$29,000 bill for 5 minutes in ER shines light on health costs—Sacramento Bee
In those five minutes, the 23-year-old California State University, Sacramento, student was hooked up to life support monitors, air pumped into his weakened lungs as he bled on a gurney.
The bill sent to Hawkins’ family was an undiscounted “rack rate” that hospitals charge the uninsured—patients who do not have the benefit of having an insurance company negotiate deep discounts.
But Dr. Lynette Scherer, a general surgeon and chief of trauma at UC Davis Medical Center, said the public simply doesn’t understand how expensive it is to run a sophisticated emergency room and trauma center like the one at UC Davis.
“Rack rate” is that rate necessary to charge individuals so that those covered by insurance may receive “deep discounts.” Imagine this was your electricity, gas, cable, or cellular coverage—you pay “rack rate” and your neighbor, solely based upon employment, gets a “deep discount[].” The public outcry would be immediate and overwhelming—legislative action would bring certain death to such practices.
There is always talk about healthcare being a right, and a right usually implies equity amongst individuals. Seems we have more of a right to electricity, gas, cable and cellular coverage. The only right to healthcare we have in the US is access (any ER) and equitable treatment (as long as an emergency medical condition exists)—all equitable rights cease beyond access and treatment.
When we look at electricity, gas, cable, and cellular services—what we pay is competitively determined for all with an equitable relationship between level of service and individual cost. The competition is external amongst providers of similar services. When we look at healthcare—what we pay is based upon a competition of groups and individuals against each other, where equitable relationships only exists within the competing classes. The competition is internal amongst payers (including self–pay).
The argument for private health insurance in the US is based fundamentally on the notion that only private entities can truly compete. It follows that competition is the only way to produce valuable health services. This is true if the competition is always external to those providing the services. It is false when competition is partially internal—becoming a variation of the “have–nots” subsidizing the “haves.”
The lasting message of the Hawkins case (beyond the tragedy) is the ugliness and pervasiveness of industry–based disenfranchisement as a competitive tool. Contrary to Scherer’s assertion: “the public simply doesn’t understand…expens[es],” the public doesn’t understand the charges. The question is not why the indigent would be charged $29,000 for 5 minutes, but what would the insured be charged for the same 5 minutes?
