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I have become the kind of person I never wanted to be, namely, a voracious consumer of medical services and a liability to my insurers. That aside, among the surprises I've encountered are long waits for doctor appointments, low standards of care sometimes experienced in top-rated hospitals, and the surprising extent to which medicine is now a mass-production industry. In this column I'll continue with more observations about the health-care industry.

I have been spending a lot of time in medical waiting rooms, and what I've seen there is a large number of people consuming expensive care because of self-inflicted wounds. Here I am referring to smokers lugging their oxygen tanks paid for by insurance, as well as 600-lb men and women unable to walk because of their obesity and who now ride expensive powered wheelchairs, also paid for by insurance.

Overall, the average family of four with an employer-sponsored health plan will incur $12,200 in medical expenses this year. But the family pays just 17% or $2,074 of the charges it incurs. The other $10,126 is paid by employers or their insurance companies.

Another characteristic of the American medical industry is that it imposes a certain amount of enforced charity on the public. Families with employer-sponsored insurance, or their employers, pay an average of $922 per year because doctors and hospitals pass along the costs of treating patients who don't pay.

Finally, just settling a bill in this environment can be maddening. Recently I was being billed inappropriately for certain procedures, and when telephone conversations with the accounting department couldn't resolve the problem, I asked for an address to which I could send a letter specifically defining the errors being made. But nobody would give me a name or address, even after several attempts. The accounting people resolutely just kept telling me to telephone, which over and over was proving to be futile.

In what was a bizarre exchange, eventually one person said she would send me an addressed envelope that I could use to mail a letter. She would not give me the address over the telephone, nor would she explain why. But even the promise to send the envelope was a lie. I never received it. So I picked an address buried in my account statement and mailed a certified letter written in the best legalese I could muster. Within days that brought a return telephone call telling me the matter had been resolved.

The big question is why the accounting department refused to give me a mailing address and insisted on communicating by telephone. My guess is that hospital billing people like the fact that a telephone conversation "evaporates" after you hang up. Then when you call again, you have to start from zero. This improves chances that inappropriate charges will eventually end up unchallenged as patients simply give up after being worn down by the grueling process of trying to correct errors.

A letter sent by certified mail seems to make an impression, especially if the letter reflects a business sense and potential knowledge of legal processes. A lot of patients in hospitals are not accustomed to negotiating with bureaucracies or are intimidated by them. Hospital billing departments apparently are aware of this and thus run roughshod over patients trying to negotiate the billing process. In light of the above, it is galling to see the endless newspaper advertising supplements and television ads placed by local hospitals to attract patients. My guess is that marketing is not a small part of their expenditures. If, however, there is so much competition among hospitals, why doesn't that drive down health costs?

-- Ronald Khol, Editor
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