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This toothache felt in wallet

By Jay MacDonald · Bankrate.com
Friday, November 25, 2011
Posted: 10 am ET

After a 10-minute visit to an emergency room to treat his toothache, Kalyan Sircar hit the street with two prescriptions, a bill for $1,367.30 and a new outlook on health care.

"I learned my lesson – never enter the emergency room alive," he told the St. Petersburg Times.

Sircar's ER shocker should serve as a cautionary tale to those who rant and rave, sometimes in my direction, about the embedded evil lurking within health care reform. They're particularly outraged that Congress would require everyone to purchase health insurance. Imagine the audacity!

My reply is always the same: The Affordable Care Act, while far from perfect, has already significantly improved America's broken health care system, and it's just getting started. With any luck, by this time next year the Supreme Court will have sent the naysayers packing and we can all get on with fixing our health care system.  

Let's see how the current system worked out for Mr. Sircar.

The 54-year-old St. Pete software developer developed a severe toothache last July from an infected cavity. Since his dentist was off, the dentist's assistant referred him to an ER because extreme dental infections can be life-threatening if they close the windpipe.

So off he went to the Bayfront Medical Center ER. The receiving physician checked out his symptoms, wrote him scripts for a painkiller and an antibiotic and sent him on his way.

Like many Americans, Sircar's health insurance ain't great, but at least he had coverage. His policy pays $250 toward ER charges, which didn't even cover the doctor's 10-minute bill for $298, much less the hospital's $1,069.30 whopper.

Why the outrageous bill? By law, every ER must treat anybody who asks for care. Since there are at least 30 million Americans who have no health insurance whatsoever, ERs often treat patients who have few or no resources to pay for their care. ERs might break even on Medicare patients if the insured make their copayments, but they usually lose money on Medicaid cases.

Private insurance companies negotiate rates in advance. This means that, regardless of what the ER might bill, the hospital will only receive the negotiated amount. But other insurers don't negotiate; instead, they pay a percentage of the bill. As the hospitals charge more, these insurance companies lower their percentage.

The result: outrageously inflated charges that occasionally land in the hands of underinsured guys like Sircar whose insurance company did not negotiate on his behalf.

Sircar plans to make payments to avoid harm to his credit rating, but admits he feels taken. "I'm willing to pay $300, but $1,400 is too much," he says.

Opponents to health care reform maintain that it will be prohibitively expensive to insure all Americans.

Guess what: we already are.

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