Sobering Medical Reality: What Doctors Charge versus What Insurance Will Pay

A new study focusing on medical costs in the U.S. has verified what millions of patients who depend on federal and state insurance coverage already know: the typical doctor charges considerable more for services than Medicare is willing to pay for.


We should all hope for a logical balance in the dollars-for-service conundrum

And this reality creates serious financial challenges for millions of patients involved.

The studyperformed by Johns Hopkins Bloomberg School of Public Health, as well as the Carey Business School researchers – can be seen in the Journal of the American Medical Association, JAMA. It reveals that almost all physicians bill patients much higher than what their federal insurance will cover, and therefore what their patients can afford. More than 50 medical specialties, for example, charge an average of 250% higher than Medicare payouts – an unsustainable fact of American healthcare for far too many folks.

The study also highlighted considerable variance in charges between different parts of the country, as well as medical specialties themselves.

At the high end of specialties anesthesiologists, for example, often bill the patient 500% over the Medicare coverage amount. At the low end, general medicine practitioners charge an average of 150%.

Those specialties that charge the highest above Medicare are invariably those where patients are not able to choose the doctor at all – like emergency care, x-ray interpretation and neurosurgery.

“The study’s senior author, Gerard F. Anderson, says this: “Many patients are shocked two months later, when they get a bill from a doctor they didn’t even meet. No one told them what the exam would cost and later they discover the price is outrageous. But this is happening all the time.”

Charges above Medicare rates also varied by state, with Wisconsin the most expensive and Hawaii the least.

Let us all hope our new President Trump’s administration can bring focus on this honestly unnecessary burden on our Medicare-dependent citizens.


Drug-Makers: The Money Train Just Keeps on Chugging its Way to the Bank



Smart about music; stupid about drugs

“The opioid lobby has been doing everything it can to preserve the status quo of aggressive prescribing. They are reaping enormous profits from aggressive prescribing.” (Doctor Andrew Kolodny, founder of Physicians for Responsible Opioid Prescribing)

You’ve just got to love – strike that, despise – America’s drug cartels. They’ve conspired with each other on a sweeping, nationwide strategy to destroy any and all legal steps to reduce narcotic overdose deaths.


This is EXACTLY how drug-makers see you

Did you know, for example, that prescription narcotic overdose deaths have gone up an astounding 400%, just since the year 2000? Yes indeed, opioid prescribing by America’s doctors fuels an ugly epidemic that has killed 165,000 citizens in the last 15 tears.

And it’s all perfectly legal.

Do you suppose these characters are losing any sleep? Does their blatant drug-pushing make you proud to be an American?

It doesn’t make the drug cartels proud. But it sure as Hell makes them rich, doesn’t it?

Time to listen up: the monster drug-makers in this country have assembled a veritable army to fight any attempt to stop this madness. They don’t even know – let alone care much – who they’ve killed. They’ve hired over a thousand political lobbyists and are spending millions of dollars to kill any political policy that might – just might – slow the deadly flood of prescribed narcotics into our neighborhoods – the exact drugs at the heart of countless crippling addictions.


Who cares about the dead ones? After all, every now and then, we DO save a few. So gimme the money

In a comprehensive study by the Center for Public Integrity and the Associated Press, it was revealed that the major drug-makers have rapidly upped the funding to drug-pushing advocacy groups, with the goal of fighting any limits on current drug policies – especially those that affect the huge money-makers, such as fentanyl, OxyContin and Vicodin.


“Healthcare”: The biggest money=grab on earth

You remember fentanyl, OxyContin and Vicodin, right? Those are the legal poisons that killed Prince in April. Of course, they also killed 1,000 other folks in April, but who remembers them?

One of the drug cartels’ most effective dollar-drivers is one the public isn’t even aware of: a behind-the-scenes network of narcotic-friendly nonprofit groups such as the Pain Care Forum, created more than 10 years ago.

The Pain Care Forum has contributed nearly $25,000,000 to 7,000 state-level political candidates over the last decade, with governors and lawmakers who control major agendas – house speakers, senate presidents and health committee chairs – getting the most money.

Obscene amounts of cash for continued drug-pushing in America. And it’s all legal.

At the state level, nearly 210 narcotic-related bills have been introduced, just in the last several years. The handful of groups pleading for tighter prescription restrictions are mostly tiny and poorly-funded, mainly families of those killed by narcotics. Together, they spent about $4,000,000 nationwide at the state and federal levels, on political contributions and lobbying. They employ an average of 8 state lobbyists each year. But their pleas consistently fall on deaf ears.

