Medical Malpractice

For a recent discussion on medical policy in this country, one may wish to read this. If you get through the entire thread, you’ll see that Holland has a “stealth” way to bring universal health care to America, which is to let all Americans, regardless of age and including those with private insurance, decide if they want to enroll in Medicare. Not a bad idea, and Holland lists quite a few impressive statistics to back up his arguments on why this would be more efficient than the current system of private, patch-work health coverage, but if you follow the thread you’ll see that Holland encounters a statistical adversary who undoubtedly is clever enough to throw dust in the eyes of many. There is, perhaps, a more straightforward and potent way to get change. See if you follow me.














In the posted images are found the medical bills of a patient who wishes to remain anonymous, but had sinus surgery (deviated septum and removal of polyps) at the Cleveland Clinic in the last year. The patient’s surgery lasted about 5 hours with a stay of one night in the hospital for observation. All the billing refers to this procedure and does not include some of the pre-surgery visits or follow-up. Image 1 and 2 are the bill from the Cleveland Clinic, and Image 3 comes from the insurance company, Medical Mutual, and details what the insurance company actually paid. It ought to be said that these billing statements say nothing particularly bad about the Cleveland Clinic or Medical Mutual – undoubtedly they adhere to industry-wide standards, so this could just as well be any hospital or insurance company in America. As one can see from Images 1 & 2, the total price tag of the Clinic, not counting prescription drugs, was $55,160.68. But in Image 3 one can see that Medical Mutual actually paid only a fraction of the total amount – roughly 1/9 (this comes out to about $6,130). For instance, on Image 3 under the first item listed we see that the “Repair of Nasal Septum” was billed by the hospital at $3389.00, but only $312.58 of this was reimbursed under “Benefits Paid.” But go back to Image 1 and notice that the hospital, in the middle column, says “Paid by insurance or adjusted” (my italics). One must assume this means that Medical Mutual told The Cleveland Clinic to jump in the lake in regards to the full amount and that they would pay only $312.58, and the Clinic said, “OK” and then adjusted the bill accordingly.

OK, so a total of about $6,130 is still a bit outrageous for a day’s work, but what would have happened to anyone who did not have insurance? In fact, we don’t have to wonder – given that somewhere between 45 and 50 million Americans do not have health insurance, and many more are underinsured, these stories are commonplace. Such a patient probably would not have even gone to the doctor and thus would have lived an uncomfortable, less productive and shorter life, full of sinus infections and breathing problems, or had he gone he would have been billed at the full rate and then would have had to beg for mercy, or would have sought outside help, or would have gone bankrupt -- it’s no wonder that over 50% of bankruptcies in this country are a result of medical bills. The plight of the uninsured or underinsured undoubtedly must be compounded by the fact that these hospital companies (yes, for-profit companies; the Cleveland Clinic calling itself a “Foundation” is an abuse of language) are difficult to deal with and would just as soon turn un unpaid bill over to a collection agency and let them harass the patient for payment. Shouldn’t the government step in and haggle for them?

So while this particular patient was happy with the hospital, happy with the doctors, happy with the surgery, even happier that the insurance company picked up most of the tab, and now feels much better, said patient wonders what could possibly justify health care being run, priced and rationed in such a way in this country? It certainly isn’t rational. It’s an utter indictment upon our government that it would allow so many citizens, whose numbers are growing every day, to live under such a cloud of uncertainty, which must be bad for business. Nor is it moral. What ever happened to being our brothers’ keepers? Maybe all citizens, especially those without insurance, should post their bills on the internet, or send them to their politicians. In the face of the sheer magnitude of the medical malpractice, against which even the most practiced sophist could not argue, maybe then something would be done about this.