Insurance companies are supposed to LOWER healthcare costs by fighting inappropriate price gouging, right? WRONG. Here’s why.
By now you guys have probably read this article on NPR about this woman who went in with a sore throat to her doctor in Manhattan and got a $26,000 bill for a throat swab. Now it turns out, the punchline here is, she didn’t have to pay for that bill because the insurance company, Blue Cross of Minnesota, covered the entire amount.
And so, people are thinking, “Well cool, the insurance company covered it. “That’s an unusual story.” Usually they’re like fighting not to pay bills. But here’s what you need to know about this story because it points at the fundamental, disgusting level of rot and graft and evil in our healthcare system that is not just hurting individual patients, it’s hurting the entire economy and our country.
If you’re a patriot of any stripe, and you care about America, we need to do something about this. This is what’s going on. This woman went in with a sore throat she’d had for a week to her primary care doc in a very fancy part of Manhattan. The doc swabbed her throat, sent it off to the lab, ordered some tests, and then gave her a prescription for antibiotics anyways, which she took, she felt better, she went on vacation.
Okay, first of all, probably shouldn’t do that for a virus. Of course, I wasn’t there, so I’m backseat quarterbacking here, who cares. Or Monday? What is it? Sunday evening quarterbacking? Whatever the hell the sports terminology is that I don’t understand.
But what ended up happening was, the doctor sent this off for a series of viral tests. I wonder what kind of cold virus you have versus all kinds of other, you know, bacterial tests, streptoccocus, whatever, et cetera. All the tests come back negative, the woman already took antibiotics.
Then she gets a bill for $26,000 because the lab that the swab was sent to was out of network. How many of you guys have gotten out of network medical bill? The insurance company often will deny these bills or make you pay a big part of it. But in this case, they didn’t.
Now here’s the dirtiest part, the lab that the doctor sent this test to is owned by the same company that the doctor is working in the same partnership that the doctor’s working in. The insurance company paid the bill. The patient had nothing. So if you ask the doctor, the doctor will say, “Well what’s the patient ever have to pay “and we needed the test.”
Okay first of all, you didn’t need a pan viral test for this. It’s a cold. You watch it or you do a rapid strep swab and that’s all you do. So first of all, the doctor is absolutely wrong to order this expensive test without talking to the patient about what the financial ramifications are of that.
The second thing is why did the insurance company pay for this? Aren’t the insurance companies supposed to protect our healthcare dollars by fighting to save themselves money. Here’s what happened with that.
Remember this thing called Obamacare? It was done with actually reasonably good intention. They told the insurance companies, hey. 80% of the dollars you’re charging in healthcare premiums to individuals and companies need to be spent on the actual cost of medical care. And then you can have 20% to cover your overhead cost and your profit margin. Sounds like a good idea, right?
Like many ideas the government has. It sounds good on paper until you put it in practice. Because what does the insurance company do? They go well okay, so we can make, let’s see 3% profit ’cause we have 17% overhead and 80% has to cover cost. How can we make more money? What if we make the pie bigger and 3% of a bigger pie is more money. What if we actually let people overcharge for procedures they don’t need? Then all we have to do is next year is raise the premiums to cover the actual medical cost, which is now higher. And then we make a higher amount of profit.
That was the untoward side-effect of the government policy on this, which by the way happens with many policies that are top down. You can’t predict what happens and then it happens. And then you go, whoops. Now here’s the thing. How does this affect people who aren’t this lady. She didn’t have to pay for it. Next year, guess what’s gonna happen to her insurance premiums?
They are going to go up by 10, 18, 20%. Guess what’s gonna happen to companies around the country who are paying the bill for this. They’re gonna drop or keep your wages flat, which is what is exactly has been happening. This has been a financial albatross this rot, this collusion between healthcare providers charging a bunch of money and insurance companies paying it, hospitals overbuilding and overcharging and doing stuff that honestly we don’t even need, and then all these money games, people getting rich, everybody else’s wages staying stagnant or going down.
Is that how it feels to you? One in five Americans have collections agencies coming after them for medical bills that are inflated and probably unnecessary. All right?
Now the question is what do we do about this rot? Well the first thing is sunlight is the best disinfectant. We need to scream and yell about what’s happening. Make these companies so uncomfortable about what they’re doing that they’re actually worried they’re gonna start losing money, right?
And the second thing is you need to tell me in the comments what you would do to fix this because there are ideas out there that will transform healthcare. We’ve given you some of them. I wanna hear yours. Okay? Do me a favor. Share the video. Get pissed off about this. This should piss you off. It pisses me off and I’m a doctor. I could get rich doing this. And I can’t, I wouldn’t be able to sleep with myself.
And those are the kind of people we should be letting into medical school, not this doctor who would charge $25,000 through her own lab for a medical test that’s gonna destroy the entire country’s economy. Alright, we out.