Imagine what grocers would charge if no one (or very few) buying groceries cared what things cost.  Imagine the demand for what was on the shelves if the items were “free.”  This is healthcare in the U.S.  This is a great deal for the grocers!  This is a great deal for those supplying the grocers, too.  And this is why the debate around TUCA (The Unaffordable Care Act) never dealt with the cost of care but rather getting everyone “coverage.”  Now imagine that you have to pay the grocers every month even though there is nothing on the shelves!  This is TUCA, in a nutshell.

What you see above is a bill sent to me by a friend.  This bill makes no sense unless you realize that a free market is not involved.  Either Adventist Health System doesn’t think whoever is paying this bill cares, or is holding them at gunpoint.  The Medical/Surgical Supplies charge ($63,371.71) represents mostly the defibrillator battery, for which Adventist paid $12K-$15K according to my sources.  They will, of course claim that every dime of this they don’t collect will be “uncompensated care,” and use this “loss” to maintain the fiction of their not for profit status, while pocketing their DSH (disproportionate share hospital) kick back courtesy of the blindsided taxpayer.  They will “carry” cash reserves to match this “bad debt” and use this slush fund to buy and build, buy and build….everything and everyone in sight.  The insurance company (if there is one) will “reprice” this bill and charge the employer group a “percentage of savings.”  The insurance company would be better off had this bill been $200,000 or more as their “repricing” take (usually around 30% of “savings”) would be even greater.

To bring this sick system under control, we must first address the cost. Imagine now that an innovative hospital published upfront pricing for defibrillator battery changes for $25,000.  How would this affect the price and availability of healthcare for everyone?   Doesn’t the lack of waste benefit all of us?

To focus on getting everyone “coverage” only guarantees bills like the one above and rationing of care to all but the uber-rich.

G. Keith Smith, M.D.