Texas Teacher Hit With $109,000 Bill Despite Having Insurance . . . Bill Reduced To $332 After Media Coverage

As reported by Kaiser Health News and NPR on Monday as part of the “Bill of the Month” series, the Calver case is all too familiar. The 44-year-old father of two had suffered his heart attack in April 2017 and rushed to the nearest emergency room. That happened to be an out-of-network hospital.  Accordingly, his school district health paid roughly $56,000 for the four days of hospitalization and later procedures.

St. David’s Medical Center in Austin then hit Calver with an additional $109,000 in as a “balance billing.”  That is when Calver went public and that amount was immediately reduced to $782 and then down to $332.

The case captures the “funny money” approach of this inherently dishonest process.  Despite endless examples of inflated billing in this broken system, Congress continues to do nothing. It has left patients to be abused and threatened in a process where these bills are little more than hold ups — or  calculated to make patients spend endless hours to challenge and correct.  It is an utter disgrace.

It is clear that Calver’s media coverage not his insurance coverage was the reason for this change.

Despite this ridiculous record, St. David’s HealthCare, continues to say “did everything right in this particular situation.” So this absurd series of billings and a reduction of $109,000 to $332 is just right in the insane medical insurance system in the United States.

155 thoughts on “Texas Teacher Hit With $109,000 Bill Despite Having Insurance . . . Bill Reduced To $332 After Media Coverage”

  1. Since they don’t publish their chargemaster, the man’s contention is quite valid. The courts meddle a great deal, but they don’t protect people very much.

  2. In biology, there are processes called convergent evolution (contemporaneous) and evolutionary relay (during different eras), in which completely different species will evolve similar traits. Examples are bats and birds, and ichthyosaurs and dolphins.

    This principal applies to other processes because there are always going to be a limited set of responses to a problem.

    Whenever a third party pays a bill between two parties, that bill is going to become wildly inflated, as the first party knows he can charge as much as he wants, as long as the second party doesn’t actually pay it himself. And the second party knows he can run up as high a bill as he wants, because he won’t actually pay it himself.

    This is the case with health insurance. Without health insurance, hospitals could not charge 6 figures for a short hospital stay, because 99% of their customer pool could not pay it. They would not be able to offer such an extensive list of services because people would not be able to pay for them. Likewise, if patients read the price list, posted out front, of every procedure and cost, which they had to pay for themselves, they would be hobbling out of their hospital beds at the soonest possible opportunity.

    Added to this inevitable evolution of medical billing is the fact that hospitals cannot turn away anyone from their emergency rooms who cannot pay. Medicare, Medicaid, Medi-Cal, and Obamacare individual policies all pay less. These combine to form losses for the hospital, which they then attempt to recoup from those who can pay – the highest paying insurance companies. Then they try to squeeze anything possible from the patients themselves who are not indigent.

    Now, politicians can regulate and legislate to their hearts’ content, but they cannot prevent evolution. If they want to address skyrocketing healthcare costs, then they have to deal with the evolutionary pressures driving them.

    My initial thoughts, from the trenches, are:

    No more employer health policies. Employers should get out of the insurance business. All polices should be individual policies, and there should be a wide selection of offerings. Anyone should be able to match their personal needs and beliefs with a policy. There could be those that cover alternative medicine like chiropractic and naturopathy, and those that cater to religious requirements. You should be able to shop for what you want, with reasonable limits that nothing harmful should be covered. That would remove the caste system of patients – from employer policies down to the untouchables of Medi-Cal and Obamacare individuals.

    Inserting a third party drives prices up. Research whether catastrophic policies with patients paying more out of pocket would drive costs down. This is the very reason why copays and deductibles evolved, to control health care costs. When patients pay something out of pocket, they monitor their own usage, and providers cannot charge so much because they won’t have a patient pool. What can we do to re-establish the direct connection between patient and doctor? Can health care savings accounts be expanded?

    1. Another example of the natural evolution of spiraling cost is the government procurement system. Contractors over charge and under deliver. Government employees blandly accept such bills they would never pay for themselves. Taxpayers foot the bill.

      By the same token, union benefits packages have bankrupted several major cities, and are poised to ruin more. Those packages would never have been approved if the officials were budgeting their own money. They assume they can always shake more money out of the taxpayer money tree, until they snap the trunk.

      1. Without unions Americans working in manufacturing would still be earning $5/hr and we’d still have child labor. But one big ‘headache’ gone – lord knows they wouldn’t be bothered with health care benefits. Yay ‘Murica!

        1. “Without unions Americans ”

          I am not against unions. However, one also has to recognize the negative effects of unions on the rest of the nation. Below is an example of union abuse of school children that has been going on for years. I am sure you would agree with me that this is one part of unions that shouldn’t exist.

          https://www.projectveritas.com/2018/05/01/nj-perry/

          1. I should have added, watch the video and listen to the union officer helping to protect teachers that have wrongfully abused students. I think another video demonstrates an admission that a teacher that raped a student is still teaching and how they tried to hide this type of incident. It’s sickening and has happened all over.

          2. Allan, you follow James O’Keefe? Now we got your number! The Project Veritas site has an urgent call for defenders of Alex Jones. Jones and O’Keefe are pretty much on the same level.

            1. Peter, that shows how ignorant you are. James O’Keefe merely takes videos of leaders and others that should know better, but non the less advocate criminal actions.

              How can you argue with the video I just posted. This is a union President talking about bending the truth to protect a potential abuser of students. The union president goes on offering to lie and backdate claims. He informs how the potential abuser of students should act and how to avoid being penalized for his bad deeds.

              Take any video of his and tell us where he is making things up. With his first major video on Acorn they said he went to a lot of places and this was this was the only one helping to break the law. That is why O’Keefe had a back up video and another back up video and loads of others showing that the laws were being broken in many states and many cities with everything on tape. That ended ACORN and its abuses.

              The same has occurred with teacher abuse. You don’t like O’Keefe because he exposed lying at the Washington Post and the NYTimes on video.

              “Now we got your number!” You don’t want to know the truth. You want to lie, lie and lie.

              1. O’Keefe is not a journalist. O’Keefe is what was known as a ‘Dirty Trickster’ in Nixon’s day. His videos are so deceptively edited they have no credibility whatsoever.

                1. Everyone edits when there are hours of tape but he permitted deniers to view the full tapes of what they claimed were edited. The people’s words speak for themselves. A few teachers union presidents have resigned, Hillary’s hit man Creamer resigned, ACORN closed, the FBI used O’Keefe’s tapes in the investigation and prosecution of those involved with misdeeds in D.C. during the inaugeration. Loads of other results that we need not mention here.

                  You live in a bubble and don’t have the slightest idea of what is going on outside the bubble. Then you lie to make up for the things you don’t know. You are a Shill, Peter Shill.

                  1. It is not a requirement to be a journalist working for the media to take a video of abuse. Animal rights activists do it all the time undercover in slaughterhouses.

                    If I took a video of an EF5 tornado, the news would not refuse to accept it because I’m not a journalist.

                    Releasing the complete, unedited footage definitely answers the concern about selective editing. I don’t know much about O’Keefe, but I do know that full, raw video exists to draw your own conclusions about various stories.

                    1. Thank you Karen. I consider James O’Keefe a journalist because video journalism is what he does to make a living and he has produced series after series of wonderful videos documenting illegal activities all over the nation. If you haven’t seen his videos you might enjoy viewing the topics you are interested in.

