Saturday, May 23, 2020

A Bizzaro World "Health Care" Example

Side and the Mrs. have been of Medicare age for some years now, and we have a Medicare Advantage Plan that we have been happy with since we came "of age."

If you have any sort of similar experience, you know that the billing paperwork flowing from CMS and your individual Program carrier can stun you with the numbers they contain.  One's main concern, of course, is the bottom line "your share" number, which in our experience has nearly always been very reasonable.

It's the numbers leading up to "your share" that can give you the vapors.  Mrs. Side spent five days in the local Hospital last year, and the numbers that flowed from that were truly a sight to behold.

The numbers we refer to are "Amount the provider billed the plan;" "Total cost (amount the plan approved);" "Plan's share;" and finally, "Your share."

As a consequence of last years hospitalization, the Mrs. was diagnosed with Sleep Apnea, among other things, during an overnight "sleep test."  Her Doctor wanted her to start using a CPAP, which is a cumbersome thing to do, and we asked if there were any other alternatives.

Turns out there is; you can use an Oxygen Supplement at night supplied by an Oxygen Concentrator.  Something typical of the breed is shown below; this is not the one she uses, which we rent from an in-state provider.  The unit is not portable in the sense of carrying around with you, but it is portable in the sense of a 30 LB or so unit you can carry upstairs to be near where you sleep.  It is called a "concentrator" because instead of feeding you oxygen from tanks, it simply filters the O2 out of the ambient air and therefore "concentrates" the level of O2 provided by the machine via the breathing tubes you use with it.

You can find these machines on the internet for purchase in the range of $1200 to $2000 or so.  Best we can tell, the prices are dropping, as they become much more common.

She has been using the machine we rent for almost a year now, and it serves the intended purpose very well.  It requires virtually no maintenance other than checking a filter on the air intake to make sure it is not clogged.  The O2 level is easily adjusted from lower maintenance rates to higher rates for exertion during exercising, etc.  We are very satisfied with the machine; and they sent someone out at 6 months of use to check it out and check the calibration, etc.

Now the Bizarro World aspect.  The rental shows up in the monthly summary of services from the various health care providers we each use.

Are you ready for this?  The monthly amount the rental provider bills the plan is $760 and change.  Or $9,120 per year for a machine that can be purchased for less than $2,000, especially if you get wholesale pricing like the renting agent no doubt does.  The Total cost approved by the plan is $81 a month, and the Plan's Share is ~$65 a month., leaving us to pay $16 a month, which is perfectly reasonable in Side's view.

It's the ratio of $760 to $81 to $65 to $16 per month that seems Bizarro to us.

Is there any doubt that the entire cost/price structure of our "Health Care System" has become completely contrived, convoluted, distorted and worse?  To the point where cost/price reality is completely unknown, and is impossible to determine?

Even worse, does it make sense to believe that a bloated Government monolith could ever make sense out of all this and reduce costs while "improving" our overall health care services?

We think not.