US Freedom Foundation

We Believe...
That restoring a true free market for health care in the United States will produce the best health care system in the world. Restoring that free market requires the financial re-empowerment of the American middle class. Every American should have access to affordable health insurance, regardless of their health status or income level. Individual Americans - not employers - should choose and own their health insurance plan. Every American should be free to choose their health care provider, hospital, and treatments. Americans should pay cash for their everyday health care needs, and insure only against medical costs in excess of their ability to pay cash. No patient who pays cash for health care or prescription drugs should be charged more than an insurance compnay would pay for the same service or drug. Every American should be able to fully enforce the terms of their health insurance contract in state court, including the ability to seek economic, non-economic, and punitive damages for breach of contract as allowed under their respective state laws.

US Freedom Foundation Needs Your Financial Support to Restore and Improve our Health Care System Nationwide. Please Help Through Your Donation!

Tonight in the Health Care Ring, HR 3200 v. HR 3400: KO?

Debate over HR 3200: America’s Affordable Health Choices Act of 2009 is ongoing, and critics stand accused of being “no men.” However, health care is hardly a black and white issue, and it’s important to explore all solutions to the problem in order to identify which one best fits our needs.

“But isn’t HR 3200 the only option going?” you might be asking. As a matter of fact there’s another reform proposal in Congress: HR 3400: The Small Business Fairness Act of 2009, sponsored by Representative Tom Price R-GA. Though this bill didn’t merit the media extravaganza surrounding HR 3200 (sponsored by Representative John Dingell, D-MI), its still well worth mention and consideration. The following compares and contrasts the main tenants of HR 3400 with its more well-known companion, to include implications for consumers, the healthcare industry and small business, and treatment of two particularly sensitive issues: abortion and illegal immigration.

What does HR 3400 do for the consumer?

Basically, it encourages purchase of health insurance by offering a tax credit to low income buyers. The amount of this credit will be the lesser of the following:

sum of all monthly premiums paid for the tax year
a monthly limitation: 1/12 of $2000 for the taxpayer, $2000 for spouse, and $500 per dependent (two dependents maximum) and then adjusted for inflation and rounded to the nearest increment of 50.

In other words, for a family of five the monthly limitation would be $5000/12, which is $417, plus 3% for inflation which is $430, rounded to the nearest increment of 50, which is $450/month. If they spent less than $450, then they will be reimbursed for that amount instead. The reason for choosing the lesser sum rather than the greater is to keep costs down and discourage “designer plans” charged to the government’s tab.

Also important to note is that 100% of the tax credit is available to persons making up to 200 percent of the federal poverty line. For every $1000 adjusted gross income above that, the tax credit is reduced by 1%.

Let’s continue with our example: the poverty line for 2009 for a family of five is $25,790. So as long as our family makes no more than $51,580, they qualify for the full tax credit. If they make $52,580, they qualify for 99% and so on and so forth.

Moreover, this tax credit can be elected as an alternative to Medicare, Medicaid, SCHIP, veteran’s benefits, subsidized group plans, Tricare, and FEHBP. Though other social security benefits would not be waived, this encourages greater competition among government sponsored health benefits, as well as decreasing reliance on those benefits. This in turn decreases funds spent by our government and saves the taxpayer money.

This part of the plan is a strong contrast to HR 3200, which encourages Americans to buy health insurance by making it illegal not to have it, under penalty of fines and garnished wages. Does Mr. Dingell imagine that the 30 million Americans lacking health care are doing so out of sheer obstinance? Apparently Mr. Price felt that more Americans would buy health insurance if they could afford it.

How will HR 3400 affect the health care industry?

HR 3400 redefines the liability of health care providers and organizations (health care organization here defined as “any person or entity which is obligated to provide or pay for health benefits under any health plan”). The reasons for this legal makeover are three findings by Congress:

The current civil justice system is adversely affecting patient access to health care services, better patient care, and cost-efficient health care.
Health care and insurance industries are affecting interstate commerce: health care litigation systems across the US contribute to high costs of health care.
Health care liability litigation systems have a significant effect on the amount, distribution, and use of Federal funds because of the large number of people who receive health care benefits from the government, the expense incurred by the government for health care items and services and the people who benefit from tax exclusions on money spent to provide health benefits.

It would be counter-productive to go through the nitty gritty details of how 3400 would redefine liability, though we encourage you to read the full text for yourself. In a nutshell, health care providers and organizations (meaning insurance companies) would be liable for unlimited economic damages, non-economic damages up to $250,000, and punitive damages up to $250,000 with proof of malicious intent.

HR 3200 does address the irresponsibility of the health insurance industry, but it does so by introducing a government-run health care option to potentially increase competition. However, the head of this option would be able to personally and arbitrarily set market standards across the board – this intrinsic conflict of interest could lead to the extinction of the private health care industry, leaving us with only the public option, which it would be illegal not to have.

Meanwhile, HR 3400 finds it more effective to improve liability procedures in order to combat irresponsibility. Essentially, it increases the chance, speed and severity of consequences for unlawful behavior.

What does HR 3400 mean for small businesses?