                      I know his organization and it is quite professional. Some of his former people have branched out on their own and done some good work.

              1. So says the man who recommends Wells Fargo, a corporation who indulged in widespread thievery, as a provider of fine health insurance. Now there is a guy whose opinion we should all respect.

                1. Henrietta Lacks – personally I think the execs should have gone to prison and so do most of the employees, however I was telling you about the perks.

            1. Raymond, have you no common sense?

              Have you looked at their videos? The FBI did and used it to arrest the vandals in Washington D.C.

              Project Veritas takes films of actual people actually doing bad things. Did the Pod People tell you Project Veritas was bad? Did you believe them?

              What about the teachers union presidents that were helping abusive teachers escape punishment. Do you like it when people beat up on children?

        2. Without unions Americans working in manufacturing would still be earning $5/hr and we’d still have child labor.

          No, labor markets don’t work that way. While we’re at it, about 1/3 of private sector employees were organized in 1955. It has fallen to 6.5% in our own time. Mean compensation per worker is currently $37 per hour, of which about 80% of that is received in cash. The share of national income accounted for by labor compensation was about the same 90 years ago as it is today.

          1. Spastic, here’s another example of you throwing statistics around without citing any sources whatsoever. Now it could be these stats are largely accurate. But we have no idea what context they were taken from.

            90 years ago was 1928; before labor unions had any muscle. So we shouldn’t be surprised that labor compensation was about the same share of national income then as it is today.

            But here you are presenting this stat to suggest that we shouldn’t be alarmed by labor’s current low share of the national income. It shows how persistently disingenuous you are. And I have found that to be true with almost everyone who identifies as ‘Libertarian’; they are persistently disingenuous.

            1. The statistics are available making use of the interactive datasets of the Bureau of Economic Analysis and the Bureau of Labor Statistics.

              The ratio of national income accounted for by employee compensation has fluctuated between 60% and 70% for the last 90 years, unions or no.

              What unions do is improve the compensation of skilled workers and / or improve the compensation in whole industries covered by a master contract. Redistribution may run from capital to labor. It also runs from unorganized labor to organized labor. Unorganized labor is less skilled and more impecunious. What they lose is primarily employment opportunity as the demand for labor declines with widespread use of collective bargaining.

              You do realize that real income per capita is higher than it was in 1914 by a factor of 7? Mr. Anonymous fancies that the entire increment would have been absorbed by management and ownership. That’s absurd on it’s face (and demonstrably untrue without regard to how common collective bargaining is).

        3. Anonymous:

          Certainly some unions have advocated for some improvements in working conditions. However, unions have also been guilty of abuses, such as physically assaulting non union members who try to work, trying to force all employees to unionize, including through violence, forcing people to pay union dues, forcing members to contribute to the Democratic Party, and strong arming benefits packages that literally bankrupt cities. They are neither all good nor all bad, but their design is conducive to abuse.

          I am also curious what your evidence is that we would still have child labor without unions. After all, most of the private sector is not unionized, and yet we don’t have child labor. Even for those improvements first advanced by unions, why do you believe that they would never have occurred otherwise? Do you actually believe that our society would never have evolved without unions, and we would be stuck in time in the 1800s? It was public opinion that drove labor laws, as well as that of the FDA and USDA. Writers like Upton Sinclair horrified the public with The Jungle. He not only championed democratic unions, run by workers rather than dictators, but he also informed the public about serious health hazards in the food supply and unsafe working conditions. Many other writers followed suit. It was public opinion that championed change.

          Capitalism is the most fair and just economic system in the world, as long as it operates in a system of robust individual liberty and rights. Any economic system, including capitalism, can be an abusive system where the individual is powerless can be an abusive system. The advantage of Capitalism is that it does not require the police state that Socialism and Communism does, but operates quite well with individual liberty. Unions run afoul when they do not respect the liberty and rights of the employer, its members, non members, and the taxpayers that pay the bills of government unions.

          1. Karen you’re stuck in this socialism vs capitalism conflict. Which makes me wonder about your age. Are you lover 70?

            In the real United States inequality is very genuine problem. Even with this economic expansion, now in its 9th year, wages have lagged behind inflation and job growth has been persistently weak in smaller markets. Furthermore, the student debt bomb could seriously hinder future growth. What’s more, an increasing number of retirees lack the savings to live out their lives.

            The lion’s share our wealth is flowing to the upper 3% ‘Yes’, there are more millionaires than ever. Which looks great on paper. But single-dight millionaires are the new ‘upper middle class’ in our biggest job markets. There’s a huge gap between single digit millionaires and billionaires.

            In our biggest job markets an increasing number of people have trouble making their rent each month. According to the L.A. Times, almost half the residents of this city are living paycheck to paycheck. And in most cities with strong job growth that’s the situation; residents spending large ratios of their income on rent.

            Therefore it’s odd that consumers of right-wing media are so fixated on the perils of socialism. In reality socialism is far less of a problem than inequality.

            1. Peter Hill – are saying the land of fruits and nuts, land of Gov. Moonbeam cannot remember to put money in a savings account? That is just too liberal for me. 😉

              1. Paul,

                Governor Brown created a rainy day fund. The unfunded pensions are actually a different pot of money than annual budgets. Unfunded pensions are a growing problem everywhere. Even cities in Texas have pension issues.

                For decades public employees settled for smaller raises in exchange for richer pensions. It was a bargaining tactic governments used going back several decades.

                The problem is that public employees are living too long. If only they’d die in their early 70’s. That’s what it comes down to. No one knows how to fix this issue. It may require a bailout at some point. Medicare and Social Security are in for years of extra pressure

                1. Peter Hill – what they did, instead of giving them raises, was give them promotions. Yes, government workers know how to work the system. So, they continued to get richer on both ends.

                2. “The problem is that public employees are living too long. If only they’d die in their early 70’s. ”

                  Sounds like Peter and the Democrats rue the fact that our society is doing well and wish people to drop dead before age 70.

            2. This is ridiculous. CA has the most income inequality in the country, and the most government meddling. Reduce everything to groups and the individual has no existence and is discarded on a whim. Keep your socialist dreams in your safe space where there is no easy argument to throw them in the trash where they belong. Life is tough and not fair. No one gets to ride a unicorn.

              1. slohrss, California has the most inequality because everyone wants to live here and affordable housing is limited.

    2. I think a lot of what Karen is saying is that government and insurance have eliminated liquidity constraint that would otherwise keep prices lower.

    3. Let me know who is the carrier that I sign up with when my husband gets a little colon cancer, I get diabetes, my baby is born with spina defida, or my son suffers from depression and anxiety. Will that necessitate four different individual policies? Unlikely, you say? What God in heaven would ever let a family be so unfortunate? Sure. But perhaps it will prompt you to think a little more deeply about your proposal, which frankly strikes me as rivaling “A Modest Proposal”.

      1. Henrietta Lacks – have your husband go to work for Wells Fargo. They have a Cadillac policy for their employees, you will be covered.

        1. Wells Fargo? You mean the folks that steal from their customers? Great idea! Can’t wait to work for those trustworthy folks.

        2. Thank you, Paul. That’s a very honest ‘conservative’ response. “Just find a good position with a blue-chip corporation and you should get good benefits.

