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has  become very apparent to me as the statements and bills from the illness and treatment of my wife have begun to arrive at our house.

I could show this clearly from many of them, but since it was 6 weeks ago this evening, just about this time, that we got the new she would not be leaving the hospital after an MRI we thought had been merely preparatory for referral to a pain management specialist, let me focus on the hospital bill.

Let me note that as a federal employee Leaves on the Current has a superb insurance plance through Blue Cross / Blue Shield, which because it has arranged with Virginia Hospital Center to be a preferred provider the hospital agrees to be bound by what the insurance provider agrees should be paid, plus an additional copay by the insured, in this case of $250.00

The insurer pai 12, 651,32.   That means the total paid was 12901.32.   Even that sum would hit most families very hard.

But what if the rest of the bill fell to the patient and family?

The total bill was 33, 556.30.   This is more than the median annual salary/wages for employed Americans.  

We probably would not be forced into bankruptcy were we forced to pay the entire bill -  federal law allows withdrawal of retirement funds early without penalty for payment for medical expenses.  Many Americans would not have access to such funds.  

One could be insured and still forced into bankruptcy -  33,665.30 - 12.651.32 would leave a responsibility of   21,013.98

We are fortunate to have access to wonderful health care.

We are very fortunate to have insurance that enables us to afford such health care.

It is a shame that others are not so fortunate.

It is effectively rationing health care by financial status.

Perhaps some can rationalize that.

I cannot.

So even as my focus remains on Leaves on the Current, I feel an obligation to speak out, to see this nation move well beyond what the Affordable Care Act offers.

It has been six weeks.

We didn't have to say - we can' go to the emergency room because we do not know how we will pay for it.

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  •  I do not argue that I am the first to notice this (184+ / 0-)
    Recommended by:
    Eileen B, rat racer, FloridaSNMOM, ladybug53, TexDem, 3goldens, Gooserock, bluezen, Mortifyd, HCKAD, alice kleeman, annieli, tofumagoo, carpunder, liberaldregs, RJDixon74135, paxpdx, happy camper, Freedomfreak, banjolele, lcrp, Debs2, MasterfullyInept, Brooke In Seattle, nupstateny, Matilda, revsue, Cassandra Waites, fumie, Ree Zen, Shelley99, Jim R, cv lurking gf, Grandma Susie, Cronesense, janmtairy, cyncynical, Anne was here, roses, ruleoflaw, ScienceMom, Showman, TheMomCat, Shippo1776, LamontCranston, SoCalJayhawk, terabytes, texasmom, petulans, tmmike, denise b, historys mysteries, blueoasis, Shockwave, One Pissed Off Liberal, Miggles, annan, glorificus, blue91, celdd, Actbriniel, leu2500, zenox, eru, sound of progress, marleycat, Pacifist, psnyder, Kevskos, Yo Bubba, Ekaterin, zerelda, kerflooey, Tom Anderson, Ckntfld, Tinfoil Hat, BYw, gooderservice, northerntier, UnionMade, slowbutsure, Geenius at Wrok, basquebob, middleagedhousewife, Habitat Vic, gfre, rmonroe, dfwlibrarian, high uintas, JayDean, mconvente, AaronInSanDiego, camlbacker, virginwoolf, wader, Jim P, old wobbly, Illinois IRV, CarolinW, deeproots, Ice Blue, pat bunny, Sylar, Observerinvancouver, worldlotus, radical simplicity, chimene, Alumbrados, FindingMyVoice, SD Goat, Rick Aucoin, myboo, maf1029, notrouble, Tross, HarpboyAK, nominalize, DBunn, bloomer 101, dotdash2u, jamess, ModerateJosh, Tennessee Dave, greengemini, JanL, Oaktown Girl, kaliope, bluesheep, onionjim, Chi, Nicci August, mbayrob, hoof32, riverlover, WheninRome, splashy, La Gitane, kareylou, lurker123, Loose Fur, radarlady, stevenwag, Horace Boothroyd III, Emerson, ItsSimpleSimon, anodnhajo, citizen dan, DefendOurConstitution, Rogneid, ksp, Noddy, VA Breeze, tbirchard, lennysfo, leeleedee, JDWolverton, quagmiremonkey, No one gets out alive, blue armadillo, Mac in Maine, the fan man, binkycat, meg, JWC, emmasnacker, Over the Edge, bfitzinAR, Texknight, absdoggy, Tam in CA, jfromga, SanFernandoValleyMom, mamamedusa, SaraBeth, 57andFemale, orlbucfan, mattc129, molunkusmol, sillia, GeorgeXVIII, jm214, cocinero, OMwordTHRUdaFOG, kurt

    others can make the arguments far more effectively than can I

    as I just finished paying bills so far (that is, our responsibilities) for the treatment Leaves has been receiving, I thought I would take a few moments and post this.

    It is now,at just about 6:55, the exact time we got the news 6 weeks ago.  

    It seemed appropriate.

    "We didn't set out to save the world; we set out to wonder how other people are doing and to reflect on how our actions affect other people's hearts." - Pema Chodron

    by teacherken on Sun Mar 10, 2013 at 03:54:11 PM PDT

      •  Steve Brill in Time (25+ / 0-)

        Has covered this well.  Obamacare has many different standards of coverage.  You must have a platinum plan like members of Congress and the WH.  Most of the rest of us will be forced into the bronze plans.  To provide contrast, Canada has universal coverage, no copays deductibles or medical bankruptcy. The standards of care in Canada are the same for all. The ACA has done little to control the costs and soon will be perceived to be the failure that it is.  You are lucky, like President Obama!

        •  We pay (24+ / 0-)

          Just shy of $17k/yr in premiums, plus $2500 per person deductible, plus co-pay, plus the %age the insurance doesn't cover on certain procedures. Last year the premiums were higher, and our total out of pocket landed somewhere in the neighborhood of $25k, courtesy of two relatively minor, but medical-time-consuming health issues.

          We may as well not have insurance, but with kids, it's imperative. There's no way we could have covered our son's broken neck two years ago without it.

          The real joke is that this qualifies as meeting the MA requirements for "affordable" health insurance coverage. $25k is 83% of the median income. Where are the rent/mortgage, food, utilities, etc. supposed to come from when you're dishing out 83% of your income? Heck, mortgages are typically expected to run ~30%, which means the median family with this "affordable" insurance would be 3% in the hole at the end of a year with just a couple of minor health issues that required medical attention, before adding food, utilities, or any other non-housing expenses. It's insane.

          If it hadn't been really, really necessary, we would not have sought treatment. We kind of figured our daughter wanted to live to adulthood, though, and I sort of need to be able to walk, so there you go. Alas, even without those ailments, we would have been out of pocket nearly $18k.

