One consequence, unintended or not, of the coronavirus pandemic is that the Democratic debate about “Medicare for All,” “Single-payer,” “Universal Healthcare,” or the virtues and/or improprieties of “Obamacare” has been put on hold.
And while the discussion about the good and bad of the entire U.S. medical care system is sadly still front and center, the nuances and minutiae regarding which is the best medical insurance program has been put on the back burner.
The good news is that Medicare is still in place and is still doing an outstanding job for its 44 million beneficiaries.
But, not without the occasional eccentricities, or rather, silly business.
A friend of mine recently had spinal surgery. As a Medicare participant, my friend did not have any out-of-pocket charges.
That’s the good news. And the great thing about Medicare.
After the surgery and all the paperwork was processed, my friend received the following statement:
Notice anything, er…strange?
For those of you not on Medicare (given the demographics of my readership, that’s probably a precious few), let me go through this.
It is common knowledge that the “charged amount” is always ridiculously high. But it is usually, at least, “plausible.”
In this case, a procedure cost of $99,999.99 means that the providers didn’t even have the imagination to dream up a number that had some sense of reality. (OK, before I get all the comments, yes, there’s probably a $100,000 cut-off, over which a whole bunch of new, more complicated forms must be used.)
Medicare, in its infinite wisdom, declared that the procedure was only worth $17,540.93, not $99,999.99 (how Medicare came up with a $17,000+ expense down to $.93 is not known).
And the providers, who originally charged $99,999.99, accepted a payment that was $82,459.06 less than their fee.
(Wait, is that $82K+ loss tax deductible so the providers will pay no income tax this year? Any accountants out there? Anyone?)
Now, if Medicare actually had a sense of humor, here’s what they should have done: The payment to the providers should have been $17,539.94, leaving my friend with a co-pay of $.99. Now, that’s funny!
But, I guess there’s no real no sense of humor in the Medicare business. Which is too bad; they just don’t realize how funny they really can be.
Final note: My friend told me that Medicare’s actual final payment to the providers was $16,500, not the $17,540.93 listed on the billing. So somehow there’s $1,040.93 floating around the Medicare system. Sounds like when all this pandemic stuff is over, we’ll need some televised hearings. After all, it’s been months since we’ve heard some real, down and dirty, Congressional pontification!