Why are Americans who are DENIED INSURANCE charged 250-600% more than insurance companies pay?

[Faryn Balyncd]

Who is responsible for our perverse medical pricing system?

An opaque system in which whatever prices a hospital will choose to charge for a particular diagnostic code is a protected proprietary secret?

A system where Americans who have been DENIED INSURANCE are then subjected to fantasy "normal rates" of 250% to 400% (or sometimes 600%) higher than the (still profitable) "discounted" rates charged to insurance companies?

Why have these fantasy "normal rates" only come into existence since insurance companies negotiated "discounts"?

Should Americans have to pay a 31% surcharge to insurance companies (for administrative costs, bonuses, etc), when they are not DENIED INSURANCE entirely, in order to avoid being charged 250% to 600% higher than those same insurance companies pay?




Is this justice?

Is this fair?

Is this really what free enterprise is all about?

Or is it PREDATORY MEDICINE . . . and a national embarrassment?






This extreme price gouging of the un-insured (many of whom are uninsured BECAUSE have been DENIED INSURANCE coverage) is a recent phenomenon . . . . .

While it may not be just, it does, from the point of view of an insurance CEO, provide strong incentive for Americans to purchase his overpriced policies (and it makes their 31% cut look like small potatoes).




But how did we come to this?



Insurance began as a noble attempt to distribute risk......

But today the health insurance industry now does everything possible to avoid writing policies for anyone other than cherry-picked low risk groups.

Have health insurance companies, like a few other corporations, become blood-sucking leaches we can no longer afford?

Can we afford universal healthcare while continuing to pay a 31% administrative surcharge to insurance companies?



Or do we need SINGLE PAYER INSURANCE FOR ALL?





:kick:

[rpannier]

1. Why do the rates of those insured go up when the company has never paid a dime in claims?

It's an f*cked up system

[mimitabby]

114. huh?

which insurance company has never paid a dime in claims?

[orbitalman]

137. You read this wrong...

There are people who have not been sick for which they have never made a claim and... the insurance company has never paid a dime on them. YET, their premiums continue to skyrocket. I KNOW.

[iamjoy]

175. It's Called A Group Plan

Very simple explanation - it's called a group plan. It's all part of our wonderful :eyes: employer based health insurance system.

So, let's say you own a company and employe 1000 people. You decide to offer your employees Kuddly-Kare HMO. You select a very generous package with broad coverage. The actuaries looked at how many employees you had, where you lived, what was to be covered, etc. and decided it would cost $4,000 per year per employee. You agree to pay 90% of the premiums, and your employees pay 10%. It's a group plan, so you pretty much have to charge the same rates for everyone (there are exceptions, but rates can't be based on medical condition or age). One of your employees gets cancer and incurs $200,000 in medical bills. Another needs a bypass (open heart surgery). About five others have big claims (over $50,000 worth), another dozen or so incur several thousand dollars as well. About a hundred don't even bother to go to the doctor - they have 0 claims. Next year, the insurance company looks at the total claims incurred by the group and raises your annual cost to $4,480 per employee. You can't just charge the people who had claims more, you have to increase costs for everyone.

And I bet even private insurers use a similar method - a hurricane comes through Florida and the insurance companies raise premiums for everyone - whether the house was demolished by the storm, sustained heavy damage, received minor damage only or didn't get so much as a drop of rain or wind stronger than a summer breeze.

[mimitabby]

202. ah, thanks

[Muttocracy]

2. Last time I went to the doctor I couldn't figure out the bill with all the credits and adjustments

The price the doctor listed, what the insurance was willing to pay for the item, and various mysterious adjustments and charges to me to fill the gaps.

[truedelphi]

158. i had an acquaintance whose job it was to

figure out people's hospital bills for them.

The client paid her, and she guaranteed it would be cheaper to pay her the hourly rate of $ 35 an hour than to pay their bill in full.

One of the more interesting "mistakes" in billing one hospital made was charging for a baby boy's circumsion THREE SEPARATE TIMES!

[matt819]

167. Truly insane - This should be on the front pages every day

Some additional points --

I had to have an eye operation last year. I asked the eye doctor what it cost. He didn't know, estimated around $4,000, "but you should check with the business office."

I did that. They didn't know, but also estimated around $4,000. It depends, they said.

Well, wouldn't you know it. It was "around $4,000," but everyone failed to make a few observations. That was the charge for the doctor. The anesthesiology group also charged me some money, as did the radiology group. Oh, and the hospital charged me another $4,000. I could make heads nor tails of the billing and so didn't know who I was paying, or for what. What I did know is that notwithstanding these charges, the amounts I owed bore no resemblance to the charges imposed because the insurance company approved of only some percentage. They didn't pay this money to the hospital. They just told the hospital they couldn't collect that money from one of their insured. In the end, this roughly $10,000 procedure cost me around $3,000.

Okay, so I'm a relatively happy camper, apart from the fact that my insurance premiums run $500 per month, and they won't really pay off unless I have a truly catastrophic problem. One can only hope.

Think about the 50 million uninsured Americans. They are on the hook for the full 10 grand. They get no break. Those least able to pay are well and truly screwed. Great country, this.

[Muttocracy]

185. indeed, it's a nightmare

A few years back I had some minor surgery, had carefully called to make sure the procedure, surgeon, hospital were all covered by my network and everyone assured me it was all OK. Afterwards I got a big bill for a nurse anesthetist (sp?) who had assisted who was NOT in the plan. Took me months to get that one straightened out but they finally paid for it. I wasn't working full-time then - now I might have just given up and paid it rather than put in the time and letter after letter to the insurance and others.

But yes, I'm glad to have health insurance, glad I am healthy (I lose money on health insurance but it's there for emergencies), and glad my insurance is cheap $1000/yr from me + $2500 paid by employer. My salary isn't fantastic, but the benefits at my employer are great, and I have to remind myself to factor that in!

[Ms. Toad]

194. Anesthesiology practices are infamous for that.

They are not part of the (covered) hospital generally. You're trapped into using whichever group the hospital uses - it isn't like you can just not use anesthesia, or acquire it elsewhere. You don't know they aren't covered until after the service is rendered.

I got stuck in that trap once - for an emergency appendectomy. I guess I should have traveled 50+ miles to the closest hospital with a covered anesthesiology group... (The insurance company did, ultimately, cover them - but it took a big fight.)

[Muttocracy]

195. I'm surprised they don't charge for out-of-network laundry service

:eyes:

[DianeG5385]

3. This is so unfair. It's why private health ins. makes no sense

[efhmc]

4. This is wrong. Capitalism at its worse.

[vixengrl]

5. The problem is that our insurance structure requires

that private companies keep an eye on the bottom line. It doesn't pay to have a client whose costs (losses) are more than his or her possible premium buy-in. The decision of hospitals to raise the cost to the uninsured is egregious, and I don't entirely grasp the rationale, except to suppose that they consider the likelihood that they will be paid later, or "on installment", and try to figure in interest--

It isn't just the fault of the insurance co's--but they do help.

And I think they suck for it, but our system, right now, both allows it and damn near makes it necessary.

Solution:

Single-paer-universal health care. If you have a social security number, you have a plan! It'll drive down costs by making preventive care, prophylaxis, if you will, the order of the day, and eliminate the monies the industry spends on, um, lobbying againt single-payer universal healthplans, and, um, the care managers who do what the conservatives think some gov't lackey would do in deciding what level of care should be supported. It would actually be beneficial to employers in that they wouldn't have to absorb the health-plan cost of their employees--depending on how the new system was structured.

[Lydia Leftcoast]

9. My brother's explanation for the messed-up pricing system is as follows:

Each insurance company has a "preferred rate" that it pays the practitioners and hospitals in its network. It may be anywhere from 50% to 75% of "normal charges."To maximize their income, practitioners and hospitals figure out a rate that would be acceptable to them and then double it or whatever to get their "normal" charge, so that the insurance company actually pays what they want.

[duhneece]

124. Exactly

I was Business Manager of a radiation Cancer Treatment facility. I'd never worked anywhere in the medical field, so I was blown away by the different amounts we could charge. It never made sense and felt wrong. Can you imagine any other service with so many different prices one can and does charge?

[jmowreader]

155. Yeah. Try a welding supply store.

The one I go to has five different price tiers, and they will never tell you which one you are in...

Tier 1 is for first-time or irregular buyers.

Tier 2 is for semi-regular buyers who rarely or never buy hazmat.

Tier 3 is for regular customers who don't buy very much at a time, who buy mostly hazmat, and who pick it up in their own vehicles.

Tier 4 is for regulars who buy a lot of hazmat, no matter what else they get, and who have it delivered.

Tier 5 is restaurants, who buy only bulk CO2.

The only reason I continue to frequent their establishment is they have really good prices even though there are three other groups who pay less for things than I do, and their cat is great.

[latebloomer]

188. In my experience, that is not true

I could bill $350 for a psychotherapy session, but I'm only going to get the $60 or $70 which I have contracted for. The rates are set for each kind of procedure. If I'm not a member of the network, I can charge a higher rate,and get paid more, but a "usual and customary" limit will still apply.

[wolfgangmo]

163. Point from a clinic owner...

... used to bill insurance companies and who no longer does.


The reason that the prices are so much higher is that the providers are playing the insurance companies game. The insurance companies will set a percentage "discount" for services, AKA threat to stop allowing you to see their patients. The providers then re-crunch their financial numbers to see if they can afford to accept the insurance companies threat/negotiation. Given that the discounted price is based on the "real" price, the provider will then re-crunch the financial numbers to see how many of the patients they see are from that insurance company. That number will given them a percentage that they have to raise their "real" price in order to have enough cash flow to keep the doors open and pay their employees a living wage.

This worked "fine" with the insurance companies keeping gouging the consumers and medical providers UNTIL we reached a point where a substantive number of people seeing docs and hospitals were no longer insured or underinsured.

Heres a piece of advice until we get universal health care. Negotiate with the hospital and find out if you can get some of the costs waived or reduced in return for regular payment or early payment. Ask them to waive service charges if you let them do a withdrawal from your account every month. Ask. You might find that they are very OK with reducing your bill. But keep in mind that the price gouging that insurance companies have done to docs and hospitals is so egregious that the providers now need cash paying customers.

Our clinic is not alone in not taking ANY insurance anymore. It is a growing trend among family and general care docs forced upon them by the insurance companies. It is either stop taking insurance or close their doors.

[dysfunctional press]

6. been there, done that...

after i was dropped by my private insurer due to a chronic condition(ankylosing spondylitis), but before i had qualified for medicare, i made several 'full price' trips to the hospital. the current system couldn't be much more unfair.

if obama doesn't get us single-payer-universal healthcare, i'll consider his tenure as potus a failure- no matter what else is or isn't accomplished.

[Name removed]

17. Deleted message

Message removed by moderator. Click here to review the message board rules.

[zeos3]

20. Excellent story

Why don't you add a unicorn to your imaginary bullshit next time?

[leftstreet]

23. ROFL

[laundry_queen]

26. LMAO!!!! eom

[Name removed]

29. Deleted message

Message removed by moderator. Click here to review the message board rules.

[zeos3]

31. There are plenty of apocryphal stories

we can come up with. As far as the wait times are concerned, they may be there, but they are here as well. We have people running across the border to fill prescriptions. Isn't that a problem? That first link you posted inspired me to create a tour bus sevice into Canada for seniors, where we will visit the nearest pharmacy and come back home.

Doctor's starting pay in England. We can stick with England's system if you like. From the article you posted: "Obviously this is not the whole story. People do not choose careers based purely on starting salary, and medicine has good prospects for salary rises as you work up the ladder"

Also: "I can't pretend that financial reward isn't an issue for myself or my peers but I can reassure Miss Spooner that the starting salary for junior doctors is actually around �30,000 (nearer �32,000 in my case)"

Also: "As a recently qualified doctor, I am happy to reassure Brendan Spooner that the financial situation for medical graduates is not quite as bleak as he portrays in his article "Deterred by the doctor's salary". It is true that that the basic starting salary for FY1 doctors is �20,741. However, this does not take into account "banding", which, depending on how many hours you work, pushes your annual salary much higher.

For example, as I am contracted to periodically work nights, weekends and long days my basic pay is increased by two-thirds to �31,500 a year. The hospital also provides my accommodation free of charge, with no heating, electricity or council tax bills. After tax this leaves me with a disposable income of around �1600 a month. I am sure even the lawyers, journalists and stockbrokers, of whom Mr Spooner seems so envious, would be quite pleased if they had this much to spend in their first job."


I don't get where your going with the commute thing. An arguement for the English healthcare system could be that it's a matter of UNDERFUNDING. The same can be said for our roads, etc. If we have republicans in power who hate the govn't (and WE the people) they try to destroy the system from within and appoint unqualified lackeys to run the federal agencies they want to eliminate and they DON'T provide adequate funding.

[jfn302]

36. About the commute.

My point about the commute is we have a system of government that was designed to be cumbersome and inefficient intentionally. So that it would not make changes too quickly that might seem good at first, but in later light end up being really bad.

Our transportation system has been the realm of the government since it's inception.

