Saturday’s Forum
Steven L. Taylor
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Saturday, August 9, 2025
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24 comments
About Steven L. Taylor
Steven L. Taylor is a Professor Emeritus of Political Science and former College of Arts and Sciences Dean. His main areas of expertise include parties, elections, and the institutional design of democracies. His most recent book is the co-authored
A Different Democracy: American Government in a 31-Country Perspective. He earned his Ph.D. from the University of Texas and his BA from the University of California, Irvine. He has been blogging since 2003 (originally at the now defunct Poliblog).
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I always marvel at the insanity of our medical billing system.
Blood work: $1206.66 charged
Medicare Paid: $124.33
10.3%
I’m not a big Medicare user yet (this is good!) so my $185/month Medicare payment more than covers what I consume in medical care but the paperwork created by our system is totally non value added.
@Scott:
Dear Wife have BCBS health insurance. We’ve been having bloodwork done by Quest Diagnostics for years.
DW went to Quest for bloodwork on Thursday. Quest has our insurance on file but still asked her for $120. She said send me the bill. After our insurance pays, I can’t remember the last time we owed Quest more than $15.
William Webster, who led at separate times, both the CIA and FBI, has passed away at age 101.
@Scott:
I liked your comment and wholly agree about the absurdity of medical billing, but I always snigger at references to our health care “system”. “System” implies some level of common purpose and coordination. We don’t have a system, we have a collection.
I recall reading years ago that, I think it was Mass General, was expanding their insurance billing department. I forget the numbers but it was something like they were expanding the department by 20%, so they were hiring 2,000 new people.
@Bill Jempty: We got our healthcare through the military for decades. No money ever changed hands. When we transitioned out of that into the world of insurance, my younger brother told me to never react to billing for about 5 months because you will be getting modified bills and it doesn’t pay to react until they get it all straight. He was right.
@Scott:
The amount submitted (charges) generally bears no relationship to what Medicare approves for payment. I’ve been told (over the years) that the original charge is significantly distorted by state and federal laws, to the effect that the “original charges” are meaningless.
What is significant is how Medicare computes the “approved charge”. The American Medical Association has a committee (AMA/Specialty Society Relative Value Scale Update Committee (RUC) that evaluates each medical procedure and assigns a point value to each procedure. CMS, historically, accepts 80-90 % of the these AMA committee recommendations. CMS then (annually) applies a conversion factor. In 2025 that conversion factor is $32.35 per point to determine what Medicare considers the “approved charge”.
You can safely ignore the original charge
However, I suggest that anyone receiving Medicare benefits enroll in MyMedicare.gov be careful to use the .gov . Here you will get a digital version of Medicare EOB, but more importantly for each claim you can select “more details” that will breakdown each component of the claim. In your case, you might be interested to discover what component of your blood test leads to a unusual charge.
BTW, the popular explanation that facility/procedure charges are so high is to influence subsequent medicare approved charges is a myth.
@Bobert:
There were 9 different procedure codes including “INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE (36415)”
None were excessively higher than the others.
This was Quest Diagnostics, BTW.
Go figure. Interestingly, the highest was a D-3 test with rack rate of $276.66. If you go to Quest website, you can get the same test private pay for $75.00. Medicare paid $29.60.
Ain’t America Great!
After due consideration, I have decided it would be a delight to be visited in rehab by OTB hosts and commenters.
My only stipulation is that you all enter my private chamber in a kickline, a la The Rockettes, whilst a recording of Ethel Merman’s “No Business Like Show Business” plays in the background.
@CSK:
So, that morphine is pretty cool, huh?
@Michael Reynolds:
No morphine (bad for the kidneys). Plenty of oxy, dilaudid, and super-Tylenol.
@Michael Reynolds:
Drugs are good.
23 years ago, I wrote a farcical story about the website my stories at. In it- Wile E Coyote and The Roadrunner, Cast members from Miss Saigon, ER, and F Troop Several superheroes and their most infamous villains, Howard Cosell, plus Swedish Chef teaching Martha Stewart how to make his favorite recipe- Chocolate Moose. Somebody asked me what drugs I was on when writing it.
@Bill Jempty:
In my case, it’s the painkiller factor of the drugs. Oxy et al. don’t do anything for me otherwise.
Irony with a heavy dose of stupidity: Owner of a Taco themed burger restaurant arrested by ICE.
TL;DR: undocumented immigrants for El Taco.
On labs and insurance:
In Mexico, pretty much you pay the lab and submit the bill to insurance for reimbursement. But it’s not that simple. Pretty much they pay for treatment per condition treated. So, for instance, I paid for a CT, a PET CT, blood tests, a COVID test, and a chest X-ray prior to the hernia surgery.