Small employers (defined as businesses with 50 employees or less) would receive a tax credit as well to help cover the cost of providing health insurance. This credit would be the lesser of the following two sums:

$1500 per employee
an amount equal to 100 percent of the amount paid or incurred by the employee for qualified health benefits expenses

For clarification purposes, if your Department Manager John Doe spent $800 on health benefits expenses, you get $800 in tax credit. If Mr. Doe spent $2200, then you receive $1500.

HR 3200 also provides a credit to small businesses to cover 50% of health coverage expenses. Compensation under this plan would be reduced proportionally when the average employee salary is more than $20,000, and also reduced proportionally when staff size is more than 10. While these provisions are most likely an effort to make sure that only small, low-income businesses are receiving the credit, it could also serve as a deterrent from increasing employee wages, and as a sort of penalty for growth. In comparison, 3200 clearly defines what it means by “small business”, and treats everyone the same under that definition.

HR 3400 on abortion and illegal aliens

Some of the most conflicting criticisms of HR 3200 are its stance on abortion and availability to illegal aliens. Proponents of the bill claim that no funding will go toward abortion under the Hyde Amendment, though there is no specific language to that effect in the bill. There is also a statement in the bill prohibiting any benefits from going to illegal aliens, though critics feel that the proof of citizenship requirements are insufficient to enforce that statement. Amendments have been introduced that would include specific language on these two controversial topics, but they were defeated. (read the proposed amendments on abortion and proof of citizenship)

So what does HR 3400 have to say? Under this plan, no funds will go to cover abortion “except in the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is performed, including a life-endangering physical condition caused by or arising from the pregnancy itself, or unless the pregnancy is the result of an act of forcible rape or incest.” Though there will be mixed feelings about this bill’s approach to the issue, the stance is laid out in clear, debatable language.

Like 3200, 3400 states, “no credit will go to individuals who are not citizens or lawful permanent residents of the United States.” Unlike 3200, as a tax credit 3400 could only go to people who file taxes – which actually keeps illegal aliens from getting it.

From the perspective of American middle-income families, the difference between these two proposed plans is stark. Under 3400, there is no danger of penalty or fine for not buying a health insurance plan. Small business owners are not proportionately punished for growth. Patients have a clear and compensatory course for seeking redress against abuse from the health care industry, and particularly health insurance companies. Most importantly in this time of economic hardship, middle-income families would have more money to help cover the expense of health care coverage, rather than being forced to stretch already thin budgets to cover an expense they can’t afford.

It is important to remember that in a democracy where all points of view are represented no one gets everything they want. Neither of these bills is one-hundred-percent good nor bad and we may disagree as to which of them is the better solution for our health care problem. The important thing when making a decision is having all the facts. We encourage you to read the full text of both HR 3200 and 3400 and make a decision for yourself.

Whatever your decision may be, the issue of health care impacts all of us in a very personal way. Make sure your voice is heard and contact your Representative and/or Senator. If you find you’re more inclined toward HR 3400, you may also want to contact Speaker of the House Nancy Pelosi and have her bring the bill to the floor.

If you know of another health care reform alternative that you would like the US Freedom Foundation to cover, or you have questions or comments about this article, please email us at xd09@freedomfoundation.us.

If a Patriot Calls in the Capitol and No One is Around to Hear...?

(September 15, 2009)

Washington, D.C. - September 12^th was an amazing day in Washington, DC: it was America in action. The March on Washington showed a cross section of the nation: people from Texas, New Jersey, Georgia and all the great states of our great country who turned out in force to stand up for their beliefs before a government they feel defies them.

Sadly, the response to the rally had nothing to do with the cause the crowd represented. Before the event even concluded, a controversy emerged over estimated attendance with numbers ranging wildly from 60,000 – 2 million. Next, the assault on the characters of those peaceably assembled dismissed their arguments as the ravings of a politically extreme minority. In total, opposed parties robbed the event of its legitimacy without ever addressing the real concerns that were represented.

USFF Photo of March on Washington Crowd by Erik Oasen

How could attendance estimates vary so broadly? Most events have some sort of number controversy. Those supporting an event want the number to be high, while those opposed are inclined to believe it was low. Thankfully, mass communication has limited such controversies by providing physical evidence such as video and photographs. So where are these crucial substantiators for the 9-12 March on Washington? Since the media declined to cover it, there are none.

“This was an exercise in free speech, and an accurate crowd count is an important part of letting elected officials get a sense of public sentiment,” said USFF executive director Deborah Stone. “The fact that there is currently no accurate crowd estimate of an event of this magnitude in our nation’s Capitol is very disturbing. We need a real figure for this event, and we don’t have one yet.”

If there really were only 60,000 rightwing extremists in attendance, perhaps it was not technically a major news event. However, the March was not just D.C. based, but also held in major cities throughout the U.S. Moreover, there is some limited physical evidence, much to the chagrin of the mainstream media. Explain this:

September 12 March from The Strata-Sphere

Presidential Inauguration from CNN.com (1.8 million est.)

Sept 12 March: Moderate in the Middle Word Press Photos

Million-Man March (400,000 est.)

The US Freedom Foundation is a non-partisan organization interested in middle-income issues. We cannot comment on this controversy without acknowledging our own bias. We both attended and supported this event. We believe that the true attendance number lies between the two extremes. We also believe that the continued numbers discussion deflects focus from the real event and the reasons for it and so will not dwell on it further here. Suffice to say that the numbers game serves as an attack on the cause of those Americans who came out to exercise their free speech.