Nearly everyone deals with the waiting it takes to get through traffic to work every day. I avoid going into the city as much as possible because of the inefficiency of our public roadways. If public transportation were more developed and reliable in my city, I would rely on it as much as possible.

So, the imagery of sitting in traffic is pretty clear to everyone. The idea that government is too inefficient to get efficient transportation right after 200 years of practice is what I was shooting for. With 200 years of practice and still being inefficient at something, I don't want them in charge of something as important as my health.

No, looking at Canada's system. We have a different discussion.

The U.S. government spends more per year per capita on medical services than Canada and Canada's expenses are directly related to universal insurance.

Granted, Canada's government provided insurance isn't as complete as the average full coverage policy in the U.S. But, I see upsides to that as well. With the draw back in coverage, such as their lack of coverage for drugs in most provinces, American's may not suck every penny they can from the insurance policy the way they try to now by getting as many prescriptions as possible. They will have to cover those expenses themselves.

England is a failed attempt and I can make more than the average doctor in England just by going to work for a tech company call center and staying there for a few years. No college needed. As the article mentions, it take a strong desire to heal people rather than concern about income to become a doctor in England.

Canada's model is much more attractive to me.

You are right, We the People, are the government, when we choose to get involved. However, there is an organization that seems to think of itself as separate from us now, and it calls itself 'The Government'. I think both sides of the isle are at fault for the haphazard growth of the monstrosity that our government has become. Republicans refuse to take apart institutions that have no part of being in the government for fear of losing votes from people those organizations are aimed at 'helping'. So, they cut funding to the point that the function is a total waste of money. Democrats listen to every special interest group that comes out of the left field and run as fast as they can to create programs and tons of money on completely stupid junk. Look at our prison(read health club) system if you want a prime example. Criminals live better than many honest people who work hard every day to do the right thing. I think that is wrong. But, some Democrat felt a gym, college and cable TV were things criminals NEEDED in order to stay alive in prison.

I am personally a small government person. I am all for paying for programs that are universally beneficial while staying within the constraints of the Constitution. But, flight museums in Freeport, TX (thanks Ron Paul), wooden arrows, sports stadiums for millionaires and such are things I don't see a reason I should be paying for them.

[zeos3]

44. The systems cumbersomeness

comes into play in drafting and enacting legislation. The various govn't agencies aren't hindered by this. This is not to say that they are streamlined but the bloat and inefficiency comes from private interests. The right does everything it can to make these agencies ineffective. Need proof? Let's come up with a list of people who made careers fighting or trying to abolish a specific agency that were appointed by Bush to head those agencies. The incentive is to make the private sector look more attractive and help it to more easily help itself to our tax dollars.

I like the way you accuse Americans of trying to SUCK every penny they can from their insurance. Your right!!1! Those STUPID Americans SHOULD pay for more of the expenses (and pay higher and higher premiums) themselves!!!11! The poor insurance companies are being taken advantage of (while they try to suck every penny they can out of us and not pay for anything yet you can't see this).

I agree with you on two things. 1) We shouldn't pay for stadiums for millionaires. 2) If I may quote you " there is an organization that seems to think of itself as separate from us now" only it's not the Govn't, it's the GOP.

[eridani]

49. I agree--the Canadian sytem has more potential as a model for the US

Just changing the payer to the government would be far less disruptive than trying to make large numbers of providers direct government employees.

[Stellabella]

136. Um, the transportation system in this country is inefficient because

it's underfunded, and has been since that asshole Reagan started cutting budgets. That isn't an example of government at its best.

Small government people are usually 'I've got mine, now screw you', and I can tell from your posts that you are, indeed, one of those people.

[eridani]

48. $42,127 is the salary quoted in your link

The 29,000 had to have been some other currency unit. $42K sounds much better if you consider that doctors have no office expenses or malpractice insurance expenses.

[jfn302]

56. Actually,

the 29,000 was based on the articles quote that doctors start out at just over 20,000 pounds. Take the 20,000.00 pounds and multiply it by the 1.4(something) conversion rate to dollars, and you come up with the 29,000.00

later in the article it mentions that higher income is possible for some starters, but $29k is average.

[Hannah Bell]

69. plus free housing, utilities, medical care, & malpractice coverage.

[eridani]

76. The reference explicitly stated $42,000--please reread n/t

[jfn302]

79. $42k quoted.

I can only guess that the $42k is what the pound to dollar conversion rate was in 06-07. The current conversion rate is 1.41904 pounds per dollar which puts the 20k pounds right about $29k US. The conversion calulator that I used unfortunately doesn't have historical information so that I can go back and look at past exchange rates.

[eridani]

82. Even $20K looks great to me if I had free housing and medical malpractice insurance

Not to mention not having to pay hordes of people to deal with insurance company bullshit.

[arikara]

148. Here in Canada

they sometimes publish the Dr's salaries. The Mr had the worst doctor who allotted 10 minutes max per patient visit - 5 for the consult and diagnosis and 5 for charting. The Mr has multiple chronic conditions... heart, diabetes etc. We'd go in with lots questions and he'd stop us, write out a prescription and walk us down the hall as we were still asking questions. He misdiagnosed and caused some serious complications. To make a long story short, this asshole who should have his license taken away was one of the top ten earners of any doctor in the city, over $400,000 in one year. The Mr is now seeing a doctor who spends a half hour with him at a time without rushing, is thorough and actually listens and cares, and provides appropriate treatments. I suspect that this good doc makes a third of what the asshole makes. What's wrong with that picture?

A thought... maybe if the doctors don't have the crippling student loans and high costs of running a practice that Canadian and American doctors have, a salary of $29 K isn't too bad while they learn on the job.

edit: typo

[Hannah Bell]

68. don't forget free housing & utilities.

[elizfeelinggreat]

98. The part that's BS

is that all the problems are government's fault.

Get a grip.

[dysfunctional press]

110. do a little research of your own, and you'll see that there are even BIGGER problems...

with the healthcare system in the united states.
NO system is perfect, but ours is farther from it than most.

[Occulus]

113. *AHEM*

http://www.democraticunderground.com/discuss/duboard.php?az=user_profiles&u_id=236378

:D

[zeos3]

122. It was fun while it lasted

I must admit I enjoy the verbal sparring every so often. I was in the mood for it last night.

[zeos3]

128. This is why I hate people like that.

One of my father's friends is on medicare. His wife still has a couple years to go. She pays about $1,400/month for insurance, just for her. This has a $2,000 deductible. He just raised the wife's deductible to $5,000 and the premium is only $900/month now. My dad's friend told me he brought a 3 month supply of their medications from Europe. The cost of these meds here is about $480/month, he got a 3 month supply for 85 Euros ($110??).

I know this sounds like one of that idiot's apocryphal stories but it's not and unfortunately I can tell you more.

My only regret is that I got tired after a bit and went to sleep and didn't have a chance to be meaner to that guy before he got tombstoned.

[LaurenG]

118. Well then I suppose you would be in favor of regulating the Ins industry right?

Insurers are almost all piranhas and the physicians, especially primary care physicians are being pinched so hard they aren't able to pay their overhead without either joining a big group or a hospital run physician group, since they can negotiate rates that will allow physicians to pay their staff as well as get their kids through college and put food on the table.

The system is broken and if Universal Healthcare comes to pass, so-be-it. So far it's republicans and greedy people who scream anytime Universal Healthcare is mentioned. as far as I can tell.

[AllyCat]

139. Hmmm....and with no loans to pay for education, that's still more than

docs here make when they start out.

[laundry_queen]

25. Wow so much bullshit I don't know where to start.

I'm in Canada and have NEVER had to wait to see a doctor. I have more U.S. friends online who have to wait to see their family doc than I do!! LOL! Not to mention I can see any doctor I want to, anywhere in Canada. I don't have to worry about "gee, if I go to this doc or that doc is my insurance going to cover them?" NO! If they are a doctor in Canada, I can go to them! Imagine that!

Now, I don't know about the UK, but the waiting list talking point is phony baloney in most places in Canada. I personally haven't had to wait long to see any specialist and neither have my kids. My FIL had knee replacements with VERY little wait time. My dad had a hip replacement and waited a bit longer than he had to because he went to a doctor who came up with a radical new way of doing it, so he opted to wait to have it done in a more technologically advanced way. He wasn't in any pain at the time. And it was his choice. When I had my children, with 3 of them I had c-sections and got to stay in the hospital 4 days each. Didn't have to worry about anyone kicking me out after 48 hours (omg, I can't even imagine!).

Oh, plus doctors here make a hell of a lot more than $30,000. You should've seen my last dr's house.

And to sum up - if you knew anything about Universal Health care you would know the gov't doesn't make the decisions. They simply fund it. Like an insurance company. Except there's only one and they're not in it for profit. Why you would trust a large corporation looking to make a buck on your illness over the government is beyond me. :eyes:
Unless you're lost online or something....

[jfn302]

27. Don't know a lot about Canada,

I do know my family lived near Quebec for a number of years while I was off doing military service.

For medical services and drugs, they went to New York. Tells me that something in the system isn't as wonderful as the U.S. system pre-maintenance insurance problem that we have now.

[zeos3]

28. You are soo right

In our system you don't have to wait for approval from the insurance company, you can go see any doctor at any time. All you have to do is pay the Out-Of-Network fee.

Opt for cheaper coverage (with a smaller network of Docs and Hosps) and good luck to you. Go to your doctor, get a diagnosis, get a second opinion, see a specialist, schedule a procedure. You can get this done in NO time at all. As I said before, you can wait to see if the insurer approves any or all of these steps if you want it to take even longer OR you can pay out of pocket. This is AWESOME!!!

PS I was being sarcastic.

[jfn302]

30. I have said our system has major problems.

But the point is you don't have to wait.

I just did some reading on Canada's system. I find it interesting that they don't have Social Medicine the way Europe does. They have privately provided medicine with publicly provided insurance. This makes a huge difference in the discussion.

How does Canada handle illegal immigrants on their medical system? Illegals in the U.S. are a major drain on medical funding, especially in the border states.

[zeos3]

32. The major problem our system has

is the For Profit status. You mentioned motivation in an earlier post. The motivation of a for profit entity (be it a hospital, insurer, etc) is PROFIT. This comes at the expense of he patients/insureds. It's not only their profits that rob us, it's also the necessity of doctors and hospitals to hire staff specifically trained to deal with the insurers and collecting payment. There is also waste when they insurers create jobs solely in existence to find reasons to not pay claims. There is a new industry that deals with helping people fight the insurers for payment of their bills.

This is all extremely wasteful.

Businesses in this country would also benefit greatly by some type of universal health care. The US Chamber of Commerce once supported this until they were pressured into falling in line with the right wingers who traditionally served them.

[jfn302]

38. You don't understand profit do you?

You work for a profit right?

Your profit is what is left over after the taxes and other fees are paid.

If you count your bills, then your profit is your discresionary money left over after all the bills are paid.

If you don't make more than your bills, you find a way to increase your income. So, are you saying your income should be limited to the amount it takes for you to pay your bills?

Or, are you saying that doctors, nurses, and anyone else that works for a hospital should only be allowed to pay thier bills, but not have extra money in their pockets?

[zeos3]

46. No, let me explain.

You're mixing corporate profit with individual income. I have no problem with doctors and nurses making a handsome salary. I have a problem with the insurers and hospitals trying to increase their profits at the expense of giving care.

How happy would you be if MY profit was directly proportional to your misery and suffering? I guarantee YOU would not be happy. :evilgrin:

[jfn302]

57. I wouldn't use you if I didn't get better.

Plain and simple.

[zeos3]

61. Then I hope your $ doesn't expire before you do

[ejpoeta]

88. yeah, it makes that line shorter when almost 50 million people have no insurance

and then there are those that are underinsured. they may not even know it until something happens and they aren't covered. it's a wonder our country is in such rough shape. everyone for themselves. as long as I have insurance, who cares about anyone else!

[elizfeelinggreat]

100. Bingo!

Hard to miss the greed when it's out in the open like that, isn't it?

[Donnachaidh]

99. wow -- let's switch to another RW talking point.

:eyes:

[wolfgangmo]

166. The point is that you DO HAVE TO WAIT in the US.

The New England Journal of Medicine in Aug 2006 published an article comparing wait times for ER's and specialists in the US, Canada, Japan, and parts of the EU. Their conclusion. The wait times are longer here on the whole.

As for Canada's system handling illegal immigrants drain on the system , they handle it this way. They treat people and afterwards they check and see if they are covered under the national insurance system. If not then they bill them. The interesting thing is that because they have rational costs that are based on not having to make up for what the insurance companies skim from them is that the bill will be much lower. Also Canada as a smaller illegal immigration problem than the US, mostly, I suspect, because it is freakishly cold up there, and they don't share a border with a poor country

Consider for a moment the fact that the reason that the US border states are having a problem with immigration drains on their system is that; the only access that immigrants have to the system is the most expensive part of it - the ER, and that the system is pretty financially stressed by the insurance companies skimming a lot of their profits from them. Canada does not have these problems.

I hope this helps.

[eridani]

51. I don't believe you. Health Care for All--Washington sends people to Canada by the busload

--for prescriptions, and also for medical appointments for those who can't get insurance in the US. The doctor visits require cash on the barrelhead, but prices are half of what they are in WA state.

