Put this man in charge

In the Sunday Trib ‘Voice of the People’ section, the lead letter to the editor was exceptional for how much it said in such a short space about the health care crisis. Things we aren’t hearing from mainstream media.

Its jumping off point is to respond to a startling and disturbing front page Trib article last week about a man who was cleared by his health insurance company to have needed back surgery with the assurance of coverage. After that surgery, the insurance company refused to pay.

Dr. Alexander Stemer, president and CEO of Medical Specialists Centers of Indiana, wrote about “Excessive Charges”:

Tribune columnist Jon Yates’ “They authorized back surgery but denied his $148,000 claim” (Page 1, July 21) is illustrative of the unexplored core of today’s health crisis.

Okay, stop right there. Why is it “unexplored”? Thankfully, he explores that core, and I’ve never heard some of this before. 

For many services, the problem is not that excellent medical care costs too much, the problem is that pharmaceutical companies, manufacturers, hospitals and some doctors charge too much.

Note he qualifies that “some doctors” do this, while the rest of the health care industry kind of bundles into categorical excess. 

As the president and CEO of a multispecialty physician practice that is similarly self-insured for medical costs, I have witnessed a nearly identical charge ($150,000 for back surgery) that was quickly negotiated down to $60,000, but should have been $30,000. However, when the supplier of the titanium plate and screws that are used in the surgery can charge more than $20,000 for what is probably worth $200, and the surgeon charges $100,000 for what is worth $14,000, and the hospital charges $30,000 for what should have been $16,000, the insurance company and, ultimately, the employer are trapped. Premiums must rise or benefits must shrink.

Why aren’t the media making these kinds of revelations? Who’s addressing these specific unjust and unethical practices? Besides this doctor in Indiana….?

Rather than illustrating a unique example, this article is demonstrative of one of the major problems of U.S. health care. Pacemaker/defibrillators that cost $50,000 (worth $5,000), joint hardware that costs $4,000 (worth $800) and pharmaceuticals that cost 2.5 times more than they do in any other developed nation are a root cause of the “crisis.” This must be addressed before our government saddles our country with an exploding health-care expense that will bankrupt the current and every future generation of taxpayers.

Yes. This makes perfect sense.

When we eliminate excessive charges, when tort reform lowers operating costs (as it does in Indiana),

and tort reform is a critical and necessary component of this out of control problem,

when cost-shifting in hospitals is eliminated (currently, the insured pay for the uninsured with higher charges) and we implement national certificate of need, costs will drop and the crisis will resolve.

But we also must decide if everybody gets everything. If there is an artificial hip that is good and costs $800, but the one your doctor recommends is $3,400, must the government absorb that cost, or is it the patient’s decision and burden to pay the $2,600 difference? Right now manufacturers have no incentive to lower charges. Defining the minimum standard for which we pay will resolve much of this concern. But as long as a pill that costs 4 cents can be sold for $4, buying more pills for more people will make the problem worse.

Has anybody in Congress explored these recommendations? We were promised transparency in government. Anybody seeing this kind of clear-minded analysis and understanding going on there? 

Another letter on the same page of the Trib opinion section, a brief one, said “Slow Down”.

Why rush the health-care bill through, unless there are things in it that Congress doesn’t want the public to know about? It is one of the most complex pieces of legislation ever attempted by Congress. A satisfactory program for everyone is of more importance than speed in passing an unsatisfactory one. Congress should take the time for proper deliberations on this most important task for the American people.

They should deliberate over Dr. Stemer’s recommendations.