Illinois passes law that requires hospitals to adjust bills of uninsured patients

This is awesome. As many of you probably don't know, most hospitals have Byzantine payment systems. For example, Mary, who is uninsured, goes to have her cholesterol levels checked at the local hospital. She is charged $250. Lucy, who is insured, also has her cholesterol levels checked at the same local hospital. She is billed $250. But then her insurance company tells the hospital "No you can't charge Lucy that much. That's above the 'allowed amount'. Instead, the hospital only asks Lucy to pay $100. So, the uninsured woman pays $250 out-of-pocket, the insured woman pays $100 out-of-pocket, the insurance company pays nothing, and the hospital profits greatly off of the uninsured woman.

In most industries this would be called price discrimination and would be considered illegal, but not in the health care industry. So, the uninsured, often the least able to pay, have to pay more out-of-pocket as individuals.

Well, at least in Illinois there is some relief. According to the Wall Street Journal Hospitals can now only charge the uninsured cost plus 35%. Not exactly a great deal, but it is something. Usually hospitals charge patients cost plus 150% and they accept as payment cost plus 2% from Medicare and cost plus 10%-15% from insurance companies and their policy holders.

"one less [efficacy] statistic"

I came across an article in the New York Times, which reviews the rush to mandate Gardasil, the vaccine against HPV, and the the fact that the longevity of immunity provided by this costly vaccine has yet to be proven.

I had read about the strange side effects of the vaccine, which range from fainting, to paralysis, to death, in obscure blogs for over a year, but this is the first mainstream news article I have seen that gives voice to skeptics of Gardasil.

The article questions the reason for the expedited application process and eventual approval of the vaccine by the CDC, which took only six months from start to finish. According to the NY Times, this process takes about three years for other vaccines. Let's just say there are some overt conflicts of interest.

Virginia is the only state to mandate the vaccine as of yet, but many more have legislation in the works. However, some relevant facts should accompany the above statment, "Merck has a growing economic interest in Virginia. In December 2006, Merck announced it would invest $57 million to expand its Elkton, Va., plant to make Gardasil, helped by a $700,000 grant from a state economic development agency that is part of the executive branch. Two months later, Gov. Tim Kaine, who has been mentioned as a possible Democratic vice presidential candidate, signed legislation requiring Gardasil for schoolgirls. Four months after that, Merck pledged to invest $193 million more in the plant to make drugs and vaccines, helped by a state grant of $1.5 million."

Why should this vaccine be mandated at all? HPV is not infectious, like the flu or other deadly disease for which the public is vaccinated against. If someone who has it sneezes on you, you won't catch it. So, why should every prepubescent girl be required to get the vaccine in order to attend school?

Doctors were also paid $4,500 by Merck, to give an hour long presentation about the vaccine and its benefits, which health-wise are uncertain and economically non-existent. You see, because the vaccines are so expensive and cervical cancer is already often caught and treated successfully, because of yearly pap smears given to most women, the "benefits" just aren't worth the cost, according to some health economists.

Meanwhile, our government will spend millions to get girls vaccinated this year, thus diverting much needed funds away from other necessary, proven, preventive care.

bad fat, bad medicene, bad news

In this article by the New York Times, the effectiveness of cholesterol-lowering medications is called into question by prominent cardiologists. Cholesterol-lowering drugs are the largest category of prescription medication with annual sales of $40 billion.

Eating oatmeal and exercising, in my unhumble opinion, is probably safer and more effective than these relatively poorly vetted drugs.

things are moving and shaking

My letter to the editor of Boise Weekly was published on July 9 and on July 13th the Idaho Statesman did an article on where the profits of the not-for-profits of the Treasure Valley go. I like to think My letter was the inspiration, but either way there is dialog about what should be expected of not-for-profit hospitals and questions about their generous mark ups on services rendered. Its sort of a split article. The article is pretty defensive of St. Luke's and St. Al's, but there is a box of additional information to the side of the main article, which contains some pretty incriminating stats and great links.

I especially found the link to hospitalvictims.org very informative and HELPFUL. The website is run by the Fairness Foundation and provides free information about every hospital in the United States and how much each individual hospital marks up the bill from its actual costs. The website provides tools for negotiating fair prices for the uninsured and under-insured, since they are often charged at least 2.5 times more than the insurance companies and the insured for the very same procedure. Righteous site, indeed.

published!

My editorial about St.Luke's was published in the Boise Weekly. You can check it out below or read the perfectly punctuated version by clicking on the link above.