[wolfgangmo]

165. More information...

.. You need to give more information. From your post I can't tell if you think things are fine, if they used to be fine, if it is better here or there or anywhere.

[eridani]

45. Non-fake cases of British health care from DU 2007

Jim Wallis published the original post on the Beliefnet blog; the URL for this article is http://www.pnhp.org/news/2007/september/my_encounter_with_i.php

The waiting room was actually quite peaceful and not crowded, I noticed, as I walked up to reception. The woman at the reception desk smiled. I didn’t expect that. “Can I help you?” “Yes,” I replied, “you see, I am an American—I guess you can tell—and I’m visiting family here—my wife is British—and we’re staying with our friend the vicar, and I have a sore foot, which I normally wouldn’t worry about but we’re going away for several weeks on vacation, and I called my health care provider in the U.S., and they told me to come in here, and thought I should get an X-ray or something.” (I wondered for a moment if it would help to tell them that I was a friend of the prime minister, but decided not.) “What do you need from me?” I asked hesitantly. “Just your name and address,” she replied with another smile. “Oh …OK.” She told me it would be about 10 minutes to see the nurse. “Yeah right,” I thought to myself.
(etc.)

Comments—

Greyskye —Similar story. I was on my once-every-seven-years sabbatical on vacation by myself in Europe. While in England, I got a nasty flare-up of a condition that I had had about 5 years previously, but not since. (Turns out that stress is a trigger for this, go figure). I ended up going to a hospital in southern England. After making my explanations to the nurse at the registration desk, I saw a doctor within about 15 minutes. I was examined, and had my prescription in hand within another 20 minutes.

And it didn't cost me a dime (or a shilling), and I didn't even have to fill out a boatload of paperwork—no paperwork at all in fact. Bring on socialized medicine is all I have to say about it!

T Wolf —My college-age daughter was in Britain for a semester last year and also had an encounter with the evil of non-capitalist medicine.

She and her roommates were in Amsterdam for the weekend and a bike accident sent them to a hospital. Luckily, the injuries were relatively minor and they were soon back on the street (to retrieve their rented bicycles which were found exactly where they had left them two hours before).

The care they received was excellent and there was so little paperwork that they were amazed. All they did was show their NYU IDs and everything was taken care of.

Displacedtexan —Same story... twice. Just different illnesses. I ate a bad banger during a trip (in Avebury) and ended up in the hospital in Winchester. Semi-private emergency room. Then a private room with a sleeping couch for my husband. No charge, but we made a donation to the children's garden fund.

Years later on another trip, my 6 year old daughter had an ear infection in Uxbridge. We took her to the emergency room, where the physician came out to meet us. He treated her, recommended that we not pursue the popular tube operation because studies were showing that the scar tissue build up could cause permanent hearing loss, and he even filled the prescription himself. Again no charge, but we donated to their hospice house.

AnneD —While touring in England our vocalist developed an ear infection and ended up in the ER. No paperwork, no ID, didn't take our insurance card, got seen, got meds, in and out in 45 minutes. This bugaboo about socialized medicine is a pile of horse c***. Every country in the world spends less and its citizens have greater access to medical care then we do. We have been sold a bill of goods and this is one nurse that wishes we were fortunate enough to have socialized medicine. Nothing can be worse than what we suffer with now.

Truedelphi —Here's my experience from Norway

Flash forward to Norway, 1979. I am visiting for the summer. In my rush to get the airplane, I have left my contacts and my glasses at home. I envision the whole summer as a blur—not exactly the way I had planned on "seeing" the sights of Europe.

Schedule a visit to an ophthalmologist in Bergen. Everyone seems to speak English. I explain that I regret leaving the contacts—I cannot afford to both travel thru Europe and now pay for contacts—so I resign myself to heavy Coke style glasses.

Nope, in Europe my prescription can be obtained using these light weight and sheer glasses. Not any more expensive than my Coke styles would have been back stateside. It is several years before anyone in the USA has access to the miracle sheer glass of my European made spectacles. I hang on to them carefully until our technology FINALLY catches up to theirs.

Silverweb —Great story. The more first-person stories like this that circulate widely in the U.S., the sooner Americans will get fed up with being ripped off and abused by our current "health care" system and demand universal, single-payer health care.

[zeos3]

47. Stop it with the non-fake stuff

The apocryphal stories allow me to take the unicorn (seen elsewhere in the thread) out of the barn and go for a joyride. Let me enjoy this.

:bounce:

[eShirl]

65. horsehockey

[zeos3]

70. Here's an EXCELLENT thread on the topic

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x5076259

[Hannah Bell]

71. your alternative country with efficient privately developed roads?

let's compare.

[conscious evolution]

75. IBTS

[HughBeaumont]

116. You called it.

No country for free marketeers.

[Faryn Balyncd]

84. Are you suggesting selling off our roadways to private toll road corporations would be desirable?

[ejpoeta]

86. this is untrue

this is lies being peddled by opponents of universal healthcare. the inherent problem is that health insurance is a for profit business. so they make money by NOT covering things. Have you watched SICKO? you should. it's quite eye opening.

[Marrah_G]

90. Freeperville called- They want you to come home now.

[raccoon]

94. All you've got is anecdotal evidence from one person.

Enjoy your stay.

[Donnachaidh]

96. isn't it funny how EVERYONE against universal healthcare has an imaginary buddy/friend/cousin

that has had some sort of *gasp* horror story in another country that does have universal healthcare. That bit always amazes me.

That little fairy tale sounds more like something that could happen here, in any major city.

First the *scary* story and then the RW gumflapping point about *the government doesn't do anything right -- doesn't that scare you?* Uhh yeah -- it DID, for the last EIGHT YEARS with der Chimpenfeuhere at the helm.

Now we have a president that can actually READ without moving his lips -- NO.

[HughBeaumont]

115. It's kind of like their imaginary Canadian girlfriend when they were younger . . .

. . . now carried into adulthood as a Republican scare story.

:rofl:

[zeos3]

130. LOL

See my unicorn above. I pick up lots of chicks with it.

[Bill McBlueState]

97. So what you're saying is...

Let's accept your premise that wait times are shorter in the US. The only reason this would be the case is that a large proportion of the population doesn't use the health care system because it's too expensive.

So apparently a country chooses between:

• Short wait times for some; prohibitively expensive care for others
  
• Longer wait times for all

The second choice might be inconvenient, but the first choice is inhumane.

[leftstreet]

7. Take the Profit out of Healthcare! n/t

[jfn302]

15. You don't seem to understand.

Profit is 'income'. You take the profit out of health care, then you take all the income away from the health care providers. You are asking them to work for free.

Let's look at it from a different point of view. You profit from the work you do for whom ever you work for. We're going to remove the profit you make from that job and just give it to people who don't work. So, now, not only are your wages taxed. But, anything that was left over was just not given to you. Would you continue working?

[leftstreet]

16. I can't take you seriously

when you suggest Europeans with serious heart conditions wait a year for medical treatment.

Nice try though.

[jfn302]

19. A quote from an England Newspaper

"The Northern Echo campaign was launched six years ago at a time when UK heart patients routinely waited 18 months for heart bypass surgery. It aimed to close the gap between England and western Europe, where heart patients were operated on within three months."

It seems that they have managed to shorten the wait.

Yet, my girlfriends brother was able to be operated on the next day after they found his problem.

From my understanding, early treatment leads to full recovery. If you wait more than a couple of days, you have permanent damage that pushes you from the bypass catagory to the transplant catagory. Even here, that is a long wait that completely changes your life.

I don't think I want to wait 3 months.

Here is the link to the article in case you doubt it's authenticity.

http://archive.thenorthernecho.co.uk/2005/4/8/17279.html

[readmoreoften]

35. If you think the British system is worse than the American system, I gotta bridge to sell you.

You don't understand "profit" either. Employees do not get paid with "profit." Profit is the difference between what corporations earn for their CEOs and stockholders and what they pay for their product (health care) and their employees. Profit is not employee INCOME. That's why the stock market shoots up when a company fires 42K people or wins a battle against a union to keep wages to a minimum. Pay is kept artificially low to create profits for people who don't do anything more than bet on a company with Daddy's money.

Time to get out of Free Republic. We have the worst healthcare in the developed world. That's pretty much common knowledge.

[jfn302]

40. I do understand profit.

I own a small business. Right now, I can't employ anyone because I have no income. I go to work everyday looking for someone that wants to buy my service so that I can make a living. My profit comes from the difference between what I can charge my customers and what I pay my employees, when I have them.

Unfortunately for me, I'm in the highly competitive field of remodeling. Where I not only compete with people who have come here from other parts of the nation to take advantage of the high demand because of Hurricane Ike, but I also compete with a large population of illegals who are litterally charging 45.00 a square for roofing while I have to pay legal labor 80.00 a square. So, while I live on my 'profit' that I made more than a month ago (and it is rapidly disappearing) I steadily look for more work from American's that believe in local legal business first.

Now, my problems with illegal immigration are not yours. My problems with high competition are not yours, and I'm not asking for anyone to bail me out because I'm broke. But, if you tell doctors that they can't make a living. Look at the post above from a doctor. His business IS being a doctor. He makes his living providing medical services. Just like any other business makes the members of the business their living by selling their goods and services.

I fault no one for trying to acheive the American Dream. Why do you have the right to tell someone they have a limit on their income? Can they say the same thing to you. If so, I say you are not allowed to have a raise for the rest of your life. You earn enough. You can afford the internet, so you are much better off then the large majority of the people in the U.S.

Sounds silly huh? That is what you are asking doctors to do when you tell them they can't work to improve their life.

Now, if you read my other posts about Canada, you would see that their system is private health care with publicly funded insurance. I'm open to this discussion.

[zeos3]

50. HA! It's Joe the roofer!!

Are you serious?? You own a small business and are against Single Payer Health Care?? That's too rich! Here I thought (with all your apocryphal stories) that you just wandered the country like Caine from "Kung Fu" only NOT helping people. You just scold them for trying to suck money out of their insurers.

[wolfgangmo]

170. Well.....

OK then.

It sounds like you are trying to say that it isn't single payer that you are agin, but rather the british system.

FYI, the British system has never been seriously considered in the US except as a thought experiment. That system was instituted post WW2 in Britain so that all the country had access to medical care and the only entity in that bombed out, broke, scared country that had even close to the money to do that was the government. And so, despite being broke, they built a system that provided their all their citizens with health care.

That would not work here because unlike Britain in 1947, we have a mostly intact system of health care providers who have no interest in becoming government employees. It is only the insurance companies that need to be replaced here.

[zeos3]

22. Non Profit Organizations

When the health insurance companies were non profit entities they weren't as ridiculous in raising their prmiums or paying claims. The same goes for the hospitals.

[zeos3]

34. YOU don't seem to understand

Nobody is being asked to work for free. We should take the profit MOTIVE out of the health care industry because it DOES NOT belong there.

Let's look at it from a different point of view. I would totally NOT work!!! In your ridiculous example, I would get YOUR money and you would still be taxed on the money you're NOT making. I wold then take YOUR money and buy myself diamond teeth so I can take as many bites as I can out of the candy coated rainbow that I fly by (on my way to your job to collect your money) on my pet unicorn (pictured above).

[eridani]

52. Insurance is not CARE

The problem is for profit INSURANCE.

[Hannah Bell]

72. huh? *i* profit from the work *i* do for someone else? wait, i thought

it was the other way round?

they wouldn't hire me if they didn't make money by doing so, correct?

so they get a return on my work *above* what they pay me, yes?

[jfn302]

91. Yes, you profit.

You own a few commodities that you offer the economy.

1) your time.
2) your energy.
3) your intellect.
4) your skills.

You then bargain with people who need a combination of your available commodities.

If you sit on your butt at home, you don't get anything in exchange for your time, energy, intellect or abilities.

If you put those commodities to work, and exchange them with someone else, who either gives you some of thier commodities (ie. the doctor who provides services for a basket of eggs), or money (which is just a tool used to trade commodities with people of dis-similar needs) you earn something you didn't have before. A profit.

Just because you sell your time to a non-human entity such as a corporation does not mean that you are no longer profiting from the transaction. It just means that the corporation is also profiting from the transaction.

[Hannah Bell]

142. Actually, I lose. I work & produce goods or services worth my salary "plus."

but i only get pai my salary & my boss gets the "plus" for free.

[druidity33]

74. so, by that logic...

YOU don't seem to understand.

You think people that work at Non-Profits work for free?

:eyes:

[Name removed]

87. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Bill McBlueState]

101. Why don't you take your anti-union bullshit somewhere else?

I don't come here to read "$74/hour" talking points.

[druidity33]

184. what an a**...

I'm glad the post got deleted before i had a chance to respond.

That $74 an hour TP really chafes my hide...

I'd love a good graph that breaks down that stat.


The Mayor of Lansing was on some stupid CNN show and freaking schooled the Talking Head on that bullshit.




ugh.



Cheers mate... and btw...






THERE IS POWER IN A UNION!

[burythehatchet]

108. what are you 4 years old?

