The Health Care Crisis Is Like an Episode of Hoarders

So, I never claimed this was going to be a “mommy blog” anyway, but health care? WTF you say? WTF, indeed.

Seriously though, we need to talk about health care. I know a thing or twenty about this topic considering my years in the industry and with this "insider knowledge" I want to put together a cohesive (perhaps entertaining) dialogue about a few things no one is talking about.

Photo: Peter Walsh Design

Health care is one of the most important and convoluted issues of our time. It’s important because it is 1/6 of our nation’s economy; convoluted, because anything that is 1/6 of a multi-trillion-dollar economy is going to have a lot of moving parts. Just thinking about it feels like walking into a house on Hoarders. It reeks, it’s cluttered and way too overwhelming.

But if you're one of the millions of uninsured American's suffering under the weight of all this crap, you know it's mandatory that we pick up our shovels and organize our piles on the lawn Peter Walsh style before this toxic, biohazardous waste gets one more piece of useless trash added to the top in the form of legislation. Because the situation is gettin’ real stank up in here and those Glade Plug-ins aren't doing a thing to mask the stench of rotting cat carcass. Over the years we've simply added one piece of ineffective legislation on top of another and it's time we attempt to understand what's under all this shit because Mr. & Mrs. Voting American, our names are on this deed. Stay tuned, crude illustrations to follow.

What got me all fired up to write this post was Xeni Jardin's Twitter stream from last week. Xeni Jardin, founder and editor at Boing Boing (@xeni) is currently receiving treatment for breast cancer. I don't know her whole story but I'm assuming it includes a struggle with insurance and paying for her treatment. Her Twitter page went crazy last week with tragic stories of people who have also struggled. Here are some of the tweets:

I have been to the hospital exactly three times. Baby #1, Baby #2 and a stress-induced case of viral meningitis. The meningitis was due to a nasty legal battle I was having with my employer. That employer happened to be a Medical Company (MC). I worked in the medical industry for six years selling pharmaceuticals, diagnostics, surgical devices and equipment to doctors and hospitals. I am well-versed in the various issues surrounding the overall problem, in particular, when it comes to the rising costs and affordability.

I used to believe that I was on the team of the "good guys." I believed that I sold innovative and medically necessary treatments to patients who needed them. If it weren't for me, who would educate the doctors on these awesome, fancy-schmancy products?  At least that’s the flavor of koolaid the MC fed me. I lapped up every last drop. At every Fiscal Quarter's end, the real motivations behind my job and my MC came bubbling to the top like the frothy head on a glass of champagne.

I had a yearly territory quota of over $2 million dollars. Significant pressure was felt to do whatever it took to reach that dollar figure. The more you exceeded it, the more money and praise you received. The more you fell short, the more you were avoided like day-old trash behind a fish market in a desert town. As you can see, we were highly valued employees.

Most companies who manage a sales force use material rewards to ensure performance and allegiance. We sales people are a competitive, sought after bunch with egos the size of luxury SUVs and they use this to their advantage. They pit us against one another with promises of iPads, diamonds and Rolex watches. Every meeting is an orgy of competition and excess; bellies are filled with booze and steak and egos are stroked and manipulated. We have private Vegas-style parties, city-wide scavenger hunts and chauffeured trips through wine country. One year for a National Sales Meeting in Orlando, all 200+ employees stayed at the Ritz Carlton and the company rented out the Islands of Adventure Theme Park after hours. I rode the Incredible Hulk Rollercoaster like 7 times in a row, kind of drunk. It was awesome.

Meanwhile, the price of our products increased every year far beyond the increased "costs of doing business and inflation" which is the koolaid we were given. In four years the market-dominating device I sold went up 30% and the champagne kept flowing. No one ever told us exactly how much one device cost to manufacture, but the rumor was that the markup was six times the cost to make one. (Which, by the way, was moved to Costa Rica in order to save hundreds of thousands of dollars it was costing to manufacture it in California.)

