NPR published an interview which highlights some of the healthcare system abuses and how some recent changes are impacting them. A Miami wildlife biologist went to the emergency room for rabies injections after being bit on the finger by a stray cat. She spent two hours in the ER and walked away with a bill for $48,512.
It was an in-network facility; the in-network discounted charge was a little less than $40,000 and the patient’s portion was the remainder of her plan deductible plus 10%: $4,535.
So, what’s the problem? The hospital charge for the vaccine was $46,422, but their cost was only $4,335 – a markup of over 1000%. Three manufacturers make the drug and there is no current shortage, so the markup does not seem warranted. After an audit the plan concluded that although excessive, it didn’t “rise to the level that would make it fraudulent.”
The month following Parker’s treatment, just before January this year, the hospital reduced its charge for the same vaccine to $9,900. The article surmises that this 79% price reduction might have been in response to the new Trump administration requirement that hospital chargemaster list costs be disclosed.
It’s working… Of course the skeptic in me wants to know why the insurance carrier only negotiated a 20% discount on this excessive charge. I think NPR missed a key point – there isn’t perfect alignment of interests. Health insurance has been a cost-plus business, and of course, there might have been drug rebates in the system somewhere.
One step at a time.