Differing hospital rates prove, once again, that we don’t have this “healthcare” thing figured out just yet

CMS Data Set: Medicare Provider ChargeBetween health insurance exchanges not being implemented by the states and a study saying that Medicaid is effectively the same as other health insurance, you may have missed missed the released CMS (Center for Medicare and Medicaid Services) data that shows what 3,000 hospitals across the country are charging for services.

According to CMS, “hospitals determine what they will charge for items and services provided to patients and these charges are the amount the hospital bills for an item or service.” Some procedures feature a $50,000 difference depending upon where you have it done.

As usual, the only people who are paying these absurd costs are those who don’t qualify for Medicaid but don’t make enough money to pay for health insurance. Costs are driven up for the uninsured because insurance companies use their bulk purchasing power to get rates lowered significantly, and Medicare, a huge driver of hospital profits, simply pays whatever formula is set by the government for a certain procedure, rather than what is billed by a hospital. As discussed in last week’s post, “the uninsured” in most states is still going to refer to childless adults who are hovering around (and often, who are below) the federal poverty level.

In short, in many states, if you make $15,000/year (minimum wage), you’ll have to worry abou the market value of your emergency procedures. Expect the pundits on FOX News to chastise you for not shopping around for the cheapest hospital costs while you’re lying on a stretcher in the ambulance.

What does this data mean in the long term? The Obama administration and HHS released it in the name of “transparency,” which is a particularly nice thing for a liberal Democrat such as myself to remember on a day like today. But transparency only goes so far. These differences will cause outrage for a little while, but mostly among a wonky set centered between Philadelphia and Richmond. Then it will continue to get ignored by the rest of America, who, frankly, has its hands full this week.

What we need is an actual change, and even among those few paying attention, there is a significant dearth of suggestions. The free market set will tell you that killing Medicare is all you need to do to drive down prices, and they may have a point. Those in favor of government-run insurance will point out that these costs would be completely controlled (and supported by taxpayers) if we could just be more like Canada or [insert European country here], and they’re not insane, either. But the reality is that, for better or worse, our “free-market” system has been commandeered by insurance companies (a completely non-transparent scheme that effectively drives up prices for those who don’t participate), and this week should be evidence enough that several government-run plans aren’t going to cut it.

We’re still left, then, with a lot of questions about the transference of costs, who is paying for healthcare, and whether the least fortunate among us are entitled to services or not. Er, okay, that last one should be easy, but some people want to just let them die because “that’s what freedom is.” Cool beans, Ron and friends.

If a serious option is letting people die because they chose not to buy health insurance/letting them die because they didn’t become wealthy enough to cover emergency hospital bills, we have a bigger problem than uneven medical procedure rates. Instead, these charges to Medicare and the federal government are just a symptom of the greater illness: that we act like buying chemotherapy versus buying food in three months is the same magnitude of decision as buying a Pepsi versus buying a Coke. We can let people die because it’s a free market! People made their choices, like when they picked Pepsi over Coke! Philosophically, there are people who really consider these choices identical.

The other option – one we somehow don’t take seriously at all – is to put aside ideology and start talking about what works. It’s obviously not that simple; we adopt ideologies because we believe they are the best way to apply theory to the real world. But healthcare is not the same kind of economic question as the one you ask when you walk up to your vending machine – this is life and death.

We desperately need more people in power who accept that healthcare doesn’t fit comfortably into our ideological compasses and who might be willing, at least in theory, to wipe the slate clean and start over. It isn’t enough to say, “hey, we gave you some data about hospitals,” and go home. This data says so much about how we understand our most precious commodity. Healthcare is not soda: it is the difference between leaving our most vulnerable to die and simply helping them live. We have to solve this problem. We have no other choice.


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