IN HEAVILY REGULATED HOSPITALS, PRICING IS ANYTHING THEY THINK THEY CAN GET AWAY WITH

So much for all the regulation. Competition anyone?

Patient advocate [translation: legal parasite] Tony Garr became a patient recently and found out how nice it is to have insurance. The X-ray alone in connection with his prostate biopsy was priced at $880. His insurance paid $167.58 for that. He was charged $18.62. Discount applied to his insurance company: about 79%. In contrast, the uninsured have long been billed the full list price, well above the amount insurance companies negotiate with individual hospitals and medical professionals. Now, Nashville-area hospitals are beginning to change their policies toward the uninsured, starting new discounts for those without insurance and, in some cases, making existing discounts for poor people more generous.

In Tennessee, an estimated 323,000 people will be removed from the state's insurance program for the poor, TennCare, starting this spring if a proposal by Gov. Phil Bredesen goes through. Some of them will find insurance elsewhere; others will join the estimated 45 million Americans who don't have private or government insurance.

Hospitals nationwide have been accused for years of charging exorbitant prices to the uninsured. Hospitals have maintained that they couldn't offer discounts because they might be punished by Medicare rules. However, the federal government recently clarified its position, saying hospitals could offer discounts to the uninsured.

Vanderbilt University Medical Center has one of the most straightforward polices toward the uninsured among the large local hospitals: Those at the federal poverty level pay nothing, and those at up to 200% of the poverty level pay no more than 7% of their income. The hospital is considering raising its discount eligibility to 275% of the poverty level.

HCA Inc., which owns several area hospitals, announced earlier this month that it is scrapping its sliding-scale discounts for the low-income uninsured and offering discounts for everyone that are similar to those insurance companies get. Company spokespeople said the discounts vary by procedure and hospital, and they were unable to provide specific examples or quantify the average discounts.

Saint Thomas Health Services, which already had a sliding-scale discount for different low-income groups, has a new program of discounts for uninsured people who don't meet its low-income guidelines. The hospital system declined to provide specifics.

The three major hospital systems in Nashville declined to give list prices for procedures, which would give an idea of the discounts' value. Patient advocates complain that the health-care system is too secretive and that patients have no way of knowing whether they're getting a raw deal. ''If you go to the hospital and say you need an appendectomy, 'How much will it cost?' They won't tell you,'' said Garr, the executive director of the Tennessee Health Care Campaign, a nonprofit organization that works on behalf of patients. ''It's pretty hard to trust these prices.''

Patient advocates have been pressuring hospitals to disclose price information. California last summer began requiring hospitals to make their list prices public, compiled in a compendium at each hospital called the chargemaster. Tennessee hospitals aren't required to publish their chargemasters, arguing that for competitive reasons they don't want other hospitals to know their prices.

But the hospitals say they do try to make people aware that they could get breaks on price. HCA plans to put signs up letting people know about the availability of discounts. Hospital staff will first try to qualify patients for Medicaid or its free charity care, but if patients don't meet its low-income guidelines, the new discounts will be applied, the company said. Vanderbilt said it would let people know about its discounts through financial counselors who get involved anytime there is an uninsured patient. ''We're actually in the process of developing brochures and signage in all areas to let patients know we have these programs,'' said the hospital's finance officer, Warren Beck.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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