An immoral, redundant, crass, bloated, discriminating Freak Show
Since the publication of my report, Sticker Shock, in 2010 on non-profit hospital accounting detailing the abusive accounting mechanisms in place (read: policies) which reward a select few at the top with outrageous salaries, bonuses, first-class travel, golf club memberships, housing allowances, personal loans, chauffer-driven limousines, tax indemnifications, specially funded split-dollar life insurance policies, and deferred compensation packages in the millions at the expense of pursuing the poor, un, and under-insured to the point of inflicting stress, bankruptcy, wage garnishment, further illness, and death for payment of hospital bills puffed up by as much as 1,500%, things have gotten much worse for people needing medical care.
The breaking point for me was the story of Wesley Warren, Jr., a 45 year old man from Las Vegas with a 132 pound scrotum (roughly the size of 8 bowling balls). Here was a guy, who for four years dressed his engorged ball in an upside down zip-up hoodie because it couldn’t fit into his pants and carted this enormous appendage around in a wheelbarrow just to go to the store for milk and coffee.
Mr. Warren’s medical issue began in 2008 when he awoke to a shooting pain in his testicles. The tissue around his penis began to swell caused by a condition called scrotal lymphedema – also called scrotal elephantiasis – where the membrane thickens and fluid accumulates around the scrotum. Medical experts warn the affected area keeps growing until the patient seeks treatment (Wesley’s grew by 3 pounds a month).
At home Wesley would rest his scrotum on an overturned milk crate using baby powder to ward off the smell of urine (his penis was lost somewhere in the folds of his engorged flesh). Because of this condition, he was unable to work and was on disability.
Wesley had surgery – five years after this condition began – and died less than a year thereafter. Preventing him from quicker corrective surgery and care was the cost to treat it estimated to be between half a million to a million dollars.
Of course that estimate is in American hospital dollars, which like Monopoly money, is pretend. By using monetary guestimates, which in no way correspond to actual cost of care, and sending medical bills for those inflated amounts (but pursuing patients by real collection agencies demanding US legal tender or else), our unique profit-first-take-care-of-the-executives-and-connected-consultants-driven health care system scares desperately sick people, like Wesley, into believing there is no cure for them, resulting in a life of unbelievable suffering.
How else can you explain, as pointed out in Steven Brill’s excellent article, Bitter Pill (Time Magazine Feb 2013) how nonprofit hospitals extort money from chronically ill, desperate people before treatment can even begin [all emphasis is added]:
“When Sean Recchi, a 42-year old from Lancaster, Ohio, was told last March that he had non-Hodgkin’s lymphoma, his wife Stephanie knew she had to get him to MD Anderson Cancer Center in Houston…Stephanie and her husband had recently started their own small technology business, and they were unable to buy comprehensive health insurance….Stephanie was told by a billing clerk that the estimated costs of Sean’s visit – just to be examined for six days so a treatment plan could be devised would be $48,900, due in advance. Stephanie got her mother to write her a check ‘You do anything you can in a situation like that’ she says. The Recchis flew to Houston…About a week later, Stephanie had to ask her mother for $35,000 more so Sean could begin the treatment the doctors had decided was urgent. His condition had worsened rapidly since he had arrived in Houston. He was ‘sweating and shaking with chills and pains’, Stephanie recalls. ‘He had a large mass in his chest that was…growing. He was panicked.’
Nonetheless Sean was held for about 90 minutes in a reception area, she says, because the hospital could not confirm that the check had cleared. Sean was allowed to see the doctor only after he advanced MD Anderson $7,500 from his credit card.”
Then there are the “hangover” payments, bills which keep pouring in even if you have “comprehensive” insurance. Recently my friend Rita, with what she thought was a solid insurance plan ($11,000 per year), gave birth to her first child. Everything about this uniquely American pregnancy and birth were normal, including the painful medical bill afterbirth. With a $1,500 deductible per person, and a 20-80 hospital co-payment, the moment her daughter took her first breath, the nonprofit hospital was there to collect $1,500 for the baby’s deductible. After insurance, Rita’s portion of the hospital bill was $5,300.
(It’s also important to note when American women go on maternity leave, in order for their income to continue in some capacity, they must file for disability. In America, a pregnant woman is considered disabled.)
I call this: The Freak Show at work.
Of course, The Freak Show has a senior circuit.
My father, who died 20 months ago at the age of 84 after a long and contentious battle with Alzheimer’s, had five insurance policies:
(1) The Veteran’s Administration (socialized medicine) – dad was a WWII veteran;
(2) Medicare B (public-private partnership around since 1965);
(3) AARP-supported supplemental profit-first insurance through United Healthcare;
(4) Medicare D (George W Bush’s gift on a silver platter to the profit-first
pharmaceutical and insurance conglomerates):
(5) Medicaid (taxpayer funded to help the poorest of the poor yet run by profit-first insurance companies like United Healthcare, Aetna, and Humana).
Despite dad’s costly, redundant, and wasteful coverage, I continue to receive invoices, now in collection, for medical services provided even though these entities were paid.
Over the last decade, I’ve completed about a thousand tax returns for senior citizens, the overwhelming majority purchased Medicare B even though economically, it didn’t matter if they were just getting by on a small pension or were sitting on a million dollar portfolio.
In fact, of those who purchased a supplemental policy, also called “medigap insurance”, most did so because they were persuaded to do so by membership in AARP, a nonprofit entity which pulls in income of $1.2 billion a year and according to their most recently filed IRS Form 990, $723 million of that revenue in royalties – mostly from their 5% cut on each supplemental medigap policy. In addition, AARP has $1.3 billion in Wall Street investment securities and pays out $2 million in compensation to the top three executives.
