Young, a retired librarian on disability and mother of two from Oklahoma was sent the crippling bill by OU Medical Center at the University of Oklahoma Health Science Center in Oklahoma City. Two weeks after surgery, Young received a letter from BlueCross BlueShield of Oklahoma, stating that it had not approved her hospital stay and that staying overnight was not “medically necessary,” and thus not covered.
She fought to get an itemized copy of her bill but when it was sent reluctantly, she found the screw charges. The OU Medical Center would not give her the part numbers for the screws in an obvious effort to prevent her checking the real prices. However, reporters found that these type of screws are normally below $300 and the most expensive is $1,000.
After considerable effort, the company agreed to cover the costs but the problem still remains the system itself where hospitals inflate reported costs. This happened to my family when my son Benjamin had a concussion from playing college sports. He was asked to fill out a form once every couple days on his condition and drop it off at the doctor’s office. He never saw a doctor, but we received a bill for thousands, including repeated charges $350 for visits with doctors who never met him. He was never hospitalized or taken to the emergency room. He was never given any medication. Yet we were charged many thousands of dollars. It took my wife literally dozens of calls before she was told that the school insurance would cover the costs. Again, the overcharging by the doctor who never met Ben was never addressed.
After all of the “reforms,” little has changed in this inherently dishonest system of overcharging and holdouts for consumers. Some, particularly elderly patients, simply pay while the rest of us have to spent hours getting the companies to honor their policies. I have spoken with many doctors who are appalled by the system. Yet, Congress continues to receive millions from health care companies and has repeatedly failed to address this corrupt and abusive system.
There have been protestant apostolates of various sorts, they’re just not so common and biased toward tertiary schooling The term ‘deaconess’ indicates some sort of sacramental role. There were ‘deaconesses’ in the early Church. The specific vocation died out and its not well understood what their role was. You could ordain a woman as a ‘deaconess’ in various Anglican bodies, but it was highly unusual. In the United States, a rebellious bishop around about 1965 ordained a woman as a female ‘deacon’ and was not disciplined by the House of Bishops or the ecclesiastical tribunals for that or any of his other abuses. About a decade later, another rebellious bishop ordained a crew of women to the ‘priesthood’ (and was also not disciplined). Distinct (if notional) liturgical and sacramental roles disappeared at that point. I assume there are deaconesses in African bodies. There are Lutheran deaconesses. The number of Lutheran clergy in this country numbers in the low four digits, so it’s a reasonable wager that the number of deaconesses doesn’t make it out of three digits. IIRC, the number of Catholic sisters in this country was at one time about 150,000.
I did not know before this year just how bad the American Hating Commie/Fascist like Woodrow Wilson, FDR & others were/are.
Health Care in the US is an intentional Mess to attempt to bring in full commie care, Single Payer. (Think VA Crap Care)
Some recall FDR brought in employer paid for health care during WW2 to hide inflation & to cement the start of a Commie/Fascist type health care system.
I forget what it was, but Nixon made a game changing effect of US Health care. I think it may have been about For Profit Hospitals.
Skip ahead to 1974 to this current law, ERISA, that’s totally Anti-American & that is used to Rob citizens of their constitutional Rights.
Maybe Prof Turley or someone might write an opinion piece on this ERISA crap.
Hell, right now almost anyone could write a book, from the beginning of the country, detailing just how far outside of their legal authority the Federal Govt has went.
ERISA is a complex piece of labor law which attempts to inhibit bait-and-switch in the realm of deferred compensation.
ERISA “Employee Retirement Income Security Act” was started to stop employers from raiding employee’s pension funds in anticipation of going out of business. Then, they started adding other things, like lien rights and other benefits for employers. But, it was started to stop the theft of employee pension funds.
It is my understanding that pension funds are not owned by the employees but the company. So, the company should be able to do what they want with it. Employees should not count on pensions being there for them. Much like the govt with S.S. They do what they want with it once they see that pile o’ money sitting there. But then again, the govt. always gets to do what they want and makes everyone else the boogie man.
Idiot, people are paying into the pension in some form or another and you think it is OK for the company to reclaim the employees’ compensation.
Employees should not count on pensions being there for them.
Um, Jim22, your pension income is deferred compensation, and pension benefits figure in anyone’s decision whether or not to sign up with an employer and stay with them. Stiffing you on your pension is equivalent to non-payment of wages, and it is a species of fraud.
Funny, I wonder why all the need for pension insurance and even then, it still doesn’t seem to guarantee the full amount.