[Bluerthanblue]

120. ??"profit is income"?? bullshit- my brother has his own business

and he's allowed to pay himself a salary- (within reason) anything his business earns that goes above expenses, (which includes his pay, equipment+ depreciation, advertising, etc is the "profit")

You are either mixed up, or trying to mis-lead.

:shrug:

[AllyCat]

141. No, we take profit from leeches called insurance companies

[Wildewolfe]

144. heh...

Income is what the doctor does(n't) make when he sees patients.

Income is what the nurse makes when they work the floor

Income is even what the insurance company employees make when the work 9 to 5 doing the things they so.

Profit is what the shareholders of the insurance companies make when they deny a claim.

Oversimplified, but exactly what we're all talking about.

[wolfgangmo]

169. I run a medical clinic. You are full of c***

Profit is not income. Profit is income minus expenses, both operating, and developmental. Anything left over is profit. Businesses deal with profit. Employees do not. Private clinics run on a profit, although it is a slim one these days in the US. My staff does not run on a profit, but rather an income.

Why the straw man argument? No one is asking anyone to work for free. Especially not health care providers.

I can't decide if you are obtuse, stupid, ignorant, or a troll.

[smalll]

200. Wrong. You can take the profit out of healthcare, and still provide income for the care providers -

When Britain imposed socialized healthcare half a century ago, there was a powerful doctors lobby opposing it. So how did it get through?

As Aneurin Bevan explained later, in reference to how the Labour government won the doctors over --

"We stuffed their mouths with gold."

And to this day, British doctors still get paid quite handsomely.

We could EASLY pay doctors the extremely high incomes they currently make, and save huge amounts of money by cutting out the middlemen "insurance" folks. The health care system America has now is not socialism, and it is not capitalism. It is instead a between-two-stools perversion which represents the WORST of both systems.

[Big Blue Marble]

8. You are so right.

This is an outrage that gets little attention. Five years ago,
my husband had a major illness. We had excellent insurance coverage
and ended up paying less than three thousand out-of-pocket. Our
insurance payed their negotiated charges of eighty thousand, but what
scared the hell out of me was that if we had not had insurance the
charges would have been over two hundred and fifty thousand. This
is beyond unfair.

I certainly hope that the Obama health care reforms will put an end to
this type of theft.

[Mika]

10. I charge less.

I don't do insurance. My fees are according the the patient's ability to afford (within reason). My fees are lower because of it. I (my business) actually gets paid.

[jfn302]

14. Thank you,

Thank you for taking a step toward what is needed to fix this problem. Doctors getting away from the maintenance health care that has driven medical prices sky high.

[napi21]

11. It's very difficult to explain, but I'll try.

Hospitals make deals or contracts with insurace company and how much will be paid for each. Hospitals have expenses. The expenses that exceed the reimbursements hae to be paid by someone. The only one left is the uninsured.

That's a very simplified explaination, but none the less the way it is.

[MrModerate]

12. Health insurance companies deliver no value, but suck up a large fraction . . .

Of every health care dollar.

They are purely a legalized protection racket. They should be nationalized for 10 cents on the dollar, their CEOs and boards tossed into the streets, and their bloated staffs downsized.

The cost of retraining every single paper pusher who might get laid off would be recovered in less than a year. You'd want to extend the same benefits to billing staffs in doctors' offices, since their function would be substantially reduced as well.

[jfn302]

13. This isn't capitalism at all.

This is a huge mess that we've managed to work ourselves into over a very long time.

You may be old enough to remember not having maintenance health care insurance. It became standard to pay higher ups in companies in the late 70's maybe early 80's. I remember my mom taking me to the doctor's office and paying the 35.00 doctor's visit fee. And then at the pharmacy paying for the medication that I needed. There wasn't any insurance forms or cards to be dealt with. Fees were relatively inexpensive.

The insurance we did have was Major Medical Insurance in case something big happened that required hospitalization.

Insurance companies saw huge dollar signs in the total number of people they could enroll if they convinced unions that maintenance health care was something employees SHOULD have as part of their compensation. So, instead of just executives and high level managers having full coverage insurance, the worker bees started getting it in force.

Cash was rolling in for the insurance companies and things were good. Until mal-practice lawsuits became a new way to strike the lottery. Doctors started ordering every sort of test to make sure they hadn't missed anything to cover their rear in case the patient decided later that the doctor could have done more. This cost insurance companies through the nose.

So, insurance companies started denying claims, and forcing doctors to give 'discounts' for insurance based work. Inflation adjusted, the 100.00 'normal' doctor's visit fee doesn't go near as far the 35.00 fee in 1970. Don't believe me, check it out on the 'Inflation Calculator' at http://www.westegg.com/inflation/infl.cgi

So, discounted rates are not 'profitable'. They may be break even propositions, especially considering todays higher liability insurance premiums for doctors because of our lawsuit happy society. I know 3 gynecologists that don't practice because it cost money to see patients. They teach high school science instead in hopes that the system will be fixed through torte reform or changes to the insurance industry.

Hospitals charge a lot more for uninsured than a regular doctor's office does. The 'normal' pricing for hospital type services is very high because the insurance discounted pricing is break even at best. The profit margin for hospitals non-existent if you don't count the money kicked in by the government to cover uninsured services that were provided to emergency room visitors.

Our medical system is as far from capitalism as it can get, and people are asking for it to be even more socialized. Once the government is in control, sure prices will be fixed. But are you going to trust the low paid 'doctor' who is working for the government? People will jump ship from the medical industry like rats from a ship going down because they will have no means of advancement except thru longevity, rather than work performance.

Doctors that do a good job are in high demand now. Those doctors still manage to make a pretty good living. Doctors used to be among the top paid careers you could strive for. Now, you can make near as much as most doctors just by obtaining any mid-level manager's position. http://www.payscale.com/research/US/Job=Information_Technology_(IT)_Manager/Salary vs. http://www.payscale.com/research/US/People_with_Jobs_as_Physicians_%2F_Doctors/Salary

You will notice the average General Practice doctor only makes about 30k more per year than someone that works as a manager in the IT field. The doctor has 8 years of college, and the IT manage probably has a bachelor's degree at best, maybe a technical school degree.

Why would anyone put that much effort and that much risk into obtaining a career that they could have been paid equivalently somewhere else for not near as much effort or risk of lawsuit?

We need serious change in the system.

First, how often does the average person really need to use their maintenance health care insurance? In the 10 years I had it, I used it 3 times. So, for easy math, 600.00 a month for 10 years, my doctor's visits worked out to about 24,000.00 each. But, because my insurance was a part of my compensation package, I wasn't able to opt out of it and receive the cash instead. I was _forced_ to pay for something I had no need of.

Employers need to change their compensation systems to give an opt out option that actually benefits the people who choose to not take the insurance package.

Second, torte reform needs to happen. We need a system where the loser pays the court costs. This way frivolous lawsuits won't be brought in front of the judicial system that cost doctors and liability insurance companies millions of dollars even though they did nothing wrong. Only when there is clear evidence that the doctor was intentionally negligent should cases be brought to trial. You think your doctor isn't taking good care of you, switch to a new doctor. His/her loss of your payments for services will reduce his income and make him look at the product he provides so that he doesn't lose further customers. You are a customer, he is a business. Speak with your wallet if you think service is inadequate.

Third, deregulate. Ask any electrician if regulations increase or decrease the cost of doing commercial projects vs. doing residential projects. There are fewer regulations on residential projects, and because of the fewer rules to follow, houses are cheaper to build than commercial buildings.

Why is it that it is so much more important to be safe when you are in and out of different businesses, than it is to be safe when you are at home sleeping? Seems to me we should be safer at home while we are sleeping, therefore unaware of our surroundings, than when we are paying attention to what is going on around us.

Same problem exists for the medical industry. They are regulated to the hilt for 'our safety'. Both insurance and service providers feel the effect of the regulation. It's a massive burden. I would think that if you saw people leaving a clinic worse than they went in, you would avoid going there and find someplace that provided better care. The place would go out of business pretty quick. Medical prices could come down while still having safe healthy care provided because of all the useless duplicated and triplicated work that doctor's offices and insurance companies have to do would be removed.

Granted, currently there are the underground clinics out there that most people only see in movies. I managed to walk into one the other day. An old house converted into a clinic in the heart of an old low income neighborhood. No sign out front. No way to know it was a clinic except to be told by someone else to go inside. Places like this exist because quality health care prices have been driven sky high in the current system.

There is no over night fix, and any changes we make will take time to bear fruit. But, to maintain the best medical system in the world and not turn into something like Europe where people wait a year to see a doctor for a heart condition, we need to take steps toward the health care system we had in the past and hope capital hill doesn't see universal health care as the solution.

[Cerridwen]

41. Well, let's see...

- You know someone who has a family member who lives in England and has to wait x amount of time for life-saving surgery. Check.

- You know someone else who lived in Canada but who drove back into the US to purchase meds or services but you know nothing of Canadian health services. Check.

- You argue that for-profit hospitals are not practicing capitalism but socialism thereby proving you don't know the definition of socialism. Check.

- You argue we need "tort reform." Check.

- You argue that those "illegals" cost us too much in medical coverage and drive up the costs for the rest of us. Check.

- You manage to distill all the positive information about Cuban health care into one entry about doctors who have defected from Cuba. Check.

- You think profit and income are the same thing. Check.

- You insult many good doctors by implying the only reason doctors practice medicine is for the huge bucks. Check.

- You appear to be of the opinion that government workers can't be relied on to do an effective job and you use as an example "200 years" of road maintenance. (you might want to check that time frame.) Check.

- Did you really say "deregulate" the medical industry? That works so well. /sarcasm and Check.

- You don't like paying for something you never have to use that might benefit others. Had to call the fire department lately? Damn, man, demand a refund of your tax dollars and go out and buy a new hose. Check.

- You're spending a lot of time defending against the "evils" of socialized medicine using r/w talking point after r/w talking point.

The way I see it, either someone is paying you decent money to post this poppycock, or when your friends were giving you directions to their website and they said head over to the corner tube and hang a right - they meant your OTHER right.

[zeos3]

53. I applaud you

You actually read his post #13.

Let me summarize: Blah blah tort reform blah blah deregulate blah blah.

Check out his Joe the Roofer (made up) story.

Also, check out my awesome unicorn.

[jfn302]

55. I don't see..

..your responses to my points, simply your denigration of me.

If you had noticed my discussion on Canada's system then you would see that I am open to a discussion of single-payer-insurance.

At the time when my parent's past that they were living in Canada, it seems that both the Canadian system and ours were pretty much the same. Why my parents chose to cross the border to come back into America for health care. I don't know. I'll ask my mom in the morning.

I've not just been pounding away at the keyboard for 4 hours here. I've been reading things that these discussion have lead me to.

For instance, this comparison of the U.S. and Canadian health care systems.
http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared

Believe it or not, Canada has a private health care system. And the doctors and hospitals for the most part are For-Profit.

When I read that the federal government is closely involved in the medical system, and that 45% of all medical expenses are paid for through the federal budget. I think socialism. Now, I may be wrong. Show me examples of where the federal government is actually encouraging hospitals to be more profitable instead of demanding them to provide more and more services with out compensation.

I am not implying at all that the only reason they are in medicine is for the money. But, do you think that people in general want to be rewarded for their effort? I do. I think you work each day with the hopes of your efforts being noticed so that when a promotion or raise comes along, you are in line for it. I think doctors are the same way. I think they love what they do, they heal people. But, they also want to be compensated for the efforts they put out.

As for paying for things that I never use but might benefit others. Depends. I agree with military spending, law enforcement, fire, schools (a topic for another discussion). I don't agree with spending federal, state or city money on charity projects that should be handled by local private community organizations such as churches and out reach programs.

I don't agree in publicly funded stadiums for multi-millionaires to play in. People argue that it brings an increase in spending to the community. Ok, let the sports team ask local businesses to invest in the stadium.

I don't agree with the direct funding of private industry. Either it is something that can be profitable or it should fail. If it fails and someone else sees a way to make it profitable, they by the assests and turn the business around.

Again, I am open to the discussion of single-payer-insurance. But I want to know how some of the particulars are managed before I sign on board.

[zeos3]

59. Let me get this straight...

You don't have a problem with socialism for "military spending, law enforcement, fire, schools." Show me the efficiencies in the military budget. Show me a story where government employees are wasting our money on private jets, million dollar bathrooms, bonuses and outings at resorts. How is this NOT waste and inefficiency??

What is this?? "Show me examples of where the federal government is actually encouraging hospitals to be more profitable instead of demanding them to provide more and more services with out compensation."

What business does they govn't have telling a private company to increase profits at the expense of public health?? ...instead of "demanding" all those ridiculous "services"?

What color is the sky in your world? Will my unicorn be able to fly in it?

[jfn302]

62. So, what you are saying is.

I need to accept total socialism or nothing?

I can not have a government that spends money on the things that are mandated by the Constitution, State Constitutions, and City Founding Documents and not spend money on everything else?

I disagree. I think the expanse of government should be limited to what the founding documents allow.

You are absolutely right though. What business does the government have telling any private company how much to earn or how much it can earn?

As for the million dollar bathroom? Obama just hired the same remodeler that did that bathroom to remodel the White House. How much are we on the hook for?