USFF photo of 9-12 protestor by Erik Oasen

Americans are used to being disagreed with; in fact our nation is founded on disagreement. The U.S. Freedom Foundation and the marchers harbor no hostility to those who disagree with our point of view. Yet in many acidic blogs and articles addressing the march comments were not directed toward our cause, but rather our personal quality. “Right wing nuts”, McCarthyism, and other terms were used to generalize the assembly into a category easily dismissed: crazies. This article from Politico illustrates:

“The protestors, whose numbers were in the tens of thousands, though no definitive estimate was available Saturday evening, aired grievances on issues ranging from the bank and auto bailouts to Obama’s push to overhaul the nation's health system to concerns about perceived erosion of First and Second Amendment rights.

Still, most of their fire was aimed at Democrats, and some of their sentiments bordered on extremist rhetoric that could do the GOP more harm than good. As the march, which began at Freedom Plaza, a park close to the White House, neared the U.S. Capitol, it was difficult to miss the signs protesting Obama’s health plan, declaring “Bury Obamacare with Kennedy” or featuring grisly images of aborted fetuses.” (read full article from Politico)

While any kind of rally will attract some extreme points of view, this kind of terminology was hardly representative of the whole. The signs we saw while attending the event (which no major media bothered to do) quoted Jefferson, bible verses, and offered creatively comic quips, including one which read “I made this sign all by myself without the government’s help.” Though the rally did support some traditionally conservative values, a great deal of disapproval was aimed towards both parties as evidenced by the very first card received by a USFF volunteer: GOOOH, and organization that advocates a clean sweep of all 435 members of the House of Representatives. Unfortunately, name-calling and personal affronts prevent reasonable debate. They also serve as another tactic to undermine the purpose of the 9-12 March on Washington without ever really addressing the issues.

USFF photo of 9-12 protester by Erik Oasen

The issue at hand was not left nor the right, top or bottom. The issue was middle income America wanting to be heard when they said:

No bail outs
No more taxes
No government run health plan
No czars
No votes on unread legislation
No more government spending
No special treatment for those in office
No more corruption
Return to the Constitution

The overwhelming theme of the event was repeated over and over in the combined voices of the hundreds of thousands there assembled, “Can you hear us now?”

Shouldn’t our government be addressing the people it serves, rather than assessing them?

Photo of USFF volunteers by Erik Oasen

All the “numbers” discussion and all the name-calling do not illegitimize the voice of free, tax-paying American citizens. Our nation thrives by the blood, sweat, and tears of the great body of such courageous people: Americans that love this country and the principals that it was founded upon.

Indeed, Saturday, September 12th, was a great day in America. Those that participated in the March on Washington were reassured; not by their government or the media, but by their own massive presence that they are not alone in their convictions. They stood shoulder to shoulder with like-minded individuals from across the nation, and reminded their government of the weight of accountability. USFF was proud to be among them meeting so many motivated, patriotic Americans. We look forward to joining them again and again for as long as it takes for our voice to be heard, for as long as our fight – our revolution – continues.

###

September 11, 2009

Healthcare Reform and the Liberty Summit

The health care system in the United States needs vast improvement – that is unquestionable. However, the latest proposal before us is an inconceivably poor alternative.

The latest proposal, HR 3200, is the one Americans are considering this week, though it is unclear if this is the proposal that President Obama was espousing in his speech on Wednesday. The power structure of HR 3200 alone sends up a stadium-sized red flag. When combined with the President’s own words and the amendments rejected by the House Committees, the alarm becomes deafening. Finally, with the aversion of our elected officials to participating in the proposed government run insurance plan, the implications become chilling.

According to HR 3200 (read the full text at Open Congress), the new Health Care machine is to be driven by the Health Care Commissioner, a single individual. The designated powers of this person include, but are not limited to:

- defining the term “dependent”

- defining the age groups for which insurance companies can vary premiums

- defining the areas for which insurance companies can vary premiums

- determining adequacy of provider networks

- identifying appropriate levels of profit for insurance companies and requiring them to return all excess profits as rebates (there are no stated limitations for this number)

- establish uniform marketing standards for the industry

- establish grievance and appeals mechanisms (for the industry he/she personally regulates)

- establishing an external review process

- most comically, develop best practices for “plain language” in documentation

And this is just the beginning of the legislation. Sounds like the referee is scheduled to play in the game he’s calling...certainly no room for a conflict of interest.

Equally disconcerting is the way the Health Care Commissioner’s activities are monitored. Apparently, there will be 26 people in three groups each presidentially appointed to the task. (Note, – “appointed” – this does not require the confirmation of any other group or persons). The President of the United States will appoint the first group of nine. The second group of nine is to be appointed by the US Comptroller (who is himself appointed by the President of the United States), and the President will again appoint the third group of up to eight. Summarizing - the 26 people that monitor this powerful Commissioner are appointed by the President, the President (once removed), and the President.

Which leads back to the President. Though Wednesday night’s address made no mention of the power structure proposed in HR 3200, two things were made stingingly clear: no funds will be spent on abortion, and no funds will cover illegal aliens.

