A Common Sense Approach To Lowering Medical Bills

Common sense approaches work well.

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

---

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.

---

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,

Data: Legalized Marijuana Does Not Increase Alcohol Sales

Cannabis Producers in Washington state

Good news for cannabis legalization advocates!

“In the three states with the longest history of legalized recreational marijuana sales – Colorado, Washington state and Oregon – there is no evidence that legalization has had any impact on spirits sales, nor is there any evidence that it has impacted total alcohol sales.”

That’s according to research conducted by the Distilled Spirits Council of the United States (DISCUS).

In other words, cannabis legalization – neither recreational (nor medical) – has had no effect, either positive or negative, upon beverage alcohol sales in states were cannabis is legal, either for recreational, or medical purposes.

David M. Ozgo, Senior Vice President and Chief Economist of the Distilled Spirits Council analyzes market trends for DISCUS, and said in part that, “The data show there has been no impact on spirits sales from recreational marijuana legalization.”

David M. Ozgo, Senior VP and Chief Economist, Distilled Spirits Council of the United States

Mr. Ozgo also produces an annual spirituous beverage industry review, and provides tax and regulatory effect analyses, including

Marijuana in Alabama: Show me the money!

How Much Money Could Alabama Earn By Legalizing, Taxing, and Regulating Marijuana?

How much money could Alabama stand to realize if it Legalized, Taxed, and Regulated (LTR) cannabis for Adult Recreational Use (ARU), and Medical Use (MMJ)?

In order to make a reasonably accurate estimate, we need certain pieces of information from reliably accurate sources, such as:

1.) How many people would purchase it?

2.) How much tax would be placed upon it?

3.) How frequently would they purchase?

There are other questions, but let’s start by answering those three.

First, let’s determine how many people consume marijuana in the state – adults, of course.

The National Survey on Drug Use and Health (NSDUH), is an annual survey which first began in 1971 and is conducted in all 50 states and the District of Columbia. It’s conducted under the auspices of the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Behavioral Health Statistics and Quality.

11 Year Study Finds Opioid Deaths Down In Medical #Marijuana States

In an article entitled “Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010” published August 25, 2014 in the Journal of the American Medical Association, researcher and primary author, Dr. Marcus A. Bachhuber, MD, with the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, 423 Guardian Dr, 1303-A Blockley Hall, Philadelphia, PA 19104 (marcus.bachhuber@gmail.com), and others concluded that, “The present study provides evidence that medical cannabis laws are associated with

Yes, it’s true: Possessing a single #marijuana cigarette is a #felony in #ALpolitics.

At the stoke of midnight tonight, 1 January 2018, at 0000 hours, California will become the 8th state (11, including the District of Columbia, Puerto Rico, and Guam) in the union to legalize, tax, and regulate the sale of cannabis for recreational purposes to adults over age 21. Presently, 73,213,005, or 22.39% of Americans have legal access to recreational cannabis.

California voters approved Proposition 64 November 2016 by 57.13% with 7,979,041 votes, which allows adults 21 and older to possess up to one ounce of marijuana and grow up to six plants in their homes. In 1996, California was the first state to permit medical marijuana when voters passed Proposition 215.

In addition to legalizing adult recreational use of marijuana, the new law also provides for the levying of two taxes upon the sale of cannabis – a 15% tax on the retail price of marijuana, and a tax

Medical, Scientific, and Economically Valid Reasons To Legalize #Marijuana In Sweet Home Alabama #ALpolitics

It’s no joke, Colorado is ROLLING (pun intended) in revenue from the taxes and licensing fees associated with legal cannabis sales.

From the Colorado Department of Revenue:
Colorado Marijuana Tax Data
“Total marijuana tax revenue includes the 2.9% retail and medical marijuana sales tax, 10% retail marijuana special sales tax, 15% marijuana excise tax, and retail/medical marijuana application and license fees.”

For the month of September 2015 (reported October 2015), Colorado had TOTAL (Total All Marijuana Taxes, Licenses) $11,656,736.

On an annualized basis, that’s at least $139,880,832.

