I have a question, and I’m looking to you for the answer.

In talking to emergency room physician Les Burson last week, we got to talking about who pays what. Medi-Cal, the California version of Medicaid, pays 10 to 15 percent of the actual cost, he said. Medicare pays about 30 percent. Private insurance typically pays up to 110 percent of what Medicare pays, he said; that means 33 percent of costs.

And this jibes with my experience. When I broke my wrist a few years back, I got bills that included an itemization of charges, and a whole bunch of credits for insurance discounts.

“In the health care industry, all costs are discounted,” Burson said.

Wait a minute. If neither government nor private insurance pay full price, who does? Is the “full price” even meaningful? If these discounts result in cost-shifting, who are the costs being shifted to?

Burson didn’t have a good answer.

So here’s my question, and maybe you know the answer. If someone goes to the doctor or the emergency room and has no insurance, do they get billed for the full price? Are they the ones paying full price? Does that mean the uninsured are subsidizing the insured? And if the uninsured are being billed “full price,” is that contributing to the number of medical bankruptcies? If one patient can’t pay the bill and it gets written off, does that drive up the cost again for the rest of the uninsured, until finally someone pays?

In short, is the “full price” of health care a fake?

If you know, please comment. If you know someone who might know, please direct them here.

UPDATE:

I just talked to Kern County Supervisor (and likely future California state senator) Michael Rubio. “The cost of health care is inflated,” he said. “And it’s inflated to compensate for the cost of people who do not pay.”

The full price may, in fact, be paid by some insurers. An uninsured person, at least at hospitals, will get a tiered discount as a self-pay patient. And then Medi-Cal, Medicare and private insurance will all pay their different amounts.

What it amounts to is that doctors and hospitals are setting the price as high as they need to, because they’re trying to collect what money they can pull in. “It’s a tiered system, to try to receive some compensation for the services being delivered,” he said.