Unreported health care costs, such as ambulance services and non-approved treatments, add up to more than $300 billion a year in health care costs. Image from Wikimedia Commons.

Health care costs that aren’t reported in many surveys and studies add up to billions. Costs beyond co-payments and deductibles add up, and those costs have hardly diminished since the passage of health care reform laws last year. As the baby boomers are crossing the threshold into retirement, these costs could increase.

Caring for family and friends can cost workers

A recent study by the Deloitte Center for Health Solutions found that unreported costs of health care add up to an estimated $363 billion per year for Americans, according to CNN. The “hidden costs” include alternative therapies and treatments, ambulance services and prescription drugs not covered by health insurance plans, among other things. However, one of the biggest costs is providing care and supervision to loved ones, such as the elderly and the disabled. The study estimates that the cost of providing unpaid home care came with a price tag of nearly $200 billion, as the average person who took time off from work to care for a loved one lost $12.60 an hour, on average. Additional health care expenses are estimated at $1,355 per year.

Elderly facing greater burden

Compounding the rise of health care expenditures and costs above the rate of inflation is the growing population of the elderly. The Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services, projects that the number of people 65 or older will rise in the next decade, increasing from a projected 40.8 million in 2011 to 50 million by 2018. The elderly pay a steep price for increasingly expensive health care; bankruptcies among people 65 to 74 rose by 178 percent between 1991 and 2007, according to Fox News. Health care expenses have risen by 56 percent since 2002 for retirees, with an average $535 per month expenditure on health care. The only thing that the elderly are estimated to spend more money on than health care is food.

Here come the Baby Boomers

Life expectancy in the United States, according to the Wall Street Journal, has risen to an average 78.2 years — 75.7 years for men and 80.6 years for women. Because the baby boomers are set to start entering retirement, more people will retire and live longer after they do. More people are going to have to provide at home care for their parents and grandparents, spend more out of pocket and miss more work opportunities to do so. The cost of health care is likely to keep rising.

Sources

CNN

Fox News

Center for Medicare and Medicaid Services (PDF – requires Adobe Reader)

Wall Street Journal

A Florida judge has ruled the health care law unconstitutional in a state v. federal case that could ultimately end up before the Supreme Court. Image: dbaron/Flickr

A Florida judge has ruled against the health care law passed by Congress in 2010. U.S. District Court Judge Roger Vinson is the second judge to support a  suit against the health care law filed by attorneys general in 26 states. At issue is the individual mandate in the health care law requiring all Americans to buy health insurance, which Vinson ruled unconstitutional.

Individual mandate and the Commerce Clause

In his ruling that the individual mandate in the health care law is unconstitutional, U.S. District Court Judge Roger Vinson, a Reagan-appointed Republican, declared that the entire Affordable Care Act should be thrown out. Vinson said in requiring the individual mandate, Congress over-stepped its powers as limited by the Commerce Clause of the U.S. Constitution. A similar ruling last month by a judge in Virgina also cited the Commerce Clause. However, Vinson takes it a step further by insisting that the entire health care law be voided. He concluded that the individual mandate and the rest of the law are “inextricably bound together in purpose and must stand or fall as a single unit.”

The Republican repeal strategy

Health care costs for the uninsured add up to about $43 billion a year. Because the government is stuck with the bill, the Obama administration contends the individual mandate is legitimate regulation. Because the individual mandate is intended to make financing health care reform possible, opponents of the law are focusing on that provision. The suit citing the Commerce Clause was initiated by 13 attorneys general — 12 Republicans and one Democrat. Since then, 13 more Republican attorneys general have jumped on the anti-health care bandwagon.

The constitutional argument supporting health care reform

The health care law is indeed constitutional, according to the Center for American Progress, a liberal-leaning Washington think tank. Jan. 18 the group issued a statement, signed by more than 125 legal scholars, that calls the individual mandate a tax provision and therefore constitutional. Opponents call it a fine. But according to the CAP, because the individual mandate requires Americans to either buy health insurance or pay a penalty, it is a tax. The Supreme Court has upheld the broad power of Congress to tax in the interests of the general welfare of the nation for 200 years.