The rhetorical question is:
What could Sweet Home do with even half the money like that?

Consider also this: That the legalization of cannabis also largely eliminates

Medical News You Can Use: Sleep Apnea Can Harm Children’s Learning

Disruption Of Sleep In Children Could Hamper Memory Processes

Sleep disordered breathing can hamper memory processes in children, according to a new study presented at the Sleep and Breathing Conference held in April in Barcelona, Spain. The research found that disrupted sleep had a negative effect upon different memory processes and how children learn.

Sleep apnea can also negatively affect growing children.

A team of researchers from the University of Szeged and Eötvös Loránd University in Hungary analyzed 17 children with sleep disordered breathing aged between 6 and 12 years. They looked at different memory processes compared to a control group of 17 children of similar age without any sleep disorders.

A story recall task was used to measure memories that can

Medical News You Can Use: “Can I Please Get Some SLEEP!?!” Edition – Children’s Hospitals Lack Standards

As anyone who has been in a hospital – either as patient, or visitor – can attest, hospitals are NOT a place where rest occurs. And THAT! is a crying shame! For healing restoration can ONLY occur with proper rest, and that means SLEEP!

—

Study Reveals An Absence Of Consistent Standards In Children’s Hospital Environments

The sound, light and temperature levels in European pediatric hospital wards often vary, highlighting the lack of consistent environmental standards, according to a new study presented at the Sleep and Breathing Conference held in April in Barcelona, Spain.

Quietude aids healing and restoration

Children and parents often suffer sleep deprivation when the environment on a ward is disruptive, which can affect disease recovery and quality of life in hospitalized children. There are no general consistent recommendations covering sound, light, and temperature levels to help guide hospitals across Europe.

Researchers measured these three factors in five pediatric wards in

Medical News You Can Use: “Musician’s Friend” Edition – Wind Instruments Lower Sleep Apnea

Playing A Wind Instrument Could Help Lower The Risk Of Sleep Apnea

A study performed in India suggests wind instrument musicians are at lower risk for Sleep Apnea. Seen here, a B-flat trumpet.

A new study has found that wind instrument players have a reduced risk of developing obstructive sleep apnea. The findings, presented at the Sleep and Breathing Conference held in April in Barcelona, Spain suggest that this could be considered beneficial to those individuals who are at high risk of developing sleep apnea.

Researchers in India conducted lung function testing in

Open Letter to Alabama Governor Robert Bentley, MD

Open Letter to Governor Bentley
October 10, 2014 at 12:45pm

Governor Bentley,

I need to go to the doctor. But I can’t. For some reason I still can’t understand you turned down Federal money set aside for people like me.

On June 24, 2014, on my way to see a doctor to determine disability benefits, I had a car accident. My car was totaled and my lip busted. I had hit the steering wheel with my face.

I still almost refused the ambulance ride because I was afraid of the bill. It took a street full of people to convince me to go. I had my lip sewn up, some scans done. I was sent home with a neck brace.

I have $12,000 in bills now, and my disability was denied. I am more disabled now than before the accident. I am waiting on an appeal with no medical care and no income. That hospital bill will never get paid. I wonder how many other people in this state are in the same situation. Sometimes I think

Why Expand Medicaid in Alabama?

If Alabamians can’t work because they’re sick, and can’t get care because they’re poor, they can’t be productive citizens.

Should we just throw ’em to the wolves?

What will become of Alabama’s present, much less it’s future?

—

Alabama medical students argue for expansion of Medicaid

on May 07, 2014 at 9:39 AM, updated May 07, 2014 at 9:51 AM

By Swaroop Vitta and Davis Bradford

In medical school, our professors often show us maps of the U.S. illustrating where diseases strike hardest and where patient outcomes are the worst. Most of the time, Alabama is red, really red. Red is bad. So bad that over 600,000 Alabamians are uninsured and have limited to no access to health care.

Alabama is our home and this state’s spirit of compassion made us who we are. Every Sunday a small group of us with other medical students and volunteer physicians heads to a homeless shelter across from Regions Field that houses our free clinic. As we open our doors to many men and women that could not otherwise see a physician, we see first-hand what life without health insurance in Alabama is like.