          •  This is exactly the reason (23+ / 0-)

            why market-based "solutions" just don't work for medicine. Crazy parents like you all over this country want your kids to live and be healthy - medical care is not some frivolous option, or something you're really in the mood to shop around for when your child has an accident or serious illness. There is an undeniable pile of evidence that the profit motive has made our system not cheaper and more efficient, but more expensive - unsustainably so.

            The way I see it, the insurance companies have had a few decades to get it right. The things we would have wanted them to do to ensure great care and access while controlling costs have not been done, mainly because insurers figured out they could make a ton of profit the easy way - by raising premiums and deductibles, denying care, and cherry-picking insurees. It's been a failure all around. If they are too lazy to implement the policies that we know can work, based on what other countries have done (like using comparative efficacy data to make reimbursement decisions about drugs and procedures, by capping drug company profits, etc.), we are left with no choice but for government to step in. How the hell can we have a healthy economy, let alone healthy people, when so much of our earnings are going straight to the insurance companies?

          •  So, sadly, in time, we will discover that the AFA (5+ / 0-)

            is by no means the solution.  We'll need to do better, a lot better.

            And we are not even talking about dental care, rapidly become another source of concern.

            The elevation of appearance over substance, of celebrity over character, of short term gains over lasting achievement displays a poverty of ambition. It distracts you from what's truly important. - Barack Obama

            by helfenburg on Mon Mar 11, 2013 at 03:49:29 AM PDT

            [ Parent ]

          •  that does not appear to be the way (0+ / 0-)

            the ACA works,   a family making $33,500 for example, the amount of the bill owed in this diary,  would be above the medicaid cutoff.  Based on a family of four,  provider age 40,  their silver plan premium i a medium price market would be just over $1200 year, with a advanceable credit of almost 11K to cover the cost of the policy.  Their out of pockets would be limited to about $4200.    You can go to Kaiser Foundation, use the calulator.   Agreed at $33,500,  $100/mo is still a lot and a full $4200 out of pocket would be a huge bill.  But nothing like what things would be without insurance at all and a serious injury or illness befell a family member.

            •  But look at it from the other side (0+ / 0-)

              I agree with all you said.. and that Kaiser calculator is really great!

              But look at this from the government's side.

              Let's say that family of four is young and pretty healthy.  Let's also say they have no accidents, injuries or illnesses that cause a visit to ER or a hospital stay.

              So.. with regular doctor visits for the whole family, maybe they would total $4,000 for the year.

              The $11k subsidy then, goes largely into insurance company profits.  

              Single payer would have paid a few thousand for the mandated doctor visits and would have been done.

              Or, if the family made only $31k they would be on Medicaid and the federal outlay is that much less.

              ACA is simply a gift to insurance companies.

              •  I didn't say it was better than (0+ / 0-)

                single payer,  only that no family at or below median income is going to be paying out 83% of salary for medical insurance.

                I see all sorts of numbers thrown around that don't fit the pattern of how these premiums are going to be subsidized to keep the real cost down to something that will be high, but not shocking.

                And yes, Kaiser's page said for younger healthy people, something like 25% will use no health care whatsoever in any given year.   Though certain preventive stuff will have to be covered, so everyone can use some if they just want to get their wellness checkup.

                The government will be feeding the maw of the medical industry (as opposed to paying for health care).  But to me it still beats nothing.

        •  I can vouch for Canada's Medicare system. (26+ / 0-)

          From mid-July to December last year I spent roughly 100 days in hospital (verrry long story), had three operations and a fourth procedure under anaesthetic, one dialysis treatment, several X-rays, three CT scans, two hip aspirations, a heart ultrasound and many smaller procedures.  The only thing we had to pay for was about $30 to $35 a day in a transitional care unit.  The system paid for all my drugs whilst I was in captivity.  

          In addition I'll have a permanent hip replacement sometime soon.  The surgeon who'll do it is the top guy in Vancouver.  

          The care I got for the serious stuff was just phenomenal.  It is quite a spectacle to see your bed surrounded by seven nephrology residents.  :)

          I break out in a cold sweat on occasion thinking if all this had happened in the U.S.  

          We must, indeed, all hang together, or assuredly we shall all hang separately. B. Franklin

          by Observerinvancouver on Sun Mar 10, 2013 at 09:01:16 PM PDT

          [ Parent ]

        •  Here's a link (15+ / 0-)

          to Steve Brill's piece in TIME magazine about medical bills. It's lengthy but comprehensive. Really, the best piece of reporting I've read in TIME probably ever.

        •  The Brill article in Time is worth reading (0+ / 0-)

          Bitter Pill: Why Medical Bills are Killing Us.

          It's long and thoroughly researched. Be sure to read the last page.

          I disagree that Obamacare is a failure. It succeeded in ending some of the most egregious insurance company abuses. When fully implemented, it will succeed in getting insurance coverage for most of those currently uninsured. As Brill documents, the cost problem is most devastating for those with no insurance.

          I agree that Obamacare did not do enough to control costs. There are a number of cost-saving provisions, but more needs to be done.

          •  ACA: A Waste of Political Capital (0+ / 0-)

            So all the time energy and political capital was wasted on legislation that does not solve the problem.  The Democratic Party owns all the wrongful deaths and medical bankruptcy since hauling the Single Payer advocates off to jail.
            We are dishonest when we ignore this failure and doomed tp pay for it at the polls as well as at the "non-profit" hospitals.
            You must be one of lucky ones with a platinum plan.
            Did I mention Medicaid clawback from estates?  That's not applicable to the Congress and WH plans.

            •  Single payer was not an option in 2009. (0+ / 0-)

              None of the presidential candidates (who actively campaigned) favored single payer. The closest was Richardson who called for a Medicare buy-in beginning at age 50.

              •  More and More (0+ / 0-)

                the democratic Party just makes me sick.  David Dayen has a new post up on Naked Capitaism describing the plans to allow privitization of Medicaid.  What could possibly go wrong?  What universe do these clowns live in?  Arkansas will be the new model.  I just want to puke sometimes looking at this stuff.

      •  I'm currently lucky enough to have decent (10+ / 0-)

        medical insurance.  I hesitate to call it health care insurance, because they don't really seem to have any interest in my health, even though it is a decent plan.

        Several times in the last decade, I've had "bills" which would have crippled 99% of the families in America.  Prior to the damn Republicans instituting "Health Savings Accounts," the company had a low deductible plan.  

        After those appeared, the deductible went up to $1000.  And increased regularly.   The max out of pocket was raised too.  It used to be around $1000.  It is currently $2800.

        Even $2800 is a lot of money for most families to come up with.  But remember, I only get that max out of pocket because I'm contributing around $3000 per year to an HSA on top of my monthly premium contributions.

