Row over hospital charges heats up

The acrimony between a hospital-industry lobbying group and a gadfly who has been pressuring hospitals over their treatment of the uninsured degenerated into name-calling Tuesday.

The American Hospital Association (AHA) and K.B. Forbes, who advocates for people without health insurance and heads the Consejo de Latinos Unidos, or Council of United Latinos, have been butting heads for several years.

But in the aftermath of a critical report on hospitals that ran on CBS News’s “60 Minutes” on Sunday, Rick Wade, the AHA’s vice president for communications fired off an e-mail to Forbes calling him “Gordito” (Spanish for “fatso”) and accusing him of carrying water for the insurance industry.

Forbes appeared on the “60 Minutes” segment and issued a statement the following day charging that the AHA representative on the program, Carmela Coyle, the group’s senior vice president for policy, misrepresented the way hospitals charge people who have no health coverage.

People without health insurance receive bills for the full price of the services they receive. The prices paid by Medicare, Medicaid and private insurance companies are often many times lower.

Forbes’s statement said that the AHA was “embattled” by the controversy about high hospital prices for uninsured patients, attributing the claim in part to anonymous sources at AHA member hospitals he says complained to his group.

“My, my Gordito … we’re embattled. You’ve got to be kidding,” Wade wrote, adding, “Controversy has swelled? Between your ears, perhaps.”

According to the Consejo, Forbes replied, “Anger is the enemy of logic. Have a happy day.”

AHA spokeswoman Alicia Mitchell described Wade’s e-mail as “part of their back-and-forth.” Wade and Forbes have a “unique relationship” and “talk all the time,” she said. Wade was not made available to be interviewed.

Forbes does not view the missive as normal. The e-mail is “nasty, vile and vicious and an absolute disgrace for members of the association,” he said in a written statement.

“In psychology, it’s called projection,” Forbes said in an interview. He said that the AHA has failed to help its members change how they bill the uninsured. Forbes also said that Wade was taking out his displeasure with CBS News on him. “They displace their anger by accusing me,” he said.

Forbes is not above taking potshots of his own: His group’s website features a picture of Wade’s head with a moving mouth accompanied by the words “Blah! Blah! Blah! Blah!”

Mitchell defended the AHA’s record in recent years and said hospitals nationwide have been implementing programs to provide discounts and help uninsured people receive medical care. “There’s a lot of good people out there in hospitals,” Mitchell said.

Some lawmakers and Bush administration officials have expressed impatience with the industry’s progress on pricing for the uninsured. The White House is pressuring hospitals to disclose their master charge lists, which include prices for each service they provide.

Forbes founded the Consejo in 2001 with the stated mission of defending people without insurance from high prices and aggressive billing practices employed by some hospitals.

Forbes’s ties to conservative Republicans and one influential insurance executive have made him the target of accusations that his efforts are underwritten by insurance interests that have a financial stake in lowering hospital prices.

Forbes denies that the Consejo, classified as a 501(c)3 not-for-profit organization, has taken donations from insurers, labor unions or political parties. He says that to protect donors from harassment the group does not reveal their identities.

But Forbes does acknowledge his relationships with conservative commentator Pat Buchanan and publisher Steve Forbes (no relation), as well as Patrick Rooney, an insurance executive who has been credited with, or declaimed for, leading the push to create health savings accounts (HSAs).

Forbes bragged that his relationship with Rooney got him a private audience a few years ago with House Speaker Dennis Hastert (R-Ill.) where they discussed hospital pricing for a half-hour.

HSAs allow individuals to set aside, spend and accrue pre-tax money for medical expenses. The accounts are used in conjunction with high-deductible health-insurance plans for “catastrophic” expenses.

The White House and conservatives in Congress are enamored of the accounts and want to expand the tax breaks they provide. Supporters of HSAs contend that making individuals responsible for meeting high deductibles will force them to become more cost-conscious.

Development of that cost-consciousness depends in large measure on disclosure by healthcare providers such as hospitals of what they charge for medical services. The White House so far has encountered stiff resistance to that idea.

The “60 Minutes” segment, and Forbes’s statements, emphasize that the only people who are billed the amounts on hospitals’ charge lists are the uninsured.

According to a transcript of the television program, Coyle asserted, “Everybody’s charged the same amount, but the Medicare program dictates to hospitals what it’s gonna pay. Big insurance companies? The same thing. They profit if they pay less”

Mitchell blamed CBS News for editing out a fuller explanation of hospitals’ business practices. AHA President Dick Davidson sent a letter to CBS correspondent Dan Rather on Monday to complain about the segment.

Forbes shot back the day after the broadcast with the statement that prompted Wade’s e-mail.

“Is the AHA deliberately trying to deceive the public?” Forbes asked. “The AHA now says that hospitals charge Medicare and insurance companies less. We say hospitals charge the uninsured more. What’s the difference? Nothing.”

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