          1. Peter:

            Well, thanks to Obama, those Cadillac plans with great benefits are getting phased out, and will be subject to heavy taxes.

            When I was on my Obamacare individual policy (spit!), I paid the premium of a Cadillac policy, and the deductible of a Catastrophic policy. Copays were large. Drug formularies were severely restricted, and off-formulary benefits were abolished. To add insult to injury, none of my doctors accepted the plans. No good doctor would in my area, or within a 100 mile radius. I was told that they would not accept the lower remuneration. Plus the added paperwork increased cost in the office. More and more doctors are no longer accepting any insurance at all. Most major cancer centers either do not accept all Obamacare individual polices, or do not accept any of them at all. Studies show that lack of access to top cancer treatment centers leads to higher mortality rates. There are also many regions in which there is either only one health insurance to “choose” from, or none at all on the Exchanges.

            Henrietta:

            So, what would you do if you had an Obamacare individual policy today, not in some fantasy dystopia, and your husband got colon cancer, you got diabetes, and your baby had spina bifida? The top colon cancer providers near you probably won’t accept your plan, nor will specialists in diabetes or spina bifida. You will go bankrupt trying to pay your astronomical premiums, deductibles, copays, as well as the out of pocket to see a quality doctor. Your medications will probably be off formulary, so your out of pocket costs won’t be counted in your max caps. Your choice is a grim one: bankruptcy or an early death of 1 to all 3 of you.

            1. Karen, I had cadillac health plans back in the ’90’s. I later had good coverage from a union plan. But cadillac plans and union plans were increasingly rare for wage employees ‘before’ Obamacare. Obamacare was implemented ‘because’ health plans were increasingly rare for non-executives.

      2. I’m not sure what Henrietta’s point is…..but let me know what auto insurer I can sign up with after I’ve had an accident.
        I hate paying for that stuff before I really need it.

        1. Tom Nash:

          Using the logic of the Left, the following are all human rights necessary for survival, and therefore should be free to all, regardless of socioeconomic status:

          1. Food
          2. Water
          3. Art
          4. Driver’s Licenses (but not ID required to vote)
          5. All healthcare costs including all medications and procedures
          6. Clothes
          7. Shelter
          8. Transportation
          9. K-Graduate School Education

          Although we are already trillions of dollars in debt, I’m sure the rich can pay for everything for everyone, and still maintain our standard of living, in which the poor are so well off hat they have TVs and an obesity problem from a surfeit of food.

          1. The best revenge we can hope for is for leftists to be mandated to live the life\world they attempt to force upon everyone else.

      3. That is quite a leap, from my concerns about the design of health insurance to eating Irish children.

    4. John McCain’s mother is 104. Wanna bet she has been covered by government health insurance for many, many years?

      1. She’s been eligible for Medicare since 1977 and her husband was a retired Admiral.

      2. I think McCain’s mother is actually 106, but in erasing 2 years off of her actual age you may have motivated her to lie about her real age.😉

  3. I think this statement categorizes what Professor Turley thinks is the appropriate solution and indicates a cradle to grave approach which would represent a left leaning ideology.

    There are other ways to get to the same endpoint while still protecting those that are needy, but my guess is he leans towards the less effective approach that can cause great harm.

    1. Allan, Republicans have promised an Obamacare alternative for 8 years. They can’t come up with one. Yet they continues sabotaging Obamacare. You might want to share with us the ‘other ways’ we can provide healthcare. Or better yet, share those ideas with the Republican leadership. Because they have no ideas.

      1. Peter, you are an ideologue that will say anything and support anything no matter how crazy it is as long as it meets your ideological needs. I am not an ideologue. I don’t look towards the Republicans or the Democrats of today for solutions. They all have to be pushed because they are working for themselves, not the American people. There are some exceptions.

        Obamacare is a hybrid. I read the House version and knew immediately it would not be able to survive and would eventually succumb to a death spiral. It wasn’t even finished legislation. It was a skelaton leaving a lot of decisions in the executive branch. Look up the Secretary… shall decide along with the variants and note how important issues were left to the executive branch to make decision.

        It was a lie to the public and Gruber admittted that on tape. Some say it took the worst from the left and the right and put the worst of both together but I wouldn’t stand fully behind that opinion.

        No system is perfect and all systems have large holes. Ask Issac about the Inuits and the rest of the native peoples of Canada. Check out the Quebec Supreme Court that said the law was inhumane. Check out the waiting times from various provinces for various procedures. I don’t want to bash Canada for they have one of the better systems but certainly not a system that would be good for the US. Take note how much variety we have with regard to races, religions etc. comparing that to the Dutch, The French, The Italians etc. Also take note of international comparisons of outcomes (will I live or will I die? Will I get better or will I get worse?) The US is at the top.

        I will add that our system has deteriorated due to excessive government involvement and that involvement starts with the tax favoritism to businesses which has been near lethal to our healthcare and our ideas behind fairness. The first thing that must go is that difference.

        1. No Republican alternative, right? You just said it here.

          I’m allegedly the ‘ideologue’ but you think a “Pay As You Go” healthcare system would be the best solution. Too bad the vast majority has no cash for ER.

          1. “no cash for ER.”

            Peter, I didn’t say people shouldn’t carry insurance. You make all sorts of statements without knowledge and without understanding what you are referring to.

              1. I don’t know. There have been Republican alternatives that were refused. I am sure we will see some alternatives but with the people representing us those alternatives will not be the best.

                One should learn from experience. Obama said we would be trying out a whole bunch of new things, but the things mentioned had already been tried and failed while others had similarities to other ideas that were tried and failed.

                The Democrats are devoid of ideas. If they had good ideas they would have passed a bill that was quite different than Obamacare. Instead they stuck with the hasbeen that before the ink was dry was waiting for the death spiral.

                1. Well Allan, a good friend of mine just had surgery for cancer; the bleakest moment of his life. The one bright spot in his entire ordeal was the coverage he received through Obamacare. All he could talk about was how grateful he was for Obamacare.

                  So when know-nothings like you tell us how horrible Obamacare is, it illustrates how intellectually bankrupt you are.

                  And I notice you still can’t describe any Republican alternative to Obamacare. There is none. Period.

                  1. Peter, your life is built around anecdotes. You have a N=1 scenario which doesn’t provide an adequate confidence level for anything.

                    I am glad that your friend no longer has cancer but you remain stupid not understanding that there are always winners and losers. Obamacare is in its death spiral and many people ended up impoverished by the program which had more losers than winners. Art Linkletter had a program called People are Funny. Listening to people like you he would he would change the name to People are Stupid.

                    By the way, did you forget the Bush plan.

                    1. Bush expanded Medicare for Prescription Drugs. That was nice. Bush forgot, however, to ‘fund’ that expansion. Funding would have gotten in the way of tax cuts.

                    2. Peter, I was talking about the Bush healthcare plan not Part D. Actually Part D is partly responsible for the increase in prices for pharmaceuticals that everyone else is paying for. You realize that 75% of the cost of that programs comes from general revenues and paid for by the taxpayer that includes people who can’t afford their insurance under Obamacare.

                      Now with all this dazzle we get from Part D and all the intermediaries created by Obamacare and other intermediaries some run of the mill medications for seniors cost more for the copayment than if the senior buys those medications for cash and doesn’t use their Part D Insurance.

