By Alieta Eck, MD
As the controversy rages between those Republicans who want full repeal and those who want to retain what might be “good” about ObamaCare, we are not asking the right questions. While they are arguing whether or not to keep the ObamaCare subsidies (or the equivalent as “tax credits”), is anyone asking what it is we are subsidizing?
Why has medical care in the United States gotten so expensive? Why did the cost of a hospital stay go from an average of $17,000 in 2000 to $33,000 in 2010, while the average length of stay declined? Why do our hospital stays cost three times more than in other industrialized countries?
The dirty little secret is that having insurance might be a guarantee that the insured pays MORE. And because deductibles have risen dramatically along with premiums, a family needs to pay thousands of dollars out of pocket before insurance kicks in. But how does this work?
Most insurance companies have networks of “preferred providers.” One would assume that a “preferred provider” is a doctor or a lab that gives better rates, but the opposite is the case. As an example, one patient spent a day in the emergency room where the total bill came to $12,000. The “preferred provider” rate brought the bill down to $10,000, which happened to be that patient’s deductible. Upon further scrutiny, the breakdown of the bill showed a lab fee of $3,500—labs that would have cost less than 100 cash on the outside.
When the hospital patient advocate was queried, the answer came back, “Your insurance company negotiated $10,000 and, since you have not met your deductible, you are bound it pay it. Paying the cash price is not an option.” She acknowledged that this seemed unfair, but would not budge.
Another patient discovered that his insurance had lapsed and was given a cash price of $75 for an office visit. Once insurance was restored, the submitted fee was $275. Since he had not met his deductible, he was expected to personally pay the higher fee.
Since 92% of people will not incur more than $5,000 per year in medical expenses, the middle class has been fleeced under ObamaCare in so many ways. Many patients have received subsidies. But this just means that taxpayers are forced to pay part of their premiums, and the patients are still stuck with those deductibles and the higher negotiated fees.
So what is really happening?
Insurance premiums have soared, and the insurance companies love it. They keep a percentage of the bloated premiums for “operating costs.” Hospitals are buying physician practices, and Medicaid and Medicare have agreed to pay the hospitals higher fees for the same service in the same location. No government official has been able to explain why.
The ratepayers and taxpayers are the “forgotten men” in our medical system. Hospital and Insurance executives are now commanding compensation that exceeds $1 million. One CEO of a consolidated hospital system in central New Jersey receives $9 million per year. What exactly does he do to merit this high salary? The usual reason for lavish executive pay is that the official brings lots of revenue into the business. The big hospital systems are businesses that profit massively at the expense of patients and taxpayers—although the excess might be called something other than profit if the hospital is tax-exempt (allegedly “nonprofit”).
Our politicians are complicit in this heist, as last year insurance companies and hospitals were among the ten greatest contributors to the campaigns of legislators who allow this scam on the middle class to continue.
The best recommendation would be for patients with high deductibles to hide any connection with an insurance company and negotiate the best cash prices for services. Find a physician who is in no network and who can help navigate where to find cash-friendly sources of medicines, labs, and x-rays.
Patients with their doctors need to take control of medical care once again.
Dr. Alieta Eck graduated from the Rutgers College of Pharmacy and the St. Louis University School of Medicine in St. Louis, MO. She studied Internal Medicine at Robert Wood Johnson University Hospital in New Brunswick, NJ and has been in private practice with her husband, Dr. John Eck, MD in Piscataway, NJ since 1988, affordablehealthinc.org. She has been involved in health care reform since residency and is convinced that the government is a poor provider of medical care.
- Dr. Eck testified before the Joint Economic Committee of the US Congress in 2004 about better ways to deliver medical care in the United States. In 2011, she testified before a Senate Health Committee chaired by Senators Bernie Sanders and Rand Paul– about ways to avoid non-urgent visits to the emergency rooms.
- In 2003, she and her husband founded the Zarephath Health Center, a non-government free clinic for the poor and uninsured that currently care for about 300 patients per month utilizing the donated services of volunteer physicians and nurses. It is only open 12 hours per week. zhcenter.org
- She is working to pass NJ S239, a bill that would provide medical malpractice protection for the private practices of physicians who donate 4 hours per week in a clinic like the ZHC. njaaps.org
- Dr. Eck was the 2012 President of the Association of American Physicians and Surgeons and serves on the board of Christian Care Medi-Share, a faith based medical cost sharing ministry.
- She was the Republican nominee for the US Congress for NJ12 in 2014.
- In March, 2015, she chaired a meeting of the National Physicians Coalition for Freedom in Medicine, about 30 physicians, who gathered in Washington, DC to draft a “One-Page Plan” to restore affordability, promote patient choice and retain quality in medical care. https://aaps.wufoo.com/forms/m
- Dr. Eck spoke at the National Press Club in Washington, DC in June, 2016 to help unveil the Wedge of Health Freedom, an initiative of the Citizens’ Council for Health Freedom, with President Twila Brase. JointheWedge.com