Sources

Bloomberg

Miami Herald

ABC News

With out-of-pocket health care costs rising, more patients are going online to shop around for a better price. Image: Thinkstock

Health care costs can be expected to rise as reliably as the sun does every morning. People are used to shopping around for the best price on such things as airfare, groceries and consumer electronics. With more out-of-pocket costs for health care these days, shopping for doctors and hospitals makes more sense than ever.

Don’t take health care costs lying down

The costs of health care about to be incurred are traditionally not discussed when a person goes to a doctor or hospital. But the New York Times reports that is changing. According to the Center for Studying Health System Change, 15 percent of people younger than 65 are spending more than 5 percent of their annual income on health care costs. As they pay more out-of-pocket, more people aren’t obediently accepting what appear to be outrageous medical costs and are looking for a better price.

Why health care costs are so confusing

When it comes to health care costs, Michael Schroeder at Angie’s List said even experts get confused. Health care providers and insurance companies are in a battle in which doctors and hospitals try to mark prices up and insurers try to mark prices down. Insurance companies often rely on reimbursement standards established by Medicare. But a health care provider told Schroeder that it bills at an even higher rate than Medicare to reap maximum profit. Insurance companies will dicker the cost down, but uninsured patients don’t enjoy that support.

How to negotiate a better price

Fortunately, controlling medical costs by shopping for doctors and hospitals is easier with online tools. The Los Angeles Times reports that one of the best tools is simply a search engine. Kathy Kristof of the Times typed “cost of a colonoscopy” into Google and got about 200,000 matches. Sites that showed up included PriceDoc.com, MyMedicalCosts.com and HealthCareBlueBook.com. These sites provide critical information about average health care prices that patients can use to negotiate with doctors and hospitals for the best price on a treatment or procedure.

Sources

New York Times

Angie’s List

Los Angeles Times

Medical studies indicate that while America can't afford not to breastfeed its children, breastfeeding rates remain lower than recommended levels. (Photo Credit: CC BY/Miki Yoshihito/Flickr)

Conventional logic indicates that if there were an easy, natural way to reduce health care costs, such a recovery method should immediately be utilized. However, according to the Centers for Disease Control and Prevention (CDC), while three-quarters of babies born in the U.S. take their first meals via breastfeeding, the rate plummets after six months, which runs contrary to CDC Healthy People standards. Medical experts believe that this breastfeeding reduction increases pediatric costs dramatically, as children who do not breastfeed have been proven to be more susceptible in general to a variety of diseases that have contributed to increased rates of infant mortality.

Breastfeeding makes for Healthy People

Dr. William Dietz of the CDC told Medpage Today that “Meeting the national breastfeeding initiation goal is a great accomplishment in women’s and children’s health, but we have more work ahead.” Considering the numbers the CDC has discovered – only 43 percent of U.S. babies still breastfeeding at six months, down to 22 percent at one year – America has a long way to go.

Uncivil treatment of breastfeeding

Breastfeeding rates vary wildly by state in the 2007 CDC Healthy People study – 90 percent of newborns are breastfeeding in Utah, versus about 53 percent in Mississippi, for instance. State support for breastfeeding policies are a significant part of the study. At the time of the study, 21 states still had no breastfeeding-friendly facilities, and the same states (plus others) tended to have hospitals with lower ratings for quality of maternity care and infant feeding instruction. According to the National Conference of State Legislatures, there has been improvement on the legislative level since the 2007 CDC study, but there remain states that do not have specific laws protecting the right to breastfeed outside the home in an area other than a cramped restroom. Considering the 2009 Facebook scandal where photos of breastfeeding mothers were removed from the site, questions still exist as to how civilized Americans are as a culture. And if the details surrounding the long-term boycott of infant formula maker Nestlé are indicative, the culture of hostility toward breastfeeding extends far beyond this nation’s borders.

The cost of not breastfeeding is sky high

According to Dr. Melissa Bartick of Harvard Medical School and Arnold Reinhold of the Alliance for the Prudent Use of Antibiotics, the growing absence of colostrum-rich breastmilk in children’s diets has caused pediatric costs to skyrocket. Their recent report in the journal Pediatrics indicates that “$3.6 billion could be saved if breastfeeding rates were increased to levels of the Healthy People objectives.” That was based on 2001 information. However, as Bartick and Reinhold updated the study, they found something quite shocking. For children six months and younger who are fed exclusively via breastfeeding, Bartick and Reinhold found that if there was at least 90 percent compliance (the Healthy People recommended minimum), the U.S. could now save “$13 billion per year and prevent an excess of 911 deaths, nearly all of which would be in infants.”

