Michael Moore's Latest Target: Your HMO

PS I work in hospital financial administration.

The fact that if you come to my hospital for an emergency appendectomy and you have a PPO or HMO with Aetna, we'll get paid about $3500 by your insurance company.

If you don't have insurance and you come in for the same emergency appendectomy, we'll charge you $150,000.

I'm not kidding.

OK, I'm no expert in this field, so I'm genuinely confused by people who say that our health care system is broken.

In your example, is this a complaint by the hospitals and doctors that they should get $150,000 for such a procedure whether an individual is covered or not? Or do they honestly feel bad for the uninsured who have to come up with this cost?

Would the situation improve if the federal government allowed for individuals to deduct the cost of their health care coverage off their income taxes? Why don't we ever hear of an offer like this if the politicians are as concerned about the uninsured as they say they are?

In your example, is this a complaint by the hospitals and doctors that they should get $150,000 for such a procedure whether an individual is covered or not? Or do they honestly feel bad for the uninsured who have to come up with this cost?

No it's definitely not a complaint, it's a necessity for financial survival.

Would the situation improve if the federal government allowed for individuals to deduct the cost of their health care coverage off their income taxes? Why don't we ever hear of an offer like this if the politicians are as concerned about the uninsured as they say they are?

No, because the federal government would lose way too much revenue. They'd have to enact some sort of other tax to make up for it, lest we end up in an even bigger federal deficit than the one Bush has already pushed us into.

I can see an argument against pharmaceutical companies to some extent, because they pull in massive profits. But you can't get all up in arms about one particular drug costing an insane amount of money. People like to say oh well that drug only costs $10 to make and they're charging $100 for it. Well that's because they spent $80 researching other possible drugs and vaccines that were deemed either ineffective or unsafe by the FDA. Pharmeceutical R&D is a huge expense and has to be factored into the equation for the drugs that do actually make it to the market.

For the record, the vast majority of drugs are insanely marked up. I understand that the research and development side is expensive, but look at cancer treatments, which have been basically the same for 20+ years. My father has been on aggressive chemo and radiation for several months now. He was getting one of each treatment almost weekly for a while, and racking up around $10,000 in bills per week. It's friggin ridiculous that people are being charged insane amounts of money for drugs that are easily mass produced and haven't changed dramatically for over two decades.

What's "sad" about our health care system?


Plenty, where should we start?

Let me answer with a question, what's good about our health care system?

For the record, the vast majority of drugs are insanely marked up. I understand that the research and development side is expensive, but look at cancer treatments, which have been basically the same for 20+ years. My father has been on aggressive chemo and radiation for several months now. He was getting one of each treatment almost weekly for a while, and racking up around $10,000 in bills per week. It's friggin ridiculous that people are being charged insane amounts of money for drugs that are easily mass produced and haven't changed dramatically for over two decades.

OK here's the lowdown on cancer drugs. Essentially, the federal government is retarded, and incapable of catching unscrupulous practices by the pharmaceutical industry.

You're right, there are cheap cancer drugs like Vincosar, Troposar, and Neosar. They're mass produced and aren't all that expensive. But pharmaceutical companies know that Medicare patients are the most frequent recipient of cancer treatments. And the pharmaceutical companies know that Medicare administrators aren't always on the ball. So, knowing that Medicare will reimburse the pharmaceutical companies at 80% of AWP (the average wholesale price), the pharmaceutical companies jacked up the AWP of cheaply manufactured generic cancer drugs. They'll charge $700 for a 2 mL dose of Vincosar, knowing that Medicare will reimburse them 80% of it ($540 per dose).

So Medicare pays this high price because they're not on the ball, and as Medicare continues to pay that price, it only lends validity to the high price in the marketplace. So... if you don't have Medicare? You better have solid insurance that has an agreement in place with the Pharmaceutical companies to pay a reasonable price for the drug (Aetna at 30% of AWP, etc.). If you don't have insurance? You're on the hook for all $700 per dose. Blame the pharmacuetical company for being unscrupulous with the pricing, blame the federal government and Medicare administration for being too inept to catch the problem, and blame yourself for not getting a job that has good insurance coverage. Plenty of blame to go around.

One of the true horrific examples of our bullshit system.

Does your father have insurance coverage? Is it commercial coverage or is he on Medicare?

Plenty, where should we start?

Let me answer with a question, what's good about our health care system?

The quality. Outcomes and survival rates are higher here than in any other developed nation. Infection rates in hospital facilities are the lowest here of anywhere in the world. While I'm deeply troubled by the cost physicians incur for malpractice coverage, at least there is a system in place to deter physicians from making mistakes. There are fewer physician errors here than in any other nation.

But from a cost standpoint, and a fairness standpoint as far as different people paying different prices for the same service? Yeah we got plenty of problems.

I'll give you quality... but I think most would agree that doesn't outweigh the negatives.

Does your father have insurance coverage? Is it commercial coverage or is he on Medicare?

I believe he has commercial coverage through his employer, but I know he was basically fighting his insurance company to get them to cover some of the costs. And thanks for the info. I always assumed that federal government was involved, but your example makes them sound completely inept(shocker...) instead of being in on the scam.

I'll give you quality... but I think most would agree that doesn't outweigh the negatives.

It sounds like you're comparing our healthcare system to those of European nations where healthcare is nationalized.

I'd take the American system any day of the week. There are more positives than just quality...

- Choice. Overseas, you are often designated to a certain facility or healthcare provider. If you don't like them, tough, you're stuck. Here, even if you have a crappy HMO, you still get to choose from a network of providers. If you have a PPO, you can see anyone.

- Fire and rescue services (including the 911 system) here are 1000% better than in Europe.

- Wait times at hospital ERs are way shorter here.

- There is a much greater specialization of surgical services here. In Europe, if you need to have a tumor removed from your spine, you often end up having a general surgeon do it. In the US, you have a spine specialist do it. Explains why survival rates are so much higher here for like procedures.

All this is not to say that we don't have major problems because we do. No matter what, it's total bullshit that someone without insurance pays 10 times what someone with insurance is charged. But I'd take quality over cost any day of the week; especially if it's my wife, daughter, mother or other family member getting taken care of.