### Health costs: The New York Times does it again!

TUESDAY, DECEMBER 16, 2014

Arranges to hide the big picture:
On the front page of today’s New York Times, the paper has done it again.

Elisabeth Rosenthal writes her latest lengthy report concerning the outlandish costs of American health care. In the process, she hides the big picture—“buries the lede”—in familiar, remarkable fashion.

In today’s report, Rosenthal focuses on the wildly varying cost of a certain medical procedure. Headline included, this is the way she starts:
ROSENTHAL (12/16/14): The Odd Math of Medical Tests: One Scan, Two Prices, Both High

Len Charlap, a retired math professor, has had two outpatient echocardiograms in the past three years that scanned the valves of his heart.
The first, performed by a technician at a community hospital near his home here in central New Jersey, lasted less than 30 minutes. The next, at a premier academic medical center in Boston, took three times as long and involved a cardiologist.

And yet, when he saw the charges, the numbers seemed backward: The community hospital had charged about \$5,500, while the Harvard teaching hospital had billed \$1,400 for the much more elaborate test. “Why would that be?” Mr. Charlap asked. “It really bothered me.”
The more elaborate echocardiogram was billed at \$1400. Earlier, at a community hospital, the patient had been charged four times as much for the same procedure.

On its face, that’s a remarkable difference. Rosenthal devotes 2357 words to questions about the way this procedure gets billed.

Along the way, very much in passing, she drops a genuine bombshell. This tiny paragraph passes so fast that a reader might not grasp its truly remarkable content:
ROSENTHAL: In other countries, regulators set what are deemed fair charges, which include built-in profit. In Belgium, the allowable charge for an echocardiogram is \$80, and in Germany, it is \$115. In Japan, the price ranges from \$50 for an older version to \$88 for the newest, Dr. Ikegami said.
Say what? Elsewhere in the developed world, this procedure costs \$115 or less, Rosenthal mentions in passing. Those prices include a built-in profit!

In Belgium, the procedure costs \$80. That is stunning fact. Rosenthal includes that fact, but it passes by so quickly, with so little hype, that readers may barely notice. Much later, in paragraph 27 (of 42), Rosenthal briefly expands this startling international comparison:
ROSENTHAL: Claims data shows that Japanese patients received 6.6 million echocardiograms last year, about five times the rate per capita in Britain.

Despite Japan's fondness for testing, its health spending is about \$4,000 a year a person, or 9.6 percent of gross domestic product. By contrast, the United States spends more than \$9,000 per person annually, more than 17 percent of G.D.P., although some studies indicate that health care spending is leveling off.

The difference is in part because Japan decides the value of each test and medicine, sets a price and demands that it decrease over time.
It isn’t just that Americans may pay vastly more for that one procedure. In paragraph 27 of a lengthy report, readers are finally told, very much in passing, that Americans spend vastly more per person for their overall health care than people in Japan.

Good grief! Americans spend \$9000 per person per year on health care; the Japanese spend only \$4000. This is a much larger, much more important story than the narrow tales about health care spending Rosenthal has presented in the past two years.

Rosenthal has done a series of front-page reports about the costs of American health care. Persistently, she focuses on the cost of some particular procedure.

In the process, she completely ignores the overall cost of our health care. Or she cites this matter in passing, in paragraph 27.

As we’ve noted for years, Americans are massively looted in the costs of health care. This looting affects liberals and conservatives alike. Correctly understood and explained, it could provide the basis for political agreement across our current tribal lines.

Americans spent vastly more per person on health care than people in any other nation. But so what? You never see that remarkable fact explained in the New York Times. You never see it discussed on MSNBC.

In these ways, the American middle class gets looted—and the health industries thrive. This morning's front-page report is just the latest example of the way the “journalism” works.

Why does the Times report this topic this way? We can't tell you that. But liberal heroes on corporate TV are never going to ask.

1. Thank you for persistently providing a reminder to your readers that even with Obamacare, we have still not addressed the problems with health care in this nation or dealt with those who are responsible for this mess.

1. Hopefully through the Howler the day of reckoning is coming and they who are responsible will be dealt with harshly.

2. The article finally says, in the next to last paragraph, “the vast majority of customers” paid much less than the listed prices.

That's because Medicare allows a certain amount to be charged for each procedure. Chances are that similar amounts were charged for both echocardiograms, and the allowable amount was a fraction of the theoretical charge. In other words, the inequity problem Rosenthal complains about is substantially solved.