Here’s but one example: in 2007 in Washington State, government leaders drafted the nation’s first set of medical guidelines urging doctors not to prescribe such high doses of opioids. The Pain Care Forum hired a PR firm to convince the state medical board that the guidelines would hurt patients with chronic pain. Never mind that those in documented chronic pain were not included in the guidelines. The bill was never brought to a vote.

The Center for Public Integrity investigation discovered that the drug-makers employed about 1,500 lobbyists between 2006-2015, when prescribed narcotics’ addictive tendency came under serious scrutiny.

More than 900 babies are born addicted in Tennessee alone each year. Many are hooked on the prescription narcotics their mothers took.

Think about that: addicted infants in the United States. Countless thousands. Think of the utter chaos we are creating in the very near future. Still wonder why a high-schooler might take a rifle to school and start shooting classmates? Why shouldn’t they? They were screwed up even before they were born.

Of course, the drug cartels say they’re committed to solving the problems of overdoses. Major narcotic makers have launched initiatives to encourage more cautious prescribing.

Coulda’ fooled us.

In the U.S. drug regulation is mostly handled at the federal level. But the drug- makers fight hard against attempts to impose common sense restrictions.

Prescription narcotics are synthetic clones of heroin and morphine, prescribed to relieve pain. Sales of the drugs have boomed and overdose deaths have risen just as fast, totaling 165,000 this millennium. Last year, 225,000,000 narcotic prescriptions were doled out in the U.S., enough to hand a bottle of pills to nine out of every 10 American adults.

The drug-makers’ bank accounts are bursting at the seams: Purdue Pharma, the maker of OxyContin and one of the largest narcotic generators, pulled in a whopping $2,400,000,000 from narcotics alone last year, according to the healthcare information company IMS Health.

And that wealth was accumulated AFTER executives pleaded guilty to lying to the public about OxyContin’s addiction risk in 2007. They paid a $600,000,000 like a parking ticket, and kept right on truckin’.


Just goes to show: you can never tell from the outside if a person has a fractured moral compass

“There’s such a hysteria going on, about those who have died from overdoses.” (Barby Ingle, President, the International Pain Foundation, which receives pharmaceutical company funding)

Yes, indeed, how utterly emotional of us. Why on earth would any decent American get “hysterical” about pain pills killing 35 people per day?

This feeble-minded woman is dumber than a box of rocks.

Trust us: she’d far rather you fret about the flu boogeyman.

Here’s another look at this subject:

Veterans Hospital Admin to Patient: ‘No More Benefits Because You’re Dead’

“At a touch of a button, because of someone’s clerical error, your whole life can be taken away.”

A North Carolina military veteran can be forgiven for showing his ‘shocked face’ when he opened a letter from legitimate government agencies advising him that he had died.

Veteran Robert Pressley

Veteran Robert Pressley

It seems that veteran Robert Pressley and his family received notification not only from the Department of Veterans Affairs, but also the Department of Defense, documenting that he was no longer among the living.

The good news was that the letters came with government checks to help pay for his funeral. The crummy news was that no more benefit checks – or insurance coverage – would be coming.

“It’s insane and it scares me to death,” Pressley told WECT TV reporters. “Now I have to prove I’m really alive.”

How such an error could happen is a bit of a mystery, but the reality is this: Pressley no longer receives his monthly disability payments, healthcare or medical insurance. To make matters worse, the U.S. Government agencies are in no apparent hurry to correct their mistake and return Pressley’s life to normal.  He is getting no help from them in resolving the issue.

The former military man supports a family and simply cannot afford to lose the income or insurance coverage. He states that due to his service-related disabilities he is unable to work. Compounding the problem is that the funeral money was reportedly mailed to Pressley’s former wife. This occurred well after he had advised the VA several times of his change of address.

“They tell us some vets have to wait nearly three years to get their benefits back,” he told reporters. “I don’t have that much time.”

News reporters at WECT TV have reached out to the Veterans Administration and Department of Defense but have received no explanation for the baffling incident.

Here’s another look:

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Related Story:

In results that should surprise nobody, a Veteran Hospital employee survey reveals that morale at the Veterans Affairs Department is down.

Only 64% of the employees who responded reported being “content” with their jobs overall. Satisfaction with the Department as a whole was down, from 55% in 2013 to 53% in 2014,saying they were satisfied.

The survey asked if they believed their leadership “maintain high standards of honesty and integrity.” 44% agreed – down from 49% the year before. Only 37% believed policies and procedures of the VA’s senior leadership were acceptable.

The number of employees who felt a “high level of respect” for their administrators also fell, from 50% to 46%.

Last Fall Veterans Affairs became embroiled in a widespread patient scheduling scandal that outraged the public. Yet in spite of their lack of confidence in leadership, a full 92% of respondents agreed that what they do is important and 85% report they enjoyed their work.

