NORTHWEST ARKANSAS — Even though I've been, for the most part, healthy and with little need of doctors and medical facilities, I've had occasion to become a regular at my doctor's office for the last several years; and this year included a bigger surgery than the ones I've had because of recurring skin cancer. And that, I must say, was an eye-opener in a number of ways.

Probably because my mind thinks I can still lift a truck when my body says, "No, you can't," I had hernia repair surgery a little more than a month ago.Though all went well and I'm pretty much back to my old self, the hospital bill and insurance statement still baffle me.

Though I was concerned that the hospital required part of my co-pay up front, even before I knew what my co-pay would be or if I would have any amount not covered by insurance, the real surprise came when I received (apparently by accident) a hospital bill prior to insurance payment and saw that the hospital bill for my out-patient surgery was almost $19,000. When I learned my insurance was paying about $2,000, I became concerned about my indebtedness; that is, until I learned that the agreement between my insurance company and the hospital required the hospital to write off more than $16,000 of the bill. Yes, Istill owed the hospital several hundred dollars, but at least not thousands.

What the billing and insurance payment made me wonder was: Who is the loser in such situations? If the hospital really had costs near $19,000 for hernia-repair surgeries, it was taking a big loss dealing with insured patients. If the actual cost was closer to what my insurance and I are paying, what about those folks who have no insurance and no insurance discount and end up stuck with an astronomical bill for a procedure which actually costs about 20 percent of the billed amount?

According to my way of thinking, someone is taking it in the shorts and getting ripped off big-time.

My insurance agent didn't tell me this, but a friend who sells insurance for another company explained that insurance companies pretty much require hospitals and medical facilities to give them huge discounts (much closer to actual costs) and charge others without insurance a much higher rate as an incentive for people to buy insurance. If this is right, it's the self-insured and uninsured who end up with a bill which they may or may not be able to pay. I suppose those who can afford to pay four or five times the actual costs are paying for the procedures done for those who cannot or do not pay their bills.

This, of course, raises another question. What if I had no insurance and could not pay a huge down payment up front? Would I have been turned away? Even with insurance paying 80 percent of an upcoming skin-cancer surgery, the surgeon would have canceled my surgery if I could not come up with the $400 or $500 co-payby the surgery date. At the same time, dermatologists say that skin cancer, if not dealt with in a timely fashion, can be life-threatening.

One time I did put off having a spot of cancer checked and removed, and the result was the loss of a lot more tissue because it spread during my delay and was harder to cut out.

This makes me curious. What about those with conditions of a more immediate threat to life? Do doctors and hospitals deny treatment to those in need of heart by-pass surgeries if they have no insurance and cannot afford to pay all or part up front? What about other cancer treatments or medicines for diseases which slowly kill? Do patients have to wait for treatment until they can afford to pay?

Before anyone thinks I am writing in favor of socialized health care, I'll mention the fact that many die awaiting their turn for surgeries and procedures in countries with such systems.

In the U.S., it could be that people die because they can't afford medical care. In socialist countries, they don’t have to pay for medical care but may die waiting for it.

What the solution to this dilemma is I don't know, but I'm interested in hearing suggestions.

One thing of which I have become convinced is that the cost for medical care is far greater than it should be; and a lot of fraud, whether legal or illegal, is going on. That certainly can't be helping the situation any.

And it appears to me, too, that as a result, we're all taking it in the shorts!

Randy Moll is the managing editor of the Westside Eagle Observer. He may be reached by email at rmoll@nwaonline.com.

Opinion, Pages 6 on 05/23/2012