Unfortunately the bill sends mixed messages on the abortion issue. When amendments were proposed in both the House and Senate which would have added specific language prohibiting any coverage of abortions, both were defeated . Meanwhile, the bill language allows participants to choose abortion coverage as an elective, while leaving open the door for the new health care panel to require this “elective” coverage in all future health plans.

HR 3200 does state that no illegal aliens will be covered under government insurance, but does not require any proof of citizenship in order to enroll. Again, an amendment was submitted to make this proof a requirement; and again, the amendment was defeated. Just say you are a US citizen, and Uncle Sam will believe you. The honor system is working well so far, as evidenced by the 20 million illegal immigrants living and working in our country today.

Finally, if government sponsored health insurance will be so wonderful, what has the House of Representatives so repulsed by the idea of enrolling themselves? When an amendment was presented mandating that all federal employees would have to participate in this health plan, it was quickly defeated. (read the full text at Open Congress) You can be sure if the rats are running off the ship, the vessel is taking on water.

So there you have it: an omnipotent Health Commissioner, appointed by the President. The President assuring the public that his plan is watertight, when in fact the key issues are either unaddressed or unenforced by this proposal. And most ominously, the House of Representatives is jumping the ship before the engines are cranked.

The picture is bleak, and we’re not blind.

This Saturday, September 12, 2009, Americans from across the nation are descending on Washington D.C. in opposition to the proposed health care reform. U.S. Freedom Foundation will be joining them.

We look forward to seeing you there.

The 2003 USFF Fair Health Care Pricing Initiative

The U.S. Health Care Services Retail Price Guide Project
July 31, 2003
Retail Price Guide News Conference
Remarks by USFF President John Stone
The Uninsured, Self-pay patients and Health Care Pricing

In December, at the U.S. News and World Report Health Care Issues Briefing at the National Press Club, CMS Director Tom Scully said three competing forces create our health care market – hospitals, insurers, caregivers.

What happened to the patient?

As long as the final end-user of any product or service has no control over what they buy and how much they pay, there is no free market.

Nowhere is that more evident than with the estimated 85+ million Americans today who try to access health care without an insurance umbrella. They are the 75 million Americans who go uninsured at some point during a calendar year, and the 10 million and growing number of patients who participate in consumer-driven health care through flexible spending accounts, medical savings accounts, and health reimbursement arrangements.

When these families try to pay cash for their health care services, they are being charged between three-and seven times the going rate, while the largest managed care companies pay for the same service frequently at below cost. Those who can least afford to pay are being gouged, primarily on hospital and pharmaceutical prices, but also in a small but growing number of caregiver offices. And they’re being gouged to pay for the discounts for the largest corporations in America.

The American media is only beginning to grasp the magnitude of this problem. A Wall Street Journal article by Lucette Lagnado graphically demonstrates the devastating effect on these type prices on uninsured Americans. Similar articles in the Christian Science Monitor and other publications reveal the same across the country.

Consumer-driven health care is America’s best and brightest hope for restoring a free health care market. But we have a message today for Chairmen Thomas and Tauzin, Senators Frist and Grassley, and the President.

Unless this problem of pricing is corrected, consumer-driven health care will fail. We already have insurers telling physicians to charge MSA patients the full inflated retail price until the patient’s savings are exhausted, and only then revert to the standard rate, when the insurer starts paying the bill.

There is no free market in America today. Consumers have no idea of health care costs, and are prevented from learning by our corporate system. They know a reasonable price for nearly every other product or service in our economy, from oil changes to television sets, but on health care they face a mammoth information blackout.

Employer sponsored health care advocates constantly bash “irresponsible” consumers who unnecessarily access expensive health care procedures, while creating a system that bars all choices and information for consumers.

Amazing – a retail industry consuming 17% of our gross domestic product, and consumers have no idea of prices.

What is a fair price? The “usual and customary” amount received for the service. That’s what the majority of patients agree to pay when being admitted to the hospital, and that’s all they should pay.

So what is the “usual and customary” amount?

We’ve spent six months investigating the answer, to produce today’s price guide.
The figures contained in the Guide were obtained from:
1. Patient receipts for both cash and insurance-reimbursed purchases
2. Phone surveys of Washington-Baltimore area providers and pharmacies
3. Online price quotes from U.S. and Canadian pharmacies
4. Physician records and interviews nationwide
5. Reimbursement information supplied by unions
6. Federal and State records on reimbursements and costs
7. Hospital input nationwide
8. Insurer records nationwide

We will protect the confidentiality of all parties who voluntarily participated in the project.

There are reasons it hasn’t been done before.

1. For low-deductible insured patients, it doesn’t matter – that’s been the bulk of the market.

2. Health care pricing is terribly complicated, each treatment situation is different, and trying to apply averages to specific treatment programs is difficult.

3. Some consumers will try to re-price their bills without full knowledge of their treatments, and wrongfully accuse honest providers of overcharging.

4. Most consumers won’t understand the terminology.

5. Publication of health care prices will undermine quality.

These were all good reasons in the past – but times have changed.