                      Peter Shill, you are a Turkey. Perhaps you will be gone after Thanksgiving.

        2. “the tax favoritism to businesses which has been near lethal to our healthcare and our ideas behind fairness.”

          Can you write more about this?

          1. Ivan, I could, but it is a very lengthy subject. This started during WW2 as a way of increasing salaries when there was a wage and price freeze. After the war the public howled so the healthcare benefits remained tax deductible.

            -Do those without employers get such deductions?
            -What happens when a person loses their job because they become too sick to work?
            -They end up on private insurance increasing the cost to those purchasing private insurance and holding the costs down for those who have employers insurnace.

            -If you paid a premium for grocery store insurance would you line up behind the spam counter to buy spam or behind the steak and lobster counter?

            -Would you carry a zero deductible or a much higher one if a lot of money was saved with the high deductible policy?

            -If you paid cash would you buy the pill that cost 10 cents and had to be taken three times a day or the pill that cost $10 that had to be taken only once per day.

            -Given the choice and no tax deduction was available would you buy an expensive insurance that offered no deductibles, all sorts care including aroma care or would you buy a stripped down insurance?

            -Are employers experts on insurance? Are they buying for what meets your needs or the needs of the business? Are everyone’s needs the same? Are emplyers adding add-ons because of the tax deduction? Third party payer is inflationary.

            I can go on and on, but the above represents a few things that should first be thought about.

  4. Many – probably most – of these billing horror stories seem to occur in southern states. Gee, I wonder why?
    In my own case, my health insurance is provided by a .org nonprofit, not a .com company. Tolerable rates and good service. No zillionaire CEOs and hungry shareholders to feed.

  5. Medical billing is a scam. The numbers are made up out of thin air to give the appearance that the insurance company saved the patient money. The made up numbers have an inflation cost added each year in spite of the fact that some procedures and despensibles go down in price with technology advancements. (bandaids cost less to make today than in 1950) I can order MRIs for $150 cash when the insurance is charged $1800.

  6. After being thoroughly abused in the same fashion and then some by the Legal community/system in WPB, FL. all I can say here is ….it takes one to know one. And something about removing a mote before pointing out…oh yeah …’How can you say to your brother, ‘Let me take the speck out of your eye,’ while there is still a beam in your own eye? 5You hypocrite! First take the beam out of your own eye, and then you will see clearly to remove the speck from your brother’s eye. ‘

    I mean really, the legislature, Congress, Senate and all levels of our political and legal system is full of Lawyers. That make break and play the laws like a pack of gambling addicts. Jerks. How the hell do you think we got to this place in this Country? Why don’t you stop pointing fingers and do your jobs and clean up your own damn act.

  7. How many people died of opioid overdose in America last year? How many were prescribed their death drug by a doctor?
    (music)
    Doctor, doctor what you say?
    How bout lettin me out today?
    Ain’t no reason for me to stay…cause..
    Everybodys far away.
    Get me back on my feet again!
    Get me back on my feet again!
    Open the door.
    Set me free.
    Get me back on my feet again.

    1. I believe most of the deaths are due to drugs are not prescribed by physicians.

      I think the number of deaths is around 72,000 yet some on the left are anxious to let illegals transport these drugs to America and get drug dealers out of jail.

      Close the borders and create real systems of immigration, works status and tems of limited stays in the US. Get serious about drugs of all types.

  8. What we have now is Trumpstercare.
    What people need to do when they get over charged is sue for fraud and seek punitive as well as actual damages and costs.

  9. As long as health care and health care insurance is a commodity, the people will get screwed. Along with the free market comes monopolies and the underlying cost generator, ‘what the market will bear’. There are over 1,200 health care insurance companies in the US, all with their employees, billing departments, CEOs, and other staff. The consumer pays for these unnecessary workers. The insurance industry is ‘re-insured’ by a handful of ‘re-insurers’ who set the basic costs: AIG, Lloyds, Swiss Re, German Re, etc. The consumer is subsidizing hundreds of thousands of jobs that don’t exist in the two dozen other peer nations that have superior health care at vastly lower costs.

    Treated as a commodity, health care in the US costs, on average, per capita, three times what it costs in the two dozen other peer nations that have superior health care at vastly lower costs, due in part to advertising. The advertising budget of the pharmaceutical industry in the US is over 20%, while the R & D budget is less than 17%. The insult added to this injury is that the Pharmaceutical industry approaches Americans as if they are that stupid so as to design consumption based upon stupid TV ads. Or perhaps they are. Aren’t doctors supposed to design what drugs their patients need? Hospitals advertise on TV and radio. That is simply stupid. The consumer pays for this stupidity and these insults.

    History has shown that some services work better in a controlled situation while some services are better left to the free market. Given that the US ranks 24th to 25th in quality of health care among other countries where health care is controlled how much more damage needs to be done to the average American before they wise up? As long as the US is an oligarchy and the health care industry, pharmaceutical industry, and health care insurance industry owns our representatives, we will continue to get screwed.

    Vote for someone who is against unregulated campaign financing and for single payer health care. So what if doctors make $350,000 a year instead of $450,000 a year. So what if a million redundant jobs are lost. So what if some investors lose money on Wall Street. So what if hospitals have to coordinate their services instead of duplicating them. Under our present system it is, so what if the average American pays three times what the average Canadian pays. Canada ranks 13th to 14th in the world compared to the US at 24th to 25th. The US ranks 99th in the world for efficiency of dollars spent to services received. Are we making America Great Again?

    I know, ‘If you don’t like it move to Canada.’

    1. issac – how come those damn Canadians, with their perfect health care system, keep coming to Arizona and using ours in the winter? You would think they would be stacking up to get into their own medical facilities instead of our third-world medicine. When the flu season hits we have to shovel our way through Canadians to get to our doctors. Do you think Canada could set up some auxiliary medicine facilities in Arizona for their citizens and take the load off our system?

      1. Paul

        You continually resist looking past the end of your nose. Canadians go to the US and other countries. Americans go to Canada and other countries. India has modern hospitals that will give you what you want when you want for much less. No system is perfect.

        In Canada some procedures are prioritized but rarely if ever at the risk of life or health. Convenience is a factor.

        A good buddy of mine recently had a triple bypass. He was admitted on a Monday. They stabilized him out of any risk and prioritized him for surgery the following Monday but delayed that until the following Friday. He was never in danger. His insurance premiums are around $150 a month. He didn’t pay a penny over that. In the US the premiums would be many times that and with co pays and such, he would have been out of pocket thousands. The cardiac department at his hospital is world class. The procedure is done in almost every advanced nation.

        I have dozens of stories where medical attention: nerve disorders, cancer, strokes, etc have been treated at Mayo Clinic levels for nothing more than a monthly premium that doesn’t exist in the US.

        If you dig a little you will find that most if not almost all those Canadians pouring down into your area for medical treatment go for non life threatening conditions or to have procedures done at their convenience. There are some rare instances where treatment in the US is not available in their province. The US has ten times the population; this is not unusual.

        Another thing almost all if not all Americans are unaware of is that there is no Canadian system. There is a Canadian Health Care Act that oversees collection and distribution of monies and keeps the provinces within reasonable limits. The health care in Canada is administered province by province: BC MED, Alberta MED, etc. If a procedure is not available in a province the individual can receive treatment elsewhere and will be reimbursed by the province. If an insured wishes to expedite a procedure such as cataracts the province will reimburse for the established cost. The difference can be deducted from taxes. In the end, however you look at it, Canada ranks 13th and the US ranks 24th averaged out. Yes, if you have unlimited funds or a Cadillac policy you can visit the Mayo Clinic and get immediate treatment. For 99% of the population, that is not the case.