Considering that infant formula is expensive (it’s generally considered inferior to breastmilk by medical experts) and looking at the ballooning of pediatric costs, it’s eye-opening to see just how much Americans who need money could save by continuing to breastfeed young children within reasonable parameters. Some mothers may be unable to breastfeed for medical reasons, however, providing one necessity for formula, even if these mothers may find that they need payday loans to be able to afford the costly powder.

Sources

Pediatrics

CDC Breast Feeding Report Card

Medpage Today

National Conference of State Legislatures

Wikipedia

UNICEF and World Breastfeeding Week (Editor’s note: Video contains scenes of breastfeeding)

Employers are protecting bottom lines in a bad economy by shifting a greater percentage of health care costs to workers. Library of Congress photo.

Health care costs are falling … for employers. A study released Thursday shows that employers are shifting a greater portion of total health care costs to workers. While the premiums employees pay for employer-sponsored health insurance rose significantly, the amount their employers contribute declined slightly. Analysts say the shift in health care costs is a corporate survival strategy as the U.S. economy continues to falter. A persistently high unemployment rate that shows no sign of decreasing leaves workers with little leverage to negotiate a better deal.

Employee premiums outpace wages

Health insurance premiums employees pay for employer-sponsored family coverage rose an average of 13.7 percent this year, according to a survey conducted by the Kaiser Family Foundation and the Health Research & Educational Trust. The amount that employers contribute fell by 0.9 percent. In coverage of the survey, the Washington Post reports that employees are paying an average of 30 percent of the premium for family coverage and 19 percent for single coverage. The workers’ share of health care costs is the highest in 12 years of the surveys. Since 2005, the employees’ share of premium payments have gone up 47 percent while overall health insurance costs have risen 27 percent. Over the same period, wages have increased 18 percent and the consumer price index, a measure of inflation, has risen 12 percent.

Job market gives employers the advantage

The recession and a difficult job market are the primary factors responsible for the rising cost of employee-paid premiums according to Deborah Chollet, an economist with a Washington research firm. Chollet told CNNMoney that companies cutting staffs to the bone are looking for other ways to save money in the face of low consumer demand. One of the remaining options available is to pass on more health care costs to workers. She said that in a strong job market, higher turnover helps companies contain health care costs. These days, people who still have jobs are holding on to them tenaciously. They also use their health benefits more.

Employees pay more, get less

Workers are paying a greater share of their health care costs and getting fewer health benefits in return. The Miami Herald’s coverage of the survey reports that 30 percent of employers cut benefits or increased out-of-pocket costs for employees. Employers are also raising annual deductibles and 23 percent raised employee premiums. Employer-sponsored insurance covers approximately 157 million Americans, down from 159 million in 2009. A greater percentage of companies provide health benefits this year–up to 69 percent from 60 percent in 2009. However, the survey report suggests that many companies that did not offer coverage did not survive the downturn, leaving a higher percentage of survivors that provide health benefits.

Rising employer health care costs in the next year despite the health care reform bill are being passed along to workers in the form of higher deductibles. Flickr photo.

Employer health care costs will continue to rise this year and next, but the rate of increasing costs for employer health insurance appears to be slowing down. Despite the health care reform bill, a nine percent employer health care cost increase is projected in 2011 compared to the 9.5 percent jump expected this year. To control rising health care costs in lieu of a health care reform bill, employers are dropping medical benefits for retirees and making workers pay a greater portion of health care premiums. Workers, in turn, are settling for higher deductibles. Hospitals shifting costs from Medicare to private payers and employers is seen as the primary reason for higher employer health care costs.

Higher health insurance deductibles

Companies are trying to offset employer health care cost increases by requiring their workers to spend more of their own money before coverage activates, according to a survey of 700 employers by PricewaterhouseCoopers. The Associated Press reports that most American workers are expected to have health insurance deductibles of $400 or more. Two years ago, only 25 percent of companies participating in the PricewaterhouseCoopers survey said they asked employees to pay deductibles of $400 or more. That grew to 43 percent in 2010 and is expected to pass 50 percent next year.