The real problem is that someone without insurance will be charged the full amount. This is unfair and unreasonable IMHO. I think all users of health care should be charged the same amount.

1. David in Cal, why do you "think all users of health care should be charged the same amount"?

2. CMike -- What happens now is that a big insurer or the government has lots of clout, so they can negotiate lower charges for medical, for prescription drugs, etc. Who pays full price? The uninsured person, who is probably in the worst position to afford the full price. Note that the "full price" is almost fictional, since so few customers pay that amount.

One justification for ObamaCare is that given this pricing structure, it's incredibly risky to be uninsured.

3. I figured you'd go that way, but let's keep pulling this thread. Granted, it's wrong for men with guns essentially to set Medicare up as a monopsonist but what's wrong with a private insurer having a lot of clout and negotiating lower charges for itself?

Now when you speak of the uninsured, what they face is not so much the "full price" but rather the "highest price"- Medicare which pays the "lowest price" is all ready paying the "full price" by any reasonable measure, all the provider's expenses for a service plus a reasonable profit or wage for their trouble on top of that as determined by a board of physicians who act as if they most fear being accused of disloyalty to their class by not providing their fellow specialists generous enough compensation schedules each year. And Medicare foregoes requiring pharmaceutical companies from being at all reasonable in what they charge. ("Both Medicaid and the Department of Veteran Affairs negotiate for lower prices, but Medicare Part D, from it’s inception in 2006, is barred from doing this." [LINK])

But I'm still trying to figure out what your complaint might be on behalf some uninsured person, one who has not planned ahead to deal with the financial demands of ill health or who does not have the talents society needs to earn the money needed to meet the medical bills associated with the various urgent or emergency medical issues that arise. Wouldn't making accommodation for those types of people encourage irresponsibility or send evolution off in the wrong direction?

As you well know, all of this price gouging disparity was going on long before our current president was elected to office so your ObamaCare reference is gratuitous, but now that you got that dig in, let's return to my original question, "why do you 'think all users of health care should be charged the same amount"'?

4. Cmike -- I didn't5 intend a dig at ObamaCare. On the contrary, my point was that the hugely inequitable pricing of health care virtually forces people to have health insurance. That situation helps justifies a federal program designed so that everyone will have health insurance.

As for your question, I can't explain my position any better than I already did.

5. You are right DiC, I misread what you wrote about ObamaCare and criticized you for a point you did not make. This is the second time in the course of a few weeks I've done that with something you've written. Hopefully, you won't demand any further satisfaction from me than the acknowledgement I give here for having made these blunders.

6. Together again. The Blunder Brothers.

Coming soon and repeatedly to a Comment Box near you.

7. It's unfortunate that this exchange had ended, and on the note that it has ended.

In particular, I would have been very interested in an explanation from David in Cal as to what principles lead him to advocate that "all users of health care should be charged the same amount."

3. OMB ( Healing health care costs with the OTB)

"As we’ve noted for years, Americans are massively looted in the costs of health care. ....Correctly understood and explained, it could provide the basis for political agreement across our current tribal lines." BOB

Yes. And let's leave it to the journalists to get us these agreements across current tribal lines!

In Campaign 2000, one candidate was the standard bearer for a party which had championed health care reform for half a century.

His campaign website had a 2,561 word section detailing his position on health care. Not once did he metntion even holding down the cost of health care, much less compare the amount spend on health care in American to the rest of the developed world.

He did, however once take a firm stand against arthritis pills for people costing more than arthritis pills for dogs. The press wasted much space savaging him for this. Only a tiny handful of bloggers took the time to fully explain for years afterward why his pronouncements on this issue were accurate.

No bloggers took him to task for not mentioning the massive looting of the nation he hoped to lead on the issue of health care costs.

1. Rachel Maddow&#39;s Glazed EyeballsDecember 16, 2014 at 3:24 PM

Yes, because out on your "planet" nobody has yet realized that Bill and Hillary were routinely savaged for proposing healthcare reform, and understanding that that would have transferred easily onto His Campaign.

Dubya got elected for proposing nothing, and (with SS privatization) less than nothing.

So go ahead, blame him for not presenting another truth that would have become spun as a lie.

(Do you doubt it? Read papers from Earth and see the gauntlet Obamacare somehow endured).