        And, this year, the company raised the employee contribution of each bill from 10% to 15%. Then they have the nerve to brag about their record profits.  The company is self-insured, meaning an insurance company is hired to manage the claims, but the company itself takes the hit.  By raising our portion of each bill from 10 to 15%, they just took money from employees to put into the corporate coffers.

        Long story short, it is readily apparent that any one of my surgeries would have bankrupted many Americans.  Certainly anyone in the lower 60% of income and perhaps others as well.  And perhaps many more

        "The law is meant to be my servant and not my master, still less my torturer and my murderer." -- James Baldwin. July 11, 1966.

        by YucatanMan on Mon Mar 11, 2013 at 12:14:03 AM PDT

        [ Parent ]

    •  I humbly direct your attention to (0+ / 0-)

      the following diary http://www.dailykos.com/.... It's very good and the teach encourages us all to hijack others' comment streams on an almost daily basis ...

    •  And the sheer *number* of bills (3+ / 0-)
      Recommended by:
      Rogneid, Noddy, cocinero

      Is daunting;  every visit to a hospital seems to generate at least four bills, especially if your doctor instructs you to get admitted via the emergency room...so you end up with an er bill, a hospital bill, a bill from the er doctor, and possibly a bill from the hospital doctors group.  And then ifyou have surgery, the bills multiply even further...anesthesiologist, doctor, hospital.  

      And all of the bills have their own payment schedule before they go to collections, and all of them require you to pay by the due date, irrespective of whether or not your insurance company has paid on them yet or not.  

  •  Thankfully, (44+ / 0-)

    you had decent insurance! My wife also has BCBS, her total out of pocket was just under $5000.00 (tumor on spinal cord). We had to pay her final MRI because the deductible had started a new year. I don't recall what was actually paid, but the total bill was nearly $100,000. Crazy money!
    Positive vibes to you and Leaves -

    •  I second that... (20+ / 0-)

      The total bill for my spinal surgery to relieve the stenosis caused by the lesion was $130,000. Thankfully, I had Kaiser Permanente, so out of pocket was somewhere in the neighborhood of $1000 including home nursing care.

      And, as I was waiting in the specialist's office for the final visit, I overheard reception talking to a person who wasn't quite as lucky as me. Their junk insurance wouldn't cover treatment, because none of the specialist's in the area were "in network." It was heartbreaking.

      We have got to keep up the fight to make that kind of thing a thing of the past.

      Best wishes to teacherken and leaves.

      •  Be careful with Kaiser -- (4+ / 0-)

        They have a great reputation, but my experience with them has been mixed.

        They have a variety of plans with various coverages and copays.   I have a grandfathered version of an individual pay plan I took out when I was last laid off.  With previous conditions, I can't find other coverage.    

        I think I have a 1500 per person deductable, and pay 30.00 copay per regular visit.  Generic drugs 10.00 per month, but full price out of pocket for anything special.
        I will have to pay out of pocket a large portion of many medical proceedures that take more than the alloted time for a usual doctor's visit.  

        I can be charged the full amount for the cost of lab tests and whatnot, not much coverage (or any at all) for durable medical equipment.

        They just hit me with over 10 percent increase on monthly premiums, now well over 900 per month.
        My total social security last year was not sufficient to cover my  medical premiums and copays and medical equipment costs and lab fees, so I had to go into savings.  

        I am high risk for breast cancer, but they would not give me genetic testing, and they prefer I get a mammogram every 2 years, not the one per year the doctor's suggested.

        Care has been pretty much impersonal and rushed, they have a wait and see, delay delay attitude that you really have to push at to get results.   My usual experience has been about 5 months and three or four visits from initial problem to resolution.   God help you if you have an end of year problem, you end up straddling year end and you end up with deductibles over two years.

        They have a great on line e-mail notification system, but many of the providers I see are not listed, easy to find, or e-mailable.   They have a complete web site where you can look up symptoms and do a sort of do it yourself examination for problems, which is helpful.   They list your medical conditions and so forth, but my vaccinations and lab results are only partially listed, a lot of info just is not there.  They recommend standard timetables for followups like colonoscopy, which don't allow for personal medical issues like previous tumors.  

        When I had outpatient surgery on a thumb, the big round bandage on it was bumped and popped off.   The attendant grabbed it quickly from the floor, and stuck it back on my thumb.  Luckily there was no infection, but still.....

        •  You're absolutely right.... (0+ / 0-)

          I have it through the Fed. They have different levels of care, some better than others. They are a lot like Tricare, the military's system, in that you have to be your own advocate.

          For emergencies, I found them to be quick, but I had to kick their ass on other things. It also really depends on the primary physician that you have and the medical center, and mine have been good thus far.

  •  Thank you for this, Ken (40+ / 0-)

    and I hope your lovely wife is doing well this evening!

    I've seen so many people, not so much here but elsewhere on the net assume that because they can afford an occasional out of pocket doctor's visit that everyone should always be able to afford it, even without insurance. When even with insurance many times co-pays and deductibles are more than most people can afford. A deductible of even $2,500 if you make minimum wage and actually get 40 hours a week would take over 2 months worth of wages.

    "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

    by FloridaSNMOM on Sun Mar 10, 2013 at 04:12:03 PM PDT

    •  the key is the providers taking less than bill (20+ / 0-)

      Gregor, her back brace, is another example

      listed at 1,850

      they wrote off 993.73

      insurance paid 727.83

      we paid 128.44

      "We didn't set out to save the world; we set out to wonder how other people are doing and to reflect on how our actions affect other people's hearts." - Pema Chodron

      by teacherken on Sun Mar 10, 2013 at 04:16:38 PM PDT

      [ Parent ]

      •  I don't think that that is the key. The key is (18+ / 0-)

        that clinics/hospitals/doctors/providers feel safe to charge as much as they want without push back from the general population.  Medicare and for profit insurance companies have done cost analysis and they write legal agreements with providers to pay as close to the actual cost as possible (with 'reasonable' profit margins).  Those that don't have insurance are stuck with whatever they can get with the provider - they're on their own.  It is not uncommon for people to negotiate down their bills if they can scrape together as little as 25% of the bill and settle.  If you can't scrape that up, sucks to be you according to the provider (in most cases - but, if you work with the social workers upon entering, or at time of diagnosis, you can get charity in some cases).

        Part of me wants to be cynical and say that there is collusion with providers and insurance companies to have outrageous provider bills that are 'negotiated' by the insurance companies so that you are 'greatful' to the insurance companies and don't complain about their profits......

        •  I think it's the other way around a bit. (10+ / 0-)

          Providers have had to jack up their prices in order to get insurance companies to pay anywhere near what it actually costs.

          Most of my doctors are not rich, (meaning they don't make $100, 000 per year) but the insurance companies sure are profiting.

          When I did have BC/BS I was embarassed by the measly amount they paid. Now that I have no insurance I have had no trouble negotiating with hospitals for services.