The sky is blue on most days. I'm sure your unicorn would enjoy flying in it.

Now, can we have a discussion on the pro's and con's of single-payer-insurance?

[zeos3]

66. Ok, I'll bite

The Constitution mandates "...in Order to form a more perfect
Union, establish Justice, insure domestic Tranquility, provide for the
common defense, promote the general Welfare, and secure the Blessings
of Liberty to ourselves and our Posterity..."

Is there justice in half the bankruptcies being the direct result of medical bills? Isn't fixing health care promoting the general welfare as access to reasonable care is essential to life, liberty, and the pursuit of happiness? Isn't insuring the blessings of liberty preventing ourselves from falling into indentured servitude because of medical expenses?

Health care is NOT a commodity that should fall victim to the laws of supply and demand or to those who control the supply.

Call it the boogieman of Socialism if you will. I prefer to call it sanity.

[donco]

112. He seems to be acquainted with quite a few strawmen. nt

[zeos3]

125. Straw men, changing topic, repetition of talking points, etc

It's the usual BS. I felt like I had to put a pre-emptive rebuttal in my posts because I knew how he would reply.

[byrok]

132. That last line

made me spit kool ade all over the screen.

[Cerridwen]

135. Oopsie.

Sorry 'bout that. :D

[HughBeaumont]

60. I'm assuming this is your favorite book:

:eyes: :eyes: :eyes: :eyes: :eyes: :eyes: :eyes: :eyes:

You said "deregulate". UNbelievable. Yeah, because, you know, that's worked SO well for every industry it's been tried in.

[jfn302]

78. I guess

we both got completely different things from the book.

I gained an insight to what I thought about people in general. I think people are good and hard working for the most part. When given the chance, they want to do the right thing. That it was ok to believe in yourself, and believe in your abilities, and your right to make choices about yourself. That it was wrong for someone else to try to make those choices for you.

I guess you took from it just the opposite?

[HughBeaumont]

89. What I get from Libertarianism . . .

. . . is that you people are for a government that doesn't exist. That you have no problem paying for the dealing of criminals and military spending, but the rest is up to us. You don't like paying for certain things? Tough. That's the price you pay for living in the society you have. Don't drive. Don't use roads. Don't go to libraries. Don't use public schools. Refuse social security when you're eligible.

You're also under the gross misconception that everyone's situation and predictability fits into the box you decide they should have, and not what it actually IS. Tossing people out of their homes for the unfortunate crime of getting sick is unjustifiable. PERIOD. The selfish reason to pay into UHC and Social Security is so that it's THERE for YOU when you're older.

Also, I always resented the implication that all of us are poor simply because we "don't work hard enough". Many of us spend half to 3/4 of our day doing something work related; whether it's commuting, the job itself, added work from the job or schooling to improve our career prospects. We're trained to be cubeslaves almost from the time we set foot into elementary school. We're not trained to think creatively (unless it benefits your employer), but merely to regurgitate feasible solutions within an hour's time. Love of learning doesn't factor in, because the schedule given and the kind you'll have in your future fabric box doesn't allow for it.

This is why I don't believe in "If you work hard and you're really determined, you'll go FAR in life" anymore. NO. That is bullshit. That is a cliche. My dad worked hard for 40 years. All he got out of it was two kidney operations, three layoffs, a defibrilator, shaky hands, tons of meds and a soon-to-be-cut-in-half pension.

At least he was "lucky" enough that his "layoff" meant he would return to the same job when business picked up, whereas our layoff means "get out", with security escorting you from the building with everyone staring as if you embezzled money from the company or something.

I believe hard work is about a 5% determinant of a person's success in life; with personality, connections, an insane amount of luck and family fortune having far more to do with it.

Randian snake oil sounds like pie in the sky until you put it in actual practice. The result is the dysfunctional society and economy we have now, run by people who use the worst of her philosophies and that of Milton Friedman's to justify selfishness and greed. Greed kills everything it touches, and capital L Libertarianism is an amalgam of the worst aspects of all political parties combined into one loathsome and greedy package.

[Name removed]

92. Deleted message

Message removed by moderator. Click here to review the message board rules.

[FatDave]

111. !

I believe hard work is about a 5% determinant of a person's success in life; with personality, connections, an insane amount of luck and family fortune having far more to do with it.

:applause: :yourock: :applause:

[druidity33]

186. a rash and the runs?

That's what i get from Libertarianism...

[HughBeaumont]

193. Dare I ask what the Fundamentalist Right gives you?

:hide:

[druidity33]

196. heh heh, no...

If you thought "the runs" was graphic...


i'll say no more.



:)

[Hannah Bell]

73. "torte reform needs to happen" make mine choco-raspberry with cream.

[susanna]

95. I thought about that too.

After reading that post, I'm looking for a genoise/hazelnut torte with a dark chocolate ganache. I may need a doctor afterwards, if I eat the whole thing. :-)

[zeos3]

126. Tasty :-)

[wolfgangmo]

172. Why your solutions are wrong

First, insurance is shared risk to lower cost of individual risk . My allowing anyone to opt out, you create less shared risk and more cost to individuals. This is similar to the process wherein private insurance companies cherry pick the healthy and either don't enroll or deny coverage to the less healthy. This is a form of eugenics. It is a RW talking point that is written by the insurance lobby.

Second, lawsuits are the only protection that regular citizens have against big corporations. Obviously you are not on the side of the average joe. The US only has a "problem" with lawsuits because we don't have universal health insurance. The costs of ongoing care, which are a not a factor in every other developed nation, means that they don't have huge rewards BECAUSE the cost of ongoing health care is not part of any reward. Also, the number of lawsuits that actually get anywhere are astronomically small. This is a red herring.

Third, deregulation? Are you nuts. The only serious area of regulation in the US has to do with training and licensing of medical professionals. They are required to have a minimum level of training and practicum experience and then they must pass board exams to get a license. I don't know about you but I don't want to see a Doctor who graduated from "Liberty Universities College of Medical Knowledge Correspondence School - git yur degree from home in 12 weeks for only $14.95 a week." In fact we need more regulation in this country. Currently diploma mills are driving bus loads of people into phony medical degrees in the integrated and alternative fields. Naturopathic Physicians who graduate from medical schools are being slammed by diploma mill phonies because of a lack of uniform regulation in the US. I guess you could say that I don't want a dumbass for a doctor anymore than I wanted a dumbass for a president. I want both of them to be the smartest people in the room.

You seriously need to rethink your positions. I still can't tell if you are ignorant, obtuse, or a troll.

[buzzycrumbhunger]

18. I work in health care and see this all the time

The problem is not only that insurance companies negotiate lower rates, but that there are so many indigent who never pay. That leaves the rest of us suckers--including those of use who ARE insured, but have sucky coverage--to pick up the so-called slack. I actually transcribe for a system in S. CA who have negotiated with Mexico to cover their citizens for free (even had one patient they met at the border with an ambulance to take him to San Diego--this was an unemployed alcoholic here for a freakin' liver transplant, mind you). I have no idea how to address the problem of aliens, but the fact that they're coming here to have their babies, organ transplants, and routine/acute medical care via our ERs is killing the system. There's an alarming number of hospitals overwhelmed with our own citizens who are forced to use ERs as their only primary care and hospitals are closing their doors because of it. Last I heard, the last public hospital in DC was going to close for this very reason. You'd think that would put the problem right where the govt. couldn't ignore it, wouldn't you?

[Mika]

21. Weird. Cubans never pay. But they have excellent health care. More clinics and hospitals every month

Been there. Seen it.

Cuba has many of the serious social ills resolved, housing, education, health care, and that's under a "dictatorship".

Just think what we could do if we had democratic representation as good as Cuba's "dictatorship"?

[jfn302]

24. I don't think they have it quite right.

"Medical staff in Cuba
According to the World Health Organization, Cuba provides a doctor for every 170 residents,<34> and has the second highest doctor to patient ratio in the world after Italy.<35> All fiscal and administrative aspects of health care in Cuba are run by the state; no private hospitals or clinics are permitted, and medical workers are required to work for the state. Historically, Cuba has long ranked high in numbers of medical personnel; in 1957, before the revolution, it ranked third in Latin America and ahead of many European nations. Medical professionals are not paid high salaries by national or international standards. In 2002 the mean monthly salary was 261 pesos, thus 1.5 times the national mean.<36> A doctor’s salary in the late 1990s was equivalent to about US$15-20 per month in purchasing power. Therefore, many prefer to work in different occupations, generally in the lucrative tourist industry (e.g. taxi drivers), where earnings could be 50 to 60 times more.<16>

The San Francisco Chronicle, The Washington Post, and NPR have all reported on Cuban doctors defecting to other countries. <4>, <5>, <6> According to the San Francisco Chronicle, one of the reasons that Cuban doctors defect is because their salary in Cuba is only $15 per month. <7>"

This is from the Wiki on healthcare in Cuba.

I'm not sure I want my taxi cab driver doing a by-pass on my dad. He may be a very good doctor, but he's more motivated to be in the cab than in the medical office.

[zeos3]

39. So the only problem you have with Cuba

is that they don't pay their doctor's enough. I wonder if we lifted the embargo against them if their economy would expand and the state would be able to pay them more.

Edited for spelling

[jfn302]

43. The problem I have with Cuba is more.

.than the doctor's low wages. I want a political system that I can have a voice in. I want a system where I am free to decide how much money is enough for me and not have to depend on the some program for my needs. One where I am free to decide what my needs are and fulfill them on my own.

The government that has the power to give things to you can and must take those things from someone else to do so.

I want a system that I agree with the majority of the programs that they are taking my money for.

My point about the doctor's low wages is this. Do you want a doctor working on your heart that is thinking he could be driving his cab right now to buy some extra groceries for the family get together he's having this weekend? Do you think his motivation is going to be, I need to do the best job possible on this bypass, or, I need to hurry here so I can earn a few more fares to cover this weekend?

I want the doctor that doesn't have to worry about adding to his income by taking up a second job. Those doctors are totally focused on my health and don't have their attention divided by thier level of compensation.. And what does it say about a country where driving a cab which requires you to simply get a drivers lisence can earn you more than being a doctor. To me it says they care more about tourism than they do about health care.

[zeos3]

54. What the hell are you talking about?

What yo want is a deregulated insurance company telling you what kind of care you CAN'T have. What you want is a system where you have NO voice to make them accountable because you want tort reform.

You don't agree with giving yourself proper health care with YOUR tax dollars??

You own a business and don't understand this?? HA!! How many times have you gone to fix a roof and didn't understand you needed a ladder? (Rhetorical question, I know the answer)

[jfn302]

58. So,

Lets have a discussion on the single payer insurance instead of slinging insults.

I've grown to hate the insurance companies, malpractice lawyers, and any number of politicians because of our current system.

Like the doctor mentioned above. He doesn't take insurance any more and still makes a reasonable living.

The problem I have been facing is people like you don't want to talk about options. You toss out a term and leave it for granted that I have a full comprehension of it. Then you turn to insulting me and the ideas I have instead of showing me where I'm wrong.

I don't like the GOP any more than you do. Bush did everything he could to piss me off. He took more of my money than even Clinton managed to. But, I don't like the Dems either. I don't understand how Charlie Wrangle says he's fighting for the little guy, when he cheats on his taxes and then lives in 3 different rent controlled apartments that are supposed to be reserved for low income people.

I could care less for party. I care about right and wrong. So, educate me.

[zeos3]

64. Ok

Try taking a look at the responses I've given you so far.

If we remove the profit motivation from the insurers and hospitals we will save about 30% of what's being spent now. (do NOT bring up the SALARIES of doctors and nurses again because they are two different things, if you don't get this you need more help than I can give)

If we had a system like Medicare for everyone it would take care of most of our bills. There may even be room for private insurers with this to offer supplemental coverage.

You expand the risk pool by including everyone. If everyone is contributing but not everyone is using the system for major care, it will bring costs down.

The system can bargain with the hospitals (if they stay for-profit) and pharmaceutical companies to control costs.

People will be more inclined to seek preventive care or catch an illness in an earlier stage to control costs.

There's more to write but maybe you should stop ignoring these things in your "research".

[jfn302]

83. I'm not ignoring them

I'm aborbing them and trying to process them thru my long standing beliefs of individual responsibility.

As mentioned previously, I'm not sure schools should be publicly run. I tend more to the private schools with public funding idea. So, the ideas that you are proposing to me are similar in quality.

I've read most of what McCamy Taylor wrote in his discusson on Universal Health Care with Private Insurers. I agree with him on his outlook on the moral situation in America today. People that I meet on the street every day are good hard wroking people just trying to make ends meet. The majority of the people in positions of power however seem to be quite a different story. The good thing is they are relatively few. The bad thing is, they hold the positions of power.

So, McCamy's position is that for profit insurance companies are the key problem in our medical system.

You have brought up the pro's of the single-payer system. What are the con's?

[Mika]

107. The Cubans people do a voice. They are the voice. That is just why/how they have HQ ed and h-c.

What? Do you think that Cubans have world class education and health care forced upon them? I know not.

No one can say with any credibility that universal education and universal health care needs to be forced on any population. Castro didn't "give" it to them either. Together, nearly all Cubans worked hard to create the infrastructure and systems that they felt were essential for any progressive system.

