The problem with healthcare in America

The problem with health care in America is that providers and locations accept different payments for the same service. For instance: Blue Cross Betty, Medicare Mary, Worker's Compensation Wendy, Car Wreck Carrie and Green Money Gert all see Dr. Doctor for a cut that requires stitches.

Dr. Doctor charges 400.00 for the visit and sutures, knowing full well that-

Betty's insurance will pay $150, Betty will have a $30 copay, Dr. D adjusts (writes off) the additional $220.


Mary's insurance will pay $85.oo, Mary will have a $15 copay, Dr. adjusts $300

Wendy's insurance pays a rate set by the state, (in most states comparable to medicare, but in Oregon, the reimbursement is pretty high) and she has no copay. Dr. D writes off the rest.

Wow, you might think that Dr. D is quite generous, writing off over 50%, but he does that because SOME insurance companies will PAY WHAT HE BILLS- like Carrie's, but only up to $15,000 or one year from the date of the car wreck.

And Green Money Gert gets a bill for $400. Even though Dr. D accepts $100 from Mary, he needs $400 from Gert.

They all got the same stitches. I don't think we can have a good conversation about capping costs until providers stop shifting the cost burden to the uninsured.