        I have personally experienced both systems and can only say that Americans are pawns of a commodity based system where hundreds of thousands of unnecessary jobs, thousands of million dollar salaries, excessive waste, and the credo of ‘what the market will bear’ set the standards and not the welfare of the individual. The American system works, but poorly. It is not designed for the consumer. If I do decide to return to Canada, it will be primarily because of health cost concerns.

        These are facts Paul, just as plain as the nose on your face, the nose which at the end is found the limit of your knowledge. And, by the way, it is not an issue of patriotism to support systems that are not in the best interests of the people. The people come first. Without the WE there would be no I. This is perhaps America’s greatest lie or illusion, thinking that the country is based on the individual.

        1. Thanks, Issaac.

          Republicans feel that billionaires come first. And their taxes must be cut on a regular basis to give Wall Street sugar rushes. That’s it; no one else matters. It’s all about Republican donors and their special needs.

          1. I thought dems were for equality and fair share.
            10% across the board for all is completely equal and fair.

            1. 10% income taxes across the board..? Is that what you actually ‘mean’..??

              10% ain’t nuttin for billionaires! That’s loose change between their couch cushions. At those rates the government wouldn’t clear enough to fund The Pentagon.

              Your comment illustrates how Libertarianism is essentially a cult. It takes a huge leap of intellectual faith to think a 10% across the board tax rate would even come close to funding America’s needs. And that’s how cults are defined; ‘leaps of intellectual faith’.

              1. If you add 10% from the millions who don’t pay taxes and reduce costs such as the multimillion dollar retirement packages for extra useless government busywork wonks who pay in less than $150,000, cutting nancy pelosi down to one government funded jet stocked with cases of $17,000 a bottle of wine so her dog and grandkids will have to fly on the same jet as her and stop paying lifetime Social Security benefits that belong to the people who paid in, to able-bodied 20 year old parasites so they can stay addicted to drugs and alcohol and 10% will be more than enough.
                BTW, Where do you think the money for all of those extra taxes that you want the billionaires who made their money mostly from businesses and investments that create millions of jobs is going to come from, the stockholders? Think again. It will be coming from cutting the cost of doing business and the first cost-cutting measure will be replacing the low-level workers who depend on those jobs to feed their children and pay their mortgages. 1 mega robot computer can easily replace 500 to 1,000 jobs and pay for itself in less than 6 months.

                1. Peter Shill doesn’t understand economics nor does he have a good understanding of history.

                  We should provide him a scholarship and pay for his plane fare to Venezuela providing a return trip back in 2 years. I think in the 1950’s Venezuela may have been rated 4th highest in the world with regard to one metric measuring economic prosperity.

                  1. HERE’S HOW YOUR TAX CUTS WORK, ALLAN

                    The top 10% of American households owned 84% of all stocks in 2016, according to a paper by NYU economist Edward Wolff. As the markets have been driven higher by an unprecedented binge in share buybacks, boosted by Trump’s historic corporate tax cuts, those gains have disproportionately gone to the very wealthy.

                    For them – it’s true – there is “more good news” to come. According to a Goldman Sachs report published last month, cash-rich US companies are poised to push $1tn into share buybacks this year.

                    While the same trend can be observed in the UK, Europe and Japan, nowhere is it more hyperactive than in the US, where companies have spent a stunning $5.1tn buying their own shares since 2008. According to a UBS report in June, repurchases are up 83% year to date, far ahead of the 9% gain in dividends.

                    Edited from: “Experts Voice Concern That Corporate Windfall From Tax Cuts Benefits The Wealthy”

                    Today’s GUARDIAN

                    1. The article goes on to note that corporate stock buybacks are a bonanza to top executives who are paid in stock options. But the average Joe scarcely benefits.

                    2. Peter, you and your citations are pure partisan garbage. Ask any friend who might be an accountant and can control his emotional attachment to his ideology.

                      Things work better for those below a certain income and that would be somewhere below 100,000. It’s difficult to say what will happen to the next group.

                      In general the rich are not making out like bandits.

                      The deduction for taxes will alter a lot of results but there a lot of things that make the actual result too complex to discuss.

                      I know that my ultimate tax bill is going to rise a lot but I am not against the bill though I think spending needs to be controlled. I have expensive homes and my taxes used to be deductible but now that is limited to $10,000. That is fine as far as I am concerned because I think tax deductions encourage spending and that is one reason some states are in trouble. New Yorkers especially those that live in Manhattan are probably furious because suddenly their taxes in excess of $10,000 will not be deductible. Then again remember that it is difficult to find an apartment in Manhattan for less than one million dollars so I am not too concerned. Subsidies should only be for those that are truly needy.

          1. Paul

            I have read this before and many other articles like it. If you read it carefully and not just to back up your usual shotgun responses, you would have noticed that the words elective and not available illustrate many of the reasons for people leaving. Elective surgery in Canadian Provincial systems is prioritized behind necessary surgery. It is, however, when done privately partially reimbursed. My mom had cataracts removed through a private clinic for $2,500 after a wait of a couple days. Her doctor prioritized the procedure with a wait of a couple months. She was swimming in a chlorine treated pool while her local non chlorine pool was closed for repairs. It was a nuisance but hardly life threatening. BC MED reimbursed her $1,300 and she wrote off the $1,200 difference-30% tax bracket=ed a few months to even out. She paid a little over a hundred dollars a month in premiums. The provincial systems are two tiered, government administered and private. The systems in Canada are designed around life threatening conditions. You are no worse off in Canada if you have need of immediate attention than any place else in the world. My dad had a very mild stroke when in his 80’s. He was immediately admitted and analyzed. A WW2 veteran who eventually lived to almost 95, not much shook him up. When I called the doctor to ask why he was still in the hospital after ten weeks, the doctor said that he was a little shook up and that when he became a nuisance they would throw him out. He stayed for two weeks. That sort of attention is not available in the US. My dad’s insurance was his military pension coverage, equivalent to BC MED.

            Supplementary insurance policies are available privately to cover the costs of elective surgery and non life threatening conditions on shorter notice. The bottom line is that on average, combining public and private insurance, Canadians, per capita pay a third of what Americans pay. The World Health Organization rates Canada 13th in the world while rating the US 24th in the world. The qualities of the provincial systems vary depending on the governments elected. When more conservative governments are in power in a province, things tend to tighten up. When more liberal governments are in power things tend to become looser.

            The bottom line Paul is that the conditions in Canada are far superior on average at vastly lower costs to the individual. I have lived in both countries and only here does one worry about getting sick and being financially whacked by the parasites. In response to your article, 1.4 million Americans will seek medical attention abroad this year. At one tenth the population of the US that should equate to 140,000 Canadians leaving Canada for medical attention. It is a little over 60,000 and that is disputed.