The Cuban people wanted universal health care for all Cubans, and they have it. They pushed for government that represented their ideals, and organized and formed infrastructure that enabled Cubans to create a fair and complete h-c system.

The people of Cuba wanted universal education for all Cubans, and they have it. They pushed for government that represented their ideals, organized and formed infrastructure that enabled Cubans to create a complete and world class ed system, and they have it.

Cubans want to assist the world's poor with doctors and educators, instead of gun ship diplomacy.. and that is what they have done WITH their government, not at odds with their government. They have gained global respect for their endeavors (well.. almost global.. no respect from the USA).

Can Americans make this claim about their own country? I'm afraid not.


edit: examples...

Before the 1959 revolution

75% of rural dwellings were huts made from palm trees.

More than 50% had no toilets of any kind.

85% had no inside running water.

91% had no electricity.

There was only 1 doctor per 2,000 people in rural areas.

More than one-third of the rural population had intestinal parasites.

Only 4% of Cuban peasants ate meat regularly; only 1% ate fish, less than 2% eggs, 3% bread, 11% milk; none ate green vegetables.

The average annual income among peasants was $91 (1956), less than 1/3 of the national income per person.

45% of the rural population was illiterate; 44% had never attended a school.

25% of the labor force was chronically unemployed.

1 million people were illiterate ( in a population of about 5.5 million).

27% of urban children, not to speak of 61% of rural children, were not attending school.

Racial discrimination was widespread.

The public school system had deteriorated badly.

Corruption was endemic; anyone could be bought, from a Supreme Court judge to a cop.

Police brutality and torture were common.

___



After the 1959 revolution

“It is in some sense almost an anti-model,” according to Eric Swanson, the programme manager for the Bank’s Development Data Group, which compiled the WDI, a tome of almost 400 pages covering scores of economic, social, and environmental indicators.

Indeed, Cuba is living proof in many ways that the Bank’s dictum that economic growth is a pre-condition for improving the lives of the poor is over-stated, if not, downright wrong.

-

It has reduced its infant mortality rate from 11 per 1,000 births in 1990 to seven in 1999, which places it firmly in the ranks of the western industrialised nations. It now stands at six, according to Jo Ritzen, the Bank’s Vice President for Development Policy, who visited Cuba privately several months ago to see for himself.

By comparison, the infant mortality rate for Argentina stood at 18 in 1999;

Chile’s was down to ten; and Costa Rica, at 12. For the entire Latin American and Caribbean region as a whole, the average was 30 in 1999.

Similarly, the mortality rate for children under the age of five in Cuba has fallen from 13 to eight per thousand over the decade. That figure is 50% lower than the rate in Chile, the Latin American country closest to Cuba’s achievement. For the region as a whole, the average was 38 in 1999.

“Six for every 1,000 in infant mortality - the same level as Spain - is just unbelievable,” according to Ritzen, a former education minister in the Netherlands. “You observe it, and so you see that Cuba has done exceedingly well in the human development area.”

Indeed, in Ritzen’s own field, the figures tell much the same story. Net primary enrolment for both girls and boys reached 100% in 1997, up from 92% in 1990. That was as high as most developed nations - higher even than the US rate and well above 80-90% rates achieved by the most advanced Latin American countries.

“Even in education performance, Cuba’s is very much in tune with the developed world, and much higher than schools in, say, Argentina, Brazil, or Chile.”

It is no wonder, in some ways. Public spending on education in Cuba amounts to about 6.7% of gross national income, twice the proportion in other Latin American and Caribbean countries and even Singapore.

There were 12 primary school pupils for every Cuban teacher in 1997, a ratio that ranked with Sweden, rather than any other developing country. The Latin American and East Asian average was twice as high at 25 to one.

The average youth (age 15-24) illiteracy rate in Latin America and the Caribbean stands at 7%. In Cuba, the rate is zero. In Latin America, where the average is 7%, only Uruguay approaches that achievement, with one percent youth illiteracy.

“Cuba managed to reduce illiteracy from 40% to zero within ten years,” said Ritzen. “If Cuba shows that it is possible, it shifts the burden of proof to those who say it’s not possible.”

Similarly, Cuba devoted 9.1% of its gross domestic product (GDP) during the 1990s to health care, roughly equivalent to Canada’s rate. Its ratio of 5.3 doctors per 1,000 people was the highest in the world.

The question that these statistics pose, of course, is whether the Cuban experience can be replicated. The answer given here is probably not.

“What does it, is the incredible dedication,” according to Wayne Smith, who was head of the US Interests Section in Havana in the late 1970s and early 1980s and has travelled to the island many times since.

[wolfgangmo]

173. You want a system where a doc doesn't need a second job.

Like Canada. A recent study compared the average time primary care doctors in Canada and the US spend their time.

Canadian doctors spend 35 hours in direct patient care per week as do US doctors. The Canadian doctors then go home, spend time studying and researching and attending seminars to learn new skills and research. The US doctors spend another 35 hours per week writing letters, making phone calls, and otherwise justifying their medical decisions to private insurance companies in order to get paid.

This leaves the Canadian doctors better prepared, more up on the latest research, and more rested and less likely to make medical mistakes, whereas the average US doc is stressed out and overworked.

Which system do you prefer? Let me guess, you want to sprinkle libertarian pixie dust on the problem and let the market figure it out. Why, if the patients could only decide then the good doctors would be rewarded and the bad ones would be punished and eventually go out of business.

The problem with libertarian pixie dust is that it ignores reality. First of all sick people should not have to decide, while they are sick, which doctor is good and which is not. Second of all bad doctors would not go out of business, they would just move and then inflict themselves on people who don't know them. This is why we need strong licensing laws for docs.

[Mika]

103. A tiny percentage of Cuba's DR have "defected".

Out of the many tens of thousands of Cuban DRs who, over decades, have served all over the world with Cuba's famous medical brigades, only a few dozen have "defected", so that aspect of the report is way overblown out of proportion (just anti Cuba blather). The medical brain drain out of Canada (for instance) is far greater. The main reason for medical brain drain from foreign countries to the US is for greater earnings.

One thing I know about the Cuban medical system is that the GPs and specialists graduate with ZERO debt, and their practice costs them NOTHING to set up.

I've been to Cuba many times on seminars/tours, training exchanges, and missions. I'm very familiar with their systems.

[buzzycrumbhunger]

33. If you get Showtime,

they're running Sicko this month. Between France and Cuba, the US looks pathetic. It's no wonder Moore is reviled by the right wingers because if they admitted he wasn't just making this shit up, they'd have to acknowledge everything that's wrong here.

Ours is the only developed country with a system like this--and Cuba isn't the only marginal country that surpasses us.

[readmoreoften]

37. How come I never see any of this on the Texas border?

Sorry, I ain't buyin' it. I see poor people with no insurance suffering from preventable illness like MRSA around here with little help from anyone...

[old mark]

42. Rec. Those who need it most are routinely denied insurance,

and then overcharged by the medical profession for sub standard care.

I had bypass surgery 5 years ago and searched for almost 2 years for an insurance company that would even accept me at all, much less one that I could afford (Blue Cross would take me - for $800 a month).

I finally got into a PA state sponsored program that I can afford. The monthly charge has increased twice in the 8 months I have had the coverage.
Everyone involved in the healthcare racket in the US seems to have a fierce need to get very rich.
(Except nurses.)

mark

[Vinca]

80. You captured the health insurance industry perfectly in 1 word: racket.

They cherry pick the young and healthy, gouge the middle aged and healthy and toss anyone older or with any history to the side of the road.

[4lbs]

63. To the OP (jfn302), I think you are misinterpreting your own stuff.

You say a UK junior doctor makes only 20,000 pounds a year to start. Based on current exchange rates, that's about $29,000 US Dollars.

Well, guess what a "UK junior doctor" is? A freaking intern! That's right, a fresh out of medical school intern. You expect those guys to make six figures right out of medical school? No way.

Guess what a US medical doctor intern makes? About $32,000 on average.

So, $29,000 US Dollars in the UK compared to $32,000 US Dollars in America.

Pretty comparable eh?

Then after their two years, they become a resident. That's when their salaries increase significantly.

After some more time, they can become specialized surgeons, where salaries of $250K USD and higher are possible.

[durablend]

77. Don't waste your time

He only knows what Rush told him

[jfn302]

93. Thank you..

for making a good comparison between our system and thiers.

[Hannah Bell]

67. Because the owning class makes the rules, & you're not in it.

[stray cat]

81. The people I know who didn't have insurance all appealed and got it discounted lower than insurance

[Laelth]

85. Blood sucking leeches that we can no longer afford. Yep.

The United States is a LIBERAL Country.

:dem:

-Laelth

[elizfeelinggreat]

102. k & r

[leftchick]

104. It NEVER should have been allowed to be a "profit driven industry"

It should be a right, like in most civilized nations.

[librechik]

106. Yes, it is no more humane to profit from disease and injury than it is to profit from war.

The Pukkkes have struggled mightily to turn that moral truth around and sneak private profits into both.

And they have succeeded beyond anyone's nightmares.

[bobbert]

105. because more than half of them don't pay

Yes, that's how much they 'charge', but how much of that do they actually receive? Any patient that goes to the ER without insurance, it's expected that they will never pay their bill. If 1/10 pay their bill then they might be close to breaking even.

People come in with medical insurance, they charge a low price and they make money.

People come in without medical insurance, they charge a high price and still lose millions of dollars a year.

[Faryn Balyncd]

119. You seem to be saying that the cost of indigent care should be born by those DENIED INSURANCE who...

...actually desire to pay their own way.

In the 3rd link in the original post, Rick Casey of the Houston Chronicle reports on the case of custodian Allan Barnett, whom Northwest Hospital in Houston billed for $67,000 for 2 outpatient lithotripsy treatments (external non-invasive shock-wave therapy for kidney stones). Northwest Hospital would gladly have accepted $8200 as full payment from his insurance company (before they denied the claim).

Why should Mr. Barnett be expected to pay an 800+% surcharge to pay for indigent and other non-paying patients, and let insured patient's INSURANCE COMPANIES pay what some have claimed is a "break-even" or low margin price (assuming Northwest Hospital actually provides lithotripsy to non-paying patients)?

Why should patients without insurance be offered a measley 20% cash, pay-in advance "discount" by many hospitals, when insurance companies (who certainly don't pay in advance, (or even on the first or second billing) are offered a 50% to 80% "discount"?

And what per cent of paying, uninsured patients are uninsured precisely BECAUSE they have been DENIED INSURANCE, or had their insurance canceled?

So why should an Allan Barnett be expected to pay for non-paying patients, while the (often late-paying or downright deadbeat) insurance companies, and only the insurance companies, get the real "discounted" price?

You have a point: Somebody must (and does) bear the cost of indigent and non-paying patients.

But is this the kind of market pricing of which Adam Smith would have been proud?

[Downwinder]

183. 20%??

All they allowed me was 10%. Then after I went broke--well what do they say about turnips. Said I needed 1 more $2,500.00 MRI before they would give me a diagnosis. Told them that wasn't in the budget. Signed up on SSI and got a diagnosis on Medicaid.

[Bluerthanblue]

121. then why not charge those of us who are excluded from the "elite" insured

who DO pay- often for months and years through the nose- the same price your insurance co. brokered to pay???

Why should those of us who are being discriminated against and (either going without care because of $ or going without other necessities to pay our medical bill), pay for those in society who default on their debts- while the 'insured' don't have to bear this burden as well???

[bobbert]

190. .

Should it be the insured and have them pay in their monthly costs? I'm sure it's a lot of that too, everyone pays for them.

I think the idea is, if you offer those people a 'discount' to what the insurance company pays (or a little more), it would seem like a great thing and they are more likely to get payment. Also, the insurance company likes getting their 'discount' which is still profitable for the hospital.

Also, if you have insurance you are in a group that is more likely to be paying their bills on time (as in health insurance premium) so when you are paying without insurance you also have to help cover the cost of collection agencies.

It really is a broken system, but it's all privatized so it's not going to change for a while.

[burythehatchet]

109. WElcome to my hell

I've been screaming about this for 20 year now. I feel in my bones that the system is about to collapse whatever we do.

[Bluerthanblue]

117. because we can't strike deals with insurance companies- it sucks

it REALLY sucks-

but that is the reasoning i've been given. Hows that for kicking you when you're down.

:shrug:

[newtothegame]

123. A few thoughts in response..

"An opaque system in which whatever prices a hospital will choose to charge for a particular diagnostic code is a protected proprietary secret?

A system where Americans who have been DENIED INSURANCE are then subjected to fantasy "normal rates" of 250% to 400% (or sometimes 600%) higher than the (still profitable) "discounted" rates charged to insurance companies?"

I am a healthcare executive in a rural hospital in Iowa. I will attempt to explain what happens...

