High cost of medicine is justified

In response to Mary Lindsley's commentary on the high cost of health care, it is simplistic to blame one link in the chain when there are many reasons for the costs. Ask someone who has worked in the billing department of a hospital or for a doctor. A doctor may be driving a snazzy car, but there are twice as many of them who are sweating when the first of the month comes around, wondering if enough patient payments are going to come in to be able to pay the rent. They also entered practice with very large school loans to repay.

The United States is the only industrialized country without universal coverage. We have good examples of what works well from other countries, as well as what needs improvement. We know the costs involved in terms of increased taxation; but we also know the costs of going without health care. Prevention or early intervention for health care is far less costly than trying to fix health problems years after it has developed.

Universal coverage might be a blessing for some physicians who spend a great deal of time and money trying to collect on their outstanding accounts, but others fear that it would greatly reduce the amount of salary they could draw. The American Medical Association is a powerful lobby looking out for their interests.

When a charge for medical care is submitted to your insurance company for reimbursement, the insurance company reviews the procedures, physician, codes used, frequency of the procedures, location, and anything else relevant to the care. If for any reason the bill is not to its rules or liking, it is denied for payment. The billing clerk must go through the billing process again after finding out why the charge was kicked back. The people reviewing your claims in the insurance office are not doctors, or even nurses for that matter. They may have gotten the job simply because they took a medical terminology course in college. If the procedure is approved, then the insurance company pays the amount they set for the procedure, not the amount the doctor charges. Did you know that insurance companies have built-in computer programming that systematically denies payment to a certain percentage of bills submitted to them knowing that the doctor's office is busy and will not have time to resubmit the charge? The insurance company saves money this way because the bill will never come their way again. But the doctor's office has to absorb that cost. HealthLink even charges the doctor's office a $1 fee for processing every claim.

There are talented doctors here in St. Louis who are so tired of fighting for their money that they have left practice. Another aspect not many people see is that most hospitals and doctors accept a percentage of patients at a reduced fee of half-price to make care accessible to the poor. Unfortunately, there are more people with need than can be accommodated.

Add in the costs of the patients who are not able to pay their bills at all. They still require the critical operation or care regardless of their finances. They may have delayed the procedures as long as possible because they know that they cannot pay for it, and this often makes their medical condition worse and more costly. The only option left for the hospitals is to cover the costs any way they can, so other patients with health insurance are charged. Medicare and Medicaid only pay a fraction of the costs of running a hospital or office. For some types of doctors, their insurance reimbursements have been reduced instead of increased. Ask your doctor next time you see her or him--or better yet--ask the people who really know--the billing clerks. Find out how much your insurance reimburses your doctor, and then add up the costs of running an office. See if you could do it.

-Nina Chastain