Uninsured’s ills worsen come bills
By jspencer@denverpost.com
Jim Spencer
Denver Post Columnist
Friday, July 09, 2004 –
To read Scott Ferguson’s hospital bill is to know the insanity of modern medical economics and the nightmare of 44 million Americans without health insurance.
Here is an albuterol inhaler available at drugstore.com for $13.99. Centura Health’s St. Anthony Central Hospital in Denver charged Ferguson $323.05.
Here is a 30-cent dose of the diuretic Lasix. Centura wanted Ferguson to pay $72.30.
Ferguson, a 51-year-old musician with a heart condition, also got 28-cent tablets of Motrin for $12.70 apiece, $1.73 doses of Ativan for $75.60 a pop and Valium for $79.15 a dose instead of the drugstore.com price of $2.24.
Six hundred milligrams of an antibiotic called Cleocin is readily available at $9.54. Centura’s charge to the uninsured? How does $136.30 grab you?
The bills from a six-day hospitalization for a heart attack last December threatened to grab Ferguson by the bank account and choke the financial life out of him.
That’s why he refused to pay his $67,000 hospital bill. Ferguson discovered that the government health-insurance programs Medicare and Medicaid would only reimburse Centura roughly $6,700 for the services he received.
“I offered them that, plus 30 percent profit,” Ferguson said. “I had the cash to pay them what the insurance companies would have.”
Centura wouldn’t settle, Ferguson said. So Ferguson joined a national lawsuit that challenges discriminatory pricing that victimizes folks already down on their luck.
“I see people destroyed by this,” Ferguson said. “I see no reason for that.”
Centura officials said they couldn’t talk about Ferguson’s case because of the lawsuit. But the people in charge of the Colorado Hospital Association claim this is how it has to be for the uninsured.
“By federal regulation, in order to participate in Medicare, Medicaid and private (health insurance) plans, everybody must be charged the same price,” said Peter Freytag, CHA’s vice president.
But while everyone gets charged the same price, nobody actually pays that price except, perhaps, the uninsured. Government and private insurance companies cut far better deals with hospitals across the country.
In an example that doesn’t involve Centura or Ferguson, records for someone with a private health-insurance plan showed a $16,108 charge for testing blood flow in the patient’s heart. The insurance company paid only $10,470 – $5,638 less than the bill.
To stay in business with so many discounts, Freytag said, hospitals must set prices high. The result is that a portion of all hospital costs are reflected in the charges. That’s why guys like Ferguson get bills of $323 for $14 inhalers.
The inflated charges can get written off as charity or bad debt, Freytag said.
Since joining the lawsuit, Ferguson says he’s heard from plenty of people who paid wacky amounts because of threats from hospital bill collectors.
The whole health-care pricing scheme reminds medical economist J.D. Kleinke of “a psychedelic version of what car dealers do with sticker prices. Everything’s on sale.”
Unless you happen to be uninsured. Then, said Kleinke, you prop up hospitals that remain “incredibly profitable.”
“The Daughters of Charity are known on Wall Street as the Daughters of Currency,” he said.
The answers aren’t easy. A single-payer health-care system would do it, Kleinke said, but Americans don’t seem ready. Meanwhile, regulatory changes that force hospitals to charge the uninsured the Medicaid reimbursement rate will have to do.
One thing is certain: Americans need a change of heart.
“There is,” contended Kleinke, “almost a disdain for the poor.”
Nothing says it better than trying to collect $136.30 for a $9.54 dose of antibiotics.
Jim Spencer’s column appears Mondays, Wednesdays and Fridays. He can be reached at 303-820-177