Retiree health benefits disappearing

The report also found a steep drop in the percentage of employers that subsidize retiree health coverage. The survey reported that only 22 percent of employers with more than 5,000 workers subsidized retiree coverage after age 65 this year. That’s down from 37 percent in 2009.

Wellness programs: missed opportunity

To slow the growth of employer health care costs, two-thirds of the companies responding to the survey said they planned to expand wellness programs and 63 percent already offer health risk questionnaires. But Reuters reports that only 39 percent offered wellness programs in the form of weight management and just 27 percent provided nutritional training. More than two-thirds of Americans are overweight or obese, a cause of many of the most expensive health conditions such as heart disease, diabetes and cancer.

Medicare changes fuel increases

The biggest employer health care cost increases for 2011 will be in hospital and physician costs, which make up 81 percent of premium costs. Industry Week reports that hospitals shifting costs from Medicare to private payers and employers is seen as the main reason for higher medical costs. In 2011, Medicare, the single largest payer for hospitals, will reduce payment rates for the first time after seven years of increases that matched or exceeded inflation. Most hospitals are likely to shift more costs to employer-based health plans.

Health care costs: could be worse

The rate of employer health care costs, although increasing, is being held down by some recent changes in the market. CNNMoney.com reports that the cost of providing COBRA coverage–which lets laid off workers extend their health plans–skyrocketed during the recession. Employers will save money as COBRA costs are expected to return to “more normal levels” in 2011.

Generic drugs soften the blow

Another factor keeping employer health care costs from accelerating faster is that drugs representing about $26 billion in annual sales are expected to go off patent in 2011. These drugs include the world’s best-selling drug, Lipitor. Expiring patents will open the drugs up to competition from cheaper generic versions. Generics account for as much as 80 percent of all prescriptions.

Life is full of unexpected expenses

Let’s face it. Life never goes as planned. Last week, I took a trip to urgent care for an unexpected medical problem, and ended up paying more than $300 for their services. This price was after the 20 percent discount for paying in full and did not include the cost of the prescribed treatments. Luckily, the prescriptions did not add up to much more. Who knows what I would have done if the prescriptions equaled the clinic visit? I had planned on using that $300 to put towards rent, and am now short on rent money.

How to cope with unforeseen bills

So, you spent money on something (like a medical bill) when you planned on spending it on a different living expense (like rent). Now what? There are many tools and financial strategies to help you get back on track. The best suggestion is to re-evaluate your current monthly budget to see if there is anything you can cut back on. If there is, do it. After my trip to urgent care, I cut out my weekly latté and skipped out on my every-other-month pedicure because I can live without them, even though I don’t want to.

Save, Save, Save. Then What?

Sometimes saving and cutting back is not enough. Just because I skipped out on my little luxuries did not mean I had enough to make rent. So whether you took a trip to the urgent care or had some other unexpected expense pop up, online payday loans are an extremely convenient tool that can give you instant cash and help you cover your usual living expenses.

Start your instant cash loan application HERE.

Americans and their aging parents

Neal Cutter, a 63-year old professor in UNC, stated, “I never thought my (93-year old) mother would live this long … and I’m paying $8,000 a month for her nursing home care. I also pay my 19-year-old daughter’s college tuition at $40,000 a year. … I’ll probably have to move money out of my nest egg before my daughter graduates to make ends meet.”

This leaves Americans to defer their own retirement savings, tapping into their 401k accounts and savings. They are also looking for installment loans to help with emergency medical bills. Although health-care costs can be large, it’s daily care that also strains families. The average assisted-living facility charges $35,000 yearly for relatively healthy elderly people to live there. The price for a nursing home is far greater, averaging out at $75,000 annually, but that’s only in moderate cities. Expect to pay well over the $100,000 mark for more popular areas.

How to avoid costs

One way to avoid large health care costs is the relatively new long-term-care insurance policy. This type of coverage takes care of assisted-living, day care and in-house nursing care. The only problem is that it needs to be started when the parent is healthy.

Michael Boone, financial planner, confirmed that “You should consider it when you’re in your early 50s…it’s critical to figure out how you want to handle this risk early on.” The premium pricing varies greatly depending on age, so getting long-term-care insurance early is key. For example, a 55-year-old healthy male looking for coverage will pay about $1,258, whereas a 65-year-old man would pay $2,200. A 79-year old man would start at $6,400.

