Hospital Accountability on Pricing and Personal Medical Records

New Orleans   Just because a big piece of the government is shutdown and a lot of stuff at the top of the heap has been totally cray-cray doesn’t mean that there is no good news to be found anywhere at the federal level.  Maybe it takes a bit of searching, but even with the attack on the Affordable Care Act, we seem to all still believe that healthcare institutions require some accountability.

For example, as of January 1st, 2019, all hospitals in the country are required to post a list of their standard charges for all of their services as well as for the drugs and tests they provide.  Furthermore, they are required by the federal government to post these charges in a way that you can download them on your computer at home and review them, even before you are under the knife or undergoing some treatment.

There are a couple of caveats of course.  One is the reminder that the charges hospital’s list may not be the real cost to the consumer’s pocketbook.  Insurance payments would impact that as well, but at least you will know the retail or sticker price that they are trying to get for a band aid, a transplant, or a new baby.

The other warning is that they are posting this on their websites.  Anyone who has ever been on their local hospital’s websites, knows that this gives them additional pains in several well-regarded body parts.  Additionally, it goes without saying that you would need internet and computer-style access in order to do the download, and many of the families that need this information the most are also numbered in the huge masses in our cities and rural areas that lack such access.

Another part of this new federal rule taking effect now is supposed to make your electronic medical records available to you.  The same problems exist there, but it’s still a good rule.  The government has spent billions helping hospitals make their information and records digital and available.

I’m skeptical whether many of these institutions are ready for prime time and the turn of the calendar.  I had occasion to need to make an appointment at my billion-dollar local nonprofit hospital, Ochsner for example.  Calling them, you are harangued about going on your computer to quicken the process.  Doing so is a horror.  Over a half-hour I was kicked off the site four times and told a dozen times that the hospital’s server was not accepting communications about scheduling – or anything else.  I called them and got an appointment on the old school telephone blower within minutes.

Another bunch of emails instructs you to go on-line and fill out your medical and other history before you show up to speed the process.  Having just done that for my annual physical and still being forced to fill out the form, I wasn’t going to be fooled by those messages a second time.  Sure enough when I showed up, they tried to give me the form to fill out again.  I said I would only do it if they can show me that my history wasn’t already in the computer since I had filled it out online and on paper previously.  The nurse said, “well this is so that the doctor has it in front of them.”  I said, “the computer is in front of them.”  Anyway, she looked and nada.  My record on past illnesses and family history wasn’t there.

In recent months Atul Gawande, the Boston-based author and doctor, wrote an amazing article in The New Yorker questioning whether computerization was helping or hindering doctors after his hospital system, the famous Partners nonprofit, had spent a billion or so making everything electronic.  Doctors were spending more time on their computers than with their patients.

Their computers might have worked, and they actually had computers at home and at work.  Both of those things might be a couple of steps ahead of many of us, but this rule will definitely be a step forward once we can catch up to it, and if there are real penalties for hospitals not complying.


The Healthcare Fixes Unfixed, Divide and Conquer on Display

Sofia    There’s no national healthcare in Bulgaria from what I learned in recent discussions, so this is a country where Americans can come to die and feel at home.  Think about that for a minute.  Living costs are relatively low.  Healthcare costs are relatively high.  Is this the world we want?  Perhaps so, because we seem headed for that situation, like it or not, ready or not.

Reading the morning papers on-line and getting past the Trump twitter tirades, the endless Russian hacking stories, and the usual grist for the mill, it was hard to miss a story in the Times that reminded us that no matter what small joy we may have harbored at the failure of the Republican Congress, the Trump project of starving the Affordable Care Act to death is making good solid progress around the land.  Worse for America, but probably great news in the West Wing of the White House is that it is yielding an even more politically beneficial result for the Trumpsters and the right wingnuts:  it’s dividing America even more.

I’ve ranted about the problems of lower waged workers suffering from the Obamacare loopholes and compromises that called them “covered” by the minimum standards of a healthcare plan if they were working for 50+ employee companies when their employers were allowed to say they were offering qualified plans with such absurd $4000 to $6000 deductibles and 9% of monthly income payments that literally NO ONE in many lower waged companies with hundreds of workers were electing coverage since it would suck up a huge portion of their checks when they were making $10 to $15 per hour.  More cynically, they were also barred because they were ostensibly covered by their employers from receiving any of the subsidies or shared cost assistance from the Obamacare marketplaces, so unless their states had expanded Medicaid, they were caught in the gap.   Nothing was sorted out in these years perhaps due to gridlock in Congress and perhaps because who really cares about low wage workers anyway?

Now in the Trump attack on the lower middle class, his starving of Affordable Care is leading, as predicted to soaring price and deductible increases on sketchy plans, almost identical to those faced by lower waged workers.  Families are seeing 50% or more increases in some states, and deductibles running up to $6000 before they are able to get benefits.  Now middle-income families are in the same boat as lower waged service workers where the cost of having insurance is creating a huge, sucking hole in their paychecks.

The shameful difference is that too many, if the Times’ report is to be believed, are not blaming Trump, the Republican Congress, gridlock, or anyone else.  They are blaming lower income families and – painful irony alert – lower waged workers.  Despite the fact that many families in both of these population segments are working their asses off at any and all jobs they can muster, this is now fueling support for even more draconian work requirements for the poor and lower income families access food stamps or even Medicaid benefits.

If that isn’t a master Machiavellian stroke approaching pure evil, what is?  Pretending Trump and his people are corrupt clowns may be satisfying to some, but as the Affordable Care fight shows, we’re in a death match now, and, friends, don’t fool yourself that we’re winning.