2. So who really savaged Bill and Hillary? Journalists? Or politicians from the other side whom journalists quoted during the debate?

Do you really want journalists taking sides all the time, choosing which side is lying then shutting them out of the debate? Or do you want the arguments -- no matter how "fair" -- of both sides to be heard, putting the burden of "winning" on one side or the other?

I also remember way back in 1964, LBJ's wild idea for a national, single-payer health insurance plan for retirees was savaged -- and duly reported -- every way til Sunday.

Somehow, LBJ still managed to get it passed, without blaming "the press" for reporting both sides of the debate.

3. Actually, Dubya was not elected the first time, in 2000.

4. 4:52- You really believe that the press doesn't have its own agenda?

5. I can't speak for 4:52 but I would bet that comment is based on the fact that Gore got more votes than Bush and Bush's victory was the result of the US Supreme Court awarding him the electoral votes from Florida as certified by their election officials prior to a state court ordered recount.

Now, may I ask you why on earth the comment from 4:52 made you think it had anything to do with the existence or non existence of a "press" agenda?

6. Rachel's FACES your response was interesting.
You have perhaps explained why Mr. Gore was silent.

We did not wish to imply fault on Mr. Gore's part. We apologize if we did.

However, our comment was meant to support BOB's contention that the press must raise and promote solutions to such divisive issues so the politicians, timid fellows that they are, may step in and claim credit once the press leads the way.

4. Like you, we can see the announcement already.

Next April, the judges will issue their happy statement, conferring a joy on the world:

For a distinguished example of investigative reporting, using any available journalistic tool, Ten thousand dollars (\$10,000).

Awarded to Elisabeth Rosenthal of the New York Times for her penetrating look into the high cost of medical care in the United States.

By all accounts, the New York Times' Elisabeth Rosenthal is on her way to a Pulitzer Prize in April 2013.

Why have none of these fiery figures even mentioned the Rosenthal series? It's going to win the Pulitzer Prize—and it's going to do so in silence! Elisabeth Rosenthal is going to win the Pulitzer Prize for a series of front-page reports about one of our most pressing policy problems.

MONDAY, APRIL 14, 2014. Waiting for Rosenthal: The 2014 Pulitzer Prizes will be announced today at 3 PM Eastern. Around here, that amounts to a case of “Waiting for Rosenthal”—waiting for Elisabeth Rosenthal,

5. The press seems to cover, constantly, all kinds of crap. TDH is at his best in raising this topic. Unfortunately it is very complicated. The press covers global warming a lot more and little gets done. We need some politicians to get on the bandwagon on this, but what are the chances of that without some type of groundswell?. Some people are reaping in an awful lot of money, and will put up a death fight to keep it flowing. If the US paid per capita what everyone else does, all the concern about crushing future deficits would dissipate, and we could avoid upcoming rationing of health care except for the well off. I still think that the press, the media fails miserably in hardly at all focusing on this..

6. It's not looting, it's FREEDOM.

1. God (sic), I hope that's sarcasm...

2. Carter believes that the rich and powerful have a "right" to loot.
What about the rest of us?

7. If only the press covered things the way Somerby wanted he would be influential.

8. We will point to the relative dearth of comments on this topic to underscore a point: maybe there's a reason Salon devotes space to sex and other "frivolous" topics. Maybe liberals, as Bob is wont to say, don't really care about, not just black kids, but much of anything. Which makes Bob's perpetual outrage over the failure of "liberal leaders" to do whatever it is Bob is outraged at them for not doing somewhat puzzling, of not downright quixotic.

As an aside, we are not the "Rachel" person above, who has decided to appropriate our schtick. It seems to us if you're going to take a fake name, you ought to at least make it unique,if for no other reason, to allay confusion.

1. Comments have nothing to do with interest. They have to do with controversy, clarity, or idiocy.

2. You have stated a possibility consistent with the meme of the OTB.

Others might suggest the dearth of comments is because BOB's point on this topic is so accurate no comment is required.

Still others might note the comment of Anon. @ 1:47, which seems to us to be a compilation of the many, many, many posts BOB has previously done on the work of Ms. Rosenthal of the New York Times. We checked the Howler out for the date, April,14, 2014 in that comment @ 1:47.

That was indeed a post by BOB on Rosenthal's work. He incorrectly predicted she would win a Pulitzer. He was not critical of her work. He railed at the silence with which it was greeted in the press.