Remember this Xray?
http://freebeacon.com/politics/chaffetz-leave-congress-foot-surgery/
Health care began as a charitable project by major religions, including Catholic nuns, Protestant Deaconesses and Jewish women. That’s because people had to work so hard just to survive that they didn’t have time to care full time for the ill, injured or elderly. So, compassionate women took in the sick and suffering. Major health care systems developed, some of which still have the religiously-affiliated names, but now health care has gradually morphed into the for-profit disaster we have now. They cover the profits by the never-ending building projects, improvements, unnecessary satellite location and getting rid of perfectly good equipment and replacing it, etc..
There is simply something wrong when an average person needs insurance to cover the cost for simple preventative care because it is priced so high. Even with insurance, co-pays and deductibles are outrageous. Eventually, the US will have to do what the rest of the civilized world has done and go to a single-payer system. That’s the only way to control costs, but the big insurers, hospital groups, specialty physician practices and other blood suckers will continue to spread fear and outright lies to prevent this as long as possible. It’s coming and that’s why hospitals are buying up doctors’ practices and merging together: to band together to keep costs as high as possible. If you think it is to provide better care, you are very naive. A couple of the many lies they spread is that Canadians don’t like their health care system, and that you have to wait “years” for elective surgery. Both of these are untrue.
Karen S claims that “voters adamantly did not want singer payor”, but that’s only because they believed the lies put out by the insurance, hospital, prescription drug companies, medical device manufacturers and doctor lobbyists, plus the racists who hated Barak Obama because of his race, and leveraged this to oppose the ACA. If we were all on Medicare, costs would be controlled and would drop dramatically. Sound hospital buildings wouldn’t be torn down and replaced.* Every little Podunk county hospital wouldn’t need the latest and most-expensive diagnostic equipment that sits unused most of the time. Prescription drug costs (and massive profits) would be brought under control, and people wouldn’t be dying of strokes, heart disease, cancer and other preventable conditions because they couldn’t afford preventative care and prescription medication. No other modern country allows the profiteering from health care that goes on in this country.
*For instance, St. Mary’s Hospital, in London, where Prince Louie was born last month, was built in the mid-1800’s. They have made improvements over time to the interior and modernized equipment, but haven’t torn the building down. The Lindo Wing, where Princes William and Harry and Middleton’s children were born, is “new”, having been built on to the original hospital in the 1950’s.
Protestant Deaconesses
Do not exist. Anglican canons once provided for such a vocation, but you hardly ever encountered any and the practice completely disappeared about 50 years ago in the United States.
Karen S claims that “voters adamantly did not want singer payor”, but that’s only because they believed the lies put out by the insurance,
Nutchacha, you’ve never demonstrated you had the least understanding of the economics of any industrial or service sector, much less one as tangled as medical care. So quit lying.
plus the racists who hated Barak Obama because of his race, and leveraged this to oppose the ACA.
Who also do not exist.
There is simply something wrong when an average person needs insurance to cover the cost for simple preventative care because it is priced so high.
‘Preventive care’ is another unicorn.
Even with insurance, co-pays and deductibles are outrageous.
Contemplating the agitations of Sandra Fluke, a wag suggested that the definition of ‘feminism’ was an open mouth saying ‘I want’.
I have a master of science degree in pediatric nursing. I worked for the health department of a major City and was in charge of a childrens’ clinic for a time before I went to law school. The health department also operated obstetric, family planning and senior care clinics at which I worked. I have also worked in hospitals. I do have first-hand knowledge of the health care system and the need for and cost of preventative care, unlike you. As an attorney, I have represented numerous people severely injured and have seen and challenged absurdly high health care bills. I have negotiated medical liens of various kinds. I’ve also seen people who cannot afford to get their prescriptions filled and who don’t go to the ER because of the co-pays and deductibles. I’ve seen medical devices that maim or kill people because the design was poor or poorly executed, the device wasn’t properly tested, wasn’t tested for a sufficient time, or had inadequate reporting of illnesses and injuries. You only need to watch late night TV to see the competing ads for medications and also attorneys advertising to represent victims injured by the very same drugs.
There are Deaconess Hospitals in the state where I live, and they were started by Protestant women. These organizations go way back, but they kept the name. There are Trinity Health and Ascension Health hospitals in the state where I live. They were started by: The Poor Little Sisters of St. Francis of Seraph (Trinity) and the Sisters of St. Vincent DePaul (Ascension), both of which are Catholic organizations. Maybe you ought to take up your claim of their nonexistence or the invalidity of their histories with these groups.
You speak of the “economics” of the “tangled medical care system”, as if you have some idea what you are talking about. Well, Canada, England, France and other countries have figured out this “tangled” web, and we could, too. In fact, we already have, and it’s called “Medicare”. CMS employs actuaries who calculate the actual cost of services and how much is fluff and pay accordingly. I am friends with such an actuary. Even though we in this country spend more than any other modern, industrialized nation on health care, Americans are not healthier and do not live longer lives. What we do is pay way more for health care and there are way more of us who receive no regular health care. What are we getting for our money?
