Navigating Healthcare Billing and Insurance

To our guest today, the current American healthcare system feels less like a means to get well and more like a gigantic racket. We’ve gone from hospital visits in the 1950s costing five dollars a day to getting billed for everything from the oxygen reader on your finger to the IV bag. So how did we get here?

Elisabeth Rosenthal is the senior contributing editor at KFF Health News and the author of the book, An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. Before her career in journalism, she spent some time practicing medicine at an emergency room in New York City. 

Elisabeth and Greg discuss the puzzling economics behind healthcare pricing, how medical bills balloon because of too many hands in the honey pot, and some practical advice for people heading to the hospital. 

*unSILOed Podcast is produced by University FM.*

Episode Quotes:

Private equity goes with where the opportunity is, and it's in health care

04:32: One person told me, when I was writing my book, between the hip manufacturer, the implant manufacturer, and the patient's bill, that there are 13 people taking a cut of the price of that implant. 13 middlemen, and we just keep adding middlemen who take more money from the system. So the interesting thing is how much of that, now 3.5 trillion dollars that we spend on healthcare, how much of that is actually going to care, and how much of that is being siphoned off for profit, for executive salaries, for investor profit. I don't know what the percentage is, but it's like a Rube Goldberg machine for extracting money. And the poor patient is, well, what about me? You're just kind of an ATM; it’s really sad. Private equity goes where the opportunity is, and it's in healthcare.

Which side are the insurers truly on?

11:48: People have this misguided thinking that, ‘Oh, my insurers are in my corner’ They're not in your corner. They're like, ‘They take in premiums, and they pay out claims.’ And if they can raise the premiums and raise the copays and deductibles, they don't really care if the prices go up. Plus, they have these very sophisticated deals with big hospital systems.

Are we regulating the wrong things in healthcare? 

39:33: We regulate all the wrong things. Yes, putting stitches in your hand is fine. You don't need a doctor to do that. A tech can do that fine. But in the U.S., you are going to be billed as if a doctor did it, whether a doctor did it or not. You might be billed for the physician assistant who did it too. You might be charged for both because the doctor might have come and looked at it and said, "Yeah, that needs stitches." So it will be billed in this crazy way, but I think on the other hand, the physician assistants and nurse practitioners are looking for independent licensing. Mostly everything they do is billed as if the doctor did it, even if the doctor was 50 miles away. So that's why some of the bills are so high.

Navigating consumer rights and prices

50:23: When you go to a hospital, and they give you that clipboard to sign 20 forms or even a tablet, I always cross out the part that says I will pay for anything that my insurance doesn't cover because that's in one of those forms that are always in there. And people should never sign that; you can shop for the electives, small-dollar items. You can get estimates, and to me, this is where the government should come in.

Show Links:

Recommended Resources:

• Uwe Reinhardt
• Willie Sutton
• Rube Goldberg machine
• No Surprises Act
• Diagnosis: Debt (KFF Health News)
• March of Dimes
• Juvenile Diabetes Research Foundation

Guest Profile:

• Professional Profile at KFF Health News

Her Work:

• An American Sickness: How Healthcare Became Big Business and How You Can Take It Back 
• How Your In-Network Health Coverage Can Vanish Before You Know It (KFF Health News)