In her latest installment, Kliff digs deep into the famously bizarre
world of ER bills and points out some of the most egregious ways in
which these are rigged.
For example, if you are injured and also financially precarious, you
might travel to a more distant ER just to be sure that the hospital
you’re visiting is in-network for your insurer, but that means nothing.
“In-network” ERs often staff “out-of-network” doctors, and there is no
way to find out whether the doctor treating you is covered by your
insurer until you get the bill: one of Kliff’s readers got bills for
$8,000 from an out-of-network surgeon who treated his broken jaw at an
in-network hospital.
And much of the care you receive at an ER is subject to bizarre price
gouging: one of Kliff’s readers was charged $238 for two drops of the
generic eyedrop ofloxacin which retails for $15/vial; the routine
pregnancy test that ERs administer to women of childbearing years can
cost up to $465, enough to buy 84 pregnancy kits at the pharmacy; and
one Seattle hospital charged $76 for a squirt of generic neosporin. Not
all hospitals gouge on all drugs, and many of these drugs are not being
administered for urgent health problems – a halfway honest hospital
could advise a patient, “We charge $238 for this eyedrop, why don’t you
pick up a bottle for $15 next door and administer it yourself?”
Finally, Kliff uncovers wild variability in the “ER facility fee,” which
is a cover-charge you’re assessed just for walking in the door at an
ER. One of Kliff’s readers paid $5,751 for sitting in a hospital waiting
room with an ice-pack and a bandage while waiting to see a doctor, but
who left because she was feeling better and didn’t need care after all.
Kliff’s work reveals that these “facility fees” are rising at twice the
rate of other health charges, with no rhyme or reason.
All of this refers to people who come into the ER under their own power,
out of an abundance of caution – for example, my daughter recently
broke her collarbone, but we didn’t know that until we went to the ER
for an X-ray, and if we’d less prudent, we could have iced it and made a
regular doctor’s appointment for the next day, leaving her untreated
and undiagnosed. But of course, ERs treat large numbers of people who
are unconscious or in agony when they arrive, either on their own or on
an ambulance gurney. These patients can’t possibly be expected to shop
around, to demand to know whether their medicines are medically
necessary (I once had a small eye injury that I went to get checked out
on a Sunday just in case and had to stop the nurses from pumping me full
of IV dramamine just in case it turned out I would need neurosurgery!),
to evaluate whether the doctors are in- or out-of-network, and so on.
(We ended up paying $2,400 out of pocket for our daughter’s ER visit,
including $2.50 for a generic tylenol, despite having gold-plated
insurance from Cigna)
Kliff’s work reveals the whole story of “market based medicine” to be a
fiction. Markets are regulated zones where consumers compare the
offerings of producers and make purchase choices based on their
information. To call being wheeled unconscious into an ER and raced into
an operating theater and then presented with a bill months later a
“market transaction” is to make a terribly, grisly joke.
It’s as good an argument for Medicare for All and single-payer health care as you could ask for.