100 Million Americans currently pay all or part of their own health costs.
75 million uninsured per year
10 million consumer-driven health plans
15 million hi-deductible policy holders

These Americans are being gouged on a regular basis, and they don’t have to take it as long as they have the knowledge to fight back. They currently have no access to even the most basic, broad information on pricing, which makes fighting back difficult if not impossible.

We offer the Guide as just that – a Guide, not to establish set prices.

What the Guide reflects is generally slightly higher than the lower managed care reimbursement averages, as insurers pay different discount rates. But they should reflect the usual overall range received for a particular service or treatment.

• Retail Price Example Sheet
• Straight Talk for Patients

If the price guide indicates your service should be $60, and it’s $85, you might not have a gripe. But if it’s $300, consumers will know to question it.

If the guide indicates a hospital bill of $3000, and you’re being asked to pay $5000, ask for an explanation, but don’t hit the ceiling. If the charge is $25,000, you know you have a problem.

Thank you, and now to the guide itself and your questions.

###

Straight Talk for Patients on Health Care Pricing:

Using the U.S. Health Care Services Retail Price Guide

Health care pricing determination is the most convoluted, bureaucratic process in our national economy. For this reason, other organizations and government agencies have avoided any attempt to produce a basic retail health care price guide. The fear that consumers will look up one particular fee, discover their charge to be higher, and unjustifiably complain without understanding the entire bill, has resulted in consumers being left in the dark for decades.

In the past, this situation didn’t affect many people. Most Americans receive health care benefits through insurers, and only have to pay the co-insurance as their part of the bill, which in most cases was the same low set fee regardless of the cost of a procedure or service.

But this neglect of consumer access to pricing information has now created a health care market situation that demands access to at least broad, general rate information, and U.S. Freedom Foundation committed to producing this guide for public access. Up to 75 million Americans are uninsured at some point during a given calendar year. An additional 10 million Americans are now paying cash for most everyday health services due to higher deductible insurance policies – and this group is growing rapidly as more families choose consumer-driven health insurance plans to escape shoddy HMO’s.

Both groups lack access to a negotiated rate from an insurer, and are frequently charged three-to-seven times the rates paid by insurers. Those who must pay these bills are losing homes to foreclosure, having their wages garnished, and are forced into bankruptcy through this price-gouging scheme.

If they are charged $14,000 for an appendectomy, how do they know if that’s a fair price?

When they were admitted to the hospital, they agreed to pay the “reasonable and customary” charges, with no idea of what their final bill would be. If a major car repair was performed under these rules, every consumer activist in the country would be screaming, and trial attorneys would be falling over each to take the case to court. Yet this is precisely what is happening in American health care today, and the injured consumer has had no place to turn for basic pricing information to determine whether their bill is out-of-line.

According to the Wall Street Journal, a major managed care insurer would only pay about $2500 for that appendectomy in New York City. Medicaid would pay around $5000. So what is the “usual and customary” charge?

According to the U.S. Health Care Services Retail Price Guide, the national average price received for an appendectomy is around $772 a day. The average patient stays in the hospital 3.3 days. So a total average bill – at the “usual and customary” charge – comes to $2550.

Now here’s where caution is advised before calling for an attorney. Fair prices are higher in New York City and other major metropolitan areas than in rural and suburban markets. Prices are generally higher in the Northeast than the South or Midwest. The initial listings in the Price Guide are for NATIONAL AVERAGE prices only. If you have an appendectomy in Manhattan, expect to pay more. If you have an appendectomy in Tupelo, Mississippi, expect to pay less. If your bill comes to $2500 anywhere, you’re likely being treated fairly. If it’s $4,000, ask for an explanation of charges before hitting the roof.

But if the bill is $14,000, and you had no medical problems other than the appendectomy, demand a massive reduction. If you don’t receive one, seek arbitration or an attorney.

All hospitalization charges in the Price Guide are listed as per-day charges, to make it easier to determine the “usual and customary” fee regardless of the length of your stay. However, be aware that while your total bill will be less if your time in the hospital is shorter than normal for your procedure, the per day charges will likely be higher, as the most expensive portion of treatment is usually undertaken up front, such as emergency room admittance, operating room fees, and intensive care following surgery.

Another major caution – there are a small number of caregivers and hospitals who accept nothing other than cash payments. They do not participate in insurance plans, Medicare, or Medicaid. Their prices are the same for everyone, so whatever they charge IS their usual and customary fee. It may be more or less than the Price Guide – they can charge whatever they like and it is still fair pricing, as all of their patients are billed the same. It is therefore imperative that you, the consumer, ask about their rates before seeking treatment. The caregiver or hospital may be worth every penny of their charges – but you need to know what those charges are before you’re in front of the cash register after receiving treatment.

We hope this Price Guide will be useful to patients, caregivers, researchers, government entities, consumer activists, and legal counsels.

###

U.S. Health Care Services Retail Price Guide

July 31, 2003

U.S. Health Care Services Retail Price Guide

U. S. Freedom Foundation Health Care Pricing Research Project, January – July, 2003: Prices reported by caregivers, institutions, patients; major managed care reimbursement rates; federal and state public access health care statistics and records; retail rate quotes by all providers.