A story:

Ms. C, a hardworking Alabamian, came into clinic with a terrible headache. It turned out that it was due to emergently high blood pressure. Ordinarily, this is easily treatable, but because Ms. C had gone without care for so long, she was now in danger of a stroke. Only the emergency room could provide relief.  But for Ms. C, like so many others in Alabama, that relief was accompanied by a bill she could never pay with the risk of unsurmountable debt. Ms. C has since become our regular patient. While her health has improved, there is only so much a group of well-intentioned medical students can do.

Had Ms. C received medical care during the years before we saw her, her high blood pressure could have been controlled before it left her with permanent injuries. Despite treatment, the chronic issues from those years without care now leave her unable to work. And at 58 years of age, her options are running low.

Even when work was an option, Ms. C’s income was

Style versus Fashion? Men prefer Style.

Peacocks on parade

January 4, 2013, 7:36 pm

By Charlie Porter

A look into the strained relationship between male style and men’s fashion

Victor Deleon; Photo ©Sophie Elgort

In the world of menswear, it has become the norm to say one is interested not in fashion but in style. It can be seen in journalism both venerable (GQ’s monthly column of clothes tips and advice is by the Style Guy, not the Fashion Guy) and modern (the influential magazine Fantastic Man describes itself as “the gentleman’s style journal”). It happens in retail, too – while women’s online store Net-A-Porter is tagged as a “fashion destination”, its two-year-old brother site Mr Porter is flagged as a “destination for men’s style”. Ask most men if they favour “fashion” or “style”, and a sizeable majority would steer sharply to the latter. It’s almost as if men wished fashion would just go away.

And yet menswear carries on regardless. From Monday, the next round of men’s fashion shows takes place, first in London, then in Florence, Milan and Paris, accompanied by announcements that the men’s luxury market is booming, often outperforming women’s; according to the consultancy Bain & Co, menswear sales worldwide are expected to have increased 10 per cent in 2012 from the year before, to €26bn. Men’s fashion shows, however, still sit at something of a remove, with men outside the industry unaware or uncaring of what’s happening on a catwalk in some European city. If ever there is any discussion of men’s fashion shows, it usually comes as ridicule: “Would real guys really wear that?” (the answer is, usually, no). What interests men is style, and that’s it.

To understand this dichotomy between fashion and style, it helps to look far from

News for the “Medical Marijuana”/420 crowd: Israeli firm grows “highless” marijuana strain

What if the so-called “medical marijuana” proponents could have their cake, and eat it to?

That is, what if they could have the “benefits” they claim they derive from smoking marijuana, while NOT having its intoxicating effects?

Would they still smoke it?

That would tell the story.

It certainly would.

—

What a drag, Israeli firm grows “highless” marijuana

A worker tends to cannabis plants at a plantation near the northern Israeli city of Safed June 11, 2012. REUTERS-Baz Ratner

By Maayan Lubell SAFED, Israel | Tue Jul 3, 2012 9:48am EDT

(Reuters) – They grow in a secret location in northern Israel. A tall fence, security cameras and an armed guard protect them from criminals. A hint of their sweet-scented blossom carries in the air: rows and rows of cannabis plants, as far as the eye can see.

It is here, at a medical marijuana plantation atop the hills of the Galilee, where researchers say they have developed marijuana that can be used to ease the symptoms of some ailments without getting patients high.

A worker tends to cannabis plants at a plantation near the northern Israeli city of Safed June 11, 2012. Credit: REUTERS/Baz Ratner

“Sometimes the high is not always what they need. Sometimes it is an unwanted side effect. For some of the people it’s not even pleasant,” said Zack Klein, head of development at Tikun Olam, the company that developed the plant.

Cannabis has more than 60 constituents called cannabinoids. THC is perhaps the best known of those, less so for its medical benefits and more for its psychoactive properties that give people a “high” feeling.