Looking to Installment loans

Because of the costs, many Americans are looking to installment loans to carry their parents’ emergency health expenses. This type of loan can prove beneficial to the qualified applicant because it gives them the funds to take care of the emergency expense. Depending on how much they qualify for, all or part of the payment can be taken care of relatively easily and quickly.

Sandra Pendleton of Niles, Illinois stated, “Installment loans helped me to face a large bill for my father’s emphysema complications. Without qualifying I would have had to dip into my 401k, which is something I’m trying to not do.”

Elder American care

As Americans age, new ways of handling debt and emergency bills need to be found. Like with any financial plan, there are unforeseen things that people need to be aware of and have solutions for. One way to handle bills is to use installment loans, dip into savings, or use 401k retirement funds. Hopefully with the new health care reform policies, there will be more viable options available.

Start your quick installment loan application HERE!

Protecting your health is a wise financial choice

Health-care costs in the United States exceed those of any other nation. Millions of Americans are uninsured, partly because of rising premium costs, and more and more, they resort to payday loans to finance both emergency and routine medical expenses.

With health-care reform issues taking the political center stage, is this not a good time to step back and assess the problem from a more basic point of view? Is it really possible to have a healthier society and more effective medical care without, first and foremost, reducing the need and thus the demand for medical treatment?

Broader access and lower costs do not mix

Presumably, the goals of various medical-reform packages are to broaden access to health care and, at the same time, reduce medical costs. The merits of any particular political agenda aside, however, absent a reduction in the demand for medical treatment, industry reform will only serve to create new costs, further restrict access, ration limited services, and adversely affect the economic interests of health-care providers, especially small businesses. Clearly, broadening access and reducing costs at the same time is an oxymoronic proposition.

Education is the key to more effective health care

Without illnesses and accidents, obviously, there would be no health care costs. According to a New England Journal of Medicine article by James F. Fries and C. Everett Koop, et al.,  (“Reducing Health Care Costs by Reducing the Need and Demand for Medical Services,” Volume 329:321-325, 1993), in the last century, medical costs have soared as a result of an enormous increase in chronic disease, despite a concomitant reduction in the occurrence of acute illness.

Obesity, heart disease, adult-onset diabetes, and other avoidable chronic illnesses, along with unnecessary emergency room and doctor office visits cause enormous wastes of medical resources. Generally speaking, healthy people don’t smoke or consume alcohol to excess. They aren’t overweight, and they exercise regularly, eat wisely, wear seat belts, and take advantage of readily-available preventive health-care measures.

Not all preventive health-care measures have been shown to save money.  But despite an overwhelming societal reluctance to admit it, an emphasis on disease and accident prevention and individual restraint in the use of medical services would, over all, reduce health-care costs.

Proper use of medical services reduces demand

A health policy directed at reducing medical demand would make a major contribution to lowering societal health-care costs because:

1. Preventable illness makes up an inexcusably large portion of our current demand for medical treatment;
2. Risky behavior is expensive in terms of lifetime medical costs;
3. Approaches involving self-management have been shown to reduce unnecessary medical treatment;
4. Health-promotion programs in the workplace have been shown to reduce overall health-care costs; and
5. Our present health-care system does not closely link the use of medical resources to the requirements of illness.

Unhealthy lifestyle choices are expensive

Fries and Koop, et al., state that preventable illness and injury account for eight of the nine leading causes of death in the United States. They cite sound authorities to support a very simple proposition, one that is inarguable from a common-sense point of view: Lifetime medical costs are clearly linked to lifestyle choices and poor health habits. Fries and Koop point out such obvious things as increased physical activity being associated with fewer visits to the doctor, health costs as well as morbidity rates being significantly higher among smokers, and medical costs among people with several lifestyle-induced risk factors (smoking, obesity, hypertension, hypercholesterolemia, and adult-onset diabetes) being double that of people with no such risk factors.

Education reduces the demand for medical care

Many studies have shown that educating patients about self-management, especially when coupled with modest medical intervention offering objective guidelines to help decide whether medical assistance is needed, reduces the demand for medical services. This has been found to be true even in cases of chronic disease.

