A Common Sense Approach To Lowering Medical Bills

Common sense approaches work well.

Unfortunately, common sense isn’t so common, anymore.

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Why Medical Bills Can Be Lower in Maryland

Dr. Elisabeth Rosenthal, MD

October 24, 2021

Guest Essay

Dr. Rosenthal is the Editor in Chief of Kaiser Health News. She was an Emergency Room physician before becoming a journalist.

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A $1,775 Doctor’s Visit Cost About $350 in Maryland. Here’s Why.

Illustration by Alvaro Dominguez

For the past 18 months, while I was undergoing intensive physical therapy and many neurological tests after a complicated head injury, my friends would point to a silver lining: “Now you’ll be able to write about your own bills.” After all, I’d spent the past decade as a journalist covering the often-bankrupting cost of U.S. medical care.

But my bills were, in fact, mostly totally reasonable.

That’s largely because I live in Washington, D.C., and received the majority of my care in next-door Maryland, the one state in the nation that controls what hospitals can charge for services and has a cap on spending growth.

Players in the health care world — from hospitals to pharmaceutical manufacturers to doctors’ groups — act as if the sky would fall if health care prices were regulated or spending capped. Instead, health care prices are determined by a dysfunctional market in which providers charge whatever they want and insurers or middlemen like pharmacy benefit managers negotiate them down to slightly less stratospheric levels.

But for decades, an independent state commission of health care experts in Maryland, appointed by the governor, has effectively told hospitals what each of them may charge, with a bit of leeway, requiring every insurer to reimburse a hospital at the same rate for a medical intervention in a system called “all-payer rate setting.” In 2014, Maryland also instituted a global cap and budget for each hospital in the state. Rather than being paid per test and procedure, hospitals would get a set amount of money for the entire year for patient care. The per capita hospital cost could rise only a small amount annually, forcing price increases to be circumspect.

If the care in the Baltimore-based Johns Hopkins Medicine system ensured my recovery, Maryland’s financial guardrails for hospitals effectively protected my wallet.

During my months of treatment, I got a second opinion at a similarly prestigious hospital in New York, giving me the opportunity to see how medical centers without such financial constraints bill for similar kinds of services.

Visits at Johns Hopkins with a top neurologist were billed at $350 to $400, which was reasonable, and arguably a bargain. In New York, the same type of appointment was $1,775. My first spinal tap, at Johns Hopkins, was done in an exam room by a neurology fellow and billed as an office visit. The second hospital had spinal taps done in a procedure suite under ultrasound guidance by neuroradiologists. It was billed as “surgery,” for a price of $6,244.38. The physician charge was $3,782.

I got terrific care at both hospitals, and the doctors who provided my care did not set these prices. All of the charges were reduced after insurance negotiations, and I generally owed very little. But since the price charged is often the starting point, hospitals that charge a lot get a lot, adding to America’s sky-high health care costs and our rising insurance premiums to cover them.

It wasn’t easy for Maryland to enact its unique health care system. The state imposed rate setting in the mid-1970s because hospital charges per patient were rising fast, and the system was in financial trouble. Hospitals supported the deal — which required a federal waiver to experiment with the new system — because even though the hospitals could no longer bill high rates for patients with commercial insurance, the state guaranteed they would get a reasonable, consistent rate for all their services, regardless of insurer.

The rate was more generous than Medicare’s usual payment, which (in theory at least) is calculated to allow hospitals to deliver high-quality care. The hospitals also got funds for teaching doctors in training and taking care of the uninsured — services that could previously go uncompensated.

In subsequent decades,

Texas Republican Makes An Easy-To-Understand Argument Against Trump’s False Election Claims

U.S. Capitol Police in plain clothes stand behind barricaded doors to the House floor and draw pistols upon Trump 2020 mobsters who violently invaded the U.S. Capitol Building, Wednesday, January 6, 2021 during the Constitutionally-ordered tallying of the states’ certified Electoral College votes.

The shocking events that unfolded yesterday in our nation’s capitol – rioting thugs, marauders, and hooligans who violently overthrew and violently invaded our Nation’s Capitol building complex thereby participating in insurrection after being egged on by their losing candidate, the soon-to-be-former President Trump – are unprecedented. Not since the War of 1812 when British soldiers breached and burned our nation’s capitol has the capitol been invaded. The sad part is, that it was brought about EXCLUSIVELY by a Lying, Lawless and Treasonous American President – Trump – whom the GOP has coddled and cultivated.

Again, yesterday’s domestic terroristic events were brought about exclusively by President Trump, who has consistently falsely asserted that he “won” the 2020 General Election, despite numerous

Why We Should Make Sex a Priority

Periodically, I receive communication from the Madison County Coalition for Healthy Marriages.

In those various email messages numerous topics are discussed, all designed with the purpose of strengthening traditional marriage between a man and a woman.

And though I am not presently married, nor in a romantic relationship, I find those messages not only uplifting and encouraging, but with a common sense approach, as well.

The following message is another one of those common sense approaches. It’s about the sexual aspect of the marriage relationship.

In many marriages,

Ever feel like cattle in a feedlot? High Fructose Corn Syrup works wonders!

Researchers at Princeton University have discovered what farmers have known for many years.

Corn will make you fat.

Corn chips, tortillas, corn meal, grits, hominy, raw corn, corn on the cob, creamed corn, sweet corn, pop corn… there are a veritable host of corn food products.

“But I don’t eat corn!,” you may say.

Sure you do.

Just read the ingredients labels of the foods you purchase.

Many, if not most, foods contain “High Fructose Corn Syrup,” which can be found in most unlikely of foods.

Ingredients are listed in order of concentration, from highest to lowest. Often, High Fructose Corn Syrup is

“Paging ‘American Healthcare Reform,’ paging ‘American Healthcare Reform’… you’re needed in the OTC Pharmacy – STAT!”

[ed. note: I wrote this post accompanying some photos I’d made and posted to my Flickr site back around October 2009.]

He wanted some OTC ranitidine. I told him, “Get omeprazole!” But he didn’t, saying he wanted more rapid relief.

So… guess what!?!

It just so happened, that at the checkout stand in front of us was a Big Pharma sales rep. She said, “Use this!,” and pulled out