          Well, by no trouble I mean that it is a lot like buying a car, I have had to stay very firm.

          Tracy B Ann - technically that is my signature.

          by ZenTrainer on Sun Mar 10, 2013 at 04:48:37 PM PDT

          [ Parent ]

          •  Sorry, but no (16+ / 0-)

            Medicare bases its reimbursements on a very careful analysis of actual costs, and all insurance companies pay more than Medicare does. If Medicare pays too little, its not by more than 10-15%. Contrast this with hospital charge master rates, which routinely run three to ten times Medicare rates.

            Read the recent article in Time on the subject, for many, many examples of this. Long but highly recommended, even if I don't personally agree with the author's conclusions.

            The fact is, most hospitals, non-profit or not, run large surpluses, and are under almost no pressure to save any money. This is one of the main reasons we pay so much more for medical care in this country compared to the rest of the world, without getting any better results.

            Also, the median pay for US physicians was $166,400 in 2010, so while I obviously don't know your doctors, the average doctor does make well above $100k/year.

            "A government that robs Peter to pay Paul can always depend on the support of Paul." - George Bernard Shaw

            by Drobin on Sun Mar 10, 2013 at 05:58:15 PM PDT

            [ Parent ]

            •  Nonprofits make money (8+ / 0-)

              They just don't call it profit, but they can up the CEO's pay, etc., just like a for-profit.

              The Catholic hospitals can allocate money to the church, if I understand the rules, and I know that the Episcopal hospital here funnels money to a Foundation. In this case, the Foundation does a lot of good, but still, it's a private non-democratically governed group that decides where the money should be spent.

              And of course, the For-Profit hospitals are just another corporate greed story.

              I don't mind all that if we can also have a public hospital to be a comparison, maybe we open the V.A. to everyone once we stop the stupid wars....

              We can safely abandon the doctrine of the eighties, namely that the rich were not working because they had too little money, the poor because they had too much. JK Galbraith, 1991

              by Urban Owl on Sun Mar 10, 2013 at 06:50:08 PM PDT

              [ Parent ]

              •  this is going away (3+ / 0-)
                Recommended by:
                ZenTrainer, Leap Year, Tennessee Dave


                There is a provision in the ACA that will make all of this crap go away as the exchanges are set up.  Why, you say?  I read this in Paul Krugman  about a year or so ago: the one provision in the ACA that spells the end of the price-gouging and price-setting and charge as much as possible is this:

                A level playing field, that level playing field is accomplished by the requirement of ObamaCare that kicked in January 1, 2012:  all health insurers must certify that they spend 80% of their premium income in patient care.  They closed the loopholes on this.  Prior to the ACA insurance companies could include all unrelated activities, all advertising, all woolgathering, all yachts and bonuses given to the CEOs and CIOs, as valid expenses paid for with premium money:  BC/BS groups (there are more than a few - they operate as separate businesses (i.e. my provider is CAreFirst BC/BS, available in Maryland and Washington DC and my company also has them as a customer as well.  This means the behemoth companies who are used to charging huge premiums that we have all complained about, are now on a level playing field with small local (sometimes as small as a local group plan in four towns (Health Partners in Minnesota is one of them, and they accepted BC/BS, their own localized plan, Cigna and several other insurances, in fact they accepted all.  AND they had their own pharmacies and labs which were cheaper and they incentivized the price so that patients would go to THEIR pharmacy, THEIR in-house lab.  Who wouldn't?  The salient point is: they are ALREADY putting well over 80% of the payments they collect into patient care.  BC/BS by contrast, will have to LOWER PREMIUM PRICES.  Price control will be a downward pressure on the price of insurance, and the price of medical care will go down to what it actually costs.  No way a back brace costs $1800 if half the cost can be blithely written off due to the actions of an intercessor: an insurer.

                "Kossacks are held to a higher standard. Like Hebrew National hot dogs." - blueaardvark

                by louisev on Sun Mar 10, 2013 at 08:12:16 PM PDT

                [ Parent ]

                •  Problem is, there's nothing to stop them from (4+ / 0-)
                  Recommended by:
                  JanL, Kickemout, SingleVoter, cocinero

                  jacking up the amounts they pay providers so that their 20% is of a bigger pot. Kaiser especially, will just inflate the charges it "pays" itself for care, and run more unnecessary tests.

                  •  It is up to you to refuse unneeded (0+ / 0-)

                    tests and treatments. Otherwise you are part of the problem.

                    An excellent diary sets out how one kossack did just that and saved thousands plus made his own life much better. And by writing it up saved many more in both $$ and quality of life.

                    Read Don't Let Them Pull Out Your Teeth by James Hepburn  

                    He gives details of how he did it.

                    I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

                    by samddobermann on Mon Mar 11, 2013 at 08:19:29 PM PDT

                    [ Parent ]

                •  I got a $300 refund from my insurance company (6+ / 0-)

                  (Assurant Health) due to that provision. Then they immediately and permanently raised my rates by $150 per month, getting the entire rebate back in two months. I raised holy hell with both the company and the local authorities, going all the way to the state insurance commissioner,  but it was perfectly legal.

                  To keep our faces turned toward change, and behave as free spirits in the presence of fate--that is strength undefeatable. (Helen Keller)

                  by kareylou on Mon Mar 11, 2013 at 02:26:09 AM PDT

                  [ Parent ]

                •  Your living in a dream world (6+ / 0-)

                  If that was the case insurance costs wouldn't be going up by double digits now.  The ACA attacked in the wrong direction. Insurance companies are a symptom of a terminal disease and yes symptoms can and do kill, but the problem is in the prices that providers  charge the insurance companies after that have consolidated.

                  In your example you completely left the provider equation out and used the 80/20 rule . You assumed there would be all kinds of insurance companies competing for business under the exchanges. That isn't true at all. The small insurance companies  have either been snapped up by the large five insurance companies are have closed their doors completely since the ACA has passed. There will be no competition in the insurance end because of the anti trust exemption that was never addressed.

                  Even if that had been able to address the mass consolidation they ignored the mass consolidation in the for -profit and even the non-profit providers. That was to give them pricing power over the insurance companies. It will also raise the cost of medicare since medicare uses a system that averages the cost of the procedures from many different areas to come up with it's reimbursement schedule.

                  Here is where your 80/20 analysis falls apart. There are no caps on provider pricing and none in insurance so while they may only be allowed to keep 20% of the profits it will be based on the higher prices they pay to the providers  and the ever rising prices that they now will get under a transfer payment system. Insurers are also getting into the provider side so they can have all the billing.

                  The subsidies promised for the ACA that lower income people will get will be key to the Health Care industry. That way they can raise prices with impunity because once again we have a transfer payment system. The people that are most vulnerable next year won't be the lower income people provided they don't slip through more cracks, the people most at risk with be upper middle class all the into the upper 10%.

