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The Villages
Thursday, March 28, 2024

Health care costs out of control

Bart Zoellner
Bart Zoellner

I believe the one thing that most everyone would agree to is that the cost of health care is out of control. Indeed there are other huge issues, but let me focus on costs.

First let’s address the cost of drugs and medicines. It would be rare for anyone to say drug costs are a bargain. If that were true, we would not see ads for getting drugs from Canada. I recently received an email from a friend in Phoenix who says they go across the border to Mexico to fill their prescriptions. All with the objective to save some money.

Not long ago, I was at Walgreens getting a prescription. A gentleman ahead of me was going to pick up his prescription – he was told the price was $612. He told the clerk he really needed the prescription, but could not afford it. He walked away in tears. It broke my heart to see that.

We spend more on drugs in this country than any country in the world, and more than the combined spending of many countries put together. Why do we often pay some of the highest prices for drugs than anyplace in the world? WHY?!!!!!! We are given many reasons for that, but the bottom line is we ALLOW it to happen.

How about our leaders declare that, effective immediately, the cost of drugs in the United States be sold as the same as the lowest price that it is sold anywhere in the world. Of course, the drug companies would howl like stuck pigs, and every lobbyist for the drug industry would be locked out of the graft of buying votes of our legislators to prop up our drug costs. Take this a step further, and declare that our drug costs will decrease by 1 percent each year until it stabilizes at 5 percent less than the lowest cost in the world.

Then, there needs to be a maximum percent markup over wholesale that a druggist can charge. This would allow the companies to charge less if their business model allowed it. Ever compare Walgreens and CVS with the cost for the same drug at Sam’s Club? So if you want the convenience of having a drug store on every corner, it might cost a few dollars more.

Let me add something additional. The retail price one pays for the drug should be the same as though one had insurance. There is no logic that says someone without drug insurance should pay more. The drug store might argue that it is volume that allows that. But that is not true because every script filled is an individual transaction whether paid by insurance or paid with cash.

This proposal is really about leveling the cost of drugs playing field. To allow anything different is a disservice to the American people.

To implement this would take tough resolve on the part of our elected officials. If this were proposed, I wonder how anyone could oppose it. If they did, one would have to wonder how much graft money they get from the drug industry.

Now let me address the costs for health care. The similar logic applies, whether it be a doctor visit, tests or a stay in the hospital. If you ever had surgery and were fortunate to have insurance, have you ever looked at your hospital bill in detail. Look at the amount billed the insurance company, and compare that with what is actually paid. The insurance company pays the negotiated rate for every procedure. Why the song and dance of billing for a certain amount, and then accept without question the negotiated amount. If you go to the hospital without insurance you will be billed the higher artificial amount. If the hospital is willing to accept an amount certain for a procedure, that price should be the same whether paid by insurance, or as a retail customer.

This same pricing and cost policy must also apply to physicians, tests, therapy, imaging services and any health service covered by insurance.

My personal experience some 14 years ago was when I had a hip replacement. I noted that the surgeon had billed the insurance company $6,200 for the surgery, but was actually paid $ 1,650.00. I asked the surgeon why. His answer was quite simple: be thankful you have insurance.  He then said, “Why do you think I do 500 hips and knees a year?” As an aside, he was one of the top ten hip surgeons in the country.

If you are fortunate to have insurance, you probably  had to go back and forth with the health care provider and the insurance company to get  a bill settled. Think of the horrendous clerical costs of this song and dance. One price if everyone pays the same whether insurance or self pay. Costs could surely go down.

The current debate of replacing Obamacare or modifying it is getting mired down in political craziness. The fact is health care costs are skyrocketing and becoming unaffordable. Even if you have an Obamacare policy, who can afford the $4,000 to $12,000 deductible before even so much as a band-aid is covered.

It is crazy to mandate that everyone be insured, or you will pay a penalty. The penalty is so ridiculously low, there is no incentive to purchase coverage.

But, if most all have some level of coverage, our emergency rooms at hospitals would not be filled with people with a cough our sore throat because they have no insurance. Emergency care is for just that, for emergency care not free care.

There needs to be a policy that most can afford that would suit their personal needs. Different levels of coverage with procedure coverage costs that reflect the cost of care in your area. And yes, insurance is just that. You buy a policy that has you covered when you incur a cost. Many of us buy auto insurance , but how many times a year do most of us file an accident claim – most of us don’t, but the coverage is there when needed. Same is true for homeowners insurance. How many have a fire that destroys our home. Very few, but the coverage is there when needed. It’s real simple we pay every year, but most of the premium pays for others until we have a claim and others help pay our claim.

But like auto and homeowners policies, we can choose the amount we want covered, along with any deductible we might choose. We should have the same level of coverage options on health policies offered along with what ever deductible we can afford or risk we choose to take.

Many will argue that policies need to cover large chronic care costs such a cancer, heart and others. Yes indeed,  all policies should provide a certain level of coverage.

Think about this. How about not buying auto insurance nor have it required, but if you knew you were going to have an accident tomorrow which totaled your car, you would go out today and buy a policy so you are covered tomorrow. Same for homeowners insurance, don’t buy it until the day before your house burns down.

Same analogy can apply to health insurance. Don’t buy it until the day before you have an emergency health issue or an accident that you can’t foresee or hip surgery, or a heart operation. Yes you can buy it the day before, but it will have a significant surcharge premium increase over had you been covered before. And this surcharge will be in effect for perhaps 5 years.

Let’s address Medicaid. It is is a program to cover medical costs for those unable to afford insurance. According to a recent New York Times article, 42% of Medicaid expenditures are for long term nursing home care, yet only 6% of Medicaid recipients receive this coverage. To qualify, one must have only minimal assets. Fact is, we are living longer, and quite possibly will outlive our assets to care for ourselves. I ask you, how many people in their 30s or 40s  think of buying a LTC (long term care) policy. Most never think about it until they are in their 60s when the premiums are quite high.

Yes it is true, Medicare will cover the first 100 days of nursing home care. After that, it is on your dime, LTC or Medicaid.

Now let me give you a real example. My mother was in a nursing facility for recovery after a hospitalization. Medicare would cover the first 100 days. There was a possibility that she would need to have been there longer. My sister and I asked what the cost would be after the 100 days. Guess what? We would have had to pay significantly more privately for the same service level that was provided by Medicare. That was ridiculous and is analogous to the above drug and health care argument. Why should a cash customer pay more than an insured customer?

We then talked with social services on what it would take to have our mother covered by Medicaid. Well, she didn’t qualify because she had some assets, a home and some savings. Those would have to be depleted before she would qualify. That was a reasonable answer.

Now, if you notice, there are now lawyers and some investment advisors holding seminars giving advice on how you can disperse assets so as to qualify for Medicaid. What a sham. All to preserve an inheritance. There should be a five to seven year look back on asset depletion in order to qualify.

Hopefully, this might start a dialogue to simplify health care, bring down costs and be fair to all. Take the graft and corruption out of politicians getting contributions and kick backs and then maybe things can change for the better.

Bart Zoellner of the Village of Harmeswood of Belle Aire.

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