That post by BOB, excluding spellcasting spam, got fewer comments than this one.

We may offer other possible explanations of our own. But like many others, we may be too bored to bother.

3. We pray daily that your boredom will increase to that point.

4. Then again, our interest is always awakened when examples of pre-human behavior manifest themselves in proof of the accuracy of what the OTB keeps saying about the human brain.

Keep that aspect of your work up, BOB. Telling people how dumb they are is the best way to show liberals how foolish it is to act like they are smarter than the other tribe!

9. Here Somerby rails against Rosenthal and her paper for burying what he thinks should be the lede. The post gets a small smattering of comments. This lack of commentary itself draws comments.

Perhaps the lack of commentary and interest in the health care issue can be found in something else buried in Rosenthal's story which Somerby saw, but apparently did not understand or think worthy of attention.

Writes Somerby: "In Belgium, the procedure costs \$80. That is stunning fact."

Look closely at what Rosenthal went on to say:

"In Belgium, the allowable charge for an echocardiogram is \$80, and in Germany, it is \$115. In Japan, the price ranges from \$50 for an older version to \$88 for the newest, Dr. Ikegami said.

Because Mr. Charlap, 76, is on Medicare, which is aggressive in setting rates, he paid only about \$80 toward the approximately \$500 fee Medicare allows."

Ms. Rosenthal and Somerby don't seem to focus on the fact that the consumer, in this case the observant Mr. Charlap, is not actually paying a hugely different fee for essentially the same service nor is he paying much more than Belgium.

When the citizenry most in need of health services, and those most likely to vote, the elderly, are not gouged out of pocket for a procedure, only your everyday retired math professor is likely to look at the total billing numbers with mild curiosity. Those who might be looted as uninsured individuals based on these outrageous and varying "prices" aren't looted because they rarely use them. Instead they die paupers in or on the way to the emergency room. Of preventable heart failure.

"Looting" is going on. If it came in the form of a carjacking by a gand of hoodie clad black teens who sometimes shot the victim in the mouth there might be outrage. But it is being done collectively to all of us systemically. Just as is the case with our national "defense." And as long as we collectively think the USA is number one, we will not only put up with it, we will take foolish pride in it.

1. I had an interesting experience recently which sort of follows the above observation about seniors not being gouged. I received a letter from a firm that audits Medicare payments informing me that Medicare was going to take back some of what they paid for a surgery in 2012, because they judged that it could have been done on an outpatient basis. However, since I hadn't been told that hospital care wouldn't be covered, I wasn't responsible for the extra cost. The hospital had to eat this unreimbursed cost.

Two observations: The audit firm was medically wrong. My surgery could not have been done as an outpatient. However, the hospital wasn't able to persuade Medicare that this was the case. IMHO Medicare was taking advantage of the hospital.

Second, they found an excuse to charge the hospital, rather than the patient. Thus, we voters aren't upset by Medicare's bad faith.

2. A better example will come in the slow collective gouging of Amercians in the form of one of the "reforms" of the Affordable Care Act.

The provision which requires 80% of premiums to be spent on health care delivery will mean that insurance companies have a built in disincentive to hold down delivery costs. 20% on top of a procedure which costs \$ 100 allows an insurance company to retain a lot less than 20% of the same procedure when it costs \$1,000.

It won't happen overnight. The frog would jump out of the pan if it did.

3. anon 11:31 am - if the medicare recipient only pays \$80 out of pocket, isn't Medicare paying the balance, whatever the balance is? If that is the case, the cost is not just \$80, the Medicare trust fund is paying it, and to the extent that US costs are double or more than they are elsewhere, this has potential grave future repercussions for the economy and patients. Also, if the total cost in Belgium is the equivalent of \$80, I would think that this cost, in whole or in part is picked up by the universal health care system they have in Belgium, so that the patient would not be out of pocket even for \$80.

4. Some good points AC/MA.

Medicare is not "paying the blance, whatever the balance is." It is paying substantially more than \$80, which is why I said looting is going on, but the kind of looting which does not provoke the kind of outrage which would ensue if the prices were imposed in individual patients rather than buried in paperwork the way Somerby claims Rosenthal buried the real story in her article.

10. Regarding the dearth of comments issue raised by "real" Rachel's.

Another explanation is that Bob's few real devoted readr/commenters are still back on a post from last Friday debating torture.

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