Nothing Is More Terrifying Than A For-Profit Hospital

Riget The Kingdom Von TrierIf you’ve ever watched Lars Von Trier’s Danish TV series “Riget (The Kingdom),” set in a haunted hospital, you may think you know scary. But there’s nothing in even Von Trier’s fevered imagination that can compare to the horror of our American health care system.

Here’s one chilling fact: cough medicine costs a certain set amount no matter where you are. Chest x-rays, though, as this Forbes article by Peter Ubel makes clear, are a different story.

If you call up the nearest hospital and ask what they charge for, say, a hip replacement, you will quickly learn that most hospitals don’t charge a single price for this procedure. (To keep things simple, let’s ignore the physician fee part of this equation, and just stick with the hospital charge.) The hospital will have a Medicaid price, and a Medicare price. They will have a price they charge BlueCross, and another they charge Cigna, and yet other prices for yet other insurance companies, each price the result of company to company negotiation. And finally, they will have the charge master price – the amount they bill for people without insurance, or for people receiving the procedure outside of their insurance network, or for people paying for the procedure with workers’ compensation insurance.

You will not be shocked to learn that 49 of the 50 hospitals with the most extravagant mark-ups in price are all for-profits. Those institutions, the New York Times recently pointed out, aren’t bound by even such light restrictions as made it into Obamacare.

Under the Affordable Care Act, nonprofit hospitals are required to provide charity care or discounts to low-income people but that mandate does not apply to for-profit hospitals. … Market forces are often not powerful enough to restrain very high prices in areas where dominant hospitals and chains can pretty much charge what they please. The best remedy might be legislation, at the federal and state levels, to limit hospital prices that have no connection to the cost of delivering the services.

Yes, the best remedy might be legislation, but we’ll never know, since the Republican-controlled legislative branch of our federal tree hasn’t had anything to show for itself for years. Anyway, these for-profit hospitals prosper in red states. Both of the nation’s two largest (and most price-gouge-y) systems are based in Tennessee. Then there’s Florida. According to a piece scathingly titled, “For-Profit Hospitals Mark Up Prices By More Than 1000% Because There’s No One To Stop Them,”

At the very top of the markup list was North Okaloosa Medical Center in Crestview, Florida. That hospital, in the Sunshine State’s panhandle, had the distinction of marking up its costs an average of 1260 percent. The Atlantic’s Olga Khazan took a look at North Okaloosa’s markups. She found, for example, that the hospital charged $79,350 to treat a hemorrhage. That’s compared to Medicare’s reimbursement of $5,177. …

of the top 50, 20 are in for-profit-hospital-friendly Florida, whose governor is former HCA CEO Rick Scott.

As a nation, we rise up in fury when one douche-bro buys the rights to one AIDS medication and grossly inflates the price. Yet hospitals all over the country grossly inflate the price of their drugs and treatments, bankrupting our sickest, most vulnerable citizens, and we allow it.

Thanks to our withering scorn, the douche-bro backpedaled. Imagine what hospitals might do if we directed our outrage at them.

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Since that’s not going to happen anytime soon, what should you do if you fall ill, so as not to become a victim of these corporate vampires? Try to see doctors in Maryland, for starters.

Only Maryland and West Virginia, in fact, set hospital rates. Bai and Anderson found that hospitals in Maryland had markups of less than 1.5 percent, lower than those of hospitals in any other state.

Can’t make it to the Chesapeake Bay? At least find out which institutions near you are not-for-profits. You can usually find one in a city:

Two-thirds of all U.S. urban hospitals are nonprofit, with the remainder split between for-profit and government ownership. These hospital types operate under different legal rules. For-profits may distribute accounting profits to shareholders, whereas government and nonprofit hospitals enjoy income and property tax exemptions.

If you can’t get to a city, well, consider Costa Rica. Save 30%-90% on what you’d pay and zip line through a rain forest while you’re at it.

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