Since the PET CT, COVID test, and chest X-ray where deemed not related to or necessary for the underlying condition, insurance didn’t pay for these. I pointed out the trump virus test and imaging inside the chest were required by the hospital for admission, so they were necessary. I think the insurance’s reply was along the lines of “Yeah? What are you gonna do ’bout it?”
Another delightful quirk is you don’t leave the hospital until you pay. Now, this means the hospital draws up a bill when the doctor discharges you, then sends it to your insurance (most insurers have small offices in every private hospital). The latter decides what it will cover and informs the hospital. Only then you can go to the cashier’s office and settle the bill. I’m told you can set up a payment plan then, but I’ve never done it.
If you think this can take hours, you’re right.
Next time, I plan to leave before paying and see what happens…
Medical billing is complicated, partially because there is no consistent system so you end up with multiple payers, who all have different rules. However, the reason why the bill is so high yet the much lower amount Medicare pays is based upon a few things. First, there used to be a fair number of “commercial”insurers, ie smaller companies not large enough to dictate pay rates to providers. They generally paid “full fare” ie whatever you charged. (Medicare sort of did this also for a few years.) So providers set their full fare rates high hoping to get full fare from the commercial payers. (It’s a bit more complicated than this but it’s close enough I think.) Providers “negotiate” with BC/BS largely meaning unless they are very large or influential enough they just accept what they offer.
On the Medicare side they almost always pay less than the private insurers. Sometimes a lot and sometimes a little but on average, IIRC, about 30% less. TBH it’s not entirely clear to me why this is so but it’s probably at least partially because private insurers want to pay more so their pts get priority and they dont want their people being refused care. Pay for any particular procedure is set by an advisory committee (Of the AMA IIRC) and pay rates determined by Congress. Some of those numbers get adjusted yearly and some dont so pay for newish procedures or ones that have had recent changes can be much more or less costly than they should.
Steve
@Gregory Lawrence Brown:
There’s a new documentary, The Atomic Bowl: Football at Ground Zero — And Nuclear Peril Today, available to stream on pbs.org. It discusses the circumstances and decision-making that led to the Nagasaki bombing, but most of its 53 minutes are spent on the post-surrender occupation, including a football game played near ground zero less than 5 months after the bombing.
@Kathy:
I see a couple of possible scenarios for the trump burger restaurant owner who was arrested by ICE — preferential (good) treatment for being a loyal servant of maga, or targeted (bad) treatment for being a leach who’s cashing in on the trump name without approval and a generous cut of the profits.
@Eusebio:
Also, PBS’s American Experience , Victory In the Pacific: Okinawa provides great insights on the decision to drop the bombs.
One small island, 12,000 US dead, nearly 100,000 Japanese.
@steve222:
I’ve heard this as well, however I had an opportunity to see how this works several years ago when I transitioned between Aetna commercial coverage to Medicare. I was under going continuing monthly procedures, so for the first approx 4 months I was under Aetna, while the remaining months were covered by Medicare. For some procedures Medicare approved more than Aetna allowed, in other procedures the reverse was the fact. However, the differences was never greater than 5%.
At least that was my personal experience (and I have the receipts ).
Edit to add – the greatest difference was in anesthesia services.
In Thursday’s forum, a country lawyer pointed out the anniversary of the landings on Guadalcanal. The Marines were small in number, carrying WW I rifles, did not have air superiority, had naval inferiority resulting in marginal supplies of food, and won an epic victory. Did no one tell the Emperor that the war was lost? Dolittle raided Tokyo four months after Pearl Harbor. Did no one tell the Emperor that it would not be the last raid? Midway, the shoot down of Yamamoto, and a thousand other events showed the inevitability of an American victory, and clearly the drawing out of the war can only result in increased anger and less concern about Japanese deaths. I consider the Japanese leadership responsible for the majority of the horrors in 1945.
On the medical cost stuff, I suspect the tariffs on Canadian imported drugs will create a significant number of outraged and highly vocal critics of Trump. A lot of old folks are used to getting their pharmaceuticals much cheaper from there, and old people tend to vote. When they speak up politicians listen.
If there is to be a time when Trump’s in big trouble, it will be when people have felt him in their wallets.
@dazedandconfused:
I see that link no-worky. Here’s the PBS video it was supposed to be:
https://www.pbs.org/video/american-experience-victory-in-the-pacific/
@dazedandconfused:
@Slugger:
My father was RAF, and in a bomber squadron in India; he was badly injured in early 1945.
A crew colleague on leave came to see him in hospital, and spoke about how much he feared what the squadron being committed to an invasion of Japan would entail.
For such men, the atomic bombs seemed a gift of providence: they were going to live.