Yule                                                                                       Stock Show Moon

My 2015 summary from SecureHorizons, our AARP medicare advantage plan, shows all you need to know that our healthcare system is broken, badly broken. In 2015 I had prostate cancer and as a result had a surgical procedure to remove my prostate, so it was an expensive year with biopsies, diagnosis, procedure and follow-up. I also had a series of physical therapy sessions for an arthritic neck and its left shoulder, elbow and hand sequelae.

Total billed to Securehorizons for the year: $101,000.

Total paid by Securehorizons for the year:    $12,000.

Our share:                                                                   $850.

First reaction might be, really good news! Look how little you had to pay, Charlie, for such an enormous bill. Uh huh. Look more at how little Securehorizons paid for such an enormous bill, about 1/8 or 12% of the total billed. This vast-$78,000-discrepancy says nobody knows what healthcare costs. Nobody knows what’s fair.

Take my very small piece of the total healthcare expenditures in 2015 and extrapolate these ratios. Say hospitals and physicians and other therapies billed $10,000,000,000 to insurance companies. Following the ratio in my 2015 report insurance companies would pay to those vendors approximately $1,200,000,000. That would leave a discrepancy of $7,800,000,000. What happens to the supposed expenses covered by discrepancy? Do hospitals and physicians and therapists go out of business? No, they live to bill another year when the whole sorry mess repeats.

It takes no analytical subtlety to smell the rot. We need to get out from under all these private insurance companies and their administrative rules, their negotiated deals.

Kate’s hair-dresser, to illustrate another problem with this mess, went to the ER when a partially removed splinter in her hand created swelling that made it impossible for her to use her scissors. No work, no money. She had the self-employed persons typical high deductible policy. An E.R. doc removed the splinter. Bill: doc=$1,500, e.r. admittance=$1,800. She refused to pay $3,300 for a splinter removal, stayed resolute and got an 80% reduction in her bill.

Colorado will have a referendum this year to create the first single-payer health plan in the United States. I’m voting for it.

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