Do you know your child's cholesterol?

The American Academy of Pediatrics released a statement today saying it suggests screening children for high cholesterol as early as age two. The AAP suggests that "cholesterol-lowering medications [LIPITOR] should considered" when treating a child, over the age of eight, with high LDL levels. Pfizer's LIPITOR patient information guide, states that the popular medication can cause "...serious muscle problems that can lead to kidney problems, including kidney failure." Liver problems are also listed as a "rare but serious" side effect. LIPITOR is the best selling drug in pharmaceutical history, with revenues of over $12 billion in 2007. Pfizer's patent on LIPITOR runs out in 2010. The new pediatric application could be grounds for a patent extension.

I'll let you you digest these facts on your own. Remember though, the doctors are the ones prescribing children this drug.

American Academy of Pediatrics Press Release

LIPITOR Patient Information

Forbes

Dear Sir,

This is a letter I wrote in response to an article in the Boise Weekly titled "Poor Farm Boise--County charity funds fill hospital coffers" It was a great article. Read it.

Dear Editor,

Nathaniel Hoffman's article "Poor Farm Boise" was spot on (BW, News, June 25, 2008). I was proud that he called out the normally sacrosanct hospitals, such as St. Luke's, that profit from the distress of the poor and the sick.

St. Luke's is, technically, a not-for-profit hospital, which enables them to be exempt from county, state and federal taxes. In order to maintain this tax-exempt status they must provide some sort of a community benefit and then publish the benefits provided in an annual report. According to the 2006 annual report, St. Luke's (Boise/Meridian) profited over $46 million.

Of course, this $46 million is not labeled as profit in the report, but instead, "The excess of available income over expenses in support of our mission." I think this label rivals "correctional facility" as one of the most ineffective euphemisms ever concocted. The report goes on to state that St. Luke's provided $27 million in unreimbursed care for Medicare patients. Basically, that $27 million is composed of the difference between the initial hospital charges, which are always inflated, and how much Medicare pays after it adjusts the cost.

I pose two questions to St. Luke's: how much unreimbursed care did you provide for your cronies, the insurance companies? Whatever the amount, I am certain that it dwarfs the discounts given to Medicaid or Medicare. Why not charge everybody one fair and reasonable price? As Paul Woods points out in Hoffman's article, lots of time and energy are wasted in haggling a fair price.

Christian Hatchett

Basic Hygiene

I was combing through the health section on cnn.com when I came across an article titled Don't Let a Hospital Kill You,
which offers tips on how to avoid hospital acquired infections which kills about 100,000 Americans every year. I have been aware of this problem for a while, but even I was shocked at the matter-of-fact attitude of the author, Elizabeth Cohen, a CNN health correspondent. However, I was mostly disgusted by the lack of common sense, decency, and basic hygiene in American health clinics.

tip # 4:

Ask where that syringe has been

"Doctors offices sometimes reuse syringes -- it's unusual, but it happens ."

This sentence is a little too nonchalant. Its like saying, "Sometimes times I kill people and bury them in my back yard-- its unusual, but it happens."

"WTF?! its "unusual"?! Let me give you some examples of appropriate forms of the word unusual: Its unusual for me to skip breakfast in the morning. Its unusual for me not to check my myspace for a week. Its unusual for Chris to put his dirty clothes in the clothes hamper. Its unusual for George Bush to give a speech with out botching it. All of these are unusual. So, CNN, let me rephrase that sentence for you.

"Doctors offices sometimes reuse syringes -- it's fucked up, but it happens ."

The article goes on to explain that...
"there have been 14 documented outbreaks of hepatitis since 1999 because of reused syringes. The recent outbreak in Nevada, where 50,000 people will be notified that they might have been infected at a colonoscopy clinic, is one example.

It's not an easy question to ask, but when someone's heading at you with a syringe, ask if this is the first time it's been used.

Dr. Thomas Frieden, commissioner of the New York City Department of Health, suggests phrasing it like this: "I read in the paper that some doctors are reusing syringes. I can't imagine anyone would do that.Do you?"

More pressure needs to be put on health care providers to follow basic hygiene. American's pay nearly $3 trillion a year on health care, the care we receive should reflect that, but often expensive care doesn't mean better care.

So watch keep your head on a swivel in a doctors office, make them open a new syringe in front of you, write your representatives and let them know that it is unacceptable for 100,000 people to die every year because of hospital acquired infections that can be prevented by following basic hygiene standards.