Opinion | High Bills for Covid Tests at a Hospital E.R.

To the Editor:

The real question raised by “At an Elite Hospital, Huge Bills to Test for Covid” (front page, March 31) is whether the medical delivery system is causing more harm than good.

The U.S. medical industry, designed to fulfill a core social need, has become an uncontrolled behemoth. Aided and abetted by a Congress in thrall to corporate interests, it commandeers enormous amounts of money — about $4 trillion a year. A high percentage of that is waste that could fund social programs that improve health. Our current system drives people to bankruptcy or avoiding health care because of the high cost. In other words, it undermines the very reason for its existence.

We know that many illnesses are a result of inequality, racism, sexism and other social determinants. We can now add to the list of liabilities the medical-industrial complex itself.

Eric Manheimer
New York
The writer is a former medical director at Bellevue Hospital and author of “Twelve Patients: Life and Death at Bellevue Hospital.”

To the Editor:

Over the past year Northwell Health expanded access to Covid-19 diagnostic testing in its emergency departments, including Lenox Health Greenwich Village (the subject of your article), while also making testing available in urgent care centers and doctor’s offices that are far less expensive to operate.

In focusing on the higher billing rates in emergency departments, The Times neglects to explain that payments we receive are based on mandated Medicare/Medicaid rates or payment rates negotiated with commercial insurers. Neither patients nor insurers pay the stated charges typically listed in “explanation of benefits” notices sent to patients by insurance companies, which have generated record profits during this public health crisis.

When patients arrive in an emergency department, federal law requires that they be evaluated and treated, regardless of their ability to pay. Patients requesting a Covid-19 test are advised when they walk in — orally, in a written consent form and with signage at the registration desk — that their test is considered an emergency visit. Regardless of where they are tested for Covid, patients incur no co-payments or out-of-pocket costs.

Fighting this pandemic has required hospitals and health systems to use every tool at their disposal, including offering testing capabilities in many different treatment settings, and setting up a vast network of vaccine distribution sites.

Operational costs incurred by health care providers in running emergency departments far outpace reimbursements they receive from insurers.

Alexander Hellinger
New York
The writer is executive director of Lenox Health Greenwich Village.

To the Editor:

Thank you for your report on the most recent (though apparently still legal) abuse by the health care sector. The fact that insurance companies are paying for these excess charges only confirms to me the symbiotic relationship the insurers have with the hospitals. This will end only with universal — Medicare-like — health care administered by the government and financed by a payroll tax.

Expanding Medicare eligibility from age 65 to 60, as proposed by Democrats, is certainly a step in the right direction to eliminate — once and for all — the shameful shenanigans that the hospitals-insurance companies-pharmaceutical companies-physicians complex has been inflicting on the public for decades.

Ira Sohn
Upper Montclair, N.J.
The writer is emeritus professor of economics and finance at Montclair State University.

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