The mid­dle class knows all about hav­ing ‘skin in the game’

Modern Healthcare - - COMMENT -

Re­gard­ing the Dec. 12 ed­i­to­rial “Mak­ing ‘more skin in the game’ work” (p. 24), the points are well-taken, as what’s left of the mid­dle class al­ready seek grafts for the amount of their “skin in the game.” Those who still have any mod­icum of health in­sur­ance as we once knew it have no say in the changed health cost struc­ture that has trans­formed the sys­tem into an eco­nomic enigma. For ex­am­ple:

Many pay hos­pi­tal­iza­tion costs at full “rack rate” for what was not cov­ered by their in­sur­ance, but would have been billed at a se­vere dis­count.

They pay higher out­pa­tient costs for the same physi­cian prac­tices and ser­vices now pur­chased by the hos­pi­tal and charg­ing higher costs.

The cost of drugs has ex­ploded thanks to deal­ing by Big Pharma for Medi­care Part D and the Af­ford­able Care Act; that barn door re­mains wide open to any mar­ket-im­posed so­lu­tions by pay­ers or even Congress.

Frankly, un­less Wash­ing­ton had proved ca­pa­ble to ef­fec­tively deal with the phar­ma­ceu­ti­cal, in­sur­ance and hos­pi­tal in­dus­tries—for the ben­e­fit of the pub­lic, not their stock­hold­ers—the mid­dle class would have been bet­ter served if each of the true 8 mil­lion lack­ing health in­sur­ance cov­er­age would have just been pro­vided a gold-plated PPO card, rather than cre­at­ing such angst and tur­moil un­der the ACA, with no real con­trols over how health­care has be­come a com­mod­ity traded on Wall Street. M.E. Singer Chicago

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