The “800lb Health Care Gorilla” in the Room

The fact is that the level of charges have nothing to do with the level of reimbursement. The hospital WISHES that Medicare and Medicaid reimbursed at 60% of their charges. Try more like 30% (based on my experience as a private pathologists billing both Medicare and Medicaid). Those levels are only high because M&M pay so low - one needs to make it up somewhere. I used to get $80 for looking at a gallbladder in 1988. Today, I get $15 for the same service from M&M.

So, while some procedures get a lot of reimbursement, others that are much more common simply don't get reimbursed enough to cover our costs. Where do you propose that we get that shortfall covered, hmmmm? Our costs aren't going down. The President has already said that one of our biggest costs - malpractice insurance - won't be going down because he wants to reward his lawyer buddies by protecting them from tort reform.

The proposals for health reform MUST begin with one of the biggest problems: tort reform. If it doesn't, it is just not a serious proposal.

Jack Chaffin, MD

I appreciate Dr. Jack Chaffin's comments. It is good to have the voice of actual experience on a topic I have spoken about. I think however, that private insurance has been influenced to some degree by M&M's scale, and it has caused premiums to increase for the insured. At least, that was my premise when I wrote my piece in the blog.

1deciple