National Average Prices*

*Pricing varies significantly by region and city

Hospital Service Usual and Customary Daily Charge

HEART FAILURE & SHOCK

$1,029

APPENDECTOMY W COMPLICATED PRINCIPAL DIAGNOSIS

$772

VAGINAL DELIVERY OF INFANT W COMPLICATED DIAGNOSIS

$942

SIMPLE PNEUMONIA & PLEURISY AGE >17 W CC

$925

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

$905

MAJOR JOINT & LIMB REATTACHMENT PROCEDURES OF LOWER EXTREMITY

$2,177

OTHER PERMANENT CARDIAC PACEMAKER IMPLANT

$3,739

SPECIFIC CEREBROVASCULAR DISORDERS EXCEPT TIA

$1,073

PSYCHOSES

$601

REHABILITATION

$691

ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17 W CC

$902

NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 W CC

$905

CHEST PAIN

$1,157

G.I. HEMORRHAGE W CC

$152

CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC

$1,057

KIDNEY & URINARY TRACT INFECTIONS AGE >17 W CC

$853

SEPTICEMIA AGE >17

$1,193

CIRCULATORY DISORDERS W AMI & MAJOR COMP, DISCHARGED ALIVE

$1,343

RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W CC

$1,090

ATHEROSCLEROSIS W CC

$1,096

TRANSIENT ISCHEMIC ATTACK & PRECEREBRAL OCCLUSIONS

$1,019

CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH & COMPLEX DIAG

$1,734

MAJOR SMALL & LARGE BOWEL PROCEDURES W CC

$1,737

HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W CC

$1,405

RENAL FAILURE

$1,210

OTHER VASCULAR PROCEDURES W CC

$1,956

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT

$2,079

SYNCOPE & COLLAPSE W CC

$1,014

RED BLOOD CELL DISORDERS AGE >17

$990

DIABETES AGE >35

$886

MEDICAL BACK PROBLEMS

$757

CELLULITIS AGE >17 W CC

$764

EXTRACRANIAL VASCULAR PROCEDURES

$2,456

ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17 W/O CC

$859

CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O COMPLEX DIAG

$1,911

CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC

$899

OTHER CIRCULATORY SYSTEM DIAGNOSES W CC

$1,251

PERIPHERAL VASCULAR DISORDERS W CC

$910

G.I. OBSTRUCTION W CC

$917

CORONARY BYPASS W CARDIAC CATH

$3,038

CIRCULATORY DISORDERS W AMI W/O MAJOR COMP, DISCHARGED ALIVE

$1,400

OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W CC

$1,128

DEGENERATIVE NERVOUS SYSTEM DISORDERS

$768

ANGINA PECTORIS

$936

RESPIRATORY NEOPLASMS

$1,113

ORGANIC DISTURBANCES & MENTAL RETARDATION

$682

EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

$1,816

DISORDERS OF PANCREAS EXCEPT MALIGNANCY

$1,159

CORONARY BYPASS W/O CARDIAC CATH

$3,128

PULMONARY EDEMA & RESPIRATORY FAILURE

$1,155

LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC

$1,636

SEIZURE & HEADACHE AGE >17 W CC

$1,147

BRONCHITIS & ASTHMA AGE >17 W CC

$808

MAJOR CARDIOVASCULAR PROCEDURES W CC

$2,907

SYNCOPE & COLLAPSE W/O CC

$997

BACK & NECK PROCEDURES EXCEPT SPINAL FUSION W/O CC

$1,893

OTHER KIDNEY & URINARY TRACT DIAGNOSES AGE >17 W CC

$1,068

PATHOLOGICAL FRACTURES & MUSCULOSKELETAL & CONN TISS MALIGNANCY

$851

NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 W/O CC

$699

SIMPLE PNEUMONIA & PLEURISY AGE >17 W/O CC

$733

TRACHEOSTOMY EXCEPT FOR FACE,MOUTH & NECK DIAGNOSES

$2,715

FRACTURES OF HIP & PELVIS

$719

AMPUTATION FOR CIRC SYSTEM DISORDERS EXCEPT UPPER LIMB & TOE

$1,285

CIRCULATORY DISORDERS W AMI, EXPIRED

$1,926

OTHER RESP SYSTEM O.R. PROCEDURES W CC

$1,564

MAJOR CHEST PROCEDURES

$1,953

O.R. PROCEDURE FOR INFECTIOUS & PARASITIC DISEASES

$1,668

HYPERTENSION

$850

CARDIAC VALVE & OTHER MAJOR CARDIOTHORACIC PROC W CARDIAC CATH

$4,326

DYSEQUILIBRIUM

$853

TRANSURETHRAL PROSTATECTOMY W CC

$1,309

OTHER CIRCULATORY SYSTEM O.R. PROCEDURES

$1,569

CRANIOTOMY AGE >17 EXCEPT FOR TRAUMA

$2,351

PULMONARY EMBOLISM

$1,089

G.I. HEMORRHAGE W/O CC

$843

BACK & NECK PROCEDURES EXCEPT SPINAL FUSION W CC

$1,734

HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W/O CC

$1,300

LYMPHOMA & NON-ACUTE LEUKEMIA W CC

$1,401

CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS

$1,561

DISORDERS OF THE BILIARY TRACT W CC

$1,150

CARDIAC VALVE & OTHER MAJOR CARDIOTHORACIC PROC W/O CARDIAC CATH

$3,999

CELLULITIS AGE >17 W/O CC

$583

UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC

$1,484

POISONING & TOXIC EFFECTS OF DRUGS AGE >17 W CC

$1,207

DIGESTIVE MALIGNANCY W CC

$1,153

LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC

$1,953

OTHER KIDNEY & URINARY TRACT O.R. PROCEDURES

$1,889

KIDNEY & URINARY TRACT INFECTIONS AGE >17 W/O CC

$688

MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS

$1,167

TRANSURETHRAL PROSTATECTOMY W/O CC

$1,286

STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE >17 W CC

$2,059

BRONCHITIS & ASTHMA AGE >17 W/O CC

$733

CRANIAL & PERIPHERAL NERVE DISORDERS W CC

$953

PERIPHERAL VASCULAR DISORDERS W/O CC

$884

SEIZURE & HEADACHE AGE >17 W/O CC

$951

SPINAL FUSION EXCEPT CERVICAL W CC

$2,818

G.I. OBSTRUCTION W/O CC

$689

SIGNS & SYMPTOMS W CC

$837

CIRRHOSIS & ALCOHOLIC HEPATITIS

$1,232

FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

$1,587

SPINAL FUSION EXCEPT CERVICAL W/O CC

$3,039

NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

$1,331

COMPLICATIONS OF TREATMENT W CC

$1,231

TRANSURETHRAL PROCEDURES W CC

$1,393

SKIN GRAFT &/OR DEBRID FOR SKN ULCER OR CELLULITIS W CC

$1,026

DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC

$1,167

OTHER VASCULAR PROCEDURES W/O CC

$2,308

POSTOPERATIVE & POST-TRAUMATIC INFECTIONS

$992

LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR AGE >17 W CC

$1,507

OTHER DISORDERS OF NERVOUS SYSTEM W CC

$1,127

RESPIRATORY SIGNS & SYMPTOMS W CC

$1,098

PLEURAL EFFUSION W CC

$1,076

OTHER RESPIRATORY SYSTEM DIAGNOSES W CC

$1,014

KIDNEY,URETER & MAJOR BLADDER PROCEDURES FOR NEOPLASM

$1,865

FX, SPRN, STRN & DISL OF FOREARM, HAND, FOOT AGE 0-17

$782

LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR AGE >17 W/O CC

$1,551

ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION

$821

UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC

$1,498

SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE

$810

PERITONEAL ADHESIOLYSIS W CC

$1,516

SKIN ULCERS

$764

MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC

$1,267

URINARY STONES W CC, &/OR ESW LITHOTRIPSY

$1,204

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W CC

$1,584

NERVOUS SYSTEM NEOPLASMS W CC

$1,086

COAGULATION DISORDERS

$1,610

DEPRESSIVE NEUROSES

$613

ENDOCRINE DISORDERS W CC

$994

RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC

$1,290

TRAUMA TO THE SKIN, SUBCUT TISS & BREAST AGE >17 W CC

$789

WND DEBRID & SKN GRFT EXCEPT HAND,FOR MUSCSKELET & CONN TISS DIS

$194

HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL AGE >17 W CC

$1,420

TOTAL MASTECTOMY FOR MALIGNANCY W/O CC

$1,791

TOTAL MASTECTOMY FOR MALIGNANCY W CC

$1,630

OTHER O.R. PROCEDURES FOR INJURIES W CC

$1,793

FEVER OF UNKNOWN ORIGIN AGE >17 W CC

$1,020

VAGINA, CERVIX & VULVA PROCEDURES

$1,550

PRM CARD PACEM IMPL W AMI,HRT FAIL OR SHK,OR AICD LEAD OR GNRTR PROC

$2,531

COMPLICATED PEPTIC ULCER

$1,129

BONE DISEASES & SPECIFIC ARTHROPATHIES W CC

$802

INTERSTITIAL LUNG DISEASE W CC

$1,021

PERIPH & CRANIAL NERVE & OTHER NERV SYST PROC W CC

$1,639

HIV W MAJOR RELATED CONDITION

$1,630

MAJOR SHOULDER/ELBOW PROC, OR OTHER UPPER EXTREMITY PROC W CC

$1,603

MAJOR JOINT & LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITY

$2,512

OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W/O CC

$911

AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE

$1,021

TENDONITIS, MYOSITIS & BURSITIS

$834

PNEUMOTHORAX W CC

$964

MAJOR MALE PELVIC PROCEDURES W/O CC

$1,788

INFLAMMATORY BOWEL DISEASE

$959

LOCAL EXCISION & REMOVAL OF INT FIX DEVICES EXCEPT HIP & FEMUR

$1,601

SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC, W/O CC

$1,852

TRAUMATIC STUPOR & COMA, COMA <1 HR AGE >17 W CC

$1,247

BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY

$3,192

HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL AGE >17 W/O CC

$1,349

KIDNEY,URETER & MAJOR BLADDER PROC FOR NON-NEOPL W CC

$1,791

CONNECTIVE TISSUE DISORDERS W CC

$1,163

NONTRAUMATIC STUPOR & COMA

$997

NONSPECIFIC CEREBROVASCULAR DISORDERS W CC

$1,052

INGUINAL & FEMORAL HERNIA PROCEDURES AGE >17 W CC

$1,390

