Sullivan’s blog continues to wallow in ignorance and sob stories — which has become de rigueur for how healthcare is debated these days.

To respond:

The complicated CPT codes were created by the AMA to standardize medical billing. If we did not have them, then insurance companies (and Medicare) would not be able to create fee schedules. To complain about them is asinine. Most practices I worked in could give you an estimate of expected medical costs (at least from their end) because the computers bring up the price immediately when you punch in the code (although not necessarily your insurer’s fees).

No one in their right mind would use a prose procedural description to bill as it would result in six thousand mails between insurer and provider clarifying exactly what was done. The CPT codes allow the insurance company to know precisely what was done and to bill accordingly. It’s never as simple as “we delivered a baby” or “we took out his appendix”. Every procedure has variants that need to be clarified. CPT allows this.

Also, the point in that post — and others — that insurance companies can reduce doctor’s fees by huge fractions while the uninsured can’t? Pure unadulterated bullshit. I’ve personally written off massive amounts of healthcare bills and have negotiated — from both ends — medical prices. One of the beauties of HSA’s is that they have given patients the incentive to negotiate directly with medical providers to reduce fees. It is frequently very easy to get a provider to knock off a significant percentage of a bill if you ask before the service is done. Or even after. They’d rather get paid something than turn you over to collections. The only people I ever turned over to collection were the people who would not respond to the letter and calls asking them to set up a payment plan — any payment plan. Even then, we occasionally took a collection claim back when someone paid us.

(That last point does color my perception of this debate and the letters Sully is printing. I read them and they sound very similar to the deadbeats from whom we would not hear until they complained that we’d turned them over to a collection agency. I don’t know what it is about healthcare; but no one wants to pay for it. No one has any perspective. People who will gladly pay $400 for a Blu-Ray player think $100 is unreasonable to get a check-up. People who will pay $50,000 for a car think $10,000 is too much to save their life. Working in the profession tends to drain your sympathy. I try to guard against it but I’m not sure I’m 100% successful.)

I am also sick to death of hearing people rave about how great their “free” healthcare is. Your healthcare is being paid by other people. Now maybe that’s a swell idea — I don’t oppose helping people in need. But don’t ask me to be surprised that you love it when somebody else pays your bills. And don’t pretend that it’s a sustainable model for running the country (or perhaps you’ve missed the trillions of dollars in Medicare debt?).

There are also two letters from HIV-positive people who are chained to their employers and their insurance. I’m not sure what this has to do with anything. The only alternative is to put HIV-positive people on the public dole — or do it by proxy by forcing insurance companies to cover them and bill everyone else for it. The one thing that would help people — eliminating the employer tax deduction to make insurance more mobile — is opposed by most in Congress and most in the punditsphere.