                  In short, people that think they are rich  in assets better make sure that it's all liquid.  The Heath Care industry will show them very quickly how they can get that to zero with one or two illnesses.

                  This will also serve to make any co-payments on any plan unaffordable .

                •  You don't get it. It is the companies (0+ / 0-)

                  that sell to these hospitals and clinics that are jacking up their prices. If an insurer pays $200 for a thing that cost $20 to make and should sell for $40 or $50 to make a decent profit and allow for R&D the insurer is credited with spending the $200 on HC services.

                  So if an item is listed as $1800 and the insurer pays $200 that $200 is what is counted. The work of the insurer in getting the costs down to that $200 is what insurers do.

                  Paying for inflated HC costs is not addressed in the law. That would constitute "price fixing" the Repubs would cry.

                  When you negotiate with the hospital you only remove, well lessen, one layer of profit taking.

                  I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

                  by samddobermann on Mon Mar 11, 2013 at 07:52:41 PM PDT

                  [ Parent ]

            •  Yeah, I thought the article was very slanted. (3+ / 0-)
              Recommended by:
              worldlotus, JanL, cocinero

              I wondered if the writer was in fact working for the insurance industry.

              But he himself said that the money is NOT going to doctors and nurses. It goes to the CEO's of hospitals and the makers of equipment.

              Median means just that. It is not a synonym for average.

              As for Medicare, about 50 million people are on it. About 50 million are uninsured. So the rest of the US is using private insurance.

              Tracy B Ann - technically that is my signature.

              by ZenTrainer on Sun Mar 10, 2013 at 06:55:19 PM PDT

              [ Parent ]

              •  most docs are in the 1%, I try not to say bad (6+ / 0-)

                things but that's just how it is. I know that CEOs make more, I know profits on hospital groups are more, but US docs make out pretty well, and unlike Ken we don't have great insurance. People in my town lose their houses, all the time. Docs don't live here.

                If any pediatrician would see my kids I'd be real happy. Wrong insurance.

                How big is your personal carbon footprint?

                by ban nock on Sun Mar 10, 2013 at 07:04:50 PM PDT

                [ Parent ]

                •  They may be rich, but most are not in 1% (21+ / 0-)

                  Physicians are clearly doing very well, as a group, but most of them are not in the top 1%.

                  The "top 1%" in the 2010 included people with income of $507,000 or greater, according to the NY Times.  The median income for those in primary care (eg pediatrics), the most common field, is cited by the Bureau of Labor Statistics for 2010 as $202,000. For specialists, the median is given as $356,000.So half the specialists are in the top 2%, and a much smaller number - eg neurosurgeons - are in the top 1%.

                  Our healthcare funding is completely daft, in every possible way including not just the examples given here. Physicians go hundreds of thousands of dollars in debt to get a degree, and many years getting training, especially for the most demanding specialties. Hospitals and physicians' offices spend huge amounts of time and money negotiating bills and costs with insurance companies and other payers (or non-payers: at one point the county owed the hospital I know best well over $100 million for care of uninsured people.) Part of the loony pricing system is an effort to try to transfer costs of the uninsured who nonetheless have to be treated, and the costs of medical training, to the larger universe. We are facing a critical shortage of primary care physicians, but our state has a cap on the number of places in medical schools that will fall far short of the needs in just a few years.

                  One person in my family had a tumor right in the middle of his spinal cord, in his neck area, at age 30. He got state-of-the-art, standard-of-care (after 3 months of fighting with the insurance company). Ten hours of microsurgery, taking his spinal cord apart one neuron at a time. One slip and the patient would have been quadriplegic and on a ventilator, if not actually dead. He was up and walking the next day, and is still doing well 10 years later. The total cost to date (with follow-ups) is probably around half a million, but the bill to the family relatively modest. The neurosurgeon who had the skill to do this had 4 years of medical school, 3 years of surgical residency, another 3 or 4 years of neurosurgery residency, another 5 or so years of specialty training at NIH, and probably was close to 40 before he actually got a "real" job, for which he works 12-14 hour days. It's hard for me to begrudge him any part of his salary, especially compared with the financiers who make several orders of magnitude more for trashing the economy.

                  •  1000 recs for this. (2+ / 0-)
                    Recommended by:
                    Tennessee Dave, mkor7

                    IN TN I don't think most primary care docs make that much.
                    My own is a huge advocate of single payer, she thinks then she would get paid $100,000 a year.

                    Even if it were true that doctors are in the top 1% (and that's not true, they are not), this a straw argument meant to take some folks minds off the fact that insurance companies are getting rich and ARE in the top 1%.

                    Tracy B Ann - technically that is my signature.

                    by ZenTrainer on Sun Mar 10, 2013 at 08:22:26 PM PDT

                    [ Parent ]

                  •  Thank you for reminding people of this (9+ / 0-)
                    The neurosurgeon who had the skill to do this had 4 years of medical school, 3 years of surgical residency, another 3 or 4 years of neurosurgery residency, another 5 or so years of specialty training at NIH, and probably was close to 40 before he actually got a "real" job, for which he works 12-14 hour days.
                    Even if someone's salary reaches the heights of the highly successful private neurosurgeon, is it really fair to think of her as part of "the 1%" if that $250,000 salary came only after accruing $500,000 in debt and having the living standard of a grad student until the age of 40? Of course, the academic medicine docs (the ones who take the tough cases) are often happy to make half that....

                    FWIW, I'm 37 and am doing an advanced training fellowship, a fully licensed and board certified physician making about $50,000/yr. My department actually loses money on many of our Medicaid patients (the ones we do Botox injections for, for example). We're not all rich.

                    Actually paying care providers more (while giving us more control/responsibility) and administrators/insurance companies less of both money and control would result in  improvements in both patient care and overall costs.

                    •  to be fair to graduate students, (4+ / 0-)

                      "grad student money" is more along the lines of 15-20K/year gross, not 40-50... if the grad student is fortunate enough to even get funding at all.  

                      I often hear about how medical residents have to  'slum it' on 50K/year, but it's helpful to remember that that is still twice the median income in this country--- half of working Americans make less than 25K, and many of them toil away at two full-time jobs.  Most are deep into debt, only they have no lucrative prospects in their future, at age 40, 60, or 80.  

                      What I mean is this: whether or not medical practitioners deserve sympathy on financial matters, they should certainly not expect to get any from the bulk of the population.  Simply because people will think "yeah, but you'd never switch places with me, would you?"   And if the reality of doctor's salaries doesn't ruin hopes of sympathy, the reputation of doctor's salaries will.  