This is exclusive of the AARP Foundation, another nonprofit serving “vulnerable people 50+” which pulls in $142 million a year mostly from government grants, pays out more millions to top executives and has a fund balance in excess of $70 million. This shuffling of money – shielded from most income, sales, and property taxes – is included in the “cost” of health care.
What many people don’t realize is these supplemental policies which cost on average $4,000 to $6,000 per year, sit behind what Medicare determines it will pay to providers for medical care. (AARP is a perfect example as it is an agent for medigap insurer giant United Healthcare whose CEO was paid $14 million in 2012, up 3.7% from the previous year.). In other words, if Medicare disallows payment for a service, United Healthcare pays nothing. Anything denied by Medicare is denied by United Healthcare: It literally uses Medicare’s excellent bargaining power to shield its profits.
This is the American health care Freak Show in perfect form.
In fact, an AARP recent article indoctrinated members to plan on socking away no less than $220,000 to pay for medical bills during retirement “and that’s after Medicare coverage kicks in.”
Our country’s economic system and its bed partners (government) force the elderly and disabled to fork over a quarter of a million dollars out of pocket for their health needs especially at a time when they need it the most?
Then there are the so-called “Invisibles”; young people caught in the web of our predatory Freak Show who absolutely refuse, no matter how much pain they are in, to go to the emergency room. I can’t tell you how many people in their 20s I’ve talked to who’ve passed kidney stones at home (urinating through a strainer looking for the “rock”), splintered broken bones, self-diagnosed through Google serious rashes and ruptures, or suffered from severe (and life-threatening) dental infections because, even though they work and have some kind of profit-first crappy insurance – or not – the last thing they want is to leave the hospital with a bill for no less than $19,000 (which seems to be the starting “bid” to pay for the outlandish executive perks) for services which actually cost less than one tenth of that.
And there’s more.
A 5/18/14 New York Times article “Doctor’s Salaries are not the Big Cost” revealed the largest health care system in New Jersey, nonprofit Barnabas Health, in 2012 paid its outgoing CEO, Ronald J. Del Mauro, a severance package worth over $20.6 million. I should mention that in 2005 (while under the direction of Mr. Del Mauro) Barnabas Health settled with the Department of Justice (“DOJ “Release” dated 6/15/2005) in the amount of $265 million (one of the largest settlements ever) “to settle allegations that it defrauded the federal Medicare program”.
From the Release:
“The settlement resolves allegations that the Saint Barnabas Corporation, and nine of the hospitals that it has operated, fraudulently increased charges to Medicare patents in order to obtain enhanced reimbursement from Medicare. The US alleged that between October 1995 and August 2003, Saint Barnabas hospitals purposefully inflated charges for inpatient and outpatient care to make these cases appear more costly than they actually were, and thereby obtained outlier payments from Medicare that they were not entitled to receive.”
(The case against Saint Barnabas was so strong it settled for a quarter of a billion – begging the question how much had it stolen from Medicare…including before the date of investigation?)
The NY Times article:
“Ellen Greene [annual compensation $337,000], a spokeswoman for Barnabas Health, said Mr. Del Mauro’s retirement package was a ‘function of over four decades of service and reflects his exceptional legacy.”
(She neglected to mention he was paid handsomely each year – $3 million plus personal car and chauffer.)
Only a giant health care Freak Show would allow nonprofit executives to be rewarded for forcing patients and taxpayers to fork over payment of $265 million for stealing from Medicare as well as over $20 million as a walking away package to the man in charge of the organization during this charge.
But it gets better.
Another giant nonprofit hospital in NJ, Robert Wood Johnson University Hospital, has the gamut of the usual blob (tax-free profit of $90 million last year, executive compensation to a select few in the millions, and Wall Street investments of half a billion). What is interesting is while they pursue the poor, un, and underinsured for puffed up hospital bills, their foundation, Robert Wood Johnson Foundation, according to their most recently-filed IRS Form 990 shows it has amassed over $8 billion in investment securities, which is eight times their annual income.
The foundation’s mission is to improve the health and health care of all Americans. In doing so, it hands out hundreds of grants in the hundreds of millions to other nonprofit entities, yet my review of some of the largest grants reveals a giant “shuffling” of money.
Case in point:
The foundation gave over $2 million to Tufts University for a study on child obesity, an amount which was equal to what Tufts paid as severance to their outgoing president. Additionally, nonprofit Tufts University is one of the most blob-ridden public education systems with six figure salaries for top administration, and almost $2 billion in investment securities (while raising tuition each year).
Another large grant from RWJ Foundation in the amount of $400,000 was to Save the Children, an amount equal to the compensation of the CEO.
So here we have several nonprofit “charitable” entities, with combined $10 billion in excess funds (escaping most taxation the rest of us pay), doing really nothing – nothing at all – to alleviate the suffering of people needing real financial help who survive (somehow) on the brink of desperation (unpaid medical bills is the number one reason for bankruptcy in the United States, and two-thirds of those people had health insurance).
It is clear our health “care” system is completely out of control (nothing in the Patient Protection and Affordable Care Act changes anything stated herein, and in fact, makes things worse by giving more power to the profit-first health insurance industry) It is a veritable Freak Show, very much like Wesley Warren’s testicle:
An engorged appendage with an insatiable appetite for sucking off life.