            You argue my point for me. If it was your intent to dispute what I wrote, then you should really do your research. When you do, if you do, you will find study after study after study reiterating the same thing: the US system is unique in that it ruins people financially, if you don’t have the money you are screwed, even Medicare is next to nothing, most of the money paid into the system is either wasted or stolen by profiteers, no other country allows this travesty, no other country allows pharmaceutical companies to advertise their drugs, no other country allows the oligarchs to buy the politicians, etc, etc. We do need to make America greater but to do so Americans have to realize where they are going wrong. That is the hard part, for an American to admit that they are wrong. Take a shot Paul.

            1. issac – your system is so good that 63000 people are leaving the country for elective or non-priority services. However, they are clogging the system in Arizona. 😉 Now we like our Canadian snowbirds, but could they bring their doctors with them? Is that too much to ask?

            2. From 2016

              The total wait time that patients face can be examined in two consecutive segments.

              From referral by a general practitioner to consultation with a specialist. The waiting time in this segment increased from 8.5 weeks in 2015 to 9.4 weeks this year. This wait time is 155% longer than in 1993, when it was 3.7 weeks. The shortest waits for specialist consultations are in Ontario (7.2 weeks) while the longest occur in New Brunswick (21.5 weeks).

              From the consultation with a specialist to the point at which the patient receives treatment. The waiting time in this segment increased from 9.8 weeks in 2015 to 10.6 weeks this year. This wait time is 88% longer than in 1993 when it was 5.6 weeks, and more than three weeks longer than what physicians consider to be clinically “reasonable”. The shortest specialist-to-treatment waits are found in Saskatchewan (7.9 weeks), while the longest are in Nova Scotia (17.7 weeks).

              It is estimated that, across the 10 provinces, the total number of procedures for which people are waiting in 2016 is 973,505. This means that, assuming that each person waits for only one procedure, 2.7% of Canadians are waiting for treatment in 2016. The proportion of the population waiting for treatment varies from a low of 1.6% in Quebec to a high of 5.8% in Nova Scotia. It is important to note that physicians report that only about 10.8% of their patients are on a waiting list because they requested a delay or postponement.

              Patients also experience significant waiting times for various diagnostic technologies across the provinces. This year, Canadians could expect to wait 3.7 weeks for a computed tomography (CT) scan, 11.1 weeks for a magnetic resonance imaging (MRI) scan, and 4.0 weeks for an ultrasound.

      1. As a retiree, I had seriously entertained the thought of moving to Canada. But it turns out that Canada does not want US retirees, even ones with a significant level of assets. Same goes for many other appealing countries, I might add.

            1. They don’t want you.

              Perhaps they wish save their social net system from people that want care and migrate to Canada. Maybe you didn’t have enough potential to pay for your stay?

              Think of what you had to offer Canada.

              1. It’s not me personally – they just don’t want it to be easy in general for Americans to emigrate to Canada. The one surest way is to have a Canadian relative. Next most surest way is to have a definite Canadian job offer. But for retirees – very very difficult.

                1. Maybe they don’t want seniors to emigrate. Seniors create increased social costs and generally don’t provide significant industry.

                  Jay, if you really want to emigrate there open a business that hires people and make it very apparent you are putting a lot of money into the Canadian system. Open in a location where they need you.

    2. We already have a single-payer healthcare system in this country. It’s called the VA. Government middle managers are paid for bonuses to keep the stats low and clear the books. The easiest way to do this is to delay treatment until patients die then cook the books so it’s not obvious or make initial treatment completely unaffordable. After all patients are not really people, they are means to desired ends such as bonu$e$ and promotion$$$.
      If this is the kind of healthcare people want where are middle managers are rewarded not for patient care, but stats that look good on paper then please implement a national Healthcare single-payer system or better yet just expand the abusive ones already in place.

      1. dawn,

        National healthcare – like in most other modern countries? I agree. It’s the way to go. And, with a MAGA president leading the way, his 30% core base would immediately rise to what? 55% or more. Then, no impeachment and full immunity for criminal charges against him and his family.

          1. dawn,

            Money laundering, obstruction of justice, conspiracies, violation of U.S. Constitution (Article I, Section 9, Paragraph 8) etc.

                1. Before the Democrat deep State coup attempt, due process included the person charged being allowed to know what crimes he’s being charged with, however since this is the post Constitutional era of Mueller I would suggest that the president use the Hillary, innocent by reason of being a Power mad hate-filled abusive America hating corrupt lying murdering vicious evil Democrat control freak out to control everyone and everything and become king of the world by way of destroying everyone that gets in the way. Works every time. Just ask Obama.

                    1. I asked you first. You’re proof of your charges please. By the way in spite of the conducting trial on CNN and having Facebook and Twitter posters as juries, in the real world evidence and proof is required. So put yours first since the question was posed to you first.

                  1. Dawn –
                    I continue to be puzzled by this “deep state” business. Who comprises it? Anybody who happened to vote against Trump? Anybody who happened to vote against Trump, that works for the Federal Government? Does the deep state have an org chart? An office? A secret handshake? A flag? How do you know it exists?

    3. Issac-
      You are exactly correct.

      By the way, most drugs prescribed or bought over the counter in the US are made in China. For others, some of the ingredients come from China. Think about quality control, tariffs, possibility for China sanctions against the US.

      In spite of that, those exorbitant drug costs aren’t going to China. Theyflow primarily to drug marketing companies – otherwise known as “US Pharmaceutical Companies”.

      1. Actually a lot of the money is going to pharmaceutical benefit managers that are middlemen and exist with high revenues primarily because of all the micro control over the healthcare sector.

        I can provide examples of certain drugs where it becomes obvious that that the PBM’s are very much involved just like I can provide examples of extreme gouging by the pharmaceutical companies. I can also demonstrate how physicians don’t always recognize the costs and why that is understandable. However, it is the highly controlled system that is causing a lot of the problems.

  10. REPUBLICANS NEVER DEVELOPED OBAMACARE ALTERNATIVE

    BECAUSE OBAMACARE IS THE ONLY FREE-MARKET SOLUTION

    Rightwing media went overboard in demonizing Obamacare. By calling it ‘socialized medicine’ and a ‘government takeover of the healthcare system’, conservative forces left themselves no room for compromise.

    There is no free-market alternative to Obamacare that provides affordable, comprehensive coverage. Obamacare is essentially the last free-market stop on the road to socialized medicine.

    Consequently Republicans can only propose lame, half-baked ‘solutions’ like cheapie plans with limited coverage. Or ‘tort reforms’ which limit most malpractice suits; giving legal protection to incompetents.

    Then there’s the big idea of letting insurance companies market policies across state lines. Like they wouldn’t all incorporate in Delaware. Raising the question, “Do we want a Delaware-based healthcare system?’ Does that sound progressive in terms of patients’ rights?

    With no real alternative to Obamacare, Republicans can only stick to molding myths; pretending we were fine ‘before’ Obamacare.

    No wonder Medicare-For-All is rapidly gaining traction. Because Republicans left no room for compromise, and never offered an alternative, Medicare-For-All became the de facto plan.

    1. Obamacare is basically a scam the Democrats put in place that guarantees insurance companies million’s of premium paid members that they will not have to spend a dime on. The average out-of-pocket for ObamaCare ranges between $6,000 and $13,000, before Obamacare actually begins to pay. I know lots of individuals who use Obamacare that simply do not use Medical Services. They self treat at home because they do not have the money. The obvious fault is, if you need Obamacare then s a general rule your budget doesn’t have in it the $6000 to $13,000 cash deductible laying around the house to fork over before you can use it. Tone of the much touted perks for ObamaCare was the fabulous free diagnostic tests. However the people that I have spoken to on Obamacare do not even utilize the free diagnostic tests. The reason they give is “What good is it going to do me to know I have cancer if I don’t have $6,000 to begin treatment. I’d rather not know.”
      Obamacare never was and still is not about patients, it is about money and payoffs to big med and pharm. The writers knew this. The writers should have their portfolios scrutinized to see how much stock they have in the medical and pharmacological Industries.

