With All The Talk About “Transparency”, Medical Prices Are Still A Secret

By TamzinRosenwasser, on June 6th, 2011

Suppose you went into a grocery store, and found no prices on anything. You ask a clerk how much five pounds of potatoes would be, and he asks you whether you are 65 or older. You’re taken aback, but you tell him you are 64, and he asks whether your income is less than $40,000.00 a year. Startled, you say it is more than that, and then he asks whether you have food insurance. Why would the
price of potatoes depend on the buyer’s age, income, and insurance status, rather than on the cost of growing, transporting, and stocking the potatoes? That would be absurd.

Yet that’s how it is with medical care. I would be unable to find out, for example, the cost of an echocardiogram from the hospital where I did my residency. The price is different for different people.  The government instituted this ridiculous situation, in 1965, with Medicare and Medicaid. There is a lot of mythology about these programs, but few people understand them like the physicians who are on the front lines actually seeing the patients. For some of them, it has been a gravy train. They game the system. For others, it has been a disaster to go through medical school and residency, and come out a de facto servant to government programs, but of
course, without “benefits” or retirement. If you are scrupulously honest, these programs will bankrupt you—even while turning you into Public Enemy #1.

Senators Ron Wyden and Charles Grassley have put forth the Medicare Data Access for Transparency and Accountability Act (the DATA Act) to open a database so that everyone can see how much money Medicare has sent to any physician enrolled in it. Regardless of the cost to provide medical services, the price the taxpayers are forced by the government to pay for other people’s medical care has gone down and down per procedure, per diagnosis, per office visit.

The public won’t see that, but it will hear about some isolated cases; for example, an Oregon neurosurgeon who allegedly performed multiple spine surgeries on the same patient, or a Florida physician accused of $3 million dollars in Medicare fraud.

Gaming the system is fraud. But the biggest fraud is the one perpetrated on the working people of this nation who are forced to pay for other people’s medical problems. When Medicare was first instituted, Americans were reassured that it would never cost the taxpayers more than $9 billion a year. It is more like $500 billion a year now.

Patients learn to game the system too. Workers must pay through their taxes for even the most trivial complaint when someone on Medicare makes an appointment for it—; say for a cosmetic skin lesion that has been present for 30 years without causing any problem. Working people are also forced to pay for the consequences of other people’s smoking, excess drinking, or risky lifestyle choices. That’s fraud, perpetrated by the government on taxpayers. It’s hidden behind political smoke and mirrors.

Amazingly, we managed somehow for 189 years after 1776 without Medicare and Medicaid, and things were getting better and better —until Lyndon Johnson came up with a good fraudulent vote-buying scheme, and then a lot of people decided there was money to be made off medical problems with the taxpayers the losers.

So, Wyden and Grassley, open your database. But include a list of all the procedures and diagnoses, and what Medicare and Medicaid actually send the physicians as “reimbursement” so people can see that physicians— who spent years of their life in training while incurring tremendous debt—are paid about the same as auto mechanics. And also account for where the rest (about 80%) of the
$500 billion goes.

That would be a good start for medical price transparency. And a good precedent for another database, one detailing just how much value politicians give taxpayers who pay their salaries.

About the Author:

Dr. Tamzin Rosenwasser earned her MD from Washington University in St Louis.  She is board-certified in Internal Medicine and Dermatology and has practiced Emergency Medicine and Dermatology.  Dr. Rosenwasser served as President of the Association of American Physicians and Surgeons (AAPS) in 2007-2008 and is currently on the Board of Directors.  She also serves as the chair of the Research Advisory Committee of the Newfoundland Club of America.  As a life-long dog lover and trainer, she realizes that her dogs have better access to medical care and more medical privacy than she has, and her veterinarians are paid more than physicians in the United States for exactly the same types of surgery.



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Legalized Plunder: Cigarette Tax Edition

By Thersites, on February 11th, 2010

From Reuters:

WASHINGTON (Reuters) – Adding a $1 per pack tax to cigarettes could raise more than $9 billion a year for states, health advocates said on Wednesday, and a poll released with the study shows Americans would support such a tax.

The poll, conducted by International Communications Research, found 60 percent of voters would support the tax to help struggling states and would prefer it over other tax increases or budget cuts.

An increase in tobacco tax rates is not only sound public health policy but a smart and predictable way to help boost the economy and generate long-term health savings for states facing deepening budget deficits,” said John Seffrin, chief executive of the American Cancer Society Cancer Action Network.

“We have irrefutable evidence that raising the tobacco tax lowers smoking rates among adults and deters millions of children from picking up their first cigarette,” Seffrin said in a statement.

The report was released by the Cancer Action Network, the advocacy arm of the American Cancer Society, the Campaign for Tobacco-Free Kids, American Heart Association, American Lung Association and the Robert Wood Johnson Foundation.

All these non-profit groups have long supported taxing tobacco more as a way to discourage smoking.

The report, available here, projects the revenue that each state could earn by increasing cigarette taxes, based on research that shows a 10 percent cigarette tax increase reduces total consumption by 4 percent.

Now first off, let me just say that I am no fan of cigarettes.  I have lived with smokers and I find it to be a repulsive habit.  That being said, that people are advocating taxing cigarettes, junk food or anything else is wrong for numerous reasons.  First, it is your choice whether or not you want to consume things that may be unhealthy.  Forced “morality” through social engineering is immoral plain and simple.  Second, these types of proposals that are sold as reducing consumption of these products (which is great so long as its voluntary) are also sold as being revenue generators, which is simply an insane concept when you think about it.  The government would literally be coming up with rationalizations for taking money from you.  Since the government has grown into such a Leviathan it will look for reasons to penalize the people to fund itself.  This is legalized plunder.  A state that has to search for things to tax is a state that has grown too big.

Now the argument that this is for the public good besides the fact that it makes our citizens healthier always falls along the following lines as mentioned in the Reuters article:

“Each year in the United States, smoking-caused disease results in $96 billion in health care costs, much of which is paid by taxpayers through higher insurance premiums and government-funded health programs such as Medicaid,” the report argues

“Indeed, higher Medicaid costs are one of the reasons states are facing budget difficulties.”

Again here, as with almost all of these proposed government fixes, that smoking or obesity for example contributes significantly to healthcare costs which in turn kills the fiscal health of the nation merely addresses a symptom, not the root cause of our ultimate insolvency which is the social welfare state itself.  Smokers, drinkers and obese people would not cost us so much if the social programs didn’t exist in the first place.  Keep people off the dole and you won’t have proposals for ridiculous social engineering nor will you have massive budgetary problems.



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