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Urgent Care Price Gaming

A simple xray at a basic urgent care clinic is inexpensive, right? Not when owners exploit payment rules to charge sky-high hospital prices for a service delivered in the mall. Gaming the system is the name of the game for our current profit-obsessed health care system. Time to switch to single payer!

June 18, 2024

Even Doctors Like Me Are Falling Into This Medical Bill Trap
The New York Times Op-Ed
June 17, 2024
By Danielle Ofri

Last July, my daughter was still limping a week after a bike injury and we needed a quick X-ray to rule out a fracture. As a doctor, I knew we didn’t need an expensive emergency room for something this straightforward. We found an urgent care at the end of a strip mall in Chicago, and 20 minutes later we received the good news that there was only a sprain.

But this is health care in America. Two weeks later a bill arrived: The radiology charge from NorthShore University HealthSystem for the ankle and wrist X-rays was $1,168, a price that seemed way out of range for something that usually costs around $100 for each X-ray. When I examined the bill more closely, I saw that the radiology portion came not from the urgent care center but from a hospital, so we were billed for hospital-based X-rays. When I inquired about the bill, I was told that the center was hospital-affiliated and as such, is allowed to charge hospital prices.

It turns out that I’d stumbled into a lucrative corner of the health care market called hospital outpatient departments, or HOPDs. They do some of the same outpatient care — colonoscopies, X-rays, medication injections — just as doctors’ offices and clinics do. But because they are considered part of a hospital, they get to charge hospital-level prices for these outpatient procedures, even though the patients aren’t as sick as inpatients. Since these facilities don’t necessarily look like hospitals, patients can be easily deceived and end up with hefty financial surprises. I’m a doctor who works in a hospital every day, and I was fooled.

Following is just a comparatively brief sampling of excerpts from a couple thousand NYT readers’ comments:

“You don’t have a health care system in the US. You have a health care industry. Your industry is designed to serve a wide range of 3rd party sharks who add huge costs to medical care without actually adding any value to the process. Now, many of your medical clinics and hospitals have been purchased by private equity which ensures that your health care will diminish and your costs will rise.”

“Now everyone from doctors to patients are asking for single payer.”

“The runaway costs of medical care will only be contained when we have Medicare for All.”

“I live in Canada. I demand my right to pay taxes. Taxes help pay for our medical system. The procedures are covered, and I won’t get billed for them.”

“Taiwan has one of the best universal healthcare systems on the planet.  For profit healthcare is an affront to basic human rights.”

“Single payer Medicare for all yesterday, today and tomorrow!”

“Get the profit out of our medical system. Eliminate the middlemen and the bloat.  One national system.  Period.”

“I’m a physician, and it’s time for universal healthcare for this country!”

“The bottom line is that it doesn’t have to be this way: different examples of single payer systems are throughout the world to glean from.”

“How desperately we need a single payer system.”

“I lived in a major Canadian city for almost a decade, and even with a substantially higher tax rate, my paychecks went a lot farther. Taxes pay for good stuff, America, if you let them.”

“We really need universal healthcare so doctors can do what they need to do, in the appropriate facility where they need to do it, without insurance companies second guessing everything.”

“In the long term, America needs a public healthcare system, one in which citizens’ health and patient care, not financial returns, are the goals.”

“Solution for patients and caregivers alike: Improved Medicare for all, AKA single payer financing of healthcare.”

“It is way beyond time that the United States adopted a single-payer health care system.”

“Just another reason we urgently need a real National Health Service that covers all medical procedures.”

“A majority of Americans have for decades favored a national healthcare system. Everybody gets over their socialism phobia as soon as they are eligible for Medicare.”

“We will get the needed change when the voters put the right people into office–the right people who put the health of the community first.”

“The only answer is nationalized health care.”

“I turned 65 and got Medicare. What a revelation – I can finally afford medical care. Everyone in this country should have this. I don’t like taxes but for universal health care I would pay more taxes.”

“I’d love to have single-payer health care. This is one of those things, like roads or managing air space, that the government does better than a for-profit corporation can do.”

“Why can’t we as citizens of the richest nation in the world agree that ALL of us deserve to have a decent roof over our heads, healthy food on the table and universal healthcare?”

“The time for a single payer system is long overdue.”

“The only conceivable solution is evolution to a single payer, single insurer system, well regulated by the government.”

“We need Medicare for all, and I do not mean profit-driven insurance company owned misleadingly-advertised Medicare Advantage.”

“Medicare for all. Get capitalism out of health care.”

“How many of you complainers have contacted your Congressional representatives to voice your opinion? One can easily find online their Washington phone numbers and emails, as well as their local offices. Medicare for all!”

“Here in Canada, never a bill from Emergency or Clinic.”

“Healthcare costs are out of control. We need national health care.”

“How to fix it?  Medicare for all.”

“Single payer health care system.”

“Single payer government funded healthcare would prevent the financial rip off that Dr Ofri describes.”

“America needs a single payer system which removes profit motivations and the costly parasites that enrich themselves at patients’ and society’s expense.It’s done well elsewhere, why can we not find the will to do it for ourselves?”

“National health is the solution.”

“Another excellent argument for universal government health care.”

“It’s time to give the current approach an unceremonious burial and replace it with a truly universal single payer system.  The American model of health care is a demonstrable failure.”

 

Comment by: Don McCanne

Within just a few hours, this New York Times article on inflated medical bills precipitated a couple thousand reader responses which overwhelmed the editors of the Comments section so they closed it off to further responses. The readers’ message was loud and clear. Not only do they understand why our health care financing system is so overpriced while underperforming, as the sampling of excerpts above demonstrates they also know what to do about it: enact and implement single payer Medicare for All.

In just a few months, the rest of us will have an opportunity to express the same sentiment when we exercise our right to vote in the upcoming election. It’s crucial to understand where the candidates stand on health care justice, including the potential for a single-payer financing system, as well as other policies to make the United States a better nation for all of us. Show your support for health justice!

About the Commentator, Don McCanne

Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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