      1. Dawn, when judging Obamacare, as it currently exists, one has to consider that Republicans did everything possible to SABOTAGE the plan. They were hell-bent on making sure Obamacare ‘would be’ expensive and a hassle to obtain. What’s more, the Trump administration continues sabotaging Obamacare. Therefore Obamacare, as it exists right now, is not the plan it ‘could’ have been or ‘would’ have been.

        Describe for us the Republican alternative.

        1. The Republicans were physically locked out of the room.
          From the results of thousands of obamacare recipients who are sick and dying because they have health insurance, but no access to health care because they don’t have the upfront thousands and thousands of dollars for the deductible, the Republicans will right to try to stop what amounts to basically a death sentence for certain poorest of poor people in this country.

          1. Yes, Dawn – what is the Republican alternative? “Don’t get sick, but if you do, die quickly” ?

            I would say that the main difference between Democratic and Republican views on health care is this: The purpose of a Democratic health plan is to keep as many people as healthy as possible, while trying to keep costs reasonable. The purpose of a Republican health plan is to spend as little money as possible on health care, whether people stay healthy or not.

            1. Who said there was a republican alternative? The whole thing is corrupt and the Republicans as well as the Democrat simply keep playing the badminton distract the people game by counting on the people being divided because they don’t realize how the power game these five hundred or so people play works. You don’t think Republicans are protecting their own ownership of medical and drug stocks too? Of course they are. They are also protecting the same big Pharma, big Med companies from the consequences of having to participate without protection in a free-market that would easily crush them, but then who would pay for their yachts and $8,000 suits, ties and shoes? The problem is not democrat or republican but corrupt government politicians and government workers financially enslaving the American taxpayer one corrupt controlling piece of legislature at a time. That is why the Trump hysteria on both sides of the aisle is it such a cosmic level. All the governor Le Petomane “we’ve got to protect our phoney baloney jobs gentlemen” denizens of Washington are seeing the eviction notices by the people being tacked on their doors. The most dangerous denizens of the swamp, the Democrats who intend to replace the Constitution with Communism are the ones that are going to go first, but systematically the voters removal of their chains will continue and the Republicans too will eventually be replaced.
              None of the politicians on Capitol Hill have the ability to see that both parties are dead as 20th Century door nails and the 21st century along with the 21st century parties that are going to return consent to the governed is here and their time is up.

            2. Jay: Dawn is what’s known as a ‘Libertarian Fundamentalist”.

              They want to take this country back to the Calvin Coolidge era. And though they currently vote Republican, they officially deny ‘any’ link to the GOP. Which allows them to bash both parties while secretly voting a straight Republican ticket.

    2. “There is no free-market alternative to Obamacare that provides affordable, comprehensive coverage.”

      One has to laugh at this ridiculous statement. Totally ignorant.

      1. Gee Allan, I guess the Republican alternative is just so obvious that even Mitch McConnel forgot what it was.

        1. Peter, learn to read even what you write: ”
          “There is no free-market alternative to Obamacare…”

          Do you see the word Republican in that sentence of yours that I criticized? This is an example of how hyper ideological you are and that affects the way you think.

          1. Allan, you’re one of those old farts who presumes he’s wise by virtue of age. That doesn’t cut it anymore. Seriously!

            1. Peter, you are just annoyed that you are unable to defend your ideas. That is why you lash out this way. Get one thing straight. You aren’t as smart as you think you are and you know less than you think you know.

  11. It seems a reasonable exercise in research would be to obtain the Chargemaster of an average hospital and compare each cost point with what is billed verses what actual cost is. From these figures we could obtain a better perspective as to where the excess is.

    Given what I have seen and read for me the billed amount is often a factor of how deadly or debilitating the malady is more than what the cost to the hospital of rendering the treatment.

    But whatever the formulae, if we assumed the billing for heart attacks was tens of thousands of dollars yet another procedure such as setting a broken limb was two thousand dollars (and involved the same labor cost / ED visit) one could see that the cost of bone settings was billed at a lower rate because a heart attack patient brought in enough revenue to lower the cost of the latter.

    But in the end if the heart attacks were instead a few thousand dollars and the bone setting was tens of thousands we could arrive at the same revenue just by manipulating the chargemaster.

    In both amortization and depreciation, for tax planning, we see the front loading of costs over time, but in the end the amount deducted is equal at the end of the schedule.

    I would venture to say if we did the same with the chargemasters where altered to represent a truer cost basis for each procedure, the cost of the heart attacks and cancer treatments would drastically lower, but then items such as routine visits might increase. What would be worse from a political position? A few people with heart attacks being angered by the rate or everyone angered about their routine checkup costing 500 dollars?

    Unfortunately many hospitals lose money on many procedures because of low reimbursements by insurers, government, and absconders.

    The system is in need of great reform. Unfortunately politicians are incapable / unwilling to help address the problem and the rest want 120% of their fair share.

    1. Hospitals guard their Chargemaster price lists more zealously than any Government secret. But they should be obliged to reveal them.

    2. The finances of every industry are skewed by wholly unconstitutional governmental intervention. Start with Medicare, which is pure unconstitutional redistribution of wealth straight out of the Communist Manifesto. You don’t need accurate accounting, simply request more taxpayer funding in an infinite number of modalities.

      Actually, Congress has no power to tax for individual welfare. Private property means any and all types of intervention shall only be accomplished through Eminent Domain. Regulation is limited to assuring the completely unrestricted free flow of commerce among the states without bias or favor to any entities or states per the commerce clause.

  12. Never thought I would say this but our current system is so flawed that we need a single payer system perhaps modeled after Australia. When Obama first proposed a plan I send an exhaustive, detailed plan to him via the DNC which also included some much needed revisions to his plan including Tort Reform, the inclusion of dental care and elimination of Workers Comp which employers would no longer need if universal care was in place. I further suggested this become an extension of Medicare since the program was already here and the tax system already existed and little red tape needed to be added. Of course, the plan was rejected outright without comment – typical Washington.

    1. Silly you, actually providing a viable alternative to the current system. That would eliminate too much of of the kickback system that allows wealth redistribution to politicians and their cronies. What were you thinking?

