> On Nov 29, 2007 2:38 PM, Doug Henwood <dhenwood at panix.com> wrote:
>
>> Gallup's annual Healthcare survey, conducted Nov. 11-14, finds 57% of
>> Americans saying they are satisfied with the total cost they pay for
>> their healthcare, while 39% are dissatisfied. These percentages have
>> been quite stable in recent years, after a slight dip in reported
>> satisfaction between 2001 (64%) and 2002 (58%).
>
> I'd be curious how many of that 57% had to collect on anything
> substantial.
=======================================
Funny you should ask...from today's WSJ:
* * * As Medical Costs Soar, The Insured Face Huge Tab Jim Dawson Hit Cap After Hospital Padding; The $1.2 Million Bill By JOHN CARREYROU Wall Street Journal November 29, 2007; Page A1
MERCED, Calif. -- One day in late July, Jim Dawson happily returned home. He had spent the previous five months in the hospital battling an infection that nearly killed him. The phone rang shortly after Mr. Dawson and his wife, Loretta, entered their house.
It was the hospital. California Pacific Medical Center was calling to remind the Dawsons that they owed it $1.2 million.
Mr. Dawson, 61 years old, had health insurance through his employer, but had maxed out his plan's $1.5 million lifetime cap halfway through his long hospital stay. In addition to the bill from CPMC, Mr. Dawson owed tens of thousands of dollars more to scores of doctors who were involved in his care. Mr. Dawson and his wife's combined assets totaled a fraction of their medical debt.
"I had never thought in a million years that anything like that could ever happen," says Mrs. Dawson.
As spending on health care has climbed to almost $2 trillion a year, or 16% of the U.S. economy, the number of Americans burdened with massive medical bills has soared as well. According to a 2005 survey by the Commonwealth Fund, an estimated 34% of adults aged 19 to 64 face problems with medical bills or have accrued medical debt. A majority of those people -- 62% -- had health insurance, the survey found.
Million-dollar medical bills like Mr. Dawson's, while still unusual, are becoming more common as insurance policies once thought to provide catastrophic coverage prove inadequate when it comes to high-cost illnesses.
Part of the problem: Even as medical progress and new technologies raise health-care costs, health plans have been slow to raise their caps. Mr. Dawson's $1.5 million cap was relatively generous by today's standards. The Segal Company, an employee-benefits consulting firm, says the average health-plan cap among companies it advises is $1 million a person -- the same as it was in the 1970s, when the purchasing power of $1 million was the equivalent of nearly $6 million today.
Another issue is the widespread practice of bill padding by hospitals and other health providers. While hospitals say bill padding is their only defense against the aggressive cost-reduction efforts of insurers and government programs, the end result is that individuals can, with little warning, be left stuck with wildly inflated medical bills.
For instance, CPMC charged Mr. Dawson $791 for stockings designed to improve blood circulation. The same pair can be purchased on the Internet for as little as $12.
Allan Pont, CPMC's chief medical officer, acknowledges that the charges on Mr. Dawson's bill are "Disneyland numbers" that health insurers and government programs like Medicare and Medicaid never pay. But he says they reflect the hospital's operating costs, such as paying for doctors, nurses and medical equipment, as well as markups to compensate for the fact that CPMC collects only a fraction of what it bills every year.
Mr. Dawson's health calamity, and the resulting $3 million in health-care bills it generated, was due to a staph infection, a bacterial skin infection that is usually easily cured if caught early. But Mr. Dawson's condition was missed by various doctors and spread throughout his body.
For 15 years, Mr. Dawson worked for oil refiner Valero Energy Corp. and its predecessor companies, selling gasoline products to gas stations across California. Big and burly -- and with a deadpan sense of humor -- Mr. Dawson spent much of his work life on the road.
[...]
John Gilbert, a spokesman for Emanuel Medical Center, says Mr. Dawson was examined by an internist, who consulted with four other specialists. He says the hospital diagnosed Mr. Dawson with cellulitis of the hand, disintegrating back discs, chronic kidney disease, acute renal failure and gout, a form of arthritis characterized by sudden attacks of pain and tenderness in joints. No one realized it at the time, but all were likely consequences of the staph.
"We feel that he was provided good care," Mr. Gilbert says. Emanuel billed Valero's health plan $31,159.75 for the three-day stay. Using its bargaining leverage as a large plan, Valero's health plan negotiated the amount it paid down to $20,339.74.
[...]
Mr. Dawson returned to see Dr. Golden, who only diagnosed him with gout. Dr. Golden gave him painkillers for his back and an anti-inflammatory drug to reduce swelling in his arm. But Mr. Dawson continued to feel ill and lost his appetite. In just a few months, he went from 305 pounds to 223 pounds, his skin turned grayish and he continued to experience terrible back pain.