                      Conservatives need to realize that their Silent Moral Majority is neither silent, nor moral, nor a majority.

                      by nominalize on Sun Mar 10, 2013 at 09:56:45 PM PDT

                      [ Parent ]

                      •  Pretty close (6+ / 0-)

                        I also did a PhD, and when I was in grad school my funding started at $16,000/yr and when I finished up it was around $23,000. The grad students in my lab make $32,000 and $35,000, I think because we live in a high cost of living area.

                        Anyway, I think it misses the point a little bit, though, to reinforce the fact that residents (and remember, I have finished residency and still make similar $) make "only" $50k/yr when they are paying off crushing student loan debt and working 80hr weeks. Not that they "deserve sympathy"-- it's obviously a better situation than many--  but that the reality tends to fly in the face of the "rich doctor" stereotype.

                        Few of the physicians I know are rich. The older ones (in their 50s and up) are very comfortable, but most of us can't afford to so much as buy a house (I know I certainly can't, and quite possibly never will if I want to live near where I work). I drive a 12yr old car and struggle to pay for daycare for my 3 month old (which actually costs nearly as much as I make). Glad my wife has a job.

                        With the really high out of pocket costs of practicing- license renewal, board certification ($3000 to take a computer-based exam this year!), DEA renewal... a decent opthalmoscope costs $1000... -- thankfully I don't pay my own malpractice insurance, couldn't afford it-- and of course loan repayment- it's a middle class life for most of us. Which is really great-- really!!-- it's just not the perception that most people have.

                        On the other hand, I know two physicians whose income approaches $1 million/yr. Rare, but it can happen. I'm just saying the perception is that we're all in that range, and we're just not. The CEOs of the hospitals and insurance companies we deal with, however, make multimillions and never touch a patient or are responsible if something bad happens to someone. How about that?

                        •  You've got an uphill battle (1+ / 0-)
                          Recommended by:
                          mudfud27

                          is what I'm saying.  If you want the financial plight of doctors to gain the sympathy of the public at large, simply saying "in fact, we're not rich" is not ever going to work, because of human nature.

                          In fact, even using the word rich muddies the water right out of the gate, because it has no fixed meaning. Instead, each of us interprets it relative to the people in our own lives.   And indeed, science finds that people only feel rich or poor based pretty much only with respect to the people they actually interact with personally:  family, friends, neighbors, and colleagues.  So people who are rich (like 1% rich) and live among even richer people, still don't feel "rich", because when they say "rich" they mean Emir of Dubai rich.  Whereas people living in dumpy apartment complexes might mean house-with-a-pool rich, or even has-a-car-from-this-century rich, because that's the comparison set closest to their lives.  Until the 'teeming masses' see doctors stuck in the apartment next door to them, they aren't going to really catch on to what you're saying.

                          The point is, using the term rich only clouds the issue, because to most folks, doctors are rich, even if to doctors, doctors aren't.  People won't switch definitions simply because you point that out--- our sense of wealth is driven by our semantics and our psychology.

                          Now, it's true that few doctors are in the "1%"--- that'd require about 350K/year in income, whereas median GPs make half that (i.e. half make less than 175K a year).  Compared to the 1%, doctors aren't "rich"... but like I said, compared to the 99%, doctors are, because the median doctor salary is still 700% of the median salary for everyone else, and it's in the 8%, so to speak.  So from the 92%, doctors simply won't get much sympathy on this matter, even if you're the 'good guys'.    

                          And sure, there are places in this country where you can't buy a house on a six-figure income (quite frankly, I don't know how anybody buys a house in such places, but that's another subject).  But if those places price doctors out, imagine how far away the medical techs have to live.  And they make more than most people, too.  The same goes for crushing student debt--- if it's bad for doctors, imagine how much worse it is for the rest of the population.  Not to mention: the cost of medical school inflates in large part because they have to pay the salaries of the faculty, which has to be decently close enough to what a professor could make in practice.  

                          All that to say, if you want to engender sympathy from the public, it will take a much different message than "we're not really rich".  I don't know what that message would be.    Maybe focus on the 'good guy' part, although sometimes that can be as stereotypical as the 'rich doctor'.  

                          Conservatives need to realize that their Silent Moral Majority is neither silent, nor moral, nor a majority.

                          by nominalize on Mon Mar 11, 2013 at 09:47:57 AM PDT

                          [ Parent ]

                    •  Huh? I can't help it. I have to ask............. (1+ / 0-)
                      Recommended by:
                      Dburn

                      Does Medicaid actually pay for Botox injections?  And who goes to a hospital for Botox?

                      •  Of course (7+ / 0-)

                        Botox is the treatment of choice for focal dystonias and oftentimes is used to treat spasticity caused by stroke or diseases like multiple sclerosis (I'm a neurologist). Botox can reduce what can be dangerous drooling in various conditions like ALS or Parkinson's too.

                        I imagine you're thinking of the cosmetic use (which was only discovered later, because we sometimes would inject it into a forehead muscle as a test); I'm sure that wouldn't be paid for (I've never tried using it for wrinkles but have occasionally fantasized about doing a weekend clinic for rich people with wrinkles that would subsidize the free treatment of people with dystonia etc...)

                        Normally Botox injections are done in the outpatient setting of course, although occasionally inpatients have severe enough spasticity that they need to have injections while hospitalized. I don't know of anyone really being admitted specifically for botox treatment but I'd guess it could happen at, say, a county facility where only inpatient treatment is covered by Medicaid etc.

                    •  It's also important to remember (4+ / 0-)
                      Recommended by:
                      La Gitane, ZenTrainer, mudfud27, orlbucfan

                      that, last time I checked, physicians' charges accounted for only 15% of medical costs, and physicians' income accounted for less than half of that (since physicians' charges have to cover the salaries of office staff, rent or mortgage on offices, and much more).

                      That means that if, say, we adopted a system where anyone who wanted to and was qualified to go into medicine would get both college and med school absolutely free, and would once qualified to practice receive a fixed working-class or lower-middle-class salary, we'd be very lucky to cut total medical costs by 4%.

                      It's just that the general public tends to focus on physician incomes because it's fairly easy to think about (it's a variation of the availability heuristic, where we assume the most likely outcome of something is the one that we have the easiest time envisioning). It's similar to the way that the general public thinks that government spending could be substantially reduced by cutting foreign aid (most people think that foreign aid is 25% of Federal spending and want to cut it to 5%; in reality, it's a little less than 1% of Federal spending).

                      Writing in all lower-case letters should be a capital offense

                      by ebohlman on Mon Mar 11, 2013 at 12:27:34 AM PDT

                      [ Parent ]

                    •  You are getting paid as a resident (0+ / 0-)

                      more than the median salary for the US. You were probably paid around $40k as an intern. I really don't weep for you.

                      If doctors would only do those procedures and tests that would actually benefit patients, and would look for lower cost ways to do so I would trust them more to let them retain the absolute control they have now.

