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913 The Hidden Costs of Health Care

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Tune in to our radio show on your local public radio station, or sign up for the podcast and listen at your leisure. Here's what it's about:

 How do hospitals determine what to charge for their services? Steven Brill, author of a stunning expose in Time magazine called "Bitter Pill," suggests there is very little rhyme or reason beyond what the market will bear. Under the current system, those who are least able to pay (the uninsured) end up being charged the most.

 Will that picture change with the implementation of the Accountable Care Act, a.k.a. Obamacare? Jonathan Oberlander, one of the country's leading experts on Medicare, tells us how Obamacare is likely to affect the prices we pay for health care in the future.

Guests: Steven Brill is author of a TIME magazine special report:  "Bitter Pill: How Medical Bills Are Killing Us."  He is also co-founder/CEO of Journalism Online, developer of an e-commerce platform that offers digital publishers flexible subscription models to collect revenue from their online readers. He founded the Yale Journalism Initiative and is author of Class Warfare: Inside the Fight To Fix America's Schools (2011) and AFTER: How America Confronted the September 12 Era (2003). The photo is of Mr. Brill.

Jonathan Oberlander, PhD, is Professor of Social Medicine and Health Policy & Management at the University of North Carolina, Chapel Hill. His book is The Political Life of Medicare.

The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free for four weeks after the date of broadcast. After that time has passed, digital downloads are available for $2.99. CDs may be purchased at any time after broadcast for $9.99.

 

 

 

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The real problem is that healthcare in the US is strictly for profit and the providers decide what and how much you will get. This fee for service system coupled with litigation risk, amounts to exorbitant costs.

We have the only system like this in the world and it is unsustainable by any measure, currently at $2.6 trillion annually.

Arguing over who pays is like arguing over where to place the deck furniture on the Titanic.

Providing health insurance for everybody, and taxing the rest of us through higher premiums (increases to my premiums based on bringing high-risk people in is a de facto tax) or the "individual mandate" (which the Supreme Court has defined as a tax) is, if it works, a good idea because it will eventually produce a healthier society, which is a good thing. Like having an educated society, which is the purpose of our mandatory public education system.

But that system isn't working very well, if you look at the ratings our students have by comparison with those in other countries, and efforts to improve the educational system in this country are routinely and fiercely resisted by the teachers unions and their political allies (unless the improvements involve giving more taxpayers' money to the schools).

But back to health care. I have heard of little or nothing in Obamacare that encourages people to live healthier lives. My experience in many years of helping people get disability through Social Security is that most people in that situation have made very poor health decisions in their lives, and now that their chickens have come home to roost, they want the rest of us to subsidize their lifestyles through our tax dollars because they can (or will) no longer work themselves.

What is the incentive for healthy, working taxpayers, like myself and my wife, to support Obamacare when it appears it will do little or nothing to stop the ever-growing ranks of the "disabled"?

Jonathan Oberlander is a very good ambassador for the Affordable Care Act. BUT the 600 lb gorilla in the room is the reality of turning over a health care system to the control of a federal government, even if it is portioned out at the state level. The overhead required to grow and then maintain the healthcare bureaucracy will have to come out of our pockets through increasing taxes. Will this really be an efficient use of our insurance dollars and tax dollars?

Also, Jonathan did not address the legendary corruption that is part and parcel of Medicare, and also did not address the fact that it will be the Internal Revenue Service that will be implementing this new 'growth' of government.

I am naturally skeptical of hospital bills and insurance evaluations. Sorry to say, I am even more skeptical of a health care system run by the same government that cannot oversee spending in so many of its other very large bureaucracies. Joe, Terry -- I'd like a second opinion!

My daughter has had to take advantage of the Affordable Care Act as she has a preexisting medical condition and is self-employed. She was exposed to rabies and had to take the series of 4 "rabies" shots and 2 gama globulin shots at our local hospital. The bill was over $15,000!!!

The ACA paid $9000 without questioning the charges and she was to pay the balance. She called surrounding hospitals to see what they would have charged. The local hospital got word of this and asked her to come in and they would "talk" about the bill. They cut the part that she owed considerably, however, she and I were just horrified that the government program would pay the $9000 without questioning it?!?!

By the way, the most that any of the surrounding hospitals would have charged was $7500 - which I still think is outlandish!!!

I should add that these shots were not administered through the ER. She could go straight back to the lab where she received them.

Re: The guest speaks highly of the insurance exchange pool where people can find low cost insurance. However, many people in low waged and/or part-time jobs don't have extra money to afford even the lowest premium. Further, will a $50/mo plan provide the same coverage as one costing $500/mo? Low cost plans will come with high deductibles that many folks can't afford, and, not cover even common illnesses so they are still in dire straits.

Ask Massachusetts citizens about their experiences with Romneycare, upon which Obamacare is based. The guest speaks of all the positives but listeners need to hear the not-so-positive realities of the insurance exchange pool.

Listeners also need to hear a show with a guest who discusses the benefits of Medicare for All where citizens are covered under an expanded Medicare program. Medicare has proven over decades to be cost effective but Big Pharma and Insurance are suppressing any positive info about Medicare for All.

Obamacare solves few problems but creates more bureaucratic red tape that confuses and confounds but fails to address the big problem: a scattershot, overpriced healthcare system that provides uneven access to people and relies too much on employers to provide coverage and allows drug and insurance companies to control the market. It's not a good that drug and insurance practically wrote the Obamacare bill.

Dr. Oberlander’s blanket statement that there is no economic downside to obamacare cannot be accepted as fact.

I would have appreciated more discussion on how the healthcare system is going to accommodate the influx of the newly insured, many of whom are in poor health.

Lastly, if you’re going to delve into a politically charged arena, then you must include an opposing view.

Exactly. There was definitely not a balance on today's program. Not everyone shares Johnathan Overlander's utopian view of Obamacare. It would have been nice to have heard some of the downsides of the law. I expect more from this show, and I was disappointed.

At least Obamacare is a start in doing something about our highly inflated health care costs that cannot be sustained if continued as is. There can always be adjustments in making the system more functional and beneficial to all. Bottom line.....something has to be done. This is a start!

Excellent show! Top-notch and highly relevant. Brill's discussion of ACA very lucid and informative--I only wish more people could hear it. Oberlander's remarks from his book The Political Life of Medicare were enlightening, and the comment that this country hasn't been this polarized since the 1870s was astonishing! Well-done!

There is much misinformation about the ACA--and those who insultingly term it "Obamacare" show their disrespect and lack of knowledge also for Ted Kennedy, who worked so hard on this program. The astonishingly high costs for medical procedures in this country, as compared to countries which have the single-payer plan, are not adequately noted by those who seek to denigrate the ACA. It is well to remember that the U.S. and South Africa are the only developed countries without universal health care!

The ACA isn't a program that pays anything.

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