FX, SPRN, STRN & DISL OF UPARM,LOWLEG EX FOOT AGE >17 W/O CC

$584

OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC

$1,638

RECTAL RESECTION W CC

$1,584

DISORDERS OF THE BILIARY TRACT W/O CC

$1,072

MAJOR MALE PELVIC PROCEDURES W CC

$1,711

AMPUTATION FOR MUSCULOSKELETAL SYSTEM & CONN TISSUE DISORDERS

$1,216

THYROID PROCEDURES

$2,160

PANCREAS, LIVER & SHUNT PROCEDURES W CC

$2,329

UNCOMPLICATED PEPTIC ULCER W CC

$1,005

MAJOR CARDIOVASCULAR PROCEDURES W/O CC

$2,904

VIRAL ILLNESS AGE >17

$888

OTHER SKIN, SUBCUT TISS & BREAST PROC W CC

$1,235

ATHEROSCLEROSIS W/O CC

$1,125

O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES

$1,028

KIDNEY & URINARY TRACT SIGNS & SYMPTOMS AGE >17 W CC

$884

RESPIRATORY SIGNS & SYMPTOMS W/O CC

$1,130

UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS

$1,117

OTITIS MEDIA & URI AGE >17 W CC

$859

CRANIAL & PERIPHERAL NERVE DISORDERS W/O CC

$992

OSTEOMYELITIS

$897

KIDNEY TRANSPLANT

$2,923

ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE AGE >17

$2,086

TRANSURETHRAL PROCEDURES W/O CC

$1,546

RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W/O CC

$859

DEEP VEIN THROMBOPHLEBITIS

$667

ANAL & STOMAL PROCEDURES W CC

$1,237

CARDIAC PACEMAKER DEVICE REPLACEMENT

$2,851

TRAUMA TO THE SKIN, SUBCUT TISS & BREAST AGE >17 W/O CC

$693

EPISTAXIS

$868

OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC

$1,157

POISONING & TOXIC EFFECTS OF DRUGS AGE >17 W/O CC

$930

UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W CC

$1,624

CARDIAC CONGENITAL & VALVULAR DISORDERS AGE >17 W CC

$1,141

URINARY STONES W/O CC

$944

MINOR BLADDER PROCEDURES W CC

$1,567

SIGNS & SYMPTOMS W/O CC

$703

OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES

$1,314

STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE >17 W/O CC

$1,802

INGUINAL & FEMORAL HERNIA PROCEDURES AGE >17 W/O CC

$1,385

Caregiver Services Usual and Customary Charge

Family/General practice office visit, new patient $87

Family/General practice office visit, established patient 50

Longer physician office visit, established patient 56

Flu shot 8

Remove impacted ear wax 65

Wart, mole, skin lesion removal 16

Biopsy of skin lesion 87

Chest X-ray 12

Foot X-ray 25

Hip X-ray 25

3D Heart Image 342

Mammogram 44

Mammogram, both breasts 66

PSA Assay 29

Urinalysis 5

Potassium Assay 4

Iron Assay 10

Allergy Skin test 5

Upper GI endoscopy, biopsy 213

Diagnostic colonoscopy 308

Cardiovascular stress test 130

IV infusion, 1 hour 50

Chemotherapy infusion 70

Initial Hospital Exam 131

Emergency room exam 72

Critical Care, 1^st hour 242

Contract Surgery Fee 802

Eye exam, new patient 95

Eye exam, established patient 68

Psychological therapy, office visit, 45 min 123

Psychological therapy, hospital visit, 30 min 72

Psychological therapy, group session 35

CT Brain/Head w/o dye 62

Chiropractic manipulation 40

Prescription Drug Average Prices

Drug U.S. Retail U.S. Managed Care Rate Canadian Internet Retail

Lipitor $118.66 71.93 56.66

Celebrex 100.99 82.00 21.60

Fosamax 230.00 114.00 50.00

Prozac 124.00 28.50 43.33

Prilosec 148.91 92.04 54.00

Aciphex 131.99 72.60 75.00

Accupril 36.33 21.07 24.66

Norvasc 128.00 64.00 57.00

Pepcid 72.00 22.00 40.00

Prevacid 135.00 73.00 68.00

Pravachol 131.00 79.90 65.33

Plavix 114.00 69.50 71.07

Vioxx 95.00 51.30 37.50

Zestril 34.70 19.00 28.80

Zocor 129.70 70.00 70.00

Zoloft 83.00 44.82 48.00

-end-

Health Care Price Guide Pricing Examples

Pricing Examples

U.S. Health Care Services Retail Price Guide Examples

Appendectomy, 3 day hospital stay

Typical Hospital Charge $12,500

Usual Managed Care Payment $2500

Usual Medicare Payment $2217

Price Guide National Average Payment $2550

Heart Failure and Shock, 5 day stay

Typical Hospital Charge $24,875

Usual Medicare Payment $4475

Usual Managed Care Payment $4975

Price Guide National Average Payment $5145

Existing Patient Family Practice Visit

Typical Retail $100

Usual Medicare Payment $48

Usual Managed Care Payment $44

Price Guide National Average Payment $50

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