A few months ago, I got a cut on my hand that got infected. It was kind of a pain in the rear, mostly because I had to spend over an hour in an emergency room waiting area, hoping to hear my name as the next one called. I actually got there after several of the people waiting arrived, and I was called after about an hour and a half of sitting, and before many of the people who were probably pretty peeved to see me called before them. Was it wrong? Probably. Was I going to care? Not at the time, no—it was Friday night as I wanted to go home.
Important Note: If the area around a cut gets swollen, tender (possibly warmer than the surrounding skin as well), and you see red streaks in your skin emanating from the area of the cut, GO TO THE HOSPITAL! Especially if you see red streaks: they mean that you have blood poisoning and you need antibiotics! The red streaks may be somewhat dim—like a 20-minute sunburn. I had a couple of them, each about 1/2 to 1/4 of an inch wide (about 1 cm or so for European, Canadians, or other weirdos), and they were a bit hard to distinguish until they extended down the length of my hand.
Fast forward a month or so and we arrive at the one thing that everyone dreads most after a visit to the hospital: the bill.
You can imagine my surprise when I opened a bill for something like $580. What the hell happened to my insurance?! I mean, I gave the lady my information, why do I have to pay $580?!
I was pretty freaked out, because I don't really have $580 sitting around—especially after just recently paying off 4 years worth of credit card debt. Then, as I examined the bill, I realized that this bill was for the doctor who saw me, not the actually hospital visit (which was mostly taken care of by my insurance). And, for some ridiculous reason, the hospital did not inform the hospital's doctor that I gave the hospital my insurance information. And why was the doctor who saw me for all of 10 minutes charging me separate from the hospital where he or she works? And no, I honestly couldn't tell you whether the doctor was a man or woman, because I barely saw him/her. Come to think of it, I can't even remember which person was the doctor... there were a lot of people who stopped in to see me.
One step I'd like to see hospitals take care of before we get into the legislature: clean up your worthless, piece-of-shit billing departments and billing systems. There are so many horror stories out there about billing errors for any number of stupid mistakes created by computers that don't talk to each other, or caused by non-sensical procedures that do nothing but result in more paperwork that can only increase the odds that something important will get lost along the way.
Okay, so I mail in my insurance information and, a couple of months later, I get the new bill. Ahhhhhhh, that's much better: some $50 after insurance. I was pretty happy about a 91% reduction in my balance owed.
Here's the part where things are important. The itemized bill for the services included a $330 reduction of the charge from $580 to something like $250.
So let me get this straight, if I have the right insurance, the bill is $250, and if I DON'T have insurance, it costs me $580? How does that make any goddamn sense? More than likely, the person without insurance can't afford it, and therefore they cannot afford a ridiculously expensive hospital bill.
According to antitrust laws, companies cannot give each other special prices that eliminate the competition. Competition forces companies to reduce their prices—if they don't, they won't be able to compete. So why are specific insurance companies given special discounts by certain hospitals they are affiliated with? Thanks to an antitrust exemption given to hospitals and insurance companies.
Why on earth do hospitals and insurance companies need an antitrust exemption for? They are both doing just fine. But they refuse to give up their antitrust exemptions because they have them and they are not interested in changing the status quo. Meanwhile, they charge people $580 for services that can be profitably performed for $250.
Hospitals say that they reduce charges for affiliated insurance companies because the insurance company sends them so much business. Well, if their prices weren't so high for other insurance companies—to say nothing of the uninsured—then they would GET more business. And they would make more money off of those new people than they would off of them not showing up.
Meanwhile, price competition would force hospitals to reduce prices, making health care much more affordable for everyone. And when hospitals need to compete for customers, they will need to improve care to keep up with competition. Internet sites could track quality of care, death rates, malpractice rates, costs, and services, forcing hospitals and doctors to improve in all of these regards. If they don't, they will need to drive down their own prices that much more to attract people willing to trade quality of care for cost. If they don't do that, then they risk losing customers.
In this case, insurance companies would actually be motivated to provide better service for their customers, rather than forcing people into their affiliated hospitals. Even if they do nothing else, insurance companies would want to point out who has the cheapest prices, so that they can save on their own costs.
For the poor, removing the antitrust exemption means that they might have a chance to afford their health care. For the wealthy, that means that they don't need to buy health insurance, because they don't need it for the discount that it comes with. For everyone across the social spectrum, it means that losing insurance is not nearly such a big deal, because that means that the uninsured person is not essentially betting against their own health: after all, the actuarial tables are very thoroughly figured and the insurance companies—just like casinos—know that the law of averages will always work out in their favor, even if they end up losing money to one or two people who happen to need a lot of chemotherapy, or a heart transplant, or any number of other, expensive procedures that cut into the insurance company's bottom line.
Airlines cut very tight profit margins because competition demands that they keep costs low. Retailers have very tight profit margins because they know that the marketplace demands that they can compete on price. Gas stations have to carefully watch the prices of the neighboring stations, or people will go to a station where the gas is a few cents cheaper. Competition keeps prices low and keeps options open. So, when healthcare costs are exorbitant and results are embarrassingly poor, it makes no sense to keep in place an antitrust exemption that allows hospitals and insurers to keep costs high for terrible service.
The antitrust exemption prevents competition from at least having a chance to do what it is supposed to do in a market economy: improve product and reduce costs. Therefore, the most sensible step for the government to take is to remove the counterproductive antitrust exemption for hospitals and health insurance companies.