You’ll get little argument over the point that modern healthcare is a mess. You’ll get no argument over the importance of hospitals to our society, or about how much good work is done in a lot of these hospitals. Where you WILL get the argument is when hospital execs start boo-hooing over how much money they “lose” while trying to save lives.
Hospitals like to complain about how Medicare puts them in the hole. The problem with that assertion? The North Carolina State Health Plan, overseen by state treasurer Dale Folwell, issued a report claiming hospitals are overcharging patients AND profiting from Medicare.
Here are some of the takeaways from that report:
An analysis by the North Carolina State Health Plan and Rice University’s Baker Institute for Public Policy found that the majority of North Carolina hospitals did not lose money on Medicare — they profited. This raises serious concerns over hospitals’ commitment to their patients and their charitable mission.
State Treasurer Dale R. Folwell, CPA, invited researchers from the North Carolina State Health Plan and Rice University’s Baker Institute for Public Policy to analyze hospitals’ Internal Revenue Service 990 tax filings, and community benefit reports, and hospitals’ self-reported Medicare Cost Reports, which were drawn from the National Academy for State Health Policy’s Hospital Cost Tool. The tax filings and Medicare cost reports use different methodologies that result in wildly different loss calculations. The report was then peer reviewed by the University of Southern California’s Sol Price School of Public Policy.
Hospital lobbyists have defended their crushing price inflation by claiming to lose billions of dollars on Medicare patients. However, hospitals’ self-reported data show that a majority of hospitals profited off of Medicare patients in North Carolina from 2015 through 2020.
Medicare losses are often the largest line item of community benefits cited by hospitals to justify their tax exemptions, mergers and price increases.North Carolina hospital lobbyists claimed they lost $3.1 billion on Medicare in 2020 — the same year hospitals actually reaped a total of $87 million in Medicare profits. The lobbyists’ loss claim was 3,670% larger than hospitals’ self-reported Medicare profits.
On average, North Carolina hospitals charge privately insured individuals 280% of Medicare, which forces patients and employers to pay thousands of dollars more for medical care. Treasurer Folwell is calling for price relief for patients, businesses and state employees.[…]
Earlier in Folwell’s tenure as state treasurer, he pressed the state’s hospitals to be more transparent in their pricing of treatment for state health plan members. The hospitals balked and ran for help from the “honorables” on Jones Street. Folwell, as the administrator of the state health plan, said he thought it was important to know pricing details for the plan’s members before he and his team paid the bills. A lot of campaign money got passed around by hospital lobbyists, and a lot of political pressure got put on Folwell via The General Assembly.
There STILL seems to be a lack of interest by state leaders in state-run hospitals’ aggressive recruitment of 4-18 year olds for “gender-norming” / “gender-affirming” (aka “sex change”) procedures. Reporting from NPR found that hospitals can pull in at least $100,000 for each of those sex change procedures:
Wren Vetens thought she’d done everything possible to prepare for her surgery.
She chose a doctoral program in physics at the University of Wisconsin-Madison, a school that not only embraced transgender students like her, but also granted insurance coverage for her gender-confirmation surgery when she enrolled in 2016. When uncertainty over the fate of an Obama-era anti-discrimination rule allowed the state to discontinue such coverage, Vetens and her mother, Kimberly Moreland, an OB-GYN, shopped for another plan.
Deducing the procedure would run from $19,000 to $25,000, based on prices posted online, they purchased insurance from Consolidated Health Plans. It would pay a maximum of $25,000 for the operation.
With that information in hand, Vetens planned ahead: She got her insurer’s preapproval and scheduled surgery during winter break of her second year, allowing time for recovery before returning to her studies.[….]
So, she was shocked when a hospital representative called her a couple of months before the long-awaited surgery estimating the bill would be $100,000. That meant she would be on the hook for as much as $75,000 after her insurer’s $25,000 payout.[…]
No wonder things are so silent in Raleigh. Nobody wants to talk about East Carolina or UNC Hospital. Folks are making big money over there. (AND getting hired.)
The next time you see or hear a bunch of boo-hooing from the hospital industry in the drive-by media, look to your elected officials in the state capital and in DC. Look at how much cash they take in from the hospital and medical lobbies. And then ask what they plan to do or can do to help us — their voters — in our struggles with their donors.