BTW: what is your background anyway, that you think entitles you to call me a liar and fraud?
Sorry, Nutchacha. Attempting to settle arguments with biographical references doesn’t cut it when you’re publishing under a pseudonym, especially when the intellectual quality of your online blather is sufficiently poor that an ordinary person would be gobsmacked to learn you had an MSN much less a JD.
Well, Canada, England, France and other countries have figured out this “tangled” web, and we could, too. I
No, they haven’t. They have different cost allocation schemes which incorporate different problems.
BTW: what is your background anyway, that you think entitles you to call me a liar and fraud?
Critically reading what you write entitles me to do that. The rest is none of your affair.
Oh, OK. You don’t have a superior or even equivalent education. You don’t have superior or even equivalent experience. There is no way to “settle an argument” with someone like you. Facts and experience don’t faze you.
You are so threatened by me that you stole my nom de plume with an added insult as your identity. That says more about you than you realize.
See, you think you have superior critical thinking skills, but unless you have education and experience to back up your arguments, you are just bitching. No, I don’t publish my name or other information because there are crazy, vindictive people out there. Have a nice day anyway.
You show no signs of any specialized education at all, nor much intellect beyond what one might see in a cheap newspaper reporter.
I actually appropriated Michael’s epithet for you the last time Mr. Smith’s spam filter forced me to change handle’s yet again.
Regarding healthcare, Americans don’t get much bang for their buck. Republicans are penny-wise, dollar foolish. And that was quite apparent in their monstrosity of a tax bill passed last fall.
Thanks Natacha for your informative comments.
Regarding healthcare, Americans don’t get much bang for their buck.
Medical care is quite adequate in this country, except in the mind of the perpetually aggrieved. The biggest problem is nursing care. There are inefficiencies derived from malfunctioning schemes of cost allocation.
So from charitable service to govt. owned. I can’t think of a worse plan for healthcare. Healthcare and insurance are two different things. Liberal logic – govt. interferes with healthcare and insurance. Both are two expensive, we need more govt. interference with healthcare/insurance.
The Lindo Wing was actually built in 1938. It is for private-pay patients.
Once the company decided to cover the expenses, I wonder how much of that bill was actually collected. I regularly see the initial billing, and then the amount accepted as full payment by the provider from the insurance carriers. There is often a huge difference between the two.
Some insurers deal with onerous charges for you. They have more power than us. Also, you don’t get a copy of the bill for weeks. Because we have Medicare and a supplemental we never see a bill, which is wrong. Sometimes you are charged for procedures by Doctors you never heard of. Probably a typo.
We need to fix the real problem, not just moan and groan about a symptom. The symptom is the refusal of the insurance companies to pay outrageous charges. The real problem is the hospitals and doctors who over-charge.
I made 3 trips to the ER. The first 2 diagnoses were incorrect so the antibiotics didn’t work. On the 3rd trip I got a different diagnosis and a different kind of prescription. The charges from the doctors for the first two visits were much higher. The result of my inquiry: the charges are based on the diagnosis. They charged more for the first two diagnoses even though they were incorrect.
The health insurance that I bought privately for years went up 15% every single year – long before the ACA was passed.
You should have shopped around for a cheaper one.
Time for universal health care.
We are just to big a country to have efficient universal healthcare. Take good care of yourself. Get the yearly shots. Charges for prescriptions can vary greatly dependening on where you have them filled. Wal-Mart really keeps the cost down. Ask doctors for a copy of what they submit. It’s on a computer and shouldn’t be difficult.
P.S. But they were the best screws she ever had.
Would you be in trouble if you were speaking in an elevator at a conference! No humor allowed in Prissy Modern USA! 🙂
Says the school marm.
Medicine in USA is run by institutionalized medical cartels and monopolies. All illegal, all winked at and ignored.
True that.
At base, the problem is third-party payors–government (e.g. Medicare, Medicaid) and private insurers. This is what happens when the payor is not a party to the transaction–price discovery is eliminated.
YES! Exactly. And add to that student loans. The presence of a third party payor and the mirage of easy repayment over their lifetime for students has no doubt played a huge role in the inflation of tuition over the last three decades. It’s ludicrous.
I agree, people are not engaged with what they are being charged.
This is the illusion of market controlled prices through free enterprise, capitalism, competition, and choice. In reality it is the oligarchical system of what the market will bear. This is one of the reasons why the US is 25th in the world in quality of health care while paying per capita two to three times as much as the 24 better systems. This is why the US system is 99th-just in front of Algeria-when it comes to efficiency of dollar spent for services received.