We lose money on every single patient that has a government payer. Every single one. Medicare, Medicaid, SCHIP, all of it. Vast amounts of money. We are reimbursed at less than 50% of our COST ALOT of the time. And the government is constantly trying to lower this reimbursement evern more. This is why I get scared when people talk about putting EVERYONE on healthcare with a government payer. I am all for universal insurance. But if we can't afford a PORTION of our patients being from government payors, we would outright have to shutdown within a MONTH if all our patients were reimbursed that way. And you can forget about ANY upgrades on technology, methods of care, etc.
The only way we make up the massive losses from government payers and don't close down after the end of each fiscal year is that we charge MORE to those with commercial and private payers. And on the commercial, a few companies have consolidated power (the Blues) so much that they can negotiate rates that are low enough that we're barely covering costs as well. And there's nothing we can do because we have to serve those patients. So, those on private pay (including those denied insurance) get charged exhorbitant rates to help us break even. Keep in mind, break even means no money to upgrade equipment technology, educate physicians, recruit new clinicians when our meager salaries fail to retain our currently employed ones.

That's the answer to your "why" question, at least for us.

[Faryn Balyncd]

134. When Americans denied insurance are forced into bankruptcy by rates you ADMIT are "EXORBITANT"- - -

...how do you feel about having given "the Blues" rates that "are barely covering costs" because "we have to serve those patients"?

How do you feel about caving into to the "consolidated power" of "the Blues", and then sticking it to the poor soul who has been denied insurance, or even dropped by "the Blues" with rates you admit are "exorbitant", simply because uninsured patients (including those denied insurance and wanting to pay their way) do not have the "consolidated power" to negotiate fair and just rates?

When the robber barons controlling the railroads in 19th century America used their raw power to gouge independent farmers, did we lie down and take it (or, as in your case, rationalize admittedly "exorbitant" pricing discrimination against the less powerful?)

Or did Americans create the Interstate Commerce Commission to outlaw such discriminatory and predatory pricing.

Whose side are you on?

Are you on the side of Americans who stand up for justice and fairness, or do you favor rationalizing the actions of pirates?

[newtothegame]

140. Your post is very hard to read, but I'll try to sort through it...

I'm not sure if you're asking us to turn down patients from Blue Cross Blue Shield? We're a community hospital; are you really asking us to turn down the majority of the community? And if not, what are you asking us to do? If you're asking us to get higher rates from BCBS so we don't have to charge personal, or self-payers, so much, don't you think we've tried? It's called a negotiation; we're going to try to get the highest rate we can, they're going to try to give us the lowest rate they can. What exactly are you asking me? You were the one who asked a question, I answered it.

ed for sp

[Faryn Balyncd]

143. The last I heard, Blue Cross/Blue Shield IS a "private payer".

[newtothegame]

145. Edited to please you Sweetheart. Hugs and kisses. :)

But you still haven't answered my question as to what you're exactly proposing for us? You wanted to know why self-payers, including those denied insurance, are charged so much, I've given you an answer. However, I still can't pick through your post; I can't tell what's a question and what's a statement.

[Faryn Balyncd]

151. Q: "What exactly are you asking me?"

A: I am appealing to your sense of fairness.

You state you attempt to get "the highest rate we can." At the risk of making my case more difficult, I imagine your statement might be a bit hyperbolic. My guess is that you (a heartland hospital administrator) carry into your negotiations, and elsewhere into your life, a sense of justice and other values, in addition to the laudable (and necessary) value of making a profit.

I would imagine you value your ideals at least as much as I.

And, in my business, while I constantly strive for profitability, the "highest rate" obtainable is not the optimal target. Frequently, the "highest rate" which can be obtained in negotiations is not even the most profitable, in the long run, as such a rate may lead to an erosion of future business. And many other values enter into one's business, or professional, decisions besides the "highest rate".

And I would imagine that hospital administrators share such an outlook.

Yet it would appear that our current opaque & discriminatory pricing system is both unhealthy for sustainable profitability of healthcare enterprises as it is offensive to American sense of fair-play.

At what point does discriminatory pricing become offensive? Certainly that is difficult to determine.

I do not know what your specific prices are at your rural Iowa hospital. (I would suppose they may be less onerous that the 800% differential between contracted insurance pricing and the "full pay" rate for outpatient lithotripsy which Northwest Hospital in Houston, Texas demanded from custodian Allan Barnett, after his insurance company denied the claim.)

But, it would seem to me, that when those denied insurance are asked to pay 250% to 400% more than a somewhat profitable price paid by a private insurer, that some sort of a line has been crossed.

In the culture of hospital emergency departments, uninsured, indigent, and non-paying patients may sometimes be viewed as monolithic. And it is sometimes tempting for hospital personnel to think of them as deadbeats, freeloaders, or thieves.

But when one who has been DENIED insurance is billed at rates even the hospital administrator terms "exorbitant", and is billed 250% to 400% (if not 800%) more than the insurance company, just who is it that deserves to be thought of as a freeloader, a gouger, a pirate, or a thief?



So, what am I asking of health care providers?

I would think that transparent and non-discriminatory pricing would be a good start.

[newtothegame]

152. Transparent and non-discminatory pricing would be a GREAT start...

And although it would make some hospitals look horrible, it would open the public's eyes to the sad state of the system and it's root causes. It would almost need to be mandated though, because no hospital is going to do it unless other hospitals are doing it, and so whose willing to be the first out there alone?

I see this coming, hopefully, because the government is already making quality data public.

[Faryn Balyncd]

153. I think you're on to something there.....

"It would almost need to be mandated though, because no hospital is going to do it unless other hospitals are doing it, and so whose willing to be the first out there alone?"

[steelyboo]

160. a question

from what you wrote, it seems the costs (the suppliers, the labs, the equipment manufacturers, drug companies) are too high for your hospital to run at a profit. Is there something else that causes you to charge such overpriced amounts? The situation as you explained it alludes to the same problem the defense dept. (remember 300 dollar hammers and 1000 dollar toilet seats?) has: Namely, greedy cocksuckers who provide you with the goods and services you need to do your job are charging outrageous amounts for said goods/services. In turn, you have to pass on that cost so that your business doesn't go broke. As a community hospital, you likely cannot apply any bargaining power with the suppliers, because what are you going to do? Go to another supplier? Good old Corporatism and its practice of economic Darwinism took care of the competiton. So you're stuck selling the patients 300 dollar bedpans that cost 10 bucks to make.
This is why single payer is needed: The government would be the only customer and would therefore be able to better negotiate terms with suppliers. What are suppliers gonna do? pack up shop? Fuck 'em. Think another supplier won't pop up to replace them? Think they are stupid enough to allow a 300 million patient market, who are world reknown for their shitty state of health, just fall to the wayside because instead of 90 cents on the dollar profit, they will only make 10 cents?
I'm not tryin' to rag on you, I'm trying to understand why your costs are so high that you apparently are bleeding capital and have to charge ridiculous rates to make ends meet.

[wolfgangmo]

174. So would you feel more comfortable if medicare was funded appropriately?

In Canada hospital administrators, doctors, nurses, etc sit down with the single payer and negotiate EVERY YEAR an appropriate amount to get paid. Every year.

The current medicare systems have been systematically underfunded since Reagan.

If you could get reimbursed appropriately would you feel better about the system. From a financial point of view, and from one clinic manager to another, the US spends TWICE as much per person than Canada does. That means that we could afford quite a bit more than a theoretical 100% and still have money left over.

Final thought. The Canadian government, through the Provinces subsidize the rural hospitals in recognition that they are providing services in difficult circumstances. How would you like that?

[newtothegame]

178. I'm not arguing against universal care :) The OP merely asked WHY we charge personal payers...

what we do, and I answered.

[wolfgangmo]

197. I get that. I really do.

I was hoping you would take a moment and comment on a government system that was adequately funded. Would that be feasible for your clinic. I am convinced that my clinic might lose a little income under universal care , but all of our staff including medical director are 100% for it.

And what if medicare got funded at over 100% of current rates which is very feasible given the disparity between what we spend and what we get as a nation ?

[newtothegame]

201. I'm not sure if we would lose income or not...

What I do know is that the government can't properly fund the current proportion of Medicare/Medicaid patients, so the system will need a 100% overall to fund EVERYONE that way. The models are out there to follow though, if the people can speak louder than the pharms/insurance companies.

[harun]

127. Some hospitals are better than others. One I go to won't charge interest

on outstanding balances and will never send to collection agencies. Give good rates on things too.

[debbierlus]

129. Yes, we need single payer health insurance for all

It will happen. They can try the MA model (the state in which I live, mandated health insurance, it will be bankrupt in two years since it fails to address the profiteering of insurance companies). The insurance companies are overreaching so far, they will break the entire system, and a universal single payer system will be the only viable option left. Too bad the country will have to crash before change happens.

[WoodyD]

131. Every dollar spent on insurance

is a dollar that could be going to healthcare instead. Insurance provides nothing but a layer of bureaucracy between you and health care. They will deny any claim they possibly can, because they don't make money by covering health care. They make money by denying coverage.

Let's take every dollar currently going for insurance paperwork and CEO's salaries and put it toward actual healthcare.

And I have a Canadian friend whose son has severe asthma. We keep inviting them to visit us, but they won't leave the country for fear that their son will need healthcare while they're in the US.

[bobbolink]

133. Because WE allow it. When we DEMAND single-payer health care, we will get it.

And not a moment sooner.

We complain to each other, rather than standing up to the powers that be. It's time to recognize our complicity in this.

[orbitalman]

138. Much of Insurance, medical or otherwise ...

is an outright fraud.

[davsand]

146. The hospital bean counters and admins will argue that they don't make any money on Gov pay patients.

The hospital folks will tell you they are losing their shirts on government covered patients. They call it "Medicare and Medicaid shortfalls." When it is a negotiated DISCOUNT rate with insurance companies it is ok, but somehow the hospitals all seem to think they are getting screwed by the government and the Chargemaster they use.

Personally, I am also really bothered by the fact that the insurance companies and the hospital accountants making determinations about what treatment is and is not covered. It boils down to cost benefit rather than what is needed by the patient, and THAT kind of decision needs to be made by the patient and the Doc--nobody else. (Same thing goes for prescription drug coverage, but that is for a different day...)

Hospitals are big business, and you cannot ever forget it. I don't care if it is the Catholic "St. _______ Hospital for the Poor" it is STILL being run as a profit center for somebody in most cases. The days of the nuns sitting around the cafeteria table talking about who needs help the most have been done and gone for a long time. Policy decisions and discussions about charity care are are made by accountants and hospital administrators who make salaries comparable to corporate execs. Those same folks are the ones, very often, who make the policy decisions about who gets sent to collections and who get treatment in that hospital. It is mercenary as hell and it is our reality in this nation.

The old argument about "rationing" of health care" in single payer systems is so bogus it should make every one of you fall out of your chair laughing. Do you honestly think that 40,000,000 people without insurance have access to health care--at all? We have people in this country who are sitting at home with life threatening illness who are trying to decide if they are willing to go into indentured servitude or just die at home. We have people DYING every day in this country because they can't afford to go to the hospital in an emergency. Make no mistake--we DO have rationed health care RIGHT NOW and it is rationed by economic status.



Laura

[Bette Noir]

147. Just another reason that profit should have no place in healthcare.

[Contrary1]

149. Many years ago, an x-ray detected a growth on my left lung...

I had just turned 18, and had been dropped from my parents' health insurance plan. I remember the panicked look on my mother's face when the surgeon told her that he could not even cut me open for less than $5,000.

She told him it would take a few days, but that she would cash in the savings bonds and take out a second mortgage on our almost paid for house.

On the morning of the surgery, the doctor told my parents not to worry about the cost, something would be worked out. I was in the hospital for 11 days altogether.

The bills started coming in a couple weeks later. My mother almost fell out of her chair, when she realized that all the charges; except for the anesthesia, han been discounted by 50%.

I don't know how he talked the hospital into that, but I will never forget his kindness to my family.

Sadly, the days of showing compassion such as this are long gone.

(It was a very large benign cyst.)

[Wizard777]

150. This is to ensure that you cannot afford healthcare and you buy insurance instead.

[zipplewrath]

154. It is outta whack

What is happening here is strange, but there are "free market" examples. These kinds of odd pricing structures were common in airline tickets for some time. Two different people paying whole integer multiple differences in prices for basically the "same seat". UNLIKE the current healthcare system however, it was those MOST able to pay the higher rates that did. In our healthcare system, it is those LEAST able to pay. A friend who is quite wealth (and therefore is basically self insured, only has truly catastrophic insurance) regularly has to sit down and negotiate the price with healthcare providers. They tend to be very negotiable. Hospitals tend to be vastly more interested in TIMELY payment than anything else. That is the reason that insurance companies can negotiate lower rates (well one of many really). They promise certain payment speeds and methods advantageous to the hospitals. With private providers, many are actually interested in payment over time. (basically, they get to charge more).

Single payer has many advantages, and inverting this system is only one of them. It is also not the only way to invert this system. One immediate step would be a patients bill of rights which addresses these needs immediately.

[Faryn Balyncd]

156. I like your idea of a "Patient's Bill of Rights", & think TRANSPARENT, NON-DISCRIMINATORY pricing...

....need to be included.

The American Hospital Association has a "Patient's Bill of Rights" posted at:
http://www.patienttalk.info/AHA-Patient_Bill_of_Rights.htm


Not surprisingly, transparency and non-dicriminatory pricing are NOT mentioned.

