I am beginning to think that President Obama hasn’t a clue about how the health care system works. The other day, he said that a foot amputation costs $30,000-$40,000-$50,000.” That seemed high to me, so I went to the New York State Medicaid site and looked up the surgical fee schedule. The cost of amputating a foot for the surgeon is only $425, about 100 times less than Obama contended.
Now, I have no doubt that private insurance companies pay more, but not 100 times more! (If anyone knows what a surgeon gets for a foot amputation in the private sphere, I would appreciate hearing from you at wjs@wesleyjsmith.com, or in a comment to this post. Thanks.)
I think some more research needs to be done on this, but the more our president speaks off the cuff in the Great Health Care Debate, the less he seems to know. More, at Secondhand Smoke, including the YouTube clip of the quote in question.
August 13th, 2009 | 12:45 am
Perhaps he was not speaking only of the surgeon’s fee but also of the cost of anesthesia, hospitalization (probably this is not outpatient!), rehabilitation (a lot must be needed), and so on and so on…
A year ago, I had laparascopic hernia surgery. Surely this is less major surgery than a foot amputation. It is outpatient. I was in the hospital maybe six hours.
Here is what the hospital charged my insurance company, and what the insurance company paid (that is their contracted reduced charges; at this point we had reached our family out of pocket limit and we paid nothing):
charges:
30,194.21
paid by insurance:
9666.11
These charges are just for the day of surgery, and include items such as “medical/surgical supplies,” “anesthesia,” “drugs,” “operating room,” etc (according to my insurance co’s explanation of benefits).
August 13th, 2009 | 2:23 am
What is billed and actual medical costs are usually quite different, and it is useful to certain groups to use the math from the billing data, which escalates the costly-health-care chatter. Obama’s tonsillectomy comments made me realize he does not know what is going on, he is likely just parroting some adviser. Over 25 years ago was when doctors took out tonsils more often. Later, after studies came out, the practice has changed, and there are rather strict criteria to take out adenoids and tonsils. By Obama’s tonsil comment, I presume he alludes to accomplishing some other result, and would like to lower specialist doctor income, at the same time not raise primary care doctor income. Doctors are a minority, make enough money to be envied by lefties, kill enough unborn children to be mistrusted by millions, and all the current medical TV dramas portray jaundiced, promiscuous physician personas. Hence, Obama is savvy to target doctors. Nevertheless, I delivered a baby boy at 3 am yesterday of first time parents, and as I placed him on mom’s chest, both parents cried with joy. Junior was wailing, too. It is because of these episodes that no matter what happens to the profession, some doctors will stick around.
August 13th, 2009 | 7:12 am
As for Obama, the truth is not in him. Listen to his speeches. They begin with some untruth, usually like the one cited, or some distortion of history. Then, based on this mendacious account of “the problem”, he offers a solution, the benefits of which he over-promises, and the disadvantages of which he lies about.
August 13th, 2009 | 8:35 am
I think the point here is that your health care paid for it. So what is the big problem?
I had a heart attack and was in the hospital for 4 days. $28000. I think your bill was a bit high, but it seems to work. Whart doesn’t work is the governement run programs like medicare and medicaid. The problem is that private indsurance already subsidizes them. When that is gone wher will they get the money? They will not get it. What they will do is ration care because it is the only solution. If 46 million people are not paying for health care now, they will not be paying for it then. Those of us who are paying for healthcare will have to pay the difference on top of what we pay now. Suppose you have a college student who chooses not to have health care because they can’t afford it. Now thy will have to have it and we will all pay more for it. And the reason they don’t have it is because when they are young they don’t really need it. But we will make them have it when they don’t need it and somehow Obama thinks that is more efficient? It doesn’t add up.
August 13th, 2009 | 8:57 am
Michael’s information is interesting. Perhaps Mr. Smith doesn’t understand health care? My impression is that the doctors and hospitals are milking the insurance companies.
August 13th, 2009 | 10:20 am
Dan Deeny:
I have some more information on all this in the comments at the post on Secondhand Smoke.
Dan (not Deeny?): No, the point isn’t that my health care paid for it (though I’m of course happy that they did), when the question is whether the POTUS doesn’t know what he’s talking about with respect to costs — which is what the post was about.
August 13th, 2009 | 10:35 am
More precision in our language is required.
There are two issues here which are being conflated.
1) How much is a surgeon paid for amputating a foot?
2) How much does a foot amputation along with accompanying services and procedures cost a patient/insurance provider?
Obama: “If a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they’re taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that’s 30,000, 40, $50,000 immediately the surgeon is reimbursed.”
Michael is wrong because Obama actually asserted that 30k, 40k, 50k what the surgeon is reimbursed, which is false (surprise, surprise) or sheer incompetence in communication. Medicare pays the surgeon between $740 and $1140.
Associated costs could run to $30-$50k, but if one thinks that is too expensive, one would be expected to show the breakdown of those costs and which part is too costly, and exactly how one would decide how much the part should cost.
I wait expectantly.
August 13th, 2009 | 10:49 am
Albert,
First, what the surgeon is reimbursed by Medicare need not be what the surgeon is reimbursed in most cases. I would guess my insurance company would reimburse the surgeon at a higher rate.
But, agreed, this is not the total cost of the operation. That cost does appear to be in the range Obama spoke of (details and links in my comments at Secondhand smoke).