So here's some basic math on one surgical procedure: The surgical device cost an estimated $250. The MC charges hospitals id="mce_marker"300. Hospital's then bill the Insurance Company (IC) up to id="mce_marker"2,000, and the IC normally pays a fraction of that. In the end, a procedure could end up costing 50 times the cost of the primary device used to perform it. Sure, there are incremental costs along the way, doctor's fees, nurses, anesthesia, supplies, etc. But in regards to the procedure I represented,  a doctor got paid $300 and spent less than 30 minutes in the operating room. Including that fee, and all the other costs, it could never add up to id="mce_marker"2,000. This is why we began pushing doctors to perform this relatively simple procedure in their office. They would make more money and the procedure would cost less overall. But that’s a story for another time. Let’s look at why the hospital charges so much for a simple procedure? The answer is all a part of the yellowed, decade-old newspapers stacked high to the ceiling.

The American Medical Association (AMA) assigns codes to procedures and those codes are ultimately assigned a dollar value. Let's say you need your appendix out. We’ll give an appendectomy the code of APPY=OUCHIE. To understand how procedures are assigned a dollar value, we have to usher in the Government, and all their crap, through the front door.

Medicare is the Government’s name for health care for people over the age of 62.5. MediCAID is the Government health care program for everyone else.  MediCARE sets the standard for the cost of most of the procedure codes the AMA comes up with. In our example, Medicare determines that it will pay a hospital $3,000 for anyone insured by them who has an everyday, ordinary APPY=OUCHIE.

Then, Insurance Companies (ICs) say, “Well, if it’s good enough for the government, then it’s good enough for me.” And they base their reimbursements off of what the government pays. But IC’s will pay “a leeettle bit” higher because you know, they’re supposed to be private and fancy. Therefore, IC’s may pay $4,000 for an everyday, ordinary APPY=OUCHIE.

To make this even more complicated, everything also depends on which state you lived in since Medicare is a state-run agency and different states, pay different prices. I think I just saw a rat scurry across the floor.

It also depends on WHERE you have your APPY=OUCHIE performed. Stand alone hospitals are the most expensive and charge the most money. Surgery Centers (if applicable to your procedure) are the second most expensive and the doctor's office (also, if applicable) are the least expensive location to have your APPY=OUCHIE. (Although I’m not sure anyone would offer to take your appendix out in their office and yet, I would not underestimate some doctor's desire to make a buck).

Meet Ms. Abby Appendix. She needs an APPY=OUCHIE real bad. Abby has private insurance, but it's not great. Of course, she doesn't know this because there's no place to compare your IC to other ICs available. Also, it's the only IC her company contracts with so she really has no choice in the matter.

This leads us to one of the biggest, reeking piles of steaming, hot trash in the whole house. All of these entities, the MCs, hospitals, ICs and doctors, (perhaps excluding the government) have ONE thing in common. Instead of being motivated by providing Abby with affordable, quality, life-saving treatments, at the end of a Fiscal Quarter’s end, they are all truly motivated by profit.

This is a LARGE reason why the house smells like feces and there’s black mold growing up the walls.

Let’s get something straight, this is not a story about greed and capitalism because I love me some free markets. MCs need to make profits in order to provide cuttin- edge medical treatments. I agree with that. But do we need to rent out Islands of Adventure Theme Park? Most hospitals are also in the business of turning a profit which seems like a conflict of interest on account that their overall product is um, life? But, we live in America so hospitals are allowed to make a profit, too. So how do they do that? They do that by attracting patients and they do THAT by providing quality service, having the fanciest medical procedures available and the best doctors money can buy.

ICs are another player in the game looking to make a buck. Again, huge red flags going up. Their mission should be to help people get the best, most effective medicines and procedures and yet, what's most important is their Quarterly report to Wall Street. But again, we live in the land of opportunity so why shouldn’t they be able to operate in a free market too? After all, competition drives costs down right? What's that? You can't buy just any ol' insurance you want because of the state you live in and/or the company you work for? Where's the competition in that? I'll tell ya...petrified pieces of dog poo.

That leaves the government to play checks and balances over all these entities. And as we all know the Government is so efficient and does everything in a timely, economical manner, right?  I don't blame them really because there are so many moving parts, the lobbyist, state regulations and all that red-surgical tape,  it’s like opening a refrigerator with milk that expired in 1998. Obviously, the government's motivations should lie in the best interest of the people, but how can it when it’s up against three powerful entities with money to burn on Remy Martin, Cuban Cigars and campaign donations?

So, Abby got that medically necessary procedure at the hospital.

But then, Abby got a bill....


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