                      But now we accept treatments just on the "hope" it gives when doctors know it won't make an overall difference.

                      Most treatments do not have scientific evidence of their effectiveness. That doesn't mean that they are not effective but that there is no good evidence that they are.

                      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

                      by samddobermann on Mon Mar 11, 2013 at 10:04:12 PM PDT

                      [ Parent ]

                  •  You didn't factor in at least one key component (2+ / 0-)
                    Recommended by:
                    orlbucfan, samddobermann

                    You took the average salaries that Doctors get. You didn't factor in the large kickbacks from the device manufacturers, diagnostics companies and the drug companies that can add hundreds of thousands to millions of dollars to a Doctors salary. There are also the paid research scams the drug companies run . The "symposiums " on luxury resort Islands with 5 minutes of Business talk and the rest a vacation that few could afford on their own. There have been terrific examples of salespeople filling up a Doctors car at Gas stations as they handed them the latest and greatest of their drug lit plus samples.

                    A perfect example is when a Whistleblower from Kos (sorry) a subsidiary of Abbott came to light that gives us a peak on what an individual Doctor can get from a prescribing a single drug. Abbott would pay the Doctor $41,000 in kick back. To get that they would write 4000+ prescriptions. On ONE drug. One drug that was proven not to work and that may be harmful. Look up Kos, Abbott, Whistleblowers . Abbott also recently paid a 1.6 Billion dollar criminal fine for pushing FDA approved drugs to be used not for the purpose they were designed and approved on.  

                    Yes there are Doctors that won't play. But there are enough that it enables an entire Health Care system to make obscene profits by using devices, testing (  you should see the figures on imaging scans) and even surgical procedures that aren't necessary.

                    There are very few clean hands in the 1% in the Health Care industry.

                    •  Our health system allows no kickbacks/gifts (1+ / 0-)
                      Recommended by:
                      ZenTrainer

                      In the health system where I work, physicians and other faculty are not allowed to accept any kickbacks, gifts, etc. No free trips to conferences. No free lunches. We are not even supposed to accept a free pen at the information booth. Similar policies are now in effect at most major medical schools, at least the ones I know. We fill out conflict-of-interest forms every year, stating everything we get from anywhere, be it money or other things of value. (You gave a talk at East Zilch Community College and they gave you an honorarium of $25? Write it down. Leave something out, and you could get fired.)

                      I know quite well what imaging costs - my own research is heavily involved in neuro-imaging (MRI, PET). NIH has negotiated some discounts and some donations, through the Foundation for NIH, but we do not get anything directly. And we work pretty hard at communicating to the press and the public exactly where the research stands, and what is or is not going to be useful yet in regular medical practice. We try pretty hard in my world to foster and support "evidence-based medicine".

                      While there certainly exist physicians, and hospitals, who are prone to the financial practices you rightly condemn, I believe these cases are the exception. That's why they stand out so strikingly. It's well to remember the adage: the plural of anecdote is not data.

            •  Actually the median pay you give (0+ / 0-)

              includes interns and residents who receive relatively low pay, Interns usually get around $40,000 a year; residents somewhat more.

              The same site shows that median pay

              According to the Medical Group Management Association, physicians practicing primary care received total median annual compensation of $202,392, and physicians practicing in medical specialties received total median annual compensation of $356,885 in 2010.
              And that is directly from their practices. Other income like for giving lectures for pharma or surgical equipment companies can be more.

              I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

              by samddobermann on Mon Mar 11, 2013 at 07:42:20 PM PDT

              [ Parent ]

          •  Yes, insurance companies are crooks. (5+ / 0-)

            But so are the hospitals.

            Believe it.  The hospitals, even the so-called "non-profit" ones, are in the money making business.  Charging patients (or is it "customers" now?) $1.50 for a single GENERIC Tylenol which retails for about 1.5 cents, should be prosecutable.

            And it happens at every damn hospital in the country, or close enough as to make no difference.

            We're getting screwed by the Insurance Companies and robbed by the doctors and hospitals.

            *The administration has done virtually nothing designed to reward its partisans. - Kos 8/31/10*

            by Rick Aucoin on Sun Mar 10, 2013 at 09:01:00 PM PDT

            [ Parent ]

            •  My neighbor who works at our local Catholic Hosp. (3+ / 0-)
              Recommended by:
              Rick Aucoin, Dburn, orlbucfan

              said they laid off people  after requiring everyone to re apply for their current jobs because of .... Yep they blamed Obamacare. (he's a loony republican who lie whenever they feel the urge to overwhelm facts) One was a woman who had worked there for 22 years. I take what he says with a grain of salt because he also said that his taxes went up $2000 a year because Obama raised them.

              I refrained from telling him they were probably cutting corners because the city and the county were cutting back on their subsidies to the hospital or that the Catholic church needs to increase its profits in order to pay off lawsuits by abuse victims or that they wanted to find another way to rid themselves of non breeders who engage in sex.

              Personally I am still paying off the bills on credit cards from years ago for my oxygen/blood problem. Our share of deductible, not allowed, and copays were huge when they got done running every damn test in the book. I had a family doc, a blood doc, a lung doc and a sleep doc. Everything they did for me that worked was based on my perceptions and insistence including my running a O2 sat recording meter at night on my own initiative to see what my O2 sats dropped to at night ( it was 55 to low 60s).... My lung doc had already run tests assuming as a former smoker that I had fried my lungs ( they were fine, its the outside that is problematic) I had 8 units of blood drawn and tossed, biopsies, blood studies, sleep studies, MRIs, scans, breathing studies, etc.... Our share of many of the tests came to between 800 and 1000. Thought the bone marrow biopsy was a bit more... And we have insurance we pay over 16K yearly for.  In the end they could have stopped with a Bipap and O2. The rest of the tests were assumptions and statistics badly applied.  I quit seeing any of them over 5 years ago. Especially the lung Doc who bought the breathing test chamber and wanted to run one yearly at 800 a pop as our share. Now the insurance pays less then 1000 a year for their share they are willing to pay.

              Fear is the Mind Killer...

              by boophus on Sun Mar 10, 2013 at 10:57:18 PM PDT

              [ Parent ]

            •  Not so fast (2+ / 0-)
              Recommended by:
              NoMoJoe, mamamedusa
              Believe it.  The hospitals, even the so-called "non-profit" ones, are in the money making business.  Charging patients (or is it "customers" now?) $1.50 for a single GENERIC Tylenol which retails for about 1.5 cents, should be prosecutable.
              Not all of that represents gouging, or is even unreasonable. The nurse who gives you that pill doesn't work for free, nor should she be expected to. A fair part of the difference represents the hospital's attempt to recover the costs incurred in treating uninsured and underinsured patients. That's not to say all of the difference is justifiable, just that you're using the wrong baseline as a comparison (much like all the horror stories about the graduation rates of college scholarship athletes, which often fail to compare them to the actual graduation rates for non-athletes at the same institutions).

