Overcharged - A Must-Read for All Health Care Providers

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Overcharged  ̶  A Must-Read for All Health Care Providers

We all have our own pet villain (insurance companies, pharmaceutical companies, pharmacy benefit managers, hospitals, doctors, pharmacists, nursing homes, CMS, malpractice suits, etc.) for the cause of the high cost of health care in the U.S. But deep down, we all know that the growth in the cost of health care in the U.S. is unsustainable and changes must be made.

While the U.S. has the most advanced health care system in terms of quality service delivery, it now consumes nearly 19% of our GDP, whereas the next closest developed country spends only 9.5%. Single payer system? Don’t count on saving anything there if CMS is in charge. It is estimated that one-third of spending in CMS programs is duplicative, fraudulent, or otherwise wasted in their “trust, but don’t verify” approach. Triage and rationing? That is a tough political sell in the U.S.
The Cato Institute has recently published a book describing the perverse incentives in the U.S. medical payment system and the downright collusion on the part of the participants. Even eliminating the fraudulent activities of some (an exercise in whack-a-mole), there is plenty of room for gaming the payment system legally. The study documents the many opportunities, including:

  • Pharmaceutical pricing without limits
  • Pharmaceutical distribution
  • Misdiagnosis
  • Ineffective treatments
  • Campaign contributions by every health care participant
  • Upcoding by hospitals
  • Over-testing or over-prescribing
  • Site of service differentials

But in reading the proposed solutions, keep in mind that Cato is a Libertarian organization firmly against big government. Thus, all solutions hint at getting politics and government out of the mix and letting the free market determine the winners.
Neither the WOA nor the author endorses the study findings, but feels that the Membership should be informed.

William J. Best
[email protected]

DISCLAIMER: Statements of fact and opinion are the responsibility of the authors alone and do not imply an opinion or endorsement on the part of the officers or the members of WOA unless such opinion or endorsement is specifically stated. Materials may be reproduced only if Touches and the Western Orthopaedic Association are credited.


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