed and skyrocketed to a point … that in many parts of the country, major cities only have one, maybe two, hospital systems. And what you see with that level of consolidation is it’s kind of a mini-monopoly.

What happens, of course, when you have a mini-monopoly is you have an enormous sway over price. And so, what we see in research over and over again is that the cities that have the most hospital consolidation tend to have the highest prices for health care without any benefit for patient results.

On the ways the health-care industry stands to profit more from lifetime treatment than it does from curing disease

It’s far better to have treatments, sometimes really great treatments … [that] go on for life. That’s much better than something that will make the disease go away overnight.

On how prices will rise to whatever the market will bear

Another concept that I think is unique to medicine is what economists call “sticky pricing,”

It basically means … once one drugmaker, one hospital, one doctor says “Hey we could charge $10,000 for that procedure or that medicine.” …everyone sees that someone’s getting away with charging $10,000, the prices all go up to that sticky ceiling.

On initiating conversations early on with doctors about fees and medical bills

You should start every conversation with a doctor’s office by asking “Is there a concierge fee? Are they affiliated with a hospital? Which hospital are they affiliated with? Is the office considered part of a hospital?” In which case you’re going to be facing hospital fees in addition to your doctor’s office fees.

You ask your doctor always … “If I need a lab test, if I need an X-ray, will you send me to an in-network provider so I don’t get hit by out-of-network fees?”

On getting charged for “drive-by doctors” brought in by the hospital or primary doctor

You do have to say “Who are you? Who called you?” and “Am I going to be billed for this?” And it’s tragic that in recovery people have to think in this kind of keep-on-your-guard, somewhat adversarial way

On how to decipher coded medical bills

Don’t be alarmed by the “prompt payment discount.” Go back to the hospital and say, “I want a fully itemized bill. I want to know what I’m paying for.”

I’ve discovered you can Google those codes and find out what you’re being charged for, often, and most importantly, you might find you’re being charged for stuff that obviously you know you didn’t have.

Elizabeth Rosenthal is editor-in-chief of Kaiser Health News, an editorially independent news program of the Henry J. Kaiser Family Foundation and a partner of NPR’s.

4 thoughts on “How U.S. Health Care Became Big Business

  1. Kathy C

    I guess Googling the Billing Codes gives people a feeling of control. those ICD 10 Codes were designed to obfuscate facts, avoid Liability, and facilitate billing. Prior to the ACA roll out they were cautiously gone over by lobbyists and and Industry lawyers. One Billing issue i noticed with Seniors, is a Double Billing. They submit the bill to Medicare, but send the Bill anyway. I have had a really hard time explaining to some older people, that they do not have to pay that bill. They Submit is to Medicare, then if there is anything uncovered, they might have to pay. After I leave they go an pay it anyway. Even though they can’t afford it.

    This gem of an Article appeared in local Newspaper. The Alternative News. The main Corporate Media ‘News” here won’t print anything negtaive about his hospital. It is really frightening.

    The Part about the “Pain Pump” is terrifying. They “Believe” it is better to have a Stroke than have “Dependence Causing Drugs.” They ” Ween” people off during Surgery, it is horrifying..

    Liked by 1 person

    1. Zyp Czyk Post author

      Opioids are the most effective and cheapest Tx for “mechanical pain” with clear, but incurable cause (like painful genetic diseases).

      My EDS pain is a direct result of mechanical problems with unstable joints & too-stretchy tissues – no amount of physical or psychological therapy can fix that.

      Because there’s no way to avoid continuous worsening of my pain with age it seems a planned death will be required eventually, but much, much sooner without opioids.


      1. Kathy C

        Yes Zyp,
        They are avoiding the facts. Nearly every “News Article,” Politicians Statement, or even Editorial and Opinion Piece on the “Opiate Epidemic” strategically leave out people with Conditions like yours, or any other that can mean lifetime physical pain. This particular Hospital has had these Policies for years. They are a “religious” Hospital so it may be about their “Beliefs.” A good percentage of the people around here believe Prayer or New Age Treatments can “Cure” Pain.
        This same Hospital even has Billboards claiming they can “Cure” pain. Of course they do not have anything more than Steroid shots, and If the patient can afford it, perhaps massage or something. I have a friend who is going there, and he is clearly gettign worse. The Pain is chewing him up. Over the past few years he has gone from Normal, to avoiding Interactions, he can no longer work, and he is a bundle of nerves. He is terrified of Opiates, something they brainwash people into at their so called “Pain Clinic.”
        It is not about facts anymore it is about belief. They strategically mislead people for their own ends. Though the standard Opiate are a lot cheaper, they have Reformulated ones that aren’t, then the various dangerous replacement too, are much more expensive. It is more profitable for big Pharma to market the alternatives. The Doctors are told in Medical Conferences, Meetings and Continuing Education, that they need to worry about liability at every turn, so they go along with all of this. Return visits are more profitable. There is no way to track the effectiveness, there are not requirements or Federal Regulations, forcing them to keep notes on any of this. Each visit is like Groundhog Day, The Insurance Companies are winning too. Painful Conditions can be denied or “Psychological Interpretation” can obscure facts, and undermine the credibility of the Patients.
        Years ago I met a woman who was injured at that hospital while working there. She was a Temp, so she wasn’t covered by Insurance. That Hospital sent her to the local Mental Health Clinic. She had a spinal Chord Injury, she slipped on ice in a walk in cooler. She was in lot of pain and distress. Her pain was clearly not being treated so when she went for “Therapy” it ruined any chance of her suing them. It is pretty likely they are “Dumping Patients” into the MH System, and even Nursing Homes in some cases. That kind of thing is not being tracked at all, they are above the Law.
        There are a lot of these people who are drinking themselves to death, because the “belief” does not work. They are not being counted either. This Hospital is a monopoly in this area. The Other Clinics would never even document anything negative about that Hospital, they are all in cahoots. It is really kind of scary.

        Liked by 2 people

        1. Zyp Czyk Post author

          We are becoming a callous and crude society controlled by money alone, pure unrestrained capitalism which ignores any social responsibility.

          It’s so sad & ruthless that I’m not sure I will want to stay alive and live “here” anyway, and there’d be little reason to stick around if my pain relief is taken away. The world I’m living in clearly doesn’t want any “non-productive” people like me around – especially if we don’t have any money to spend anymore.



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