Your Hospital Bill

If you haven’t read the piece in the Time Magazine entitled Bitter Pill: Why Medical Bills Are Killing Us then please do……but on an empty stomach.   It will make you sick.   Here are just a few standout points for me:

  • When you look behind the bills that Sean Recchi and other patients receive, you see nothing rational — no rhyme or reason — about the costs they faced in a marketplace they enter through no choice of their own. The only constant is the sticker shock for the patients who are asked to pay.
  • And in our largest cities, the system offers lavish paychecks even to midlevel hospital managers, like the 14 administrators at New York City’s Memorial Sloan-Kettering Cancer Center who are paid over $500,000 a year, including six who make over $1 million.
  • That might take care of the self-fulfilling peer dynamic that Gunn of Sloan-Kettering cited when he explained, “We all use the same compensation consultants.
The article, which is really an investigative piece, is long but worth it.  It exposes the absolute greed by hospitals and their minions who work there.  Doctors are not excluded.   It also shows how powerless patients are in dealing with their bills (especially if they have no insurance).   Everyone else has someone negotiate for them, whether it is the managed care company, Medicaid or Medicare, but the guy who cannot afford health insurance is screwed.  This is the embarrassing part of America’s healthcare system.   There is no transparency.    There are no set fees.  It is a shell game where you have grossly exaggerated mark ups to gouge the common man to pay an overpriced CEO who does, well, basically nothing.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  6 comments for “Your Hospital Bill

  1. mamadoc
    March 6, 2013 at 9:41 pm

    I won’t argue with what the article said about the hospital CEO salaries, but it also said that insurance companies are “powerless.” Huh? And clearly they hadn’t checked on any health insurance company CEO salaries, which are just as obscene. As was said before, the people making money in health care are not the ones who are doing the work. And why, exactly is a hospital adminstrator paid more than a neurosurgeon?

  2. jcm
    March 6, 2013 at 9:50 am

    Ya got me with this one. You are usually spot on with your commentary but I have to take exception to the inconsistency you demonstrate. You cannot complain that NPR believes primary care docs are easily replaced ie they don’t do anything special, and then state hospital CEOs “do nothing”. If being a hospital CEO requires no skill or talent then apply for the job. Many docs have done so but they realize that it’s no chip shot. Their salary may be too much but that’s for the market to decide. NPR claims your salary is too high for what you do. You complain that specialists make too much. When you engage in sniping at the person above you in the salary range you open yourself up to the same criticism from those below you and it’s illogical. When you let a market determine what your worth based on your skill and availability in the market place you’re paid fairly. There are inefficiencies in market forces but they are not as bad as the artificial ones imposed by a biased govt agency. I know many will say that the market hasn’t worked in health care but it hasn’t existed. Our prices are controlled by the govt and insurance companies and the patients have “no financial skin” in the game so they can demand EVERYTHING. Your home owners insurance doesn’t cover weed removal in your lawn if it did weed service costs would be available for everyone at an astronomical price.

    • Doug Farrago
      March 6, 2013 at 9:56 am

      I agree that saying they “do nothing” is unfair. I think the fact that there at 5:1 ratio of administrators to doctors is where my issue lies. And they actually do not bring in any money to the hospital. As far as market demands, I am a big believer of capitalism but the statement where all the CEOs uses the same salary consultants means they have rigged the game. I agree, I do NOT want a gov’t agency involved. The healthcare system is broken for many reason – no skin in the game by patients, no direct payment between patient and doctor and too many middle men grabbing all the profits. I still believe primary care doctors should get paid more, specialists should get paid less (though still more than PCPs) and CEOS should get less than half of what they get paid.

      • Sir Lance-a-Lot
        March 6, 2013 at 10:37 am

        “… CEOS should get less than half of what they get paid.”

        No, CEOs should be taken out and shot in middle of the fancy piano atria that they all seem to love building.
        Doctors could cheer as their blood runs down the well-designed, OSHA-compliant drains.

        How many months salary would you be willing to bet that if there were no hospital CEOs tomorrow, there would be absolutely NO negative effect on the health system?

    • March 6, 2013 at 4:02 pm

      Actually, the point made in the article is that the people who are definitely NOT making money in US healthcare are the people actually providing healthcare services. Unless, of course, they also happen to own one of the profit-making entities. The CEOs and administrators may be geniuses at gaming the system – something that may well be beyond the capability (or conscience?) of most people. But any discussion of fair pay and market value misses the point entirely. These people at least represent, if not embody, the fundamental problem.

  3. Pat
    March 3, 2013 at 12:16 pm

    All true. And as a consequence, it will all be nationalized.

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