In February 2007, Mr. Dawson collapsed at a convention in Las Vegas. Mrs. Dawson and their 25-year-old son, Noel, drove 450 miles from Merced to pick him up. Mr. Dawson went back to see Dr. Golden, but he says Dr. Golden continued to maintain that his condition wasn't serious and told him to return for a checkup in 90 days. Reached at his office in Fresno, Dr. Golden declined to comment.
With her husband looking sicker by the day, Mrs. Dawson grew frantic. Thinking Mr. Dawson was suffering from a spine infection, she called her dentist, who she knew had back problems. He recommended going to the spine center at Seton Medical Center in Daly City.
On March 6, Mr. Dawson was admitted to Seton delirious and screaming. It was there doctors realized he had a staph infection that had spread through his bloodstream and invaded his entire body. His organs were failing and he was going into septic shock. A nurse told Mrs. Dawson her husband was very sick and might die.
Doctors at Seton began treating Mr. Dawson with massive doses of antibiotics but surmised they wouldn't be able to cure him unless they removed Mr. Dawson's pacemaker, which was encased in bacteria. Mr. Dawson had been carrying the device in his chest since 1995.
The surgery didn't go well. One of the pacemaker's two leads, wires that connect the device to the heart, broke off as it was being extracted and remained stuck in Mr. Dawson's right ventricle. On April 20, Mr. Dawson was transferred to CPMC in San Francisco, a leading cardiac hospital in the region.
The Dawsons wouldn't find out until later, but the six-week stay at Seton was costly. The hospital billed Valero's health plan $1,135,633.84. After negotiating a $283,908.46 discount, Valero's plan paid $851,725.38. More than half of Mr. Dawson's insurance had been used up. A spokeswoman for Seton declined to comment about Mr. Dawson's case, citing the hospital's patient-privacy policy.
[...]
On June 29, Mrs. Dawson says she was leaving the hospital when she was ushered into a small conference room by Ema Beronilla, an employee from CPMC's financial office. She says Ms. Beronilla told her that her husband's insurance had run out and showed her a sheet of paper indicating that they owed the hospital more than $1 million. Valero's health plan had just paid CPMC $553,727.12 for Mr. Dawson's care through May 19 and informed the hospital that he had maxed out his policy. Any additional bills were Mr. Dawson's responsibility.
A spokesman for CPMC, Kevin McCormack, confirms the meeting but says Ms. Beronilla was merely trying to help Mrs. Dawson understand her financial options, not pressuring her to pay the bill.
[...]
Hoping to stall CPMC, Mrs. Dawson sent the hospital two checks for $30. Bills were also piling up from doctors, so Mrs. Dawson also sent them small sums to keep them at bay. The Dawsons weighed whether to declare personal bankruptcy.
Before they made any decision, Mrs. Dawson asked to see an itemized bill from CPMC. When she received it, she was shocked by how much the hospital had marked up inexpensive items like the stockings. CPMC charged Mr. Dawson between $2,225 and $6,675 a night for an oxygen mask to help him breathe while he slept. After he was discharged from the hospital, the Dawsons rented one from a medical-supply store for $250 a month. Mrs. Dawson resolved to try to negotiate the bill drastically down.
"I do not deny that our charges look insane," says Dr. Pont, CPMC's chief medical officer. But all hospitals operate the same way, he says. "It's the reality of the industry."
Once its operating costs are factored into an item's charge price, Dr. Pont says the hospital marks up that price by threefold to account for the fact that it only collects on average a third of what it bills in any given year. Although the nonprofit hospital reported $123.7 million in operating income last year, Dr. Pont says the money goes to charity care, cutting-edge medical equipment and new facilities to comply with the state's stringent earthquake-safety guidelines. CPMC says it dispensed $5 million in charity care last year and gave another $6 million to community clinics and health centers.
In her quest to know exactly what she was being billed for, Mrs. Dawson also asked the hospital for copies of all her husband's medical records. A copy service used by the hospital called to say the copies would cost $1,030. Mrs. Dawson was outraged. Further angering her, a letter from CPMC's foundation soliciting a donation came in the mail.
Earlier this week, Mrs. Dawson was contacted by a CPMC official with surprising news. The hospital said Mr. Dawson had qualified for financial assistance under its charity-care policy and wrote off his entire bill. Asked why the Dawsons hadn't been told they could qualify for charity care before a reporter contacted the hospital, CPMC said Mrs. Dawson never gave it the opportunity to explain its policy to her.
Told at one point that he would never walk again, Mr. Dawson is looking forward to going back to work at Valero in January. An avid car-racing fan, he recently went to see his son officiate at a race.