This is not an argument so much regarding what system is in place but whether or not Americans live in a democracy or the illusion of a democracy. The ingredients that make up our predicament are corruption on the part of government and stupidity on the part of the voter. And Trump just opted to allow the corruption to continue to grow. Congress is paid by the oligarchs to allow the corruption to grow. Trump said he’d stop this and yet he is augmenting the corruption. Yup.
Yup.
After a long health care career, I reached the conclusion that it is immoral for people to profit financially from the suffering, disability, diagnosis and treatment, hospitalizations, morbidity and mortality of their fellow human beings.
So you do not believe in doctors. Who would go through that much education to make as much as a broom pusher?
Is it immoral for a farmer to make a profit too?
Amazing the number of dolts who represent themselves as graduates of nursing schools.
loverly – immoral to profit from illness? Doctors go through grueling years of schooling. Working the emergency room, or an oncology ward, is emotionally draining. Do you require that such work be volunteer? Because, after all, if anyone gets paid at all, they are profiting from illness or accident. Are they to be paid at all? Or if they are paid, perhaps the same as non skilled workers? You would never attract anyone to the field if it did not make a good living.
To be sure, doctors used to make a far more modest living. They would be paid in poultry or hams if they worked in the country. “Sawbones” who worked on naval vessels had brutish work. However, they did not go to medical school or residency. They apprenticed with a senior surgeon for years and then went out on their own. Equine dentists were the same. It was considered more of a trade than a profession. Until the 1800s, it was not regulated or ordered at all. Inn keepers would double as the town surgeon. Physicians got degrees, while surgeons apprenticed. Pharmacists were called apothecaries, and they learned through apprenticeships, too.
If you want doctors to be paid similar to historical levels, then the training would have to decrease to that of the surgeon of the 1700s, as well. You don’t get something for nothing.
Nope, this is what you get when a govt. sticks its nose into capitalism and turns it into crony capitalism. If you want real change, remove health insurance from employment and let the little green lizard fight for your dollar nationally.
You’re mistaken about the problem.
And medical care is not a simple fee-for-service transaction. You’d have to scrounge for circumstances wherein it was regarded that way as a matter of course.
Jim22
With the US the only country with a failing health care system, you sound like the mother who declares that her son, the soldier, is the only one in step. We pay more because health care is a commodity in the US. The first dictum of a free market is to charge what the market will bear, or get as much as you can. In this case it is not from consumers deciding on which big screen or car to buy but from a captured audience, the sick. Our system is sick and disgusting. Facts and statistics prove this. Sometimes one’s opinion becomes nothing more than an illusion.
” The first dictum of a free market is to charge what the market will bear, or get as much as you can. ”
True enough. So get the govt. out of it and let people compete outside of their employer for other peoples dollars. Most people get handed their health insurance from their employer and get to “choose” between A or B and that is about as much as the common person is engaged in the process. If treated like house or car insurance, people would think twice about making claims and would be engaged in the prices they pay. When I hear a person say, “My co-pay is only $20” they are the problem since they don’t care what the inflated costs are.
Best medical service I’ve ever had was lasik surgery. Went in that day, got tested, had the procedure later that day and for another $300 got a lifetime guarantee for future adjustments. Free market at its best.
Yes, and the AMA is complicit in this as well. You should be able to get all the dirt on your physician for whatever service they provide. And yes, the government; who sets prices in a lot of ways. One of my inlaws was a healthcare administrator, and talked about how gov would complain if the cost of materials billed for were not what they expected. Materials were frequently pointed to as parts of the billing not being high enough and “inline” with the rest of providers. Generally speaking, 200% markup wasn’t sufficient. Wish the government told me to mark my vendors services up 200%, and I could just say, “Gov tellin’ mae do dat., sorry…” If one doesn’t see where this is a problem, well, no use in continuing the discussion.
On another note, inlaw had tricky cervical surgery years ago. That doc is so good that he moved away, and is cash only now. That says something if your service is that good that people will forgo the government model and pay for it. More power to him. But I would wager that if the government didn’t set the market, he would not be able to charge what he charges now since the whole service is grossly inflated compared to the rest of the economy. All pricing when not controlled is “what the market will bear.” If you have a lot of competitors, it will even out. But once again, this is just common sense.
Yes, another sane person in this discussion.
Jim22-
Your experience with Lasik really only applies to elective procedures. If you got hit by a car and taken to the hospital, would you really sit up on your gurney and negotiate price? Or put your emergency treatment out for competitive bids? For the most part, medical care is not like buying a TV set or a car.
Jay, I see your point and for ER you are correct. But I disagree that “For the most part, medical care is not like buying a TV set or a car.” Most of my experience is that doctor visits are very seldom “emergencies”. Also, if I get hit by a car, I’m most likely not using my insurance.
But I disagree that “For the most part, medical care is not like buying a TV set or a car.
