Sick, Uninsured and Charged 10 Times the Cost of Hospital Care
A pack of for-profit hospitals are taking too many liberties with their for-profit names. A new study by Health Affairs found 50 hospitals in the U.S. have markups over 10 times the actual cost of care. The data was found using 2012 Medicare cost reports.
At the top of the list is North Okaloosa Medical Center, located about an hour outside of Pensacola, Fla. The hospital was found to charge uninsured patients 12.6 times the actual cost of patient care. A typical hospital charges 3.4 times the cost of patient care.
The largest numbers of the hospitals on the list – 20 – are in Florida. Of the 50, 49 are for-profit and 46 are owned by for-profit hospital systems. One for-profit hospital system, Community Health Systems, owns and operates 25 of the hospitals on the list. Hospital Corporation of America operates 14 others.
Related: If SCOTUS Rule Against Obamacare, Health Care Costs Will Soar
Uninsured individuals are commonly asked to pay the full amount, unaware they are being scammed. The markups can lead to personal bankruptcy or the avoidance of necessary medical attention.
"The main causes of these extremely high markups are a lack of price transparency and negotiating power by uninsured patients, out-of network patients, casualty and workers' compensation insurers and even in-network insurers," the study reads. "Federal and state policymakers need to recognize the extent of hospital markups and consider policy solutions to contain them."
Most astounding of all, these markups are not illegal. Maryland and West Virginia are the only states with laws limiting hospital fees.
Researchers offered solutions in the study, including limitations on the charge-to-cost ratio, mandated price disclosure to regulate the markups or some form of all-payer rate setting.
Chart of the Day: High Deductible Blues
The higher the deductible in your health insurance plan, the less happy you probably are with it. That’s according to a new report on employer-sponsored health insurance from the Kaiser Family Foundation and the Los Angeles Times.
Chart of the Day: Tax Cuts and the Missing Capex Boom
Despite the Republican tax overhaul, businesses aren’t significantly increasing their capital expenditures. “The federal government will have to borrow an added $1 trillion through 2027 to pay for the corporate tax breaks,” says Bloomberg’s Mark Whitehouse. “So far, it’s hard to see what the country is getting in return.”
Chart of the Day: 2019’s Lobbying Leaders
Roll Call reports that trade, infrastructure and health care issues including prescription drug prices “dominated the lobbying agendas of some of the biggest spenders on K Street early this year.” Here’s Roll Call’s look at the top lobbying spenders so far this year:
Can You Fix Social Security? A New Tool Lets You Try
The Congressional Budget Office released an interactive tool Wednesday that shows how some widely discussed policy changes would affect the long-run financial health of the Social Security system.
“This interactive tool allows the user to explore seven policy options that could be used to improve the Social Security program’s finances and delay the trust funds’ exhaustion,” CBO said. “Four options would reduce benefits, and three options would increase payroll taxes. The tool allows for any combination of those options. It also lets the user change implementation dates and choose whether to show scheduled or payable benefits. … The tool also shows the impact of the options on different groups of people.”
Click here to view the interactive tool on the CBO website.
Why Prescription Drug Prices Keep Rising – and 3 Ways to Bring Them Down
Prescription drug prices have been rising at a blistering rate over the last few decades. Between 1980 and 2016, overall spending on prescription drugs rose from about $12 billion to roughly $330 billion, while its share of total health care spending doubled, from 5% to 10%.
Although lawmakers have shown renewed interest in addressing the problem, with pharmaceutical CEOs testifying before the Senate Finance Committee in February and pharmacy benefit managers (PBMS) scheduled to do so this week, no comprehensive plan to halt the relentless increase in prices has been proposed, let alone agreed upon.
Robin Feldman, a professor at the University of California Hastings College of Law, takes a look at the drug pricing system in a new book, “Drugs, Money and Secret Handshakes: The Unstoppable Growth of Prescription Drug Prices.” In a recent conversation with Bloomberg’s Joe Nocera, Feldman said that one of the key drivers of rising prices is the ongoing effort of pharmaceutical companies to maintain control of the market.
Fearing competition from lower-cost generics, drugmakers began over the last 10 or 15 years to focus on innovations “outside of the lab,” Feldman said. These innovations include paying PBMs to reduce competition from generics; creating complex systems of rebates to PBMs, hospitals and doctors to maintain high prices; and gaming the patent system to extend monopoly pricing power.
Feldman’s research on the dynamics of the drug market led her to formulate three general solutions for the problem of ever-rising prices:
1) Transparency: The current system thrives on secret deals between drug companies and middlemen. Transparency “lets competitors figure out how to compete and it lets regulators see where the bad behaviors occur,” Feldman says.
2) Patent limitations: Drugmakers have become experts at extending patents on existing drugs, often by making minor modifications in formulation, dosage or delivery. Feldman says that 78% of drugs getting new patents are actually old drugs gaining another round of protection, and thus another round of production and pricing exclusivity. A “one-and-done” patent system would eliminate this increasingly common strategy.
3) Simplification: Feldman says that “complexity breeds opportunity,” and warns that the U.S. “drug price system is so complex that the gaming opportunities are endless.” While “ruthless simplification” of regulatory rules and approval systems could help eliminate some of those opportunities, Feldman says that the U.S. doesn’t seem to be moving in this direction.
Read the full interview at Bloomberg News.