$76,000? Nope.

When John McCain had his eye surgery that delayed the Senate vote on healthcare you just knew that it was going to be fodder for the critics.  Well, here it is:

If John McCain were uninsured, his surgery could have cost $76,000

Not exactly. First of all, no one really knows what the cost of the surgery would have been since there is NO transparency.  Would you buy a television or a car without knowing the price?  Healthcare is a fantasy world created by these idiots in Congress who have been in cahoots with the insurance industry.

If McCain had one of the health ministries (MediShare, CHM, etc.) then the price, from my experience with my patients, would have been dropped significantly. Using a similar example from someone I know, his cost would have come to about $50K and the health ministry would have paid it all.  Even better, the $26K savings would have been applied to his $5K deductible so it would have cost McCain nothing.  Would a regular insurance do that?

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If McCain had a bare bones plan or catastrophic plan then his monthly fees would have been very reasonable (see these short term plans at United) and his out of pocket cost would have been his deductible or about $10K.  Who could afford $10K you say?  Well, I pay more than that in a year with my monthly premium and that is before my deductible. And I am not alone.

This article is bogus.  I don’t want to say “fake news” but how about hyperbole news or embellished news?

There is an answer.  Let the free market work.  And take away the special heath coverage for Congress as well.

 

 

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] 

  7 comments for “$76,000? Nope.

  1. July 18, 2017 at 10:39 am

    I think something is missing from the “transparency” argument. Indeed, someone in extremis is not going to shop around, but that’s not exactly the point or even necessary. If there was price transparency, then market forces would place downward pressure on health service pricing overall. Consumers will gravitate to higher-value providers—which may not be the cheapest, but best for the money.

  2. Avery Comarow
    July 18, 2017 at 8:07 am

    In my comment above, I forgot to mark where the excerpted material from the cited article starts. It’s after my final plea to listen, not yell.

    Avery

  3. July 18, 2017 at 8:05 am

    Come on, Doug. Health ministries have a specific faith-based focus that obviously is not suited to large, diverse populations. And the premiums for catastrophic plans, for those with modest or lower incomes, are not within reach. How can you compare what you pay as a reasonably well-compensated physician with what a family with a household income of $30-$35K pays?

    As for the figures in the article, they were put in context to a degree that is astonishing for mass media coverage. If anything, the $76,000 list price, based on charges submitted to CMS for Medicare reimbursement, is understated. An uninsured patient younger than 65 is likely to be charged far more (although the hospital knows perfectly well it is unlikely to collect a dime of it).

    The article brackets the Medicare list price and the Medicare reimbursement, and accurately notes that someone who is uninsured would almost certainly have to pay more than the reimbursement amount. And a lengthy footnote makes your point about the absence of transparency in healthcare pricing. I’ve pasted the relevant text from the article below.

    As for your point about shopping around (“Would you buy a television or a car without knowing the price?”): are you kidding? You’ve been diagnosed with a blood clot and you’re supposed to call around to check prices–and with no assurance whatsoever that whoever offers the lowest price (which you won’t be able to get anyway) is the safest and best facility for this procedure?

    I know you’re passionate about the free market, but please don’t let it turn into a reflexive punch when you read a piece with which you disagree. We need to listen, not yell.

    At the Mayo Clinic in Phoenix (line 1598 of this spreadsheet), the most recent data (2014) suggests the average Medicare charge for a craniotomy at Mayo in Phoenix was $76,119, while average payments ranged from $25,932 to $33,958.

    For help interpreting these costs, I called up Jeanne Pinder, the founder and CEO of clearhealthcosts.com. She said this kind of variation is completely normal in the US, and that an uninsured American would be “very fortunate” to pay what Medicare amount for the bill. So they could be on the hook for more than $76,000. (We asked Mayo Clinic to confirm the average cost of the procedure, and haven’t heard back. McCain’s office referred us to their press release.)
    [snip]
    That means that if McCain happened to be one of his uninsured or under-insured constituents, he could be paying some $76,000 — more than the average annual household income in America.

    *Caveat about the price estimate: Finding the precise price of a procedure in America can be an exercise in futility: different hospitals charge different patients different prices on different days. We decided to go with the Medicare rate, though, since this is often used as a benchmark by experts for the cost of a procedure and it’s what the government considers reasonable to pay for a service. But a hospital could apply tens or hundreds of billing codes for a complicated episode of care like the one McCain received, so the cost of the craniotomy alone is really just a ballpark.

    • Doug Farrago
      July 18, 2017 at 10:05 am

      1 Health ministries – it is a model that works. People love it. It is cost friendly and should be reproducible without religion
      2 All premiums on the ACA and outside the ACA are unaffordable. They weren’t in the past. They are filled with unnecessary mandates via the ACA. Look at the http://www.UHC.com link I gave in the article. Put in some numbers and your zip. Get back to me.
      3. The uninsured will pay more than the $76K. Agreed. That is because there is no transparency and he/she has no negotiating power. That is what the insurance and hospital industry has created
      4. Shopping around: Agreed that emergency shopping is difficult. How much of care is emergency care, though. Very little. 90% of care is family medicine.
      5. I am not yelling. I am just hammering the point that our system can be fixed by the free market. I see it happen every day. I live in it.

      Sorry, Avery, I am sticking to my guns here. 🙂

      • Jacqueline Sloan
        July 18, 2017 at 11:02 pm

        We are part of a health ministry and shop around for transparent pricing on MDSave.com. It has worked well for us. There are also pharmacy ministries.

    • Dino Ramzi
      July 19, 2017 at 8:28 am

      Faith-based focus? While informed by faith, the behaviors they request as a condition of participation are widely considered moral issues: no drugs, no drunkenness, no multiple sexual partners, do not kill (no abortion)

      Do people really have objections to basic health behaviors?

  4. Randy
    July 18, 2017 at 7:56 am

    I often see posts in social media critical of the insurance Senators and Congressmen get, and to me it’s kind of a red herring. Senators like McCain are employees of a large entity, and are given health insurance as a benefit of employment just like millions of other employees in the US. This isn’t an endorsement of the GOP plan as I doubt they have any more idea how to solve problems in health care than the Democrats did. I’m just saying focusing on the Congress’ health insurance is sort of taking your eye off the ball of the real problems in health care.

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