Tag Archives: health insurance


This is a true story.  A family member had an accident in the home.  She took a nasty backward fall and her head slammed against a piece of sharp edged furniture.  The result was a bloody mess and a call to 911 for assistance.  Ambulance, police and fire department vehicles were promptly on the scene.  The patient was transported to the hospital about 4 miles distant.

Three stitches were required to close the wound.  Some tests were made to be sure there were no hidden injuries.  Twelve hours later the patient was released and walked out of the hospital.  It was as simple as that; there were no extenuating circumstances.  The medical care was good; the healing was complete.  That’s not the story.

When the bill came, it was $27,607.92.  That’s the story.  One item was $13,541.54.  It was called Trauma Response Level II.  That’s the price for the house call.  The other items were all various hospital charges.  One does not expect good medical care to be cheap but having to pay these prices is bizarre!  But wait.

There were two more items on the bill.  One item was Insurance Paid $1,610.51.  The other was Insurance Adjustment $25,947.41.  Translation – A) the prices were highly inflated, and B) nobody paid the artificially inflated prices.  Nobody was ever expected to.  The injured was a Medicare patient.  Medicare only pays a certain percentage of the “price” for each service, so the price is set high because the percentage paid is low.  There is something seriously wrong with a system that requires healthcare providers to bill at horrendous rates in order to receive modest remuneration for their services.  That’s the story.

Oh yes, there was one more item.  There was a box at the top of the bill that read Your Portion $50.00.  And so in round numbers, the patient paid $50, the healthcare providers got $1,600 but they had to bill for $27,000 to get it.

What about the uninsured, perhaps a mid-life family provider currently out of work, a foreign tourist or a member of the perpetually unemployed?  Is there a separate billing rate for them?  In some cases there is not.  Full rate billings happen every day.  In these cases it is up to the patient to negotiate a better rate.  It’s similar in the doctor’s office.  There is a list price, the price an insurance company pays and there is the price Medicare pays, all different prices for exactly the same service.  What you pay if you are uninsured may be different from all the other three and it will be the highest.  Health care in America is superb.  The financial administration of it stinks.


Harvard Professor Greg Mankiw explains the reality of the President’s ostensible concession in a published piece aptly titled Semantics at the Highest Level.

Consider these two policies:

A. An employer is required to provide its employees health insurance that covers birth control.

B. An employer is required to provide its employees health insurance.  The health insurance company is required to cover birth control.

The President changed the law from A to B which is no change at all.  The claimed concession is not an about face; it’s about farce.  It has oft been said that perception is reality.  The two are not the same, of course, but the aphorism makes the point that the difference is irrelevant.  Perceptions are formed by speeches and headlines while truth and reality often remain in obscurity.  In a prior post on this subject, I wrote “If there is one thing the President knows well, it is the art of agitation, how to create it, how to use it as a tool for accomplishing an objective and even how to deal with it if it turns negative to your cause.”  The pot is still simmering on the issue but thus far Obama has dealt with it effectively.


Proposition C voters said YES to the tune of 71% in favor of the Proposition which says NO to mandated insurance for health care. Missouri thus joins with Arizona in entering into a serious conflict between a sovereign State and the Federal government, AZ over illegal immigration, MO over Obamacare. What State will be next? What issue will be next?

This case is almost certain to go to the U.S. Supreme Court. If the Court upholds Missouri’s Proposition C, Missouri residents will be exempt from the Federal mandate to buy this insurance. An avalanche of states will follow. Obamacare will be in trouble. Kagan, if appointed, will be the leftmost judge on the court. The direction in which she would vote is not in doubt.

One of the reasons America surpassed Europe to become a superpower is that Europe is comprised of nation states that repeatedly make war with each other while our states remain united, even following a civil war.

We were a nation that had grown harshly divided along political lines in recent years. Obama promised to bring unity. Instead, we have seen only a widening of the gap and a hardening of the hostility along political lines.

We have quoted Lincoln before and we will quote him again, “A house divided cannot stand.”

Bob B