I apologize Jon... I could have phrased that differently.
I agree with you.... No one could survive with the Medicare reimbursement rates... nor the schedule with which the gov pays those bills.
My thought goes to a more level playing field. The 'guy off the street', the IC's, and yup even Medicare could be billed to an actual cost basis plus reasonable profit, market controlled rate structure much the same as any other business...ie furniture, (which carries upwards of 300% profit margins).
Maybe a system like Public Utilities Comm. would be the answer... controlled care rates. Doesn't appear electric/gas providers have any problem with profits. They are permitted to bill the end user for their infrastructure costs...and itemize on the bill they're doing it.
The IC industry has the luxury of 'negotiated fee schedule', the private/self pay patient doesn't.
In the conversation I had with the billing dept, I could certainly contract with a bill review co., and negotiate a possible 10% reduction in that bill if I were to pay in full. My alternative, at the suggestion of the Hosp., ...file BK. That's what everyone else does.
Maybe it's not equitable to charge different amounts for the same service depending on who is paying, but so what? Profit is the engine that drives industry,
In a get what you pay for world... I'll refer to Desert Hosp as that's where Im most familiar, and I would not suggest this happens everywhere... this campus is owned by Desert Hospital District, a foundation. They operated as non-profit for years. As costs increased, and Medicare reimbursements became more difficult, the facility was leased to Tenet, a for profit . As a foundation/district, it's supported by property tax dollars, and prvt/corp donations. As well as the volunteer services...'candy stripers'.
None of the freebies were forfeited when the for profit took over.
Realizing the arguement is those 'freebies' were negotiated in the lease agreement... the 'guy on the street' doesn't know about those issues when presented with a 'usual and customary' bill for private fee for services vs those the carries enjoy. Certainly have knowledge of the property tax dollars paid.
The inequality in charges is a real-world necessity.
There are 3 major hosp within 10-12 mile radius of one another, 7 (last count) ImmediateCare facilities in that same arena, and who knows the number of outpatient surgery centers... seems half the 1000+ M.D's have these in-house. Yet no 'competition'.
IC contract, Medicare just says 'thats what we pay'... you and I (as among the uninsured) don't have any recourse but to pay 'usual & customary' in a industry that is not market controlled....oh... BK.