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Wednesday, January 19, 2011



Wednesday, 8:15 AM.  10 degrees, wind W, calm.  We had a dusting of snow last night, just enough to have to clear the driveway, walk and decks. It is a dark, overcast morning. The barometer predicts partly cloudy skies. We could use some sunshine.
    Anyone wishing to get some insight into what is wrong with our national health system need look no further than an insurance statement for a service rendered by a doctor or hospital.  Being on Medicare for a number of years now, I regularly receive statements from it and my supplemental insurance.  I have been pretty healthy so I have mostly just glanced at my “explanation of benefits” and filed them.  But in 2010  I needed an outpatient operation for carpel tunnel syndrome.  The service was great and the results were good. The bill for a couple hours of services rendered was $6,728.00.  I can’t argue with the fee because I don’t know what the costs and profit margin are.  But, here’s the rub: Medicare paid $1,699 and my medigap insurance paid $340, a total actually paid for the services, of $2,039.  There were a few other charges billed separately.  So the pay for services that was accepted by the provider was almost70% less than the amount billed, with no further charges to me, thankfully. What a bargain! However, if someone did not have insurance, they would have had to pay $4,689 more. How is that either possible or equitable? It is no wonder that virtually everyone is obliged to carry health insurance, at almost any cost (my insurance is far from free by the way, as I pay 100 per month for Medicare Part D, and $150 per month for my supplemental insurance, a total of $3,000 per year). If overcharges by hospitals can be made at will, and without scrutiny, the costs to Medicare and my coinsurance will keep going up ad infinitum, and both premiums will be continually raised, as they have been.  The true cost of services and the profit margins involved are virtually impossible to determine, and the patient does not have any role in approving costs or outcomes. I was never any good at three card monte, the dealer’s hand was always quicker than my eye.  But that didn’t keep me from realizing it was a con game.

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