The Amazing, Self-Fisking Gap Report

According to USA Today, "(t)he uninsured pay nearly three times more for hospital services than health insurers pay, and the gap between what they're charged and what insurers pay has soared since 1984."

Except that they don't, and it hasn't:

"Hospitals rarely recoup the full amount they charge patients."

Nice little sleight-of-hand there, USA Today! Bravo!

Let's take a closer look at how this trick was done:

First, "what hospitals charge" and "what uninsured folks pay" are two entirely separate things. Providers (not just hospitals) enter into agreements with insurers (or MCO's) which set the terms for reimbursement of services. The providers offer to discount what they charge, and the insurer/MCO agrees to pay that full amount in a timely manner, and to "steer" its customers to that provider, thereby increasing its sales volume. It gets even better with Medicare/Medicaid, because the gummint itself sets the price; no negotiations necessary.

Pretty simple, even for a journalist.

An uninsured person has no such agreement, and has little (if any) leverage. Many folks will (attempt to) negotiate with a provider, with limited success. One sees this especially in maternity cases, where the date of future service is pretty easy to define, and prepayment may be an option. It's pretty hard, though, to negotiate with the ER crew while you're having a stroke.

Which is not to say that I'm unsympathetic; it's a matter of economics and contract law. The providers have an agreement with the insurers, and none with those who are uninsured. For their part, they have little leverage with the patient: the law requires that they treat emergency cases regardless of insurance status, but they are restricted in how they can collect if a patient skips out on payment.

Of course, the cost of the skippee's treatment will be passed on to the rest of us, much as the cost of shoplifting is at KMart (or wherever). One can argue about the fundamental "fairness" of such a system, but it's what we have.

The point [ed: Yay! We knew there'd be one!] is that uninsured folks don't actually "pay" 3 or 4 or 5 times what an insured patient does: just because they're charged more, doesn't mean they pay more.

I also loved this: "The gap between what the uninsured and other self-paying patients are charged for hospital care and what Medicare pays has more than doubled in the past 20 years." Um, what hasn't? Again, it's simple economics, this time coupled with everyday politics: pretty much everything costs more (in raw dollars) now than 20 years ago. Of course, we're making more money than we did back then, too. And Medicare reimbursement fees are set by the gummint, and are applicable to Medicare patients, who -- by definition! -- are insured. Nice job of muddying the waters, USA Today!

And finally, there's this gem: "Hospitals provide $25 billion a year in uncompensated care every year." Um, no they don't: they pass along those costs to their insured population. I suspect that Stephanie Armour (the author of the silly piece) also believes that the government subsidizes health care, and employers pay taxes, as well.

Gotta love freedom of the press.