An American Sickness: How Healthcare Became Big Business and How You Can Take It Back

by Elisabeth Rosenthal

Business consultants offered advice about “Seizing Opportunities Provided by the ACA,” as one article in Physician’s Weekly indelicately put it. “As health insurance exchanges go live, hospitals and emergency providers should take advantage of the protections provided by the ACA,” the article maintained, finishing with a phrase that has seemingly displaced “First do no harm” as medicine’s mantra: “Providers should not leave money on the table.” But the small financial incentives to encourage good behavior and coordinated medical care often paled compared to the profit that could be garnered by creative or aggressive billing that tested the boundaries of the law. Physical exams had to be free, for example, but not all the attendant blood tests a doctor might order. As Ms. Ciszewski discovered, the ACA benefit that required no-cost preventive screenings was distorted as doctors perverted the meaning of “preventive” and “covered” and “no cost” to no end. There is no Supreme Court of the ACA to parse its original intent. The doctor’s fee was covered, but the room rental or the anesthesiologist’s charges were not. Fifty percent of colonoscopies involve removing a polyp, but if one was removed many doctors said it was no longer a free screening procedure. Logically, of course, the Affordable Care Act didn’t mean that tests were no longer free if something was found and removed for scrutiny. That’s the whole point. Connecticut’s Office of the Healthcare Advocate said that getting...