And you’d be wrong, too. Imperfect information and fire-sale circumstances are bog standard in the provision of medical care. Retailing an anecdote about elective surgery isn’t going to change that.
So I’m wrong about my personal experience being that I have had very few emergencies in my life? Please tell how you know me better than me. I would guess that roughly 95% of my doctor visits included time to shop around if the system were set up as such.
Your personal experience with elective surgery does not address the systemic problems at hand. It was elective surgery.
Funny, my brother recently had his hip replaced. Was that elective surgery too? He wasn’t going to die if he didn’t have it done. If it was treated more like lasik, there would be more competition competing for his dollars. But that is not the system he had. Most doctor visits a elective or have time for evaluation before they are performed.
You seem addled by the idea that health care costs are a function of ‘the gub mint’. Without a doubt, there are all kinds of inefficiencies which result from the disordered price system. I’d also point out, however, that you’ve had a revolution in costs in the realm of veterinary care, which hasn’t much in the way of public subsidy or penetration by insurance carriers. Technological adaptations are part of that as well as changes in income allocation as people grow more affluent. Cost disease of personal services is another factor.
You’re not going to be free of the domestic and social policy dilemmas which created a market for medical insurance to begin with and then for public financing of medical care a generation later. Medical and long-term care are given to unpredictable spikes in people’s propensity to consume. Unlike buying a new hot-water heater, these can be of enormous import. That creates a demand for risk pooling and temporal re-allocation of expenditures. At the same time, medical insurance is not like casualty-property insurance: stable actuarial pools do not emerge spontaneously without leaving you with social policy dilemmas. You can respond to the social policy dilemmas by reciting inane homilies about Davy Crockett (Wm.Voegli will help you elaborate on them) or animadversions by Ayn Rand. Likely to be rather ineffective, of course.
Some simple market rules make sense, such as full disclosure of price before the transaction is OK’d by the consumer. We require price pre-disclosure when buying cereal, when getting our car repaired, renting an apartment, enrolling in college, ad infinitum. Why shouldn’t medical service providers fall under the same norm of commerce? Thy are capable of pre-disclosure. They avoid it to avoid having to compete on price. They do it to charge more. Here’s a simple regulation that everyone understands….make medical service providers pre-diclose all prices to the paying customer.
Yes, go to a super market and you can see the unit cost on everything. It quickly lets you know who is scamming you on packaging.
Jim22
You have it a**backwards. The reason for disclosure is the government. Left to private enterprise the consumer gets screwed. All, and I mean all, the facts, statistics, and conditions point to better healthcare at lower costs when the private sector is involved in a peripheral way only. We have hundreds of thousands of clerks because of the convoluted system that is based on the illusion of choice and lower prices with better service from competition. When you lose your home because you become a victim of this system it is not the same as buying a car you can’t afford. In the 24 countries with better and lower cost systems you can go bankrupt for living beyond your means but not if you have a heart attack and need bypass surgery. The US ranks 25th and pays 2 to 3 times as much per capita because it is the only country suffering under this nonsensical illusion. Again, you seem to be the only one in step.
You are so full of it. Health insurance is the biggest crony capitalism scheme there is. The govt. has its hands in it everywhere from pricing to regulations to approvals. The system sucks because the govt. is involved and you want them in it more.
“We have hundreds of thousands of clerks because of the convoluted system that is based on the illusion of choice and lower prices with better service from competition.”
I agree, but this is not due to the free market. Who is forcing all of these clerks to be required? You honestly mean to tell em that a private company would rather fill their workforce full of worthless overhead instead of being able to lower their price to beat the next guy?
“In the 24 countries with better and lower cost systems you can go bankrupt for living beyond your means but not if you have a heart attack and need bypass surgery.”
Well maybe you shouldn’t be living beyond your means and then steal others property for your health problems.
“Again, you seem to be the only one in step.”
I’m not even sure what the hell you are talking about here, but sure, ok.
Somehow it seems that we are on the same page. The problem is you think it is the fault of the government. It is the fault of the government as they are in the pocket of the health care industry. You don’t get elected in the US unless you spend millions to advertise. You don’t get millions unless you do what the special interests tell you to. Call it what you want. The fact of the matter is that health care is treated as a service in every other country and comes in better for less. In the US it is treated as a commodity and comes in two to three times as expensive per capita and in 25th place. These are facts.
The free market of ‘choice’ creates the quagmire that necessitate the hundreds of thousands of clerks to wade through. There are over 1200 health insurance companies in the US, each with dozens of plans. It takes four clerks for every doctor to handle this ‘free enterprise’ mess. This exists only in the US. When you pay your premiums in the 24 better off countries you pay for medical care and minimal administration. When you pay your premiums in the US you pay for hundreds of thousands of jobs to sort out the mess, unregulated pricing, corporate jets and million dollar salaries, stock dividends of investors, etc.