In the entire 1400 word document, the only mention of billing and charges is this terse statement:

"The patient has the right to be informed of the hospital's charges for services and available payment methods."

And yet if one were to think that this might mean that charges were to be transparent, that one could find out what your charges would be in advance for a particular service, or for a Tylenol, or what items might occur on your emergency department or inpatient bill, or God Forbid, look at a price list for the hospitals charges for various diagnostic or procedural codes, or expect to be able to pay the same price as an insurance company, or pay 120% of the price paid by same company, or 150%, or 200%, one may be sorely disappointed.



In what other business does one walk in the door, be required to sign a statement of personal, individual liability for an unlimited and unknown set of charges, have those charges incurred by decisions of numerous people you neither see, consult with, or even know of their existance, are denied the right to see a list of charges in advance, or to know what other members of the public are charged for the same service, and are held responsible for the bill under threat of lien against your homestead, and denied access to Chapter 11 bankruptcy by politicians paid by lobbyists of said business (even as most bankrupties have been caused by individuals entrapped by that very same industry?????????


Americans would not put up with opaque, non-transparent pricing in any other line of business.


By what logic should we accept such practices in medicine?

[zipplewrath]

161. Charge all the same

I'm not saying you can't charge people differently based upon whether they accept some services, or pay over time, or buy in bulk to some extent. But just charging retail because they can't negotiate a lower price is absurd. If HMO is paying in advance for services, yes they'll get a discount. But patients must be advised of their ability to ALSO pay in advance and get a discount.

[wolfgangmo]

176. Small problem with transparency.

It would be suicide to do this without getting rid of or regulating the insurance industry. If they got ahold of that data they would move profits for doctors and hospitals to zero in about a day. This is why they don't publish this information so that the bloodsuckers at the insurance companies don't carve them up like a turkey at thanksgiving.

You want transparency, get single payer.

[Faryn Balyncd]

182. I think you are on to something......... (Single Payer)

Meanwhile, our present insurance system, like our banking system, has undergone a malignant transformation in recent decades.

Historically, medical prices ONCE WERE fairly transparent, and non-discriminatory.

But this all changed with the intense insurance negotiations involving PPO's, HMO's, and other managed care contracts which have dominated the scene since the 1980's.

The theory behind all of HMO's sounded wonderful (prevent illness, keep patients healthy).

But the reality is that insurance companies, rather than distributing risk, have assiduously avoided the most medically needy portion of the population, and the results of those policies has been good for insurance CEO's bonuses, but bad for America both economically and socially.

For all this, insurance companies extract a 31% cut for administration. Approximately twice what other nation's, and our own Medicare system, costs in administration.

And our insurance system now yields inferior reults, even though we spend a much higher % of GDP (17%)on medical care than other nations.

Can we now afford to cover all of our uninsured while still paying insurance companies their 31% cut for their CEO bonuses, while they cherry pick the population to cover only the healthy?

Insurance companies, to paraphrase Ronald Reagan, are not solving the problem. Insurance companies ARE the problem.

[wolfgangmo]

198. Small quibble.

I agree with you on all of your points except one.

The developed country with the next highest administrative cost after the US (I have read studied estimates of an AVERAGE administrative overhead (which is insurance-speak for bonuses, CEO salaries, private planes and exotic corporate "retreats")of between 29 and 31%) is Canada with an administrative overhead of 7%.

That means that we have costs about 4.5 times AKA 450% higher than any other country on the planet. And we don't even get everyone covered for that. And let's not factor in the leading cause of bankruptcy... It makes my blood boil.

I'd call my congress critter but mine is called Michelle Bachmann. I swear I must have done something bad in a previous life.

[Blue_Tires]

157. one word: RACKET

[Kurovski]

159. K&R. (nt)

[valerief]

162. I wish we lived in one of those civilized countries who provide health care. Fuck insurance.

I want tax paid care. You know, like the President and Congress and Supreme Court get.

[BrklynLiberal]

164. And whenever they can deny payment, they will.....and let you fight hoping you give up.

or die.
Insurance companies are as bad as the banks and big oil and big pharma. They are all crooks..out and out crooks.

[county worker]

168. Rates are not "charged" to insurance companies.

A medical practice negotiates with insurance companies for a fee schedule. If the fee schedule is satisfactory then the practice contracts with the insurance company. They don't have to. In such a case the practice does not accept the insurance and the patient is charged the billing rate but the practice usually accepts less.

Generally an insurance company pays something just above or just below medicare rates.

Usually what an insurance company pays just barely covers the costs of the procedure plus what the doctor is paid. Many times the doctor is paid a percentage of the cash he generates. About 46% is common.

So if a procedure is billed at $150 and medicare pays $80 for it an insurance company may pay $100. The doctor gets $46 and the rest has to cover all other operating costs. An insured person is usually charged the $150 but pays the medicare rate of $80.

At least that is how it worked at the clinic where I was controller. The costs of doing the procedure exhists whether someone pays or not. If enough people don't pay the practice goes out of business.

[rambler_american]

171. Not to doubt your premise

but just to tell another side of this story.
Until about a year ago I worked in the billing department of a small New Hampshire hospital. ALL uninsured patients were given a discount similar to those given to the insurance companies. And a very large nearby hospital has a similar policy. And at most NH hospitals patients unable to pay at all may apply for financial assistance and have anywhere from 25% to 100% of their debt forgiven. Not all hospitals suck blood from their patients.
I still support universal single payer insurance.

[Faryn Balyncd]

180. You are right...... (not all hospitals are blood suckers).....

(...Not all hospitals are blood suckers.)

And the arrangements you describe in New Hampshire make sense, and describe what was once common practice throughout the nation.

And it is true that patient's unable to pay many times can arrange to have their debt forgiven.

And yet many times patient's are unable to extricate themselves from unjust bills unless and until they find a sympathetic journalist willing to expose the offensive billing practices of even our most prestigious hospitals.

Yale-New Haven Hospital,the teaching hospital of Yale University only stopped home foreclosure threats against 170 patients, and forgave the $38,000, 1982 bill incurred by a widower's DECEASED WIFE 25 years earlier, when they were embarrassed by a Wall Street Journal profile of their billing practices.

Other institutions can be more obstinate. When Rick Casey of the Houston Chronicle published a story describing how Northwest Hospital in Houston, Texas billed custodian Allan Barnett $78,000 for 2 outpatient lithotripsy treatments (external, non-invasive shockwave treatment of kidney stones), after his insurance company denied the claim (The in full price charged to the insurance company for the outpatient treatment was a "discounted' $8200). Yet, even after extensive negative publicity for the hospital, even after the urologist agreed to accept the "reduced" price, Northwest Hospital held firm, and would not accept the "reduced" price ($8200) from the patient. This case was finally settled, as reported by the Chronicle, when thew patient won an appeal against the insurance company, and the insurance company finally paid the bill.

Such behavior,& an 800% premium charged to uninsured patients, stretches the limits of credibility, yet the 2 links in the original post show that the excess charges billed by hospitals to uninsured patients (many of whom are uninsured because they are denied coverage for preexisting conditions, or who are dropped by their insurance companies) is in the range of 250% to 400% nationwide.

Accurate reporting on this is impeded because hospitals and insurance companies regard their prices and negotiated "discounts" as proprietary information, and will not divulge the details of a pricing system that they would find embarrassing.

But should not medical pricing routinely be transparent, and non-discriminatory?

And should not patients denied insurance coverage be able to access fair pricing (ie, the still profitable, supposedly "discounted" price charged Blue Cross and other insurance companies) as a matter of policy, and not just when they can engage a friendly Wall Street Journal or Houston Chronicle reporter?

And should not an American citizen who has been denied insurance, but who may not meet hospital criteria for "indigence", also be able to pay a fair price (rather than a 250% to 600% inflated "regular" price) as a matter of justice, not simply if he runs in to a kind-hearted hospital billing department in New Hampshire?

[wolfgangmo]

199. This is a great example of...

... what happens when what were previously non-profit or community hospitals become privatized. They are beholden to stockholders and share prices. Of course they will squeeze everyone they can. The standard practice seems to be to deny coverage, put the bill into collections, and hope the patient dies or gives up.

This is not a new thing exactly. Does anyone here remember the movie The Rainmaker?

[Prophet 451]

177. Because they can

It's fairly simple really: The provider to a captive market (which is everyone, when the product is healthcare) charges whatever they can get away with.

[McCamy Taylor]

179. For profits collect premiums from healthy people and illegally disenroll or deny coverage to sick

people. They also delay paying out claims for months to years to collect interest. They deny claims which they are obligated to pay and only rarely does an insurance board or court force them to cough up the money. They try to force doctors who treat sick people off their plans and force patients who have medical problem off their plans.

The ideal universe for a for profit insurance company is one in which the government insures everyone with a health problem and they collect all the premiums from everyone who will never see a doctor. They spend all their time and resources making this dream come true.

I have spent enough years in medicine and dealt with enough for profits to know that this is how insurance works. Anyone who tells you something different is a mole working for private insurance and that person is lying. There is no other money making strategy right now for the for profits. Cherry pick, collect premiums and deny payment is the only system they know----along with buying politicians and regulators.

It will not be long before they start hiring contract killers to murder their sickest, most expensive members. I would not be surprised if they are doing it already.

[Kansas Wyatt]

191. Contract killers? No, they just deny treatment for their problem members....

And then their problem members die off.
Insurance Companies: 'Well, you have the right to appeal our decision with our arbitrator and fight us every step of the way for years, or you can accept our decision and die.'

Which is exactly why insurance companies do not belong anywhere near health care.

[McCamy Taylor]

181. But to answer your question, I think that some hospitals jack up the rates so that they can bill the

government more. I took my son who was on private insurance to a public hospital, because it was closest when he was having an asthma attack and all they did was an updraft with albuterol and then sell him a autochamber devise at their pharmacy to go with his hand held nebulizer. No monitering, no lab, it took us forever to be seen. It should have been a couple of hundred dollars max even if they were rip off artists.

The bill was two thousand dollars.

The insurance we had at the time was a total rip off scam that would refuse to pay anything. So, of course, they did not want to pay the emergency room, which wanted me to pay two thousand dollars for that updraft.

Like hell I was going to pay two thousand dollars for an updraft at the hospital where I did my internship and residency. I bitched until I got to someone high enough to take care of the problem.

I also collected enough info on my insurance company to successfully send the state insurance board after them for an illegal pattern of failure to pay for covered services (it is easier to detect these things if you are a health care provider yourself, I guess) but that is another story.

However, I think what it shows is that if the hospital in question does most of its business with the government through Medicare or Medicaid, it will jack up its rates so that it can get the maximum from the government, figuring that it will not drive away any self pay patients, since none of them will show up anyway. The moral is that self pay patients had better steer clear of teaching hospitals and public hospitals, because they will try to charge you two thousand dollars for an updraft.

I also remember that when I was in medical school at Parkland in Dallas, the self pay rates were supposed to be exorbitant. Of course, almost no one there was paying for their care. But if we had anyone with money but without insurance, we were supposed to get them out fast, because the rates were so high.

[Faryn Balyncd]

192. Your $2000 albuterol is a story to go with Allan Barnett's $78,000 lithotripsy

(http://www.chron.com/CDA/archives/archive.mpl?id=2003_3679711 )

Thanks for sharing.

[Grinchie]

187. Shhh... Your not supposed to noticed that they Obfuscate everything on purpose

Not only that, it helps when the billing system is written using offshore IT firms like Satyam and Infosys that produce incomprehensible, undocumented Medical Billing Software that has little to no documentation. The outsourcing of the software allows the insurance companies and HMO's to point the finger elsewhere, because everyone that you can talk to about billing is just a befuddled as you are.

The truth of the matter is that Health is our own responsibility, and the medical system knows this. I am not talking about broken bones, or other accidental trauma, but for the general health that we maintain, we are responsible.

When people realize that the desired Social Insurance has been bastardized into the Auto Insurance model, where higher risk patients pay more, instead of everyone paying the same and helping those that need it more, maybe then they will start seeing the exhorbitant costs for what they really are... Unsustainable, and of little benefit. They need to just refuse to pay for the exhorbitant fees in protest ans watch as these HMO's and Hospitals die a self imposed slow death.

The make work policies of the U.S. -- Creating jobs that really serve no other purpose than a means of redistributing wealth to the Government via taxes on payroll needs to stop.

http://video.google.com/videoplay?docid=-8506668136396723343">Bruce Lipton - The New Biology - Where Mind and Matter Meet 1of 2.avi
I came across this video the other day and Mr. Lipton explains the philosophy of taking control of your health in a very concise, understandable manner. It touches on what scientists no and don't know, and explains the complex connections that we all have to each other. I truly believe that his explanation of the bodies reaction to fear or stress explains how we self destruct, merely by focusing on protection instead of growth.

Screw the reductionists. Live by the truth that lives in your heart and soul.

[hughee99]

189. I hate to make this comparison

but aren't insurance companies like labor unions in that some organization is bargaining for many people, and because of the large number of people represented, they have some leverage to force a better deal than an individual might get.

Yes, I know there are millions of differences including who actually benefits from this type of bargaining, but the concept is the same.