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Paramedics Celebrate National Nurses Week


National Nurses Week is well-worth tipping our hats to. (Sometimes you just have to end a sentence with a preposition). So now is the time to celebrate nurses, and we do it by providing our readers with the coolest things we’ve ever heard nurses say, while on the job. Trust us, every single one of them is true:

“How many male doctors does it take to screw in a light bulb?”

“It only takes one.  But he’ll need a nurse at some point to finish the procedure.”

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(Patient to nurse):  “Why does this prescription list forty side effects?”

“Because that’s all they’ve discovered so far.”

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“In our Columbus, Ohio urgent care clinic several of us nurses decided to play pranks on the physician we worked for, a guy who was truly an insufferable  jerk. The guy was having an endless string of affairs and we all agonized over whether we should tell his wife.

In the break room one day my friend said, ‘I stuffed cotton in his stethoscope.  That ought to mess him up.’

Another said, ‘I mailed a picture of his girlfriend to his wife.’

The third said, ‘Well, I topped you both. I poked holes in the condoms he keeps in his desk drawer.’

That’s when our new receptionist fainted, bumped her head on the counter and was taken by ambulance to the E.R.”

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“What’s the difference between a cardiac surgeon and God?”

“God knows who really controls the heartbeats.”

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A private doctor and his head nurse were arguing over who should be in charge of making the coffee each morning.  The nurse was saying, “You should do it, because you never like the way we fix it.”

The doc said, “You’re in charge of things around here and you guys wanted this neat little break room, so you fix the coffee.”

“Nope.  I’m way too busy prepping your schedule.  You do it.  Besides, I’ve seen you studying the Talmud, and the fact is, it’s written in the Bible.”

The doctor looked baffled.  “What are you talking about?”

 Whereupon the wily nurse  produced the Good Book, flipped to the Old Testament and pointed to six coffee instructions on one page alone.

They read, “Hebrews.”

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“In the late 1980’s at Merced Community Medical Center in California, our ER was getting bombed by 200 patients a day over a 4th of July weekend.  Our staff of eight nurses and two MDs were sprinting from room to room, with barely enough time to catch our breath.  In the middle of the chaos a particularly twitty little private doc strutted through the door and started barking demands.  About the time we were ready to start throwing things at him, one of our veteran LVN’s screeched to a halt in the middle of the corridor, blood all over her scrubs, pointed to him from forty feet away and waved him forward with a glare.

“Whiner?  Party of one?  Whiner?”

The explosion of laughter by two dozen people rattled the windows.

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And finally, our personal favorite:

“A female punk rocker came into our O.R. (Highland Hospital, Oakland, California) for a STAT appendectomy.  Among other clever adornments was pubic hair dyed green and a tattoo above it stating, “Keep off the Grass.”

When the little darling awoke in recovery she was seen staring groggily at the bandage over her lower abdomen, trying to focus on the note written by the O.R. staff:  “Too bad.  Had to mow the lawn.”

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Go nurses! And please do keep fighting the good fight. Lord knows  we need all the sanity we can muster.

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Ah, But Don’t You Just Love the Language of Healthcare . . .

“The most exquisite pleasure in the practice of medicine comes from nudging a layman in the direction of terror, then bringing him back to safety again.”
Kurt Vonnegut, God Bless You, Mr. Rosewater  

It takes about a month to become fluent in physician doublespeak:

“You’ll soon find . . .”  (really means) “But you will never really believe . . . ”

“It has long been known . . .” (really means)  “I can’t find the damned reference . . . ”

“Three conditions were chosen for study . . .”  (means)  “The others disprove my point . . .”

“In my experience . . .”  (means) “One time . . .”

“In case after case . . .”  (means) “A couple of times . . .”

“It is believed that . . .”    (means) “I think . . .”

“It is generally believed that . . .”  (means) “A few other guys think so, too . . .”

“Accurate within plus or minus 3 . . .” (means) “It isn’t entirely accurate . . .’

“According to statistical inference . . .” (means) “Rumor has it . . .”

“An impressive body of evidence . . .”  (means) “I once saw a few beer-stained pages that said . . .”

“But more research needs to be done . . .”  (means) “I’m covering my ass here . . .”

“Additional studies by my colleagues . . .”  (means) “They’re covering theirs, too . . .”

”Highly significant area for future study . . .”  (means) “A useless committee topic . . .”

“I’d like to thank Joe Blow for his assistance and Suzie Q for her valuable contributions . . .”

(means) “Joe did all the work and Suzie taught me what the hell it meant . . .”

“It is hoped that this study will stimulate further investigation by others . . .”  (means) “Because I quit.”

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