Even you should be able to understand that there is no freedom of choice except to whom to pay twice to three times as much for substandard health care. Like I said, your the soldier with the proud mom who declares that her boy is the only one in step.
” It takes four clerks for every doctor to handle this ‘free enterprise’ mess. ”
There you go again, you almost start sounding rational but you refuse to recognize that the insurance/healthcare industry is far far from free market. Again, do you really think a business wants to do or see all of that paperwork? Who do you think is forcing this upon doctor offices? you really are just arguing to argue if you do not see that this is govt. controlled and regulated.
The answer to bad govt. is not more bad govt.
Jim22
The free enterprise mess is a monopoly supported by the bought and paid for so called elected representatives. Government owned by the oligarchs is neither a free market nor a democracy. It is an oligarchical monopoly. The US as well as other societies has plowed through this travesty before with the railroads, industries, banks, and communications monopolies. The natural tendency of capitalism is to control all things monetary; in other words monopolize. Good government is there to regulate and see that monopolies do not happen. Unfortunately the US is at a point where the only answer is government intervention to separate the inescapable services such as health care, education, and transportation from the oligarchs who control them. In 24 better systems no private control is allowed in health care and these systems cost a half to a third per capita than the US system and provide better health care, at a substantially lower per capita price. You fail to address these facts but continue to dance around the issue ranting and raving about the evils of government. The answer to bad government is good government. The both do exist. The US does not need any more extremist haters. Take a pill.
Here is a medical example of capitalism – laser eye surgery. It is not covered by insurance. There are specials all the time. Radio stations give discounts. Some surgeons specialize only in laser eye surgery, and have a high throughput pricing structure, along with a lot of experience. The cost of vision corrective surgery used to be quite high, but has gone down over the years.
The customer pays for it out of pocket. If insurance ever covers it, the prices will go up. There will no longer be any impetus for customers to shop around. Surgeons could charge a boatload of money, because all the consumer will ever pay is their copay (and, of course, their ever increasing premiums.)
Insurers have market power to negotiate with providers. The problem with price transparency antedates the use of insurance, and needs to be attacked directly.
Karen
In British Columbia when a participant in BC Med, wants to expedite laser eye surgery, which is free/covered by the most basic program they can go to a private clinic and get it done in a day, instead of perhaps weeks or a month depending on the urgency. Urgent stuff gets done immediately; stuff done for convenience or to schedule with other stuff like vacations, etc is prioritized. BC Med then pays their cost back to the patient, eg cataracts are costed at $1,300. So, the patient will probably pay an extra $1,200 for the $2,500 private clinic, get $1,300 back from the government and then deduct the $1,200 from taxes which on the average would amount to $400. That means $800 to get something done at your convenience. The premiums are the same for incomes $40k to $400k, around $150 a month. In a month or two the difference in premiums between the three times as expensive US system and the so called evil government system is absorbed.
Bypass surgery, costs nothing and is dealt with immediately. No copays, no ‘out of pocket’, etc. The US system is the worst in the world and we are at the bottom of the list of priorities after corporate profits, investment profits, CEO million dollar salaries, redundant labor, etc. The only reason someone prefers the US system is ignorance. And, I mean that in a nice way.
I was encouraged by the Sec of HHS’s comments last week, but it’s a wait-and-see if they will put even a quarter of those proposals in place. They speak about rushing generics to market, but generics are also going up in price at a rapid rate. It was interesting to see how immediately after Trump’s “get-the-pharma-companies” speech that the companies’ stocks took big hits, but by the time the HHS sec finished, they had recovered. I guess it took investors a few minutes to realize that Big Pharma always gets its way.
A lot of costs for medicine is due to the FDA approval required. That has to get passed on to us or that company would go out of business. Some European countries have no FDA requirements. So the medicine gets to the patient sooner for less cost. Insurance companies and Hospitals stopped requiring patients submit their charges for payment. That’s where you question unidentifiable charges.
Isaac, allow me to use words that are familiar to other arguments. Europe does not pay it’s fair share. Pharmaceutical companies can afford to sell their products at lower, fixed government prices in places like UK and Canada, because US consumers and insurance companies pay more. We also fund research and development. Europe and Canada enjoy the benefits of a pharmaceutical industry we of the United States fund, without chipping in a fair amount. This is also why drug companies can afford to donate their product gratis to impoverished African nations – because the rest of us subsidize it. Now, I certainly do not mind covering the cost of free medicine to Africa, but I do object to paying more so that Canada can pay less.
