Monday, November 16, 2009

The Peanut Bar

(fm the BC thread "In sickness and in health")

When people have to pay cash up front, they show up when they are sick.

This is all true but it does not take into account one of the major distortions in the pricing system that we face. The cash prices assigned to people who do not assign their bills to a 3rd party are simply divorced from the actual value of the services rendered. A few months ago I shared with the Club how I went to a local ER for a cut finger, that turned out to look bad but only needed Bacitracin™ and a bandage. Unlike most people who walk in uninsured I honestly showed my ID. The result is a bill for $1,100 that may sit out there until I take a dirt nap.

If you walk into a restaurant and they don't show you a menu before you ask a cup of coffee but then hand you a bill for a thousand dollars people would say "No way." That doesn't happen anywhere in America anymore outside of a hospital. Even the hotel minibar has a price list warning you before you drink the bottled water. You hear stories like that from people who ate the peanuts in a bar in Japan.

The problem isn't with the physicians but with the regulated administrators. There should be standard costs for common services published by region and any deviation from those fees should be prominently advertised before any services are rendered. We need more daylight on the costs being charged. That is the opposite of a controlled government system that increases the distances between consumers, practitioners and payers.

an effort to collect because ... they can be prosecuted for Medicare fraud

If they had looked at me and said "We will charge you $200 to have an Intern (he may have been a Resident or a 4th year Med Student, one never knows) look at it, or you can go to the Municipal, which is it?" I would have said "Fine, go ahead" and paid for my folly. If I needed a stitch they could have looked at me and said, "A stitch will cost you $100. Do you want us to do it or will you go elsewhere? You'll live so either is medically OK." That would be OK also. By not giving up front pricing information and then quoting a price they knew they wouldn't collect they were making me a party to their perpetration of fraud against the Medicare system.

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