An old, dishonorable practice needs to be seen in a new light, namely making people without health insurance pay far more than others for needed health care. This especially affects immigrant groups, and among them, Latinos have the highest rate of uninsurance.
For decades, providers and especially hospitals, have kept raising their charges, far higher than their costs, in order to raise their "profile" for discount payments from government programs and insurers. Each year they raise the charges, and each year the payers respond by lowering the percentage of "charges" they will pay. This game is fine for those in them, and conversations about those not in them usually focus on Sheiks. In a recently conversation, a sub-specialist at a famous hospital was explaining how only millionaires and Sheiks pay full charges - they are so outrageous -and these windfall sums help pay for the uninsured.
But first, the uninsured are billed the "standard charges" (which no insured person pays). Then, when they cannot pay, bill collectors are sent, who attach their credit cards or homes (if they have one), and who threaten to report them to the INS. These charges are typically 3-6 times greater than what is normally collected from HMOs, insurers, and managed care plans. I recently experienced this personally, when a routine blood test was deemed not covered. The lab (a large national company) normally collects $85 for the test from discount contractors, but because they were billing me as an individual, their itemized bill was $401, more than 4 times greater. I got my physician to write a note and the bill was adjusted down to $85. If this had been for a hospitalization, the bill might have been $8500 to a plan or insurer, but $40,100 to an individual.
These practices have been documented by Consejo De Latinos Unidos, and they have a class action suit against Tenet, the huge managed care corporation, for ethnic discrimination. They have even shown in what unsystematic data they have been able to gather, that a hospital recovers more income from uninsured Latinos than from HMOs, i.e., the collection agents get them to pay a third of the bill, or $12,000 before taking them to court and/or getting them deported, when a routine payment would be $8500. Their material include a number of case studies that are an embarrassment to read.
Of course, Tenet replies they are doing what they always do, and that is correct. That's "how the system works." The judge on the case happened to speak about it off the record and comments that courts are not set up to change systems. In short, a dishonorable old practice of charge inflation has tragic consequences for the uninsured and especially for immigrants. All discussions about the uninsured, and about individualizing health care by having employees get health insurance for themselves, need to include these issues and practices.
Joanne Landy, Executive Director of the New York Chapter of Physicians for a National Health Program, responds to Rima Cohen on the Health Care Access Resolution - House Concurrent Resolution 99 (HCAR or HCR 99):
I was happy to see on the Q of the D that Rima Cohen, Vice President at the Greater New York Hospital Foundation and Director of the Insurance Options for the Uninsured Project, supports the Health Care Access Resolution - House Concurrent Resolution 99. As a statement committing Congress to enact universal health care by 2004, it is an urgent and necessary resolution.
It's important to note that HCAR goes beyond calling for universal care; it calls for a guarantee that every person in the United States, regardless of income, age, or employment or health status, has access to decent, humane and affordable care, as detailed in the resolution (see below.)
It is important, however, to urge the public and members of Congress to work simultaneously for a single-payer health care system in the United States that can actually achieve the crucial goals enumerated in HCAR. A single payer system would create a universal risk pool and would finance health care through progressive taxation rather than through an employer-based system that depends on private insurance companies. A single payer system (essentially an improved and expanded Medicare-for-All) would save enormous amounts of precious health care dollars currently spent on marketing, on profits, and on the administrative costs built in to a system that forces providers to comply with hundreds of different insurance plans.
HCAR was introduced by U.S. Representative John Conyers, who is to be congratulated for his vision in doing so. He will shortly be introducing a single-payer health care bill, which will address the question of how to contain health care costs while assuring universal access to quality health care. I hope that Rima Cohen and other supporters of House Concurrent Resolution 99 support the Conyers single-payer bill as well.
HCAR calls for healthcare that: (1) is affordable to individuals and families, businesses and taxpayers and that removes financial barriers to needed care ; (2) is as cost efficient as possible, spending the maximum amount of dollars on direct patient care; (3) provides comprehensive benefits, including benefits for mental health and long term care services; (4) promotes prevention and early intervention; (5) includes parity for mental health and other services; (6) eliminates disparities in access to quality health care; (7) addresses the needs of people with special health care needs and underserved populations in rural and urban areas; (8) promotes quality and better health outcomes; (9) addresses the need to have adequate numbers of qualified health care caregivers, practitioners, and providers to guarantee timely access to quality care; (10) provides adequate and timely payments in order to guarantee access to providers; (11) fosters a strong network of health care facilities, including safety net providers; (12) ensures continuity of coverage and continuity of care; (13) maximizes consumer choice of health care providers and practitioners; and (14) is easy for patients, providers and practitioners to use and reduces paperwork.
Does anyone seriously believe that our private, employer based heath care system can deliver this package? To ask the question is to answer it.
--Joanne Landy Executive Director Physicians for a National Health Program New York Chapter
Comment: It is very easy to ask your member of Congress to support House Concurrent Resolution 99 by sending a message through the following link: http://www.house.gov/writerep/