Why doesn’t everyone pay less? Why aren’t drugs free? Because, it takes a minimum of numerous failed investigational new drugs, 10 years in the FDA trials, and millions of dollars in order to take a single drug to market. Then, after it hits the market and the general population, you may or may not find out there are adverse events that did not surface in clinical trials, in which case come the avalanche of lawsuits. Best case scenario, you have scant years to make as much as possible off of your discovery, before your patent runs out, and the generic manufacturers based in some FDA-forsaken country like China undercut you. Who’s going to pay for all of this? Are taxpayers going to pay millions upon millions of dollars for the creation of each and every new drug? And if they did, how would this affect R&D?
You would be surprised how many familiar drugs are on the market today, because they failed their intended FDA trial, but were pushed through capitalizing on one of their side effects. Or, perhaps they did succeed in making it through the FDA gauntlet, but their side effects had more marketability than their target. (Hint: rheumatoid arthritis medications are big in this field of serendipity.)
It may be possible for the pharmaceutical industry to survive massive price fixing. There may be unintended consequences.
Karen
Here again you miss the reality. US pharmaceutical companies are the only ones in the world that are allowed to advertise their drugs. The marketing budget averages 22% of the overall budget for US drug companies. The R & D budget is just above 16%. Much of the world’s advances in pharmaceuticals is accomplished by companies in Canada, Switzerland, Germany, France, etc. The US has the largest single market and does accomplish much. However, it is not the R & D that keeps prices so high, or the lower prices in other countries. It is the marketing costs and simple greed. Take out marketing and lower the costs by 22%. We are played like idiots. Only an idiot would affect the purchasing of drugs after watching an animated commercial on TV showing cartoon people becoming happier after taking Ziplock or Sassafraz. Americans don’t register very high on the average common sense meter when you put them up against the 24 other better systems, found in those backward countries like Canada and Europe. Yup
This is precisely why Medicaid does NOT issue explanations of benefits. I wonder how much those screws were if she had been on Medicaid or even how many days she supposedly stayed.
Hospitals use these overcharges to pay for people who stiff the hospital on their bills. Although, this is a bit high even in the overcharge business.
Failed collections would be amortized over the whole patient load and reflected in the re-imbursements the insurance companies receive. This as described is just an attempt at plunder.
The insurance company’s explanation is that it was a pro-forma bill they sent her because the provider hadn’t submitted sufficient information to them.
The complete lack of transparency from the perspective of the patient should render this debt one unenforceable in court. The law on this question is perverse.
“…the provider hadn’t submitted sufficient information to them.” They much teach this excuse in every entry-level claims handler orientation class. Every single provider I use gets the same BS. Now even veterinary medicine insurers have jumped on that delay tactic bandwagon!
1. You already have the ICD-9 diagnoses manual. Why not a federal commission to design a controlled vocabulary for medical billing?
2. Have a federal commission develop model legislation for the states. The content and object of the legislation would be compelling service providers to publish their chargemasters and commit to them for periods of, say, a year. The Commission on Uniform State Laws might take up the project.
3. It’s absurd she was apparently expected to review her insurance contract and ascertain whether or not her doctor’s decision to admit her to the hospital was ‘medically necessary’. Decisions about medical care are not legal proceedings and are made in minutes, hours, or days. It’s doubly absurd when the price of the hospital’s care is completely opaque to all parties but the hospital’s billing office. In effect, commercial and contract law are expecting people to assume default responsibility for costs in re their information base is nil. You need both substantive and procedural adjustments to the law. One start would be a dedicated set of mediators and arbitrators in these cases, auxilliary to state court systems.
4. The doctor who defrauded you needs to be brought to the attention of the state attorney-general.
Nutchacha, it sounds like you support an activist government. How do you reconcile that with supporting Republicans?
First you manufacture caricatures. They have little reality outside your head. Then you complain the Republicans you encounter don’t match the caricature.
I live in L.A. and rarely encounter Republicans. But on this thread, Trumpers live up to the caricatures.
Trumpers live up to the caricatures.
Say something smart before you call others stupid.
Your fine examples of the progressive mind at work are bettykath (no further comment), the senile Dr. Benson (who posts only drive-bys), Jill / Natacha (whose posts consist of shrewish emotional blurt), and Autumn (whose posts differ from Jill / Natacha in that she has an occasional original thought and despises Jews), and miscellanous juveniles (‘Fishwings’, David Benson in his ‘Ken’ persona, Mark M). Mr. Enigma and Annie / Inga / DIane / Late4Dinner are your side’s concession to the idea that one’s posts ought to have semantic content that isn’t blatantly stupid.
I call it fraud.
I would also like to point out that her X-rays may show the real problem: modern footwear. If you are a woman, and you look at your own shoes, you most likely will find that the longest part of the shoe is not directly in line with the inside of your foot, where your big toe should lie if barefoot. No. That apparently is not a pretty silhouette. What is fashionable is for the big toe to be pushed inward, towards the middle of your foot. Likewise, it is not fashionable for the toe box to follow the natural line of your smaller toes, either. They are purposely scrunched into a more delicately shaped toe box.
