Healthcare By The Numbers

What is the American public buying when it pays for its health insurance and is it a good value? If the public knew that their insurance company kept as much as 33% of what they spent how would they react? While there is nothing wrong with making a profit, there is also no issue with insisting that money provide a good value. On his weekly podcast, Dr. Steven Goldstein describes in detail where all that money goes. The Houston Healthcare Initiative podcast can be heard on : Apple Podcasts, LibSyn, Spotify, Radio.Com, Listen Notes, iHeart Radio, Podcast Addict, Podbay, Backtracks, Player FM, Stitcher, and SoundCloud.

Where Does That Money Go?

Most people and their families who have health insurance, have it through their employer. The business pays for some if not most of the premiums and the employees pay deductible and out of pocket costs. But where does all that money really go? Does the public purchase more benefits or receive a better value as a result of what they were charged for that insurance?

Hospitalization Charges & Costs

Dr. Goldstein told his listeners, that in 2018 the average cost of hospitalization was about $10,000.00. The average charge for hospitalization with private insurance was about $20,000.00, thus the amount charged was double the cost. “Now let’s multiply that same number by a sample of the population, Dr. Goldstein proposed. “The average number of hospitalizations per year was about 9 for every 100 people. So, for those nine, the amount the insurance company collected was $180,000.00.” But there was more to healthcare payments than simple hospitalization. “People often go to the doctor and have what are classified as outpatient charges. Those are charged at about $500.00 a year, per person,” he said.

Add Drug Costs

The drug costs across the population were estimated at $1200.00 each. “We can reasonably assume that drug costs are higher for the over 65 population,” Dr. Goldstein said. “Now, for people under 65 years of age the expense estimate is less. So, the amount paid overall by the population of 100 people is about $500.00 each. The total for 100 people at $500.00 each is another $50,000.00.”

Factor Insurance Into The Equation

To get to the ultimate amount of money spent and where it all ends up, the cost of insurance factors in. “Say someone has a $50,000.00 deductible along with discounts they receive from the Preferred Provider Organization (PPO), we can figure a $20K discount for our 100 people,” He said. “Or charges to them all of $30,000.00.”

It is here the distinction between price and costs reveal an interesting outcome. Insurance will generally pay two thirds of the cost with the other, remaining third paid by the individual in the form of co-payments and applied deductions. “If we add these costs together, we find the total charges for 100 people = $300,000.00,” Dr. Goldstein declared. So where does the other one third go?  “The very cheapest Blue Cross policy for a 31-year-old male living in zip code 77096 (the Houston are) was $257/month or $3084/year, said Dr. Goldstein. “The cost for 100 people would be $308,000.00 annually but would have a $7400.00 deductible.”

For someone age 50, the cost was $4000.00 annually. The high deductible means that outpatient care is not paid for and that the insurance only pays for the reinsurance and hospitalization costs of $200K. So, who benefits the most from these expenditures?

No surprise, it’s the insurance company. “The gross profit for them is at least $100K. That is income per 100 patients of at least $300K less claims of $200K.” Is this a good value for the public? It’s a fair question and good way to think about healthcare costs.

A study in ‘Health Affairs’ co-authored by a Princeton University health economist, found that Americans use the same amount of health care as residents of other nations. They just pay more for them. U.S. hospital prices are 60% higher than those in Europe. Government efforts to reform health care and cut costs raised them instead. “Our system is broken and needs to be overhauled,” Dr. Goldstein said. “Efforts at reform, that we have talked about before on the podcast, are a waste of time and effort when the overall system for providing and charging for healthcare is so fundamentally broken.”

About Dr. Steven Goldstein and the Houston Healthcare Initiative

The Houston Healthcare Initiative (HHI) was founded by respected, Houston neurologist Dr. Steven Goldstein. Like many Americans, Dr. Goldstein is concerned about the state of the U.S healthcare system and the sorry state of the public’s health. The Houston Healthcare Initiative web site is an aggregator of news, healthcare pricing information, and resources for those who want to help drive reform for the healthcare industry. HHI’s emphasis for reform is on free market innovation and personal responsibility.  

The goal of the Houston Healthcare Initiative is to be a catalyst for change in the way Americans receive and pay for medical treatment. To cause change the site aggregates information, tools, and targets for the reform of the healthcare industry with an emphasis on free market innovation and personal responsibility. Visit online at www.houstonhealthcareinitiative.org.