Former rural health policy chief explains why hospitals inflate charges, and how rural hospitals fit into the picture

Hospital bills are increasingly in the spotlight this election season, as Democratic primary candidates hash out the best way to improve the nation's health-care system. One of the chief complaints is that some of the poorest end up with huge hospital bills. It's a complicated subject, but retired physician Wayne Myers offers a guide to the basic principles at work in our health care system in a piece for The Daily Yonder. Myers headed the federal Office of Rural Health Policy from 1998 to 2000 and is a former president of the National Rural Health Association.

Dr. Wayne Myers

Essentially, Myers explains, there are three kinds of patients: those without insurance, those covered by Medicaid or Medicare, and those with private insurance. Because hospitals end up eating a little of the cost of care for Medicaid and Medicare patients, and a lot or all of the cost of care for uninsured patients, they charge privately insured patients more to make up the difference, Myers writes. One notorious recent example is an emergency room trip that ended with a Band-Aid applied to a toddler's finger, and a $629 bill for her parents.

Such anecdotes are prime fodder for outrage, and hospitals frequently write them off once a reporter starts digging around (as Sarah Kliff did in an investigation of high emergency room fees) But hospitals keep doing it because, if the cost of care for uninsured or under-insured patients isn't covered, "the hospital[s] will go broke and close. Rural hospital closures are relatively uncommon in states that have expanded their Medicaid programs, because some payment is better than no payment," Myers writes. There's more to it; read the whole thing here.