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They'll take $90, but negotiations will start at $1,000

By MARTIN DYCKMAN
Published August 15, 2004

TALLAHASSEE - Though it didn't belong in the Florida Constitution, it's a bit of a pity that the trial lawyers have shelved their initiative to make physicians charge the same fees to everyone. The idea deserves more talk A lot of it.

The current event that inspires this dudgeon happens to be from my own household, but something like it most likely has happened to you or to someone you know.

The doctor sent one of my sons to the lab for some blood work not long ago. The laboratory company, one of those immense national chains, sent him a bill for $1,384.

Now here's what the newspaper's health insurance company says those tests were worth: $90.88. Less than 10 percent of what was billed. A big difference. Under the laboratory company's contract with the insurance company, that's all we'll have to pay. I'm not fussing.

But what if we didn't have insurance? Or if it were a couple of years down the road when my son no longer qualifies for dependent coverage? Would the laboratory company ruin our lives trying to squeeze out the full $1,384?

I sent them an e-mail. I asked whether they were making or losing money on those tests by agreeing to take only $90.88 for what they purport to be worth $1,384. If they lose money, why do they agree to contracts like that? If they do not lose money, how is it conscionable to charge so high a sticker price? Since some hospitals are discounting bills to uninsured patients, would they have done the same?

This, in full, is the reply I received: "In response to your recent inquiry, we believe our billing practices are consistent with other health care providers offering comparable services. Beyond that there is nothing we can contribute to your story."

Translated: "We are part of an enormous nationwide racket that doesn't have to explain anything to you or anybody."

One result of that racket is that people who can least afford health care - which is to say, the uninsured - are charged the most for it. What was said of the yachting crowd is now true of health care: If you have to ask what it costs, you can't afford it.

And that's why that trial lawyers' initiative raises an issue that deserves another day.

One trouble with it is that it applies only to doctors, not hospitals or laboratories. Another is that it would put an end to health insurance as we know it, which is the real if unacknowledged reason why the trial lawyers aren't pushing it for now. They have other issues against the doctors, who could have beaten them on that one.

But maybe, just maybe, it would be a good idea to destroy health insurance as we know it. I read the other day where some uninsured people are suing a hospital for the same discounts that insured patients get. The right verdict in that lawsuit would be a step on the way toward national health insurance covering everyone. The same sort of insurance enjoyed by almost everyone else in the civilized world.

The paradoxical, profane nature of the hit-and-miss insurance Americans have - and Medicare was the first to blame for this - is to relentlessly inflate the base prices that providers quote to the insuring agencies. It's a negotiating tactic that ruthlessly abuses the uninsured and eventually everyone else.

* * *

Jeb Bush wasn't kidding when he got dreamy-eyed during his last inaugural address about all the Capitol Center office buildings he wanted to see emptied of state workers. But it's beginning to sound as if he wants them filled with lobbyists.

Okay, maybe that's a little too tough. But it's not an illogical outcome of his current scheme to put much of the Capitol Center on the market and move the state workers to modern high-rises in the suburbs.

Some 17 buildings of all sizes are potentially on the market, supposedly because they are all uneconomical. Local agencies could use some; the administration fancies others might be bought up for conversion to condominiums. More likely, though, is that the lobbyists and trade organizations would bid a higher price. Those are the same folks who have already banished virtually all retail merchandising from the heart of Florida's capital. There's one haberdashery, one flower shop, and that's it. Only bars and restaurants can afford to compete with the lobbyists for prized locations near the Capitol, which is why there are already too many lobbyists too close.

The governor's approach may be more economical - although nobody in the Legislature seems to be asking the necessary questions - but there ought to be more to the capital of a great state than simple efficiency. It ought not to be a wasteland after dark, but an exemplar of what a vibrant downtown center can and should be, a place that every Floridian would want to visit.

If the old buildings are truly inefficient, then by all means, raze them. But replace them on site, with retail businesses, not lobbyists, encouraged to rent the ground floors.

[Last modified August 14, 2004, 00:32:58]


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