What industry or business on this planet can implement significant increases in their cost every year and still be around, profiting and surviving very happily today?

Answer: healthcare and the health insurance industry.

Why don’t we purchase health care like we purchase everything else in this country?  When you go to the grocery store and purchase any vegetables, canned goods, or meat, etc., everything is labeled and has a price. If you go to an auto dealer and purchase a vehicle, the sticker price is on the window and while you may negotiate something different, or customize the vehicle to your liking, you know exactly what you’re purchasing and for how much.

In other words, we wouldn’t go to the grocery store and fill up our cart with all kinds of food and never check prices. Nor would we go to a dealer and order a card and say “just send me the bill 90 days from now.”

So why is it different in healthcare?

As of January 1, 2019 the Trump administration has required all hospitals to publish their charges. While transparency is a good thing and allows us to compare prices (if you can understand the methodology), it’s all relative – just because one price is lower than another, how do you know that the lower price isn’t too high to begin with? 

The problem we have in this country is that these charges not only do not reflect their stated cost to the Federal Government at the Centers for Medicare and Medicaid, or their reimbursement from Medicare, but the charges can be whatever they want them to be and can change them anytime they want. There are no rules, no regulations, no laws, or anything else that regulates healthcare prices.

So how do you know if the charges are fair?  You don’t.  It’s from these charges that the insurance companies negotiate their PPO discounts – which by the way are confidential – so at the end of the day you still don’t know what the charges actually are – until you get the bill.

Even if you sign a document at the hospital that states that you will be responsible for anything that the insurance doesn’t pay, there is rarely a price stated.  How can you be responsible for something that doesn’t have a price?  The Latin term Quantum Meruit which applies to State contract law and infers a “reasonable” price into any contract without a stated price – something hospital bills almost always do not have.

I’m certainly not in favor of Federal regulations of prices but something has to be done to keep prices fair.  Those in favor of a single payor system e.g. Medicare For All, and think that will control prices should think about the many negative ramifications.  If providers think that Medicare pays too little, what will they think when the Federal government decides to lower them further?  Lower reimbursements will foster fewer medical providers who can’t make a living, which will then ration care because there aren’t enough providers to see those who are ill or have accidents.  We won’t have a “Canada” to run to in order to avoid waiting lines.  Oh, and our taxes?  I hate to think what they may go up to.

There is a solution – pay providers a fair and reasonable profit over their costs.  Mechanisms and programs are available today to do just that.  There is a way to make our current form of healthcare affordable and sustainable.

If you would like to learn more about how you can take advantage of these programs, please email me at frank.stichter@strategichpc.com or call me at 970-349-7707.