Hospitals’ Medicare Billing

I am an attorney with the Center for Health Care Rights (CHCR), a nonprofit group that assists Medicare beneficiaries, both as individuals and with respect to systemic problems such as the one experienced by Phil Willon and his wife (“Medicare Through the Looking Glass,” Commentary, Dec. 14). Unfortunately, Willon’s “Alice in Wonderland” experience with the financial side of health-care coverage is not uncommon. As a result of the situation described by Willon, Medicare beneficiaries generally pay about 48% of the amount hospitals receive for outpatient surgery, rather than the 20% that hospitals, Medicare and Medicare supplemental insurance companies lead them to believe.

CHCR has been trying to rectify this injustice. I am the lead attorney in a nationwide class-action lawsuit challenging both how much Medicare beneficiaries may be charged for hospital outpatient services and the Medicare notices that falsely claim Medicare pays 80% of such charges. However, even if successful, litigation often takes years. Last year, Rep. William J. Coyne (D-Pa.) introduced a bill in Congress to limit how much people with Medicare must pay for hospital outpatient services. The bill died along with health-care reform, but will be reintroduced in the next Congress.

CAROL S. JIMENEZ

Director of Litigation

Center for Health Care Rights

Los Angeles

* Willon’s article explains the morass of Medicare payments well, but reaches an incorrect conclusion. He clearly demonstrates that politicians make huge promises (e.g., Medicare), then government jury-rigs the system (paying “50 cents or less on the dollar”) so politicians can avoid admitting that they can’t fulfill their promises. As a result, the private client/private insurance companies pay artificial high prices to keep the medical system afloat. Government ducking its share is a major contributor to medical cost inflation.

Willon properly notes the problems caused because patients do not see/dispute their bills. The solution is not for government to make more big promises (like Social Security, which is also grossly underfunded) and incur more debt, nor is it to make big business the sole payer.

Our primary medical-care payment system must encourage individuals to contain costs by avoiding unnecessary treatment and by monitoring their charges. This is best accomplished by making the individual responsible for his/her bills, with the availability of private insurance that would leave the individual paying a meaningful deductible and coinsurance percentage.

CLAUDE THAU

Arcadia