Health Care in the US:Criminals in White Uniforms

It has been common knowledge for a long time that a bunch of criminals, who line their pockets knowing the sick will pay any sum to be treated, provide healthcare in the U.S.

Personally, I discovered and described this sad truth two years ago when, soon after settling down in the States, I took my child to the hospital for a knee X-ray, which costs several dozen zlotys ($20-30) in a private clinic in Warsaw. In Washington, the bill read $1,469, including $164 for straightening the leg: A Dr. Markle entered the room and straightened my child’s leg during the X-ray so that the photo would be more accurate. In the description of costs, this was called “Dr. Markle’s medical consultation,” which set me back the $164 as mentioned above. I received the bill only for informational purposes because I had health insurance; however, if I had not, I would have had to pay it myself.

As can be seen, I was familiar with the insolence of the “American white apron gang of thieves.” However, only the figures revealed by Obama’s administration this week show the mind-boggling scale of this phenomenon. Specifically, the bills for the treatment of senior citizens, which hospitals issue to the states, were published for the first time (people aged 65 and over have their treatment covered by the state as part of the Medicare program.)

It turns out that, for example, the same artificial joint procedure costs $5,000 in a hospital in Oklahoma and $223,000 in a hospital in California, or 42 times as much. One might say that California is a wealthy state, while Oklahoma is poor and far away. There is no point comparing the two. However, this huge gulf exists even within one city. For example, the treatment of pneumonia — without complications — is valued at $14,000 in one hospital in Dallas and at $38,000 in another. Similarly, the treatment of a urinary tract infection costs $21,000 in the northern suburbs of Miami and $95,000 in its southern counterparts.

Such vast differences in price prove that hospitals are free to take as much money as they deem appropriate for their services; some are less ruthless, while others are completely neutral toward patients’ financial status.

However, it is not so easy to play the state for a fool because it pays hospitals according to the official Medicare price list: Most frequently, the figures are a few times lower [for the state] than in the above-mentioned bills. What is more, hospitals do not have the right to undermine the price list. Private insurance companies also pay less — although about 30 percent more than the state — as they negotiate group contracts and therefore attain a powerful bargaining position.

Only the weakest and poorest are “privileged enough” to pay the full prices without any discounts, which amounts to about 50 million uninsured in the U.S. — that is, if they can afford it, since about 1 million people a year go belly-up in the U.S. as a consequence of the high cost of health care.

Recently, Time magazine described a salutary example of such practices. Sixty-four year old Janice S. from Connecticut had been unemployed for a year, so she could not afford health insurance, which costs a few hundred thousand dollars a year. Last summer, she felt chest pains, panic sank in, and she called 911. She was admitted to Stamford Hospital, located four miles away. After a three-hour examination, the doctor gave her a soothing diagnosis: a mild food poisoning. She was sent back home.

Some time later, she received the bill: $995 for the ambulance, $3,000 for medical consultation and $17,000 for various tests and examinations, amounting to $21,000 in total.

The bill lists, for example, a troponin test conducted in the event of heart attack symptoms, which the hospital valued at $200 (it was administered three times, so the bill showed $600). If Janice had been one year older, she would have qualified for the Medicare program and had to cover only a small percentage of the bill, meant to deter hypochondriacs from flooding hospitals and health care centers. According to the official price list, Stamford Hospital would have gotten $13.94 for each troponin test, or approximately $42 in total.

There would have been no other alternative for the bandits in white uniforms than to accept the $42 because they cannot argue with the state. But unemployed Janice was too weak, so they effortlessly wrung 15 times more from her. Every penny counts for Stamford Hospital, which is, just like many other health care facilities in the U.S., a nonprofit organization — thanks to which they are free from taxes. They have to make enough money to cover the $2 million-a-year salary of the director, not to mention that the doctors employed there are top-notch experts requiring top dollar for their service.

The bill sent to Janice S. was only the first stage of the operation of sucking her dry, which requires adroit and shrewd maneuvering since, in the event of the patient being unwilling to pay, the whole issue has to be brought to court, a debt collector needs to be appointed, the seized goods are auctioned, and all these activities are highly impractical.

The later course of events was as follows: Terrified Janice S. came across a medical bill negotiator on the Internet. Usually, hospitals agree to reduce the bill by 30 to 50 percent if the patient declares willingness to pay, said the negotiator, whom Janice paid an extravagant $97 per hour. But the money turned out to be well invested. Stamford Hospital lowered the bill from $21,000 to $11,000.

That left everyone happy and content: Janice — because the nightmare was two times less scary than it had looked at the beginning — and the outlaws in white uniforms — because they found another sucker who paid them a few times more than the state or a private insurance company, although treating patients with health insurance, who are in the vast majority, still brings enormous profits! The negotiator also did not have any reason to complain. She earned plenty of money working as an intermediary between the criminals and their victim.

Looking at this universal happiness, even I catch myself thinking whether I am right calling doctors in the U.S. criminals. After all, when we are exchanging wishes we always say, “Stay healthy because health is the most important thing in life!” If it is so, we should not spend most of our money on cars, traveling abroad or houses, but on health. From this perspective, even the record 20 percent of gross national income Americans allot to health care is still way too little.