The Healthcare Oligopoly

The healthcare system is a maze of contradictions. It is an oligopoly. 

Everyone needs a decent healthcare system. But what Americans want and what they need often conflict.

I am sure readers would agree that our collection of physicians, insurance companies, billing companies, hospitals and the overarching specter of debt collectors grabbing for scraps is baffling.

I don’t profess to understand every nuance of the Affordable Care Act. Only lawyers and bean counters have that talent.

A trend is emerging.

A Bloomberg article, “Patients Pay Before Seeing Doctor as Deductibles Spread,” noted that many hospitals and physicians are demanding an upfront payment before they can be seen. 

 The Affordable Care Act is blamed for the up tick in deductibles and thus the upfront costs to patients. 

Hospitals say they need to charge patients prior to treatment because Americans are increasingly on the hook for more of their own medical costs, the article said. And once care is provided, it’s often difficult for hospitals to collect.

“It used to be taboo to look like you were looking for money at a time when you were supposed to be focused on patient care,” David Williams, president of Boston-based consulting firm Health Business Group, said in the article. “It’s not taboo anymore.”

Have you ever noticed how many forms you have to sign before the triage nurse sees you in the emergency room?

The healthcare system is an oligopoly, from hospitals to physicians, which control your health.

Before I get paid, I have to produce something. Tell me which industry or profession gets paid before they even provide a service or product.

Walk into your physician’s office. A sign saying payment is required before services are rendered smacks you in the face – and the wallet.

 Physicians whine and complain that they should be paid because they have thousands of dollars in loans for attending years of medical school.

My response: that was your choice; don’t place the burden on your patients or society.

Hospitals complain they have to write-off millions of dollars in indigent care.

Note that the Internal Revenue Service has classified these hospitals as non-profit, so they are exempt from taxation. Hospitals are also exempt from state and local taxes, as well.
So many non-profit hospitals are flush with cash, which they invest in new buildings, parking lots, equipment and salaries. To be fair, a fraction is donated to community organizations. 

Instead of doing what is right, hospitals and physicians do what is profitable – and the profit motive is about self-interest.