In my opinion, Obama spoke imprecisely, but with enough vagueness and ambiguity that it is not clear that he meant what you say. I don’t know if this goes under “sheer incompetence in communication” or “normal imprecision of off-the-cuff unprepared remarks.” However, it is indeed also possible that he was confused.
On the other hand, perhaps the issue isn’t really whether the charges for surgery are too high, case-by-case, but whether it wouldn’t be beneficial to reduce the number of surgeries needed by spending more on preventative care. This seemed to be his main point.
August 13th, 2009 | 11:45 am
@Dan (not Deeny):
You wrote, “Suppose you have a college student who chooses not to have health care because they can’t afford it…And the reason they don’t have it is because when they are young they don’t really need it.”
As a graduate student in Theology who doesn’t have health insurance I can assure you that it is not a “choice”. I have not “chosen” to not insure myself. I am uninsured because I cannot pay ever-climbing tuition fees (close to 20k for this coming year) + rent + food/gas/all the other crap life throws at you and at the end of the day still find a few hundred a month for health insurance (the university I’m attending, and the other I almost chose, do not fund their MA students). That’s why you have uninsured students.
Additionally, your second point that we don’t need it is equally ridiculous. Say, just as an example, that you have a young person who undergoes surgery to repair a seriously dislocated shoulder. And say, for instance, that this young person then gets kicked off his parents’ insurance plan for graduating from university and no longer being a full time student. Then, and this is just me theorizing here, say this young person can no longer afford the physical therapy necessary for a full recovery, because he’s stuck tending bar without much else for job prospects in a crap labor market. But obviously that could never happen.
August 13th, 2009 | 12:04 pm
For Dan Deeny,
Doctors and hospitals are definitely NOT milking the insurance companies. Insurance companies and Medicare hold the purse strings for health care. Medicare reimburses doctors for most types of visits and procedures at a rate that is less than the cost of actually providing the service to the patient. Insurance companies usually negotiate with doctors a little higher rate of reimbursement than Medicare (maybe 110% of what medicare pays) just so people will play ball with that insurers plans. The current situation (from a primary care perspective) is that if a doctor has a certain percentage of patients (for most >30%) covered by Medicare that he/she treats, the physician may not be able to cover the cost it takes providing services to those patients. For this reason, many doctors limit the number of Medicare patients they will agree to have in their practice and many refuse to see Medicare patients at all. Private insurers will often refuse claims submitted by physicians or reimburse at a lower rate than the service should merit (down-coding) in order to hold on to more money (profits for share holders). Because of the way contracts between insurers and physicians are written, it is near impossible for the physician to get back any of the non-reimbursed charge. There have been some class action law suits to cut down on those abuses but similar practices still exist. True, most doctors are not in the poor house, but there is a worsening cycle of needing to hire more staff to navigate the intricacies of contracts/reimbursement with insurers, handle the increasing flow of paper work that re-documents information already available to the insurance co. about patient encounters, etc. Most physician offices need at least 2-3 people per physician to handle purely administrative aspects of running an office because of the bureaucratic hoops put up by insurers and medicare. Staff cost more money each year, reimbursement rates have tended to stay flat or even fall (Medicare), requiring more people to be seen in less time to maintain the practice…There is little connection between what a doctor charges and what is actually reimbursed as reimbursement is controlled by the payors (insurance, Medicare) which gets to the point of how Obama may be able to make certain claims which turn out to be only half-truths, if there really is such a thing. Overall, I am skeptical that such a large undertaking “overhaul healthcare” can be accomplished in an effective manner in such a short amount of time. Fewer, more well-defined goals pursued individually over the course of a presidential term rather than promising the moon to everyone would seem a more effective approach. Oh, and where is tort reform in all this?
August 13th, 2009 | 4:56 pm
@Dan (not Deeny)
Healthy people bring the cost of insurance down for everyone else, because they pay premiums and don’t get their money back. This is true of all forms of insurance: It’s a lot cheaper to insure a lot of people than it is to insure just a few! Some universities out there are requiring that all students buy health insurance for just this reason.
Following up on James’s comment, when I was a student I broke my arm. I know there are students out there that feel invincible–I felt mostly invincible before breaking my arm–but they’re not. I had health insurance, so I didn’t have to pay tens of thousands of dollars in medical bills (it was a bad break). Paying all those premiums was worth it!
August 13th, 2009 | 4:57 pm
James,
I did the no insurance thing for awhile because I thought it was “too expensive,” but after a while was convinced that I could get a fairly reasonable catastrophic care insurance coverage for considerably less than other plans. Since I was in good health I did that–and for the minor stuff I paid out of pocket. This was 10+ years ago, but I’m guessing that you could still find such a plan if you looked around.
August 13th, 2009 | 5:47 pm
President Obama didn’t reference the total cost of the operation, he referenced the surgeon’s fees. He was plain wrong, and now the AMA and the College of Surgeons have corrected him.
He should be judged on what he says, and what he has been saying about health care is ignorant.
August 14th, 2009 | 10:02 am
[...] Fact checking Mr Obama… oops. [...]
August 14th, 2009 | 10:03 am
[...] Fact checking Mr Obama… oops. [...]
August 14th, 2009 | 7:23 pm
You can put the President’s remarks on surgery in the folder with his remark that “Sweden had, like, five banks”, when Sweden had had 114 banks. Given that Sweden had produced for us a road map of how to deal with our banking crisis, the fact he had done no study of the situation there when he had had months to do so was shocking. The guy reads the TelePrompTer well, though.
Links
Blogs
Find Us
Contact