The following was triggered by an excellent article I read today about a piece of the fraud that is the USAmerican corporate, for-profit remedial sick care industry (abbreviated below as RSC) that has personally effected (afflicted) me over the last few years: privatized "Medicare Advantage".
The complete article, "Stop Medicare Privatization" and my point by point comments are at: https://popularresistance.org/stop-medicare-privatization/
USAmerican "Health Care" is a MASSIVE Fraud
Let's briefly talk about "costs", an underlying lie that underpins delivery of "care" in the entire FRAUDULENT RSC Industry?
There was an OUTSTANDING COVER article published in Time Magazine in 2013 by Steven Brill titled, "Bitter Pill. Why Medical Bills Are Killing Us". This article described the "Chargemaster", a Top-Secret and ever pliable "list of charges" that the bean counters and CFOs working at the RSC provider corporations use as the basis of their massive fraud.
If you're among the "fortunate few" who have a stack of these on hand, follow this discussion using one of your "medical bills". I'm going to use the large stack of bills I got from Kaiser that totals around $195,000 (Chargemaster) for treatment of the heart attack I suffered from June 9 through the 10th (it took them 11 hours to get me to care) that was in no small part caused by decisions made in 2012 at another hospital in order to serve their profit-motive and left me with an occluded main artery in my heart.
Starting in the left hand column there is usually a column of incredibly high numbers that are labeled something like "Amount Provider Billed the Plan". This is the completely inflated, bullsh*t "cost" pulled from the "hospital/Medical Center" corporation's "Chargemaster", that secret list of "charges" for "procedures" that even most doctors don't have access to (or care about), is ever changing (increasing) and is the amount that SOMEONE WHO DOES NOT HAVE INSURANCE IS CHARGED!**
Then is another magic column, "Amount the Plan Approved". This is another bloated but usually*** much smaller "cost" that allegedly the insurance provider has "negotiated" with the provider to be the amount they agree to pay. Of course, in reality, the "negotiation" is usually one-sided, the insurance corporations (that will be eliminated in HR676) set their profit goals (add 20-40% for profits and overhead) and then determine the minimum they're likely to have to pay in claims once their mechanisms of denial of care fail to block payment and adjust what they will pay accordingly to maintain high rates of profit and overhead.
Then is the "Plan's Share" - the amount of that inflated "cost" that they will pay to provider.
And of course, after that is the nearly ONLY IN AMERICA(sic): YOUR SHARE. This is the punitive, Calvinist "CO-PAY" that's designed mainly to deter you from using Health Care until it's often too late to alleviate a minor condition with minimal interventions but rather one is forced to avail oneself much later in the disease process with expensive, extraordinary and extremely profitable remedial "care" for much more critical, often life-threatening conditions.
Passing HR676 - Expanded and Improved Medicare for All would eliminate this last column.
** A good friend of mine had his entire savings for his retirement from a lifetime as a truck driver taken from him by a hospital in California to pay this phony charge from the Chargemaster since he didn't have "insurance" when they cut off his leg. He was not employed at the time and was too young for Medicare.
*** I'm still trying to follow up on ONE charge in my stack of bills. Thanks to missing some important symptoms in May of this year, my massive heart attack (and overdosing me with a blood pressure medicine in my 2nd day of the stay) resulted in a 6 day stay in the hospital in June. There is a charge in my bills for "Room and Board" that defies the above pattern.
Amount Provider Billed the Plan is $9,580 and the Amount the Plan Approved is FORTY FOUR THOUSAND SEVEN HUNDRED AND SIXTY SIX DOLLARS ($44,766) with a WHOPPING "Co-PAY" of $1,160 that I allegedly OWE!!
Every other item in the bills is "discounted" by at least 40% between the 1st and 2nd column so this one should have been "Amount the Plan Approved" at around $5,800 with my co-pay calculated to be about $150. I'm still trying to get an answer from the Grievance Dept as to WTF that is all about!