Healthcare for Profit

Approximately 85% of our health care costs in this country are for physician and hospital care. This is by far the largest bulk of our expenditures on healthcare. In the US we spend an average of $7960 per person per year on Health care. The world average is $2342 so we spend 339% of the international average on health care. Yet… we rank 37th on the World Health Care Organization’s ranking of national health care systems; right between Slovenia and Costa Rica who spend $2084 and $1059 respectively according to WHO for 2009.

The United States remains the only industrialized nation without a public health care system. Let’s look at why our costs are so high….

Doctors compensation
US General Practitioner- $161,000 Rest of the World- $78000
US Specialist Doctor- $230,000 Rest of the World- $107,000
While both of these are over 200% higher than the rest of the world this is not the whole story either…

Let’s start with our insurance system. Most Americans get their health insurance through a carrier that works with their employers. This was basically set up originally because the government helped subsidize it by offering tax breaks for employers who provided health insurance. The insurance companies liked it because it tied the insurance to people who were working and therefore less likely to have serious health issues that would cost a lot of money to treat. This has led to a system wherein the vast majority of Americans who have health insurance purchase it through their employer. Health insurance is just like car insurance in that it takes a lot of people who don’t file accident claims to pay for those who do. In effect, younger healthier employees who don’t file claims help balance out the system for the older employees who have more health problems.

Therefore, there is a large pool of employees paying into plans that do not file a lot of medical claims and therefore make this a profitable business for private health care insurance companies. However, as soon as these people retire or reach the age where they start to have more health problems they are no longer on the roles of the private health care carriers and become the problem of the government Medicare system. This is exactly why our system does not work and public health care systems do. A private health care carrier gets the benefit of receiving premiums for the part of our life where we don’t really need a lot of health care and then turns us over to the Medicare system when we do. By this time, the profit from a large pool of healthy people is in the pockets of a private health care insurer and the government is stuck with paying for all of our health care when we need it most.

In 2008 Wellpoint (one of the ten largest health care carriers in the country) reported total revenue of $61,579,200,000. From this total they reported a 4.07% profit. This comes out to $250,627,334 for one company. If we assume there are ten other companies with this same level of profit we are talking about 250 billion dollars in profit for health care companies that would go a long way towards solving our deficit problem because we could eliminate this by going to a public health care system. We must remember that privatize actually means profitize.
While some may claim that private companies are more efficient actual numbers in health care show this is not true. The average administration cost for private health care carriers is around 13% while the average administrative cost of Medicare is less than 2%. It is much simpler to administrate a system where everything is covered as there is no time spent trying to decide what is covered and what is not. Canada’s public health care system has similar administrative costs as do those in Great Britain and France.

How hospitals work…

Most public hospitals (including my local hospital) are now 501C non- profit corporations. They also get special dispensation from the Federal Government for providing community services such as free health care for indigents and uninsured. These dispensations mean they pay no income tax, no property tax, and no sales tax. They are also eligible for special loan rates and bond issue rates as a part of these dispensations.

Let’s look at what they actually do. Most hospitals average around 5-7% rate of people who either cannot pay for treatment or do not pay although many of the larger systems actually have knocked this rate down to around 2% and still maintained their tax exempt status. If you added up the taxes they are exempt from you would easily come up to the 45-50% range that they would be paying if they were not tax exempt so a 5% loss is very acceptable as they are in effect producing a 45% savings for their board of directors by providing free health care.
Hospitals have what are called “master charge” or “billable” rates that are used to calculate these numbers. Unfortunately, these “master charge” rates have little to do with actual costs. For example, if you go to the hospital without insurance and have a colonoscopy you will be charged from $6000 - $8000 dollars for this procedure. Blue Cross often settles these claims for less than $1000 (this just happened to my daughter). Plainly, the hospital cannot accept less than $1000 if the actual cost of the procedure is $8000 and stay in business so there is something very wrong with the math.

The only people who ever pay these “master charge” rates or those who do not have insurance or are indigent. In other words, the vast majority of them are not paid but are used by the hospital to estimate their loss to get their losses in the 5% range. However, the Federal Government has what are called DSH (Disproportionate Share Hospital) plans. These are funds that are available to reimburse hospitals for their losses through free health care. There were around 43 Billion dollars paid out on this plan in 2003. There are only two requirements that a hospital has to meet to receive these funds.

1) At least 1% of a facilties total in patients must be Medicaid patients
2) If the hospital offers obstetrical services, the hospital must provide at least two obstetricians with staff privileges who agree to serve Medicaid beneficiaries.

If the hospital meets these requirements they are eligible to receive up to 100% of their shortfalls due to Medicaid, Medicare, and uninsured patients.
Medicare typically pays 91-93% of all medical costs. Medicaid typically pays 45% of all medical costs with the rest made up by the states and DSH payments. However, since hospitals cannot collect 100% of their costs through these two programs they typically add a 38% fee to all private health care carrier bills to make this money up (even though it is usually totally reimbursed by DSH payments).

It is easy to see why our health care system is broken. We don't have a lack of insurance problem we have a cost of healthcare problem. Between insurance providers, doctors, and health care providers (hospitals and nursing homes) we have a system where it is impossible to track actual costs. This has led to the bloated, ineffective system we all struggle with when we need healthcare. Anyone who doesn't have healthcare insurance is one illness or accident away from bankruptcy. Anyone who does have healthcare insurance is paying through the nose for it and it will only increase as time goes by. We cannot solve the problem with more insurance. We have to get costs under control before we can even make a dent in it.

It really is quite simple. As long as we have a profit based system we will have healthcare that concentrates on the most profitable areas of healthcare; hospitalization, surgery, and major illness treatments. This is basically the reason that our healthcare system in this country does not resemble that of any other industrialized nation. It is also the reason why we are all at the mercy of insurance providers and hospitals. Last year, my mother passed away after a long stay in the hospital. She was in an automobile accident and later died from complications from that accident. The bill for the first month of her stay was over 600,000 dollars. You might want to keep that figure in mind if you think you can save enough to cover your own healthcare without Medicare under the current system. The plain and simple truth is that this is impossible for all but the wealthiest among us.

The next time you drive by your local hospital and notice the gleaming new buildings and constant expansion you might want to think about this post. The truth is that a large part of our national wealth and most all of our private wealth is eventually going into the coffers of insurance providers, doctors, and health care providers. They are sitting there just waiting because they know something you don't. If you live long enough, you will give them everything you have worked for your whole life in the last few months of your life.