You can see on her X-ray what most feet of American women look like. It is the product of a mild form of foot binding. The big toe has been pushed over, causing a bunion. Her smaller toes are also pushed inward, and also curled. After walking around in shoes with this shape of toe box, since infancy, her foot eventually gave up trying to grow naturally and said, fine, if this is how you want me to look, then this is what we will do. After the toes deformed, they hardened that way, so that when she walks barefoot, her toes stay curled and pushed over.
Men are not immune, either, as their shoes also typically do not follow the natural outline of feet. They just are not often as severe as women’s footwear. However, cowboy boots with pointed toe boxes are one of the biggest offenders for men’s feet. (Cowboys, choose square toe boots for the most relief for your feet, and just root around a tiny bit more for your stirrups.)
Why, why, why, are there no shoe manufacturer besides maybe the flip flop that allows the foot a natural shape? And even the humble flip flop is murder for plantar fasciitis. Such a shoe would require the big toe to be straight ahead, and allow enough room for the little toes. This would make the shoe look far more spread out than modern shoes look like nowadays. It would be devastating for the over charging industry of the surgical correction of bunions, hammer toes, and other man (or woman) made deformities.
Try Shoes For Crews. Which is a real company not to be confused with Shoe for Screws. Other than that company I buy through Amazon. and o hell with fashion. I always laugh at the pretentious “This season Madam wants skirt flared at the knee and six inch stilettos. Guaranteed Madame was never asked but Madame was dumb enough to buy the BS. So was her husband. But mommy daddyh ALL the kids are wearing $500 Jeans from Good Will????.
Have you tried Vionic/Orthaheel by Dr. Weil, a podiatrist?
Thanks, guys. I’ll have to check those out. I usually wear either sneakers or riding boots, but I do love pretty heels for going out occasionally. One of my pet peeves is when shoes, especially heels, pushes my big toe over or cramps my little toes. Not only is it uncomfortable, but people in my family and my husband’s family have bunions and I. Do. Not. Want. Them.
I’ve tried all sorts of heels for when I dress up. I can find extremely well cushioned heels that don’t look like old lady shoes, but I’ve never found a toe box in a heel that actually follows the natural shape of the foot. Every single closed toe heel on the market, that I’ve seen, appears to be purposely designed to deform the foot and cause bunions and other maladies. I remember in my dancing days in my twenties, excruciating foot pain was just the normal cost of the evening. If you weren’t limping to your car, then you didn’t dance enough. Silly, really. It’s amazing what the human mind can accept as normal.
Natacha:
Take a look at this Kitten Heel by Vironic, and you will see the problem:
https://www.vionicshoes.com/women/wedges/josie-kitten-heel.html?76=20
Where is the longest part of the shoe? In the center of the foot. You can clearly see that the toe box would push the big toe way over. Plus, then the toe box is then elongated even further into a point, which may be why Helen Mirren keeps tripping when she wears pointy shoes. This is the problem. I can find well cushioned shoes, but I cannot find a heel that follows the natural shape of the toes. Such a heel would have the big toe straight, and then taper to the little toes. It would not be rounded, or pointy, but would look like a recognizable foot. Fashion has avoided such a silhouette for hundreds of years. A heel that didn’t deform the toes would look weird by today’s standards. The only way to get this shape today is an open toe sandal.
Here is another article on medical cost ridiculousness.
Four stents and a total of seven days in hospital (two visits apart by about a week) = $239,840.23
https://jonathanturley.org/2014/08/02/a-heart-attack-and-the-numbers/
Geez, the cardiologist bills alone, on each day, were more than many people make in a year. One wonders how they calculate compensation.
How are you doing now? Hopefully no more heart trouble.
Insurance companies are partly responsible for the high cost of medical care. They are the cash cows that keep the industry of over charging going. If no on had insurance, hospitals wouldn’t charge $15,000 for two pairs of screws, because almost no one could pay that. However, to pay devil’s advocate, perhaps that slush fund of insurance money also finances medical innovation. Either way, the system is bloated and not a true market economy.
Now we know who wrote ACA. DNC was trying to copy the insurance companies
My impression was that the ACA dangled a big carrot in front of the insurance companies, especially with the mandate. Then, as the cost of healthcare predictably skyrocketed, so that everyone who is not subsidized by either the government or their employer now pays the equivalent of a mortgage on their insurance. That would, again predictably, lead to the public clamoring for single payor.
Polls showed voters adamantly did not want single payor, they wanted their existing health insurance, and could afford it. So the government ruined their coverage and made it unaffordable to force people to ask for single payor.
The government hurt its own people to get what it wanted.