  13. Hospital billing (and medical office billing for that matter) is a confused landscape at best. I do not pretend to understand it fully, but I feel that I know enough to opine that the fault is not entirely that of the hospitals. Although there are many causes of this confusion (which seems an awful lot like deception), I’ll just mention three. First, as a general rule, hospitals are not allowed to bill for anything other than medical related services provided directly to patients. Billing for a percentage of overhead is not allowed. This limitation is mandated by insurance carrier rules and policies and for medical services regulated by the state, such as workers’ compensation, it is mandated by law. In order to generate enough revenue to pay for those things which cannot be billed directly to patients, such as the cost of the building and its offices and parking lots, equipping and maintaining operating rooms, ER departments, administrative offices, patient rooms, food service facilities, nursing and administrative personnel and the host of other costs that it takes to run a hospital, hospitals tend to charge a lot for those things a patient can be billed. A fifty cents toothbrush may be billed at $5.00 as are other “personal” items provided to each patient. The actual time spent in the operating room and recovery room may be billed at seemingly exorbitant rates. Hospitals were encouraged in this practice by insurance carriers who paid typically a percentage of “billed charges” thereby encouraging hospitals to bill more. The trend now is for hospitals, physicians and other health care providers to move toward billing practices based on Medicare models, weights and values, but it will be some time before the practice is universal. Another factor influencing billing is that a considerably high percentage of the population that a hospital must serve (especially through its ER department) is uninsured and unable to pay. In Texas, anyone in need of emergency care cannot be turned away, regardless of ability to pay. A consequence is that those who can afford to pay are relied on heavily to make up for those who cannot. The biggest hospital bills typically go to those who are private pay. A third factor contributing to the problem is the long-standing battle between health care providers and insurers, with the former wanting to be paid more and the latter wanting to pay as little as possible. The shift to Medicare billing practices still has flaws. There are numerous examples of reimbursement rates under both Medicare and Medicaid where the amounts paid for a particular service do not cover the costs. Because of the financial pressures, we are witnessing the disappearance of community based hospitals and a shift toward huge hospital systems like St. David’s located in large metropolitan areas. None of this relieves the anxiety of a school teacher who receives a hospital bill that is several times his annual income. Perhaps the best that can be said is that there are reasons for the madness.

    1. honestlawyermostly – one of my doctors explained to me that since Obamacare they have increased the number of billing codes by about 1/3 which is one of the reasons most drs have a computer in the room with them. They can do the coding on the spot. It also means your GP will only see you for one illness at a time unless you happen to go in for your annual and they catch a couple of things at that time.

      1. Paul C Schulte – Reimbursement rates for specific procedures and examinations and the various medical billing coding systems are two factors that control the quality and quantity of health care, probably more so than any other. In the past year, I have been to my local doctor’s office four or five times for various things, including one visit for pneumonia. I actually saw my doctor once (not for pneumonia). For each of the other visits, I was examined and treated and medications were prescribed by a PA. Doctors’ offices now must maintain a large volume, reserving the doctor only for those procedures and examinations that yield the highest reimbursement rate and delegating all the rest to lower cost employees. Reimbursement rates and the limitations on coding also dictate how much time a physician can spend with each patient before it becomes a money loser. I agree with you that billing codes and the rules behind them frequently dictate how many conditions one will be treated for during each visit. Many procedures must be “bundled” with other procedures if done during the same visit which may cut reimbursement for the second procedure to one-half or less what it otherwise would be. If the procedures are done at separate visits, billing codes and rules usually allow full reimbursement for each. It really is a screwy system.

        1. Maybe most doctors and all hospitals should be government-owned and operated. Works for the military, and could work for the civilian population.

          1. bill mcwilliams – I do not hear good stories about medical treatment in military hospitals these days. It is like the VA. However, my information is anecdotal.

          2. Bill, look at Medicare, Medicaid and the VA all constrolled by the government. All are over budget. All have major structural problems. All create gaming of the system and those in most need are the ones frequently that are hurt the most.

  14. Public schools should have been automated long ago. Teachers are glorified day-care workers. One DVD per subject nationally is sufficient. Students could attend class at the beach on their I-phones. Industries have operated people-less factories for decades. They’re not stupid; not going to pay for nothing. Lazy, greedy, striking, thug, union teachers are a massive fraud and total rip-off of the deep-pocketed taxpayer; and wholly unnecessary.

      1. There is a teachers strike somewhere once a month.

        All other public employees obtain “comparable pay.”

        Turn public schools over to Rockwell Automation which will create teacher-less campi.

        The military uses pilot-less drones.

        The use of bio-teachers is an obsolete redistribution of wealth program.

        Is the product of public schools (i.e. forklift drivers and 7/11 clerks) worth $200K per teacher/administrator/overhead?

        The lazy, greedy, striking, thug teachers union psychos are going at it right now in Seattle.

        The military is the first workforce of every nation and the military will never unionize or strike.

        Public workers must never be allowed to unionize.

        All pubic employees must be fired for being AWOL, immediately and irrevocably.

  15. In WA, a case two weeks ago before its court of appeals has a bit of relevance here. Essentially an uninsured patient went to hospital for a procedure and refused to pay the bill–exceeding thirty grand. He and other similarly situated plaintiffs argued that the fees for procedures were unenforceable due to being “indefinite” upon his admittance into the hospital. The court ruled against him.

    http://www.courts.wa.gov/opinions/pdf/767208.pdf

    The court relied upon his acceptance of the facility’s “chargemaster” which enumerates each procedure or item and its cost to the patient, and that plaintiffs agreed to be bound to pay according to this list.

    1. That indicates a functional problem with the law and the judges, There is no law saying the chargemaster should be used since how could a contract actually be legitimate if the payer is prevented from knowing the price beforehand? I think that contracts should spell things out before hand and that if not adequately spelled out it should become the problem of the hospital or physician.

      The chargemaster price can be anything. I have had charges 20X the going rate and refused to pay.

        1. Here’s the thing. You red state folks need to grasp the facts. Some of you (Dakotas, Wyoming, et al.) need to accept that your power over our Congress and our laws will diminish. Your votes need to reflect the fact that you are a small number of nice but over represented folks. We appreciate your counsel and ideas, but it is time for you to get real. You are a few million people and you should not be able to hamstring the rest of the country. Get it? If not, go back to school. Sure, you are nice, but you are but a few of us. The rest of us want to move forward in the 21st century. Those of you who don’t agree can hang with Dick Cheney in his Wyoming habitat.

          1. hollywood – AZ has constantly grown since I have been here. Right now we have 9 Representatives, but we should have 11. If the Republicans control the House and Senate after the 2020 Census we should get 13. Plus 2 Senators. Of course that means some blue state(s) is going to lose 2-4 representatives.

          2. As much as the left continues to jones for the US to be a democracy the US is not a democracy, aka mob rule where 51% rule the other 49%. The United States is a Constitutional Republic. Here everyone gets representation. If the United States was a democracy not a Constitutional Republic, blacks would still be slaves and women would still be property.

            1. Dawn, “Constitutional Republic’ is just a noble way of saying that older Whites in small towns know what’s best for everyone.

              Here’s a fact: 75% of America lives in the 20 most populous states. Which means only 25% of the country lives in the 30 least populous states. Yet that 25% controls 60 U.S. Senate seats.

              So consequently a small, White minority, in little towns is forever dictating the national agenda. Banning abortion and preserving gun rights are their main concerns. That’s your ‘Constitutional Republic’. What a joke!

              1. Dawn, “Constitutional Republic’ is just a noble way of saying that older Whites in small towns know what’s best for everyone.

                You never utter an honest word.

        2. Paul C. Schulte……..well, Mr alphabet soup Nazi 😁, .again, I say, It is I who found out about Aetna. My moniker thing was acting up, ergo, anonymous and Cindy Indi…….. I will bet you a bottle of Stubbs BBQ sauce that I am correct 😊 regarding the grammar! LOL

  16. Oh I can’t believe it was St. David’s! That’s our best one in the Austin area.
    How embarrassing.

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