There is more insight to glean from the Phoenix scorpion story.  Imagine that this poor patient went to a hospital that her personal physician owned.   How would things be different if this woman’s personal physician were taking care of her in an emergency room he owned?  You think that this greedy doctor would take her for all she was worth?  Or, as her personal physician and advocate, would he bear some additional responsibility for her financial well-being.  Not discussing the cost of the anti-venom would represent a betrayal of this patient-doctor relationship, would it not?  

In addition, the outrageous profit-seeking of the “not for profit” hospital would be mostly absent, as this doctor could not in good conscience financially abuse this patient in his hospital any more than he could in his own office.  He would be happy to just recover his cost on this drug.  He would be really happy that she didn’t go to the Chandler Regional Medical Center, an outfit that he knew would bankrupt her. Contrary to what the goons at the American Hospital Association and their lobbyists would have you believe, physician-owned facilities are bargains compared to their “not for profit” competitors across town.

But in all likelihood, the insurance company that paid the hospital $57000 wouldn’t “contract” with this physician-owned hospital.  They would be “out of network.”  Why?  Because the insurance company makes more with the hospitals that charge the most!  This is so important to understand.  Most of the insurance company’s money comes from money management and “repricing” fees, not from premiums, according to several insiders I have talked with.  

The doctor that recommended and administered this antivenom in Phoenix didn’t work for the patient, though.  The lack of any patient-doctor relationship results in a lack of accountability of the doctor to the patient, medically and financially.  This emergency room physician is not likely to ever see this patient again.  Some emergency physician groups labor under performance contracts with these mercenary hospitals where their compensation directly reflects the extent to which the hospital has profited from their efforts.  These arrangements guarantee almost unlimited and unnecessary testing and expensive drug administration like the Phoenix case.  

It is also important to understand that the giant hospital gets paid even when it doesn’t get paid.  Overcharging the poor and inflicting exaggerated bills on the sick inflate the uncompensated care claim by these outfits, and that’s just what they do.  This pads the pockets of their insurance friends who ride in to the rescue and “mark down” the bills, hoping no one realizes they skim 35% of the marked-down amount.  

Now that you know this, wouldn’t it be a great idea to put these giant hospitals in charge of all of the care in the country?  Well, that’s exactly what the Unaffordable Care Act calls for!  Beginning in 2014, Medicare payments will go to the big hospital systems and they will dole out the money to the doctors.  No more trustworthy and charitable bunch than the “not for profit” administrators!  

Maybe a black market for scorpion anti-venom will develop.  The FDA’s granting exclusive distribution rights for seven years to the company distributing this drug is sort of like prohibition.  The same drug for $100 could be purchased over the counter in Juarez or Nogales and sold at an anti-venom kiosk outside of the emergency rooms all over Arizona were it not for the wonderful “deal” the FDA struck with the Tennessee fellows.  

The only thing worse than total corporate control or total government control of medicine is these two syndicates together.  This episode in Phoenix is a window in to understanding the control the cartel has over health care in this country.

G. Keith Smith, M.D.