A worker tends to cannabis plants at a plantation near the northern Israeli city of Safed June 11, 2012. Credit: REUTERS/Baz Ratner

But cannabis also contains Cannabidiol, or CBD, a substance that some researchers say has

Good News for Birthing Mothers! – Audio Post

Wonderful News out of Nashville! /%20%20/%20Post

Human Breast Milk Ice Cream… now on sale in the UK

Those crazy Brits…

Oh well.

I’m surprised also that medical and other ethicists have not jumped on this issue – even that the government has allowed this, which is the sale of human tissue. Hair, however, is sold – but body parts, such as cornea, heart and/or valves, etc., are not. That, of course, is also entirely discounting that many medications are excreted in breast milk. For example also, what happens when the supply is gone?

Reckon what the LaLeche League thinks of this?

And then, there’s the inevitable humor that will result.

24 February 2011 Last updated at 13:40 ET

Breast milk ice cream goes on sale in Covent Garden

A restaurant in London’s Covent Garden is serving a new range of ice cream, made with breast milk.

The dessert, called Baby Gaga, is churned with donations from London mother

PETA to protest Feeding the Hungry, Housing the Homeless, and Healing the Sick in Huntsville, AL

PETA (People for the Ethical Treatment of Animals) was once a respectable group, not only for what they promoted, but for how they promoted, as well. Now, they’ve become a “fringe element” group, which at times has operated similarly to a terrorist organization. It’s no wonder that people have lost confidence in them and their ideals.

Tomorrow – Saturday, November 13, 2010 – PETA will demonstrate in Huntsville, Alabama at a church which has an outstanding name in the community for their many good works, not the least of which is their always-immensely successful, long-standing “LobsterFest.” This year’s Lobsterfest XVII at St. Thomas Episcopal promises to be no different – that is, it will be a sold-out success.

What is particularly disconcerting is that PETA, in their fringe element mentality, offers only

A Short History of “Privacy” in American Jurisprudence

Privacy

[Note: This entry was originally entitled “Privacy,” and was transferred to this site, having previously been posted by me on Monday, May 3, 2010 at 2:57pm.]

“Privacy” is a relatively new term in American jurisprudence, and public dialogue. Former US Supreme Court Justice Hugo Black, an AL native, wrote against “privacy” in his dissent in Griswold v Connecticut.

The development of our right to privacy emerged, interestingly enough, from Griswold v Connecticut, a 1965 Supreme Court Case which challenged the state’s 1879 criminalizing of a married couple’s use of contraceptive devices. Appellants were the

Huntsville Hospital… all that AND a bag of chips? Wow! …NOT QUITE!

Most folks don’t know it, but Huntsville Hospital is NOT, has not ever been, does not meet criteria for, and is not making any plans to obtain or become:

1.) a certified or verified Trauma Center;
2.) meet the a) American College of Surgeons, or, b) American Trauma Society qualifications for Trauma Center status;
3.) an Academic Medical Center;
4.) university affiliate;
5.) teaching hospital;
6.) research center; nor
7.) Nursing Magnet Hospital.

So what? What does that mean for you, your family, friends and others in this part of the Tennessee Valley?

American Medical Association, AARP OKs Obama Health Reform Bill

Saying “We cannot let the perfect be the enemy of the good,” J. James Rohack, MD, President of the American Medical Association, reiterated organizational support last Friday for the Affordable Health Care for America Act (H.R. 3962/H.R. 3961),  which is often referred to as President Obama’s healthcare overhaul bill.

Dr. Rohack said the AMA Board of Trustees voted unanimous approval after reviewing the House of Representatives’ reconciliation bill, added that the bill wasn’t perfect saying, “This is certainly not the bill we would have written.” [ed. note: Nothing in this world is perfect.]

Joining Dr. Rohack, senior staff and board certified cardiologist at Scott & White Clinic in Temple, Texas, whom became the 164th president of the American Medical Association (AMA) in June 2009, was the non-partisan, 40 Million member strong, American Association of Retired Persons.

The Scott & White Clinic is a 636-bed not-for-profit, Level I trauma center and teaching hospital, which also operates