Education reduces the demand for life-sustaining treatment

Not only are overly intensive services for terminal illness extraordinarily expensive, they are not desired by most people. Fries and Koop note that “Seventy percent of people request no life-sustaining treatments for themselves when they are dying, and 89 percent desire living wills and other advance directives. Yet only 9 percent have made such directives.” An emphasis on educating patients about the importance of health-care directives could result in an enormous reduction of health-care costs.  It would also promote more humane medical treatment and a more effective allocation of limited medical resources.

Deep pockets stand to save by spending on education

It costs money to educate people, especially when that education involves altering long-standing lifestyle choices, and, even more so, on a wide scale. But if the entities now bearing the costs of skyrocketing medical care – insurers, industry, and government – were convinced that educational programs designed to reduce the demand for medical services could actually save money, they’d be funding those programs right now, without a doubt.

For people living from paycheck to paycheck without health insurance, it would take a hefty cash advance or personal loan just to step inside a doctor’s office. And for people who have health insurance or extra cash stashed away for medical expenses, more than half of every dollar spent on medical care is a waste. According to a recent study by PricewaterhouseCoopers’ Health Research Institute (HRI), approximately $1.2 trillion of the $2.2 trillion spent on medical care annually in the United States is the result of wasteful health-care practices.

The HRI report describes three general areas of waste:

• Behavioral where individual behaviors are shown to lead to health problems, and have potential opportunities for earlier, non-medical interventions.
• Clinical where medical care itself is considered inappropriate, entailing overuse, misuse or under-use of particular interventions, missed opportunities for earlier interventions, and overt errors leading to quality problems for the patient, plus cost and rework.
• Operational where administrative or other business processes appear to add costs without creating value.

Before you light up or take another bite . . .

Big may be beautiful, but it's an enormous waste of health-care resources.

The report concludes that the impact of obesity, alcohol abuse, smoking, and non-adherence to medical advice and prescriptions are exponential factors affecting all three categories. Every year, these risky choices and behaviors result in an avoidable $493 billion waste.

Some of the specific contributors to the $1.2 trillion leak are:

1. Over-testing: $210 billion
2. Processing claims: up to $210 billion
3. Ignoring doctor orders: $100 billion
4. Ineffective use of technology: up to $88 billion
5. Hospital re-admissions: $25 billion
6. Medical staffing turnover: $21 billion
7. Medical errors: $17 billion
8. Unnecessary emergency room visits: $14 billion
9. Prescriptions written on paper: $4 billion
10. Hospital-acquired infections: $3 billion
11. Over-prescribing of antibiotics: $1 billion

Too many tests

Defensive medicine – the ordering of tests or procedures based on concern for liability or to pad income — is the single biggest waste of health care dollars. In a recent CNN report, Dr. Arthur Garson, provost of the University of Virginia and former dean of its medical school said, “Sometimes the motivation is to avoid malpractice suits, or to make more money because they are compensated more for doing more. Many are also convinced that doing more tests is the right thing to do. But any money that is spent on a patient that doesn’t improve the outcome is a waste.”

Those annoying claim forms

Inefficient claims processing is the second-biggest area of wasteful expenditure. Doctors spend enormous amounts of time and money trying to get paid by insurers. They also spend a lot of time and money getting advance approval from insurers for higher-priced or non-routine procedures. Those necessary efforts significantly increase the cost of medical care

Using the emergency room as a clinic

Because emergency rooms are legally obligated to treat all patients, more insured and uninsured patients are getting their primary care in emergency rooms. An emergency room visit for a routine condition can cost 10 times what the same medical care would cost at an urgent care clinic. Not only are unnecessary emergency room visits a waste of medical resources, many uninsured patients cannot or do not pay their emergency room bills, and medical providers ultimately find ways to pass on the costs to insured patients and uninsured patients who do pay out-of-pocket.

Going back to the hospital

Frequently – to the tune of $25 billion a year — patients don’t follow care instructions after being discharged from the hospital and wind up being readmitted for complications that could have been avoided. Preventable re-admissions are also common among elderly patients who are discharged prematurely because of insurance shortages or hospital bed unavailability.

Spreading it around

Infection control is ever-evasive in a building full of sick people. Patients sometimes come in with infections which then spread in the hospital. The problem is one of enormous proportions, and the ironic fact is that the hospital is a very dangerous place to be when you’re vulnerable to infection. Something as simple as hand-washing often can reduce the problem, but the risk of infection is enormous and so is the $3 billion annual bill for hospital-acquired infections.