This commentary is by Elayne Clift, who writes about health and social justice from her home in Brattleboro.
It’s no secret that America’s health care system is broken. Most of us can cite a litany of problems we’ve personally experienced. But few would include the travesty surrounding how health care costs are billed and covered.
I ventured into that morass recently and what I learned provided another compelling reason for universal health care and a single-payer system.
It began with a pneumonia vaccination that I received at my doctor’s office instead of a Walgreens pharmacy. I expected a charge but assumed it would be minimal. Then I got the “patient statement” from the hospital where my doctor practices. On the statement, a “pharmacy” line item appeared in the staggering amount of nearly $700.
Other charges were for “preventive care services” and “physician fees.” I saw these charges as redundant since I saw my doctor for a “wellness check” that constituted preventive care with a physician.
Although I was billed a small amount for these services because “contractual allowance adjustments” covered the bulk of the bill, I began trying to learn what it all meant. I started with two simple questions: Who sets health care costs and fees, and who regulates those fees, which included overhead costs and $243 the hospital is charged for “medicine” (serum).
Thus began an exhaustive search for answers that led me down a frustrating rabbit hole.
Among the Vermont state offices called for information were the governor’s office, the Healthcare Administration Financial Regulations office, the Division of Licensing Protection, the Department of Health Division of Rate Setting, and more. Fifteen calls later I still had no answers. Instead, each call resulted in a circular handoff, often to agencies I’d already called.
No one in these agencies, it seemed, had any idea how costs were established, who regulated them, and who paid for them.
This led to a discussion with my local hospital’s CEO and financial officer, who walked me through a bureaucratic maze of rules and regulations emanating from federal and state mandates, organizational finance relationships and more. It was so complex that, even though I worked in public health as an educator, policy analyst and advocate for over 40 years and hold a master’s degree in health communication and promotion, I could not understand everything they shared with me.
One of the things I learned is that no one actually pays the gross charges, which are based on what will be reimbursed by insurance companies, and the costs of various services and procedures as identified by Medicaid and Medicare, with fixed rates periodically negotiated based on current reimbursements. This is known as “cost shifting.”
In Vermont, organizational relationships regarding financing of health care also play a part in this cost-sharing.
Christopher Dougherty, CEO of Brattleboro Memorial Hospital, agrees that the current system of health care financing is an odd system that “puts us at risk.” He is troubled by the fact that the financing system is modeled on covering the costs of services rather than measurable outcomes of patient care. That viewpoint aligns with equitable, accessible, quality health care for all and it is grounded in the holistic and cost-saving idea of health promotion and wellness, and the fact that health care is a human right.
To explain the convoluted, crazy financing of American health care, which is fundamentally a national disaster, requires a full investigative report, if not an entire book.
My purpose here is twofold.
First, it’s to expose the problems in health care financing and to encourage health care consumers to self-advocate when those, or other health care dilemmas, affect them personally. That means asking key questions of politicians and health care professionals along with other measures that lead to accountability and transparency. It also means voting for leaders who understand and care about health care issues.
My second objective is to underscore the urgency of a universal health care system that eliminates the outrageous bureaucratic enigma and the power brokers that now drive health care and costs. To paraphrase the late Princess Diana, “there are three (organizations) in this marriage,” and one of them is not the patient. It is Big Pharma, the insurance industry, and the fact that health care delivery systems like hospitals are increasingly dedicated to business models rather than putting people above profits.
This powerful triumvirate must be called into question, revised and reinvented in ways that will be difficult to achieve. But they are not impossible.
In 2020, T.R. Reid wrote a book called “The Healing of America.” Reid researched five developed countries in which some form of universal health care was practiced. Drawing upon what he learned, he developed a model of universal health care that would be viable in the U.S.
His recommendations went nowhere because Americans are loath to pay higher taxes for social services (a chunk of which would be financed by corporate America paying its fair share of taxes), and very few in Congress, who are loath to lose an election, understand what a social democracy looks like.
Ironically, when I was mired in trying to get to the bottom of health care costs, not just in my state, but nationally, I was facilitating a seminar for hospital personnel called “Humanity at the Heart of Healthcare.” As great physician writers and profoundly humanistic caregivers still out there know, we need to return to that foundational idea in the delivery of health care. With enough people standing up for the principle that caring and curing can go hand in hand, we can focus on the Hippocratic idea to “do no harm” (including financially).
As poet Amanda Gorman wrote in her poem “Hymn for the Hurting”: “May we not just ache, but act.” Now is the time.
