Who’s really paying for health care?

In Editorial on April 16, 2012 at 11:41 am


Everyone in favor of ObamaCare, raise your hand.

The most brilliant propagandist technique will yield no success unless one fundamental principle is borne in mind constantly – it must confine itself to a few points and repeat them over and over.” – Joseph Goebbels

Goebbels, the Nazi propagandist, truly understood marketing. So do the statists pushing ObamaCare.

Their oft-repeated theme in letters to newspaper editors and in orchestrated television sound bites has dealt with an alleged mandate the uninsured place upon those who dutifully buy corporate health insurance. It goes something like this:

“We already have an insurance mandate created by those who don’t have insurance and cannot pay their medical bills. Those of us with insurance end up paying for them. Isn’t that a true mandate?”

No, it is not. Clearly, the purveyors of such useful idiocy do not understand medical billing.

Here’s how it works:

“Clara”, a new doctor, hangs out her shingle and hopes to charge $100 for patients to use her very expensive machine that goes ‘PING!’ Her hopes are bolstered because almost every other doctor having the machine that goes ‘PING!’ is also charging $100 for its use. This, then, becomes the usual and customary fee/charge.

However, this is not how much the doctors are paid.

Medicare, the almost ‘free’ insurance one obtains for…well…just surviving, pulls out its Ouija Board and calculates that the welfare state will allow doctors with pinging machines to charge $45 per its use. This is called the allowed charge and Medicare generously and cheerfully will pay 80% of the allowed fee.

A private health insurance company,“The Reptilian”, will allow 200% of Medicare’s allowed charges for each of their insured who wants to be hooked up to the very expensive machine that goes ‘PING!’ The discount is given to the doctor in exchange for “being allowed access to the lives we insure”. The insurance company will typically pay 80% of charges.

So, for the Medicare patient:

PING charge:            $100

Allowed:            $45

Paid to doctor: $36


And, for the patient covered by The Reptilian:

PING charge:            $100

Allowed:            $90

Paid to doctor: $72


And, what about those evil uninsured folks?

PING charge:            $100

Allowed:            $100

Paid to doctor: $100

Now, who’s paying for whose care?

“What about the deductibles and co-pays, Mr. Smartypants?”

About 75% of doctors, to avoid pissing off patients, will “write off” deductibles or “bill” (wink-wink) the insured patients later for their deductible and co-pay charges. Of course, doing so is typically a violation of the doctor’s contract, but such things are almost never enforced. The insured parasites on the system know this and, with more than a little chutzpah, often ask (or demand) further discounts than their insurance already negotiated.

The 20% share called patient responsibility (LOL!)?

Medicare specifically states that providers cannot write off the patient’s share. But there is nothing mandating how aggressively the provider must enforce payment of those charges. To keep old farts loyal, many docs write off the patient’s portion of the charges to avoid a scene involving Grandpa Simpson screaming, “BUT MY OTHER DOCTORS DON’T MAKE ME PAY!”

Samey-same for the privately insured. Most doctors would rather grin and bear the loss of 20% of a fee if it means a happy patient…since happy patients seldom sue or complain to medical licensing boards…or even walk down the street in search of a better deal.

So, let’s re-cap for the dullards:

If Doctor “Clara” hooks up the following patients to her very expensive machine that goes ‘PING!’ she will expect payment in the following amounts:

Medicare: $36

Private Insurance: $72

The Uninsured: $100

While the folks at Medicare cannot mandate how diligently a doctor must pursue recovery of the patient’s share of the bill, they are very diligent in enforcement of rules prohibiting doctors from providing discounts to non-Medicare


covered patients. In other words, Clara cannot be kind-hearted to a person and agree to charge them only the $36 she would be paid if the person had Medicare. If she did so, Medicare can assert that the true usual and customary ‘PING!’ charge for ‘Clara’ is actually $36, not $100. While Medicare will reimburse up to $45 and Clara will not be negatively impacted, The Reptilian may assert that its company is being overcharged.

Also, if a private insurer or the welfare state decides the benefit of any machine going ‘PING!’ is dubious and not worth coverage, they create a paperwork storm of advanced beneficiary notices which must be provided to the patient before the machine is hooked up. Otherwise, Clara ends up providing free pings.

The uninsured? They get no such notices, or often, not even an estimate of the possible charges related to ping testing. They can simply be lined up, hooked up, and billed for a “PING!” that has dubious medical value. This happens in hospitals all the time. Patients are passed from specialist to specialist (“Share the Wealth!”) and wheeled from test to test while a financial improvised explosive device is assembled in the billing department to be handed to the patient upon discharge.

No insurance company or welfare program would (or should) willingly pay $12 for an aspirin, but the uninsured are simply told, “Pay up, or we’ll sue.”

So, the question remains: “Who is paying for whose care?”


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s

%d bloggers like this: