Monday, February 25, 2013

The Goddamned List on How to Save Money on Health Care

I was reading Hausdorff's Bible Blog earlier today and read his post Bitter Pill: Every American Needs to Read this Article (based on the Time magazine article you can read here). Hausdorff, you will not be surprised, writes about the Bible, but today the inanities of the American health care system spurred him on to write about the graft and corruption that goes into what many Republicans call the greatest health care system ever.

Here are 6 Goddamned suggestions on how we can lower health care costs. All the quotes are taken from the Time magazine article.

1. Bring your own Goddamn aspirin to the hospital.
The first of the 344 lines printed out across eight pages of his hospital bill — filled with indecipherable numerical codes and acronyms — seemed innocuous. But it set the tone for all that followed. It read, “1 ACETAMINOPHE TABS 325 MG.” The charge was only $1.50, but it was for a generic version of a Tylenol pill. You can buy 100 of them on Amazon for $1.49 even without a hospital’s purchasing power. [emphasis mine]

2. Move to another Goddamned country.
Taken as a whole, these powerful institutions and the bills they churn out dominate the nation’s economy and put demands on taxpayers to a degree unequaled anywhere else on earth. In the U.S., people spend almost 20% of the gross domestic product on health care, compared with about half that in most developed countries. Yet in every measurable way, the results our health care system produces are no better and often worse than the outcomes in those countries.
According to one of a series of exhaustive studies done by the McKinsey & Co. consulting firm, we spend more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia.
For those who want a chart and information to support the above assertion, I offer up these from the Economist.

3. Shakespeare was wrong! First we kill all the Goddamned Health Care lobbyists, and then we go after the lawyers (following The Business Before Pleasure Rule).

The health care industry seems to have the will and the means to keep it that way. According to the Center for Responsive Politics, the pharmaceutical and health-care-product industries, combined with organizations representing doctors, hospitals, nursing homes, health services and HMOs, have spent $5.36 billion since 1998 on lobbying in Washington. That dwarfs the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by oil and gas interests over the same period. That’s right: the health-care-industrial complex spends more than three times what the military-industrial complex spends in Washington.
Oh, c'mon, we all know that Shakespeare quote, right?

4. Goddamned, if Kafka were alive today, The Trial would be about the way American hospitals use the chargemaster to determine how much to bill consumers.
The chargemaster, I learned, is every hospital’s internal price list. Decades ago it was a document the size of a phone book; now it’s a massive computer file, thousands of items long, maintained by every hospital.
Stamford Hospital’s chargemaster assigns prices to everything, including Janice S.’s blood tests. It would seem to be an important document. However, I quickly found that although every hospital has a chargemaster, officials treat it as if it were an eccentric uncle living in the attic. Whenever I asked, they deflected all conversation away from it. They even argued that it is irrelevant. I soon found that they have good reason to hope that outsiders pay no attention to the chargemaster or the process that produces it. For there seems to be no process, no rationale, behind the core document that is the basis for hundreds of billions of dollars in health care bills.
* Yes, I shoehorned the Goddamned into #4, and, in fact, shoehorned #4 into this list even though a health care consumer can't really lower his or her costs by reading The Trial in the ER (even though such a book may create an uproar for reform much like The Jungle did for the food industry).

5. Make Goddamned nonprofit hospitals nonprofit.
Its nearly half-billion dollars in revenue also makes Stamford Hospital by far the city’s largest business serving only local residents. In fact, the hospital’s revenue exceeded all money paid to the city of Stamford in taxes and fees. The hospital is a bigger business than its host city.
There is nothing special about the hospital’s fortunes. Its operating profit margin is about the same as the average for all nonprofit hospitals, 11.7%, even when those that lose money are included. And Stamford’s 12.7% was tallied after the hospital paid a slew of high salaries to its management, including $744,000 to its chief financial officer and $1,860,000 to CEO Grissler.
In fact, when McKinsey, aided by a Bank of America survey, pulled together all hospital financial reports, it found that the 2,900 nonprofit hospitals across the country, which are exempt from income taxes, actually end up averaging higher operating profit margins than the 1,000 for-profit hospitals after the for-profits’ income-tax obligations are deducted. In health care, being nonprofit produces more profit.
6. Take the Goddamned bus to the hospital.

Janis S. had hired a professional to negotiate on her behalf to lower her bills.
But the best the ambulance company would offer Goencz was to let Janice S. pay off its $995 ride in $25-a-month installments. “The ambulances never negotiate the amount,” says Goencz.


  1. It is pathetic how much hospitalization costs. Here in SOuthern Illinois, an ambulance ride is $300 or more, and the ER makes sure to charge at least $2,000 for a visit, even for a relatively minor walk in visit (like a broken arm)

  2. Thanks for posting this Andrew, and for the shout out. I just want to add that anyone who reads this should definitely check out the original article (even though it is long) and share it on twitter, facebook, G+ and whatever else you got. And of course if you have a blog it would be great to make a quick post about it as well. I really would love it if everyone saw this article. If we can shift the national conversation perhaps we can start taking steps to bring down that price curve.

  3. Interesting post. I wonder - what's the overhead in VA hospitals because those are pretty much EVERYWHERE. In fact near me I have the main VA hospital, and down the street there's the otolaryngology unit. I seem to recall Medicare and Medicaid run at about 3% overhead, so VA can't be far behind.

    I do know of a study done by a VA hospital in Missouri about 6 or 7 years ago. At the time they were spending $45,000 per patient and health outcomes were very poor. So they tried a novel experiment; they sent the physicians out into the field.

    What they got out of that, and even the doctors agreed, was that they could head off events that would lead to hospitalization just be doing house calls. For example, a quadriplegic who was prone to pneumonia? The doctor would be able to head it off by treating the patient. So not only did health outcomes improve, the cost to provide the care dropped from $45,000 to $17,000 per patient or by 62%

  4. U.S. is number one in fucking the little guy!

  5. Yeah, number 5 is the big one on my radar. So many organizations that make huge profits are allowed to call themselves nonprofits for some strange reason, doling out huge sums to the people at the top. It seems so off the wall that someone is making a seven figure salary working at a nonprofit.

  6. If I ever have to be rushed to the hospital, I'll call a cab.


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