              Writing in all lower-case letters should be a capital offense

              by ebohlman on Mon Mar 11, 2013 at 12:41:28 AM PDT

              [ Parent ]

              •  No, because there's a Hospital Room charge. (0+ / 0-)

                The bill you get for that generic Tylenol is seperate from the bill for the room, which includes the cost of nursing.

                Its criminal, they're ripping you off for their bottom line.  And they're doing it in a way that you can't exactly shop for competitive services.  Once you're in the hospital, you're there and stuck and likely in a condition that makes you say "Yes, whatever you think is best" to everything that the business suggests to you.

                And that business is everything, from the tylenol to the specialist who comes in for a consult.

                And yes, it's not just unreasonable to charge a buck fifty for a one cent generic tylenol, it would be actionable in any reasonable society.

                *The administration has done virtually nothing designed to reward its partisans. - Kos 8/31/10*

                by Rick Aucoin on Mon Mar 11, 2013 at 09:08:35 AM PDT

                [ Parent ]

            •  I fail to understand how these so-called "non- (2+ / 0-)
              Recommended by:
              Rick Aucoin, orlbucfan

              profit" hospitals get away with generating profits.

              It seems to me that that could be easily challenged by government at some level, local or national.

              The elevation of appearance over substance, of celebrity over character, of short term gains over lasting achievement displays a poverty of ambition. It distracts you from what's truly important. - Barack Obama

              by helfenburg on Mon Mar 11, 2013 at 04:08:00 AM PDT

              [ Parent ]

              •  Government, acting on behalf of consumers? (1+ / 0-)
                Recommended by:
                orlbucfan

                Or patients, instead of big business?

                Hehe.  I mean, I get it, but I know you're joking.  :)

                *The administration has done virtually nothing designed to reward its partisans. - Kos 8/31/10*

                by Rick Aucoin on Mon Mar 11, 2013 at 09:09:35 AM PDT

                [ Parent ]

                •  No, actually, I am not joking at all. If you read (0+ / 0-)

                  the Brill article, there are supposedly non-profit institutions which are paying their directors many millions of dollars and raking in the dough.  That's not a non-profit.  Their non- profit status should be removed.

                  The elevation of appearance over substance, of celebrity over character, of short term gains over lasting achievement displays a poverty of ambition. It distracts you from what's truly important. - Barack Obama

                  by helfenburg on Tue Mar 12, 2013 at 03:20:45 AM PDT

                  [ Parent ]

                  •  I agree with that, but... (0+ / 0-)

                    ... you actually think there's some part of government that's going to act on behalf of consumers?  Against the interests of big business?

                    That's the part that I figured you had to be joking about.  I mean, we all know that just isn't going to happen.  We live in the United States of America, with government by the corporation, for the corporation.

                    *The administration has done virtually nothing designed to reward its partisans. - Kos 8/31/10*

                    by Rick Aucoin on Tue Mar 12, 2013 at 09:08:39 AM PDT

                    [ Parent ]

                    •  Well, Rick, sadly, of course, I know you are (1+ / 0-)
                      Recommended by:
                      Rick Aucoin

                      right.  But still, if we keep pointing out what's wrong with the picture, maybe, just maybe.....

                      The elevation of appearance over substance, of celebrity over character, of short term gains over lasting achievement displays a poverty of ambition. It distracts you from what's truly important. - Barack Obama

                      by helfenburg on Wed Mar 13, 2013 at 03:30:17 AM PDT

                      [ Parent ]

              •  in America? But I do think (0+ / 0-)

                the IRS should take away tax exempt status if they don't do sufficient charity work.

                I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

                by samddobermann on Tue Mar 12, 2013 at 02:47:45 AM PDT

                [ Parent ]

          •  You couldn't be more wrong (1+ / 0-)
            Recommended by:
            orlbucfan

            Insurance companies are like a large painful wart on a large inoperable tumor. The tumor being the providers.
            The providers have been consolidating like mad over the last 10 years or so they would have pricing power over the insurance companies depending on what area that  you live in.

            Regardless of what others may say, the pure profit motive pushes an insurance company to get the lowest possible price on every procedure. The prices arrived at are purely a matter of leverage. In the area or zip codes that the Insurer covers, prices are determined by  how many providers are there that they can play one off the other to get the lowest price and then use that price to get a lower price from the desired in-network provider.

            The providers recognize this,  hence the massive and quite silent consolidation that has taken place.

            The end result is even the non-profits have such great surpluses they are going to extraordinary means by hiding.  They are paying the executives private sector for profit wages in the millions.

            The for profits have a after tax margin of around 25%. That is the after they pay the executive suite, the Doctors that work in the system , nurses and other skilled help. The administrative execs strike it rich here with multi-million dollar compensation packages. Even after all that , they are still having record profits.

            Lets compare that to insurance companies. They are allowed a 20% GROSS profit to pay all the the overhead in the insurance company . Their net margins come in at or below 5%.  The large pay packages that the executives get are mostly stock based compensation. The cash portion is usually less than 7 figures

            The net result is there are no good guys here. The extreme profit motive the runs through the entire system has driven health care costs to unsustainable levels.

            Brill's article also points out what most people don't know. The providers make a crap load of money off of Medicare reimbursements despite all the whining.

        •  No, but insurers have not been proactive. (0+ / 0-)

          They can't. The problem with this is if the insurers (and that includes Medicare) want to negotiate they have to be willing to "walk away." That is they have to be able to say NO, we wont accept this.

          Now each pharma company, each hip protheses maker, each of every other supplier has to be dealt with — and it has to cover each item.

          Another layer of complexity is added by the fact that much of these "things" are sold to hospitals which have their own system for buying and their own markups.

          Would you be willing to have some thing (drug, piece of equipment, what ever ... ) be unavailable while the process is playing out?

          Try the thought experiment with a drug — you have been taking it, you need it, your insurer (even through Medicare) tells you it is off the market at least for a while. Your doctor can try a substitute or can say that's the only one. What do you do? Have a fit? Rail against the insurer? Go buy it on the open market at the wildly inflated price?

          Most all the people here blame insurers for everything but if they try to fix it they have fits.

          A big factor in increasing costs are doing medical treatments (from prescriptions to surgery) that don't real help or do more harm than good. Yet people scream if there is any attempt to change that.

          I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

          by samddobermann on Mon Mar 11, 2013 at 07:22:51 PM PDT

          [ Parent ]

      •  I agree this is part of the "key"... don't know, (9+ / 0-)

        however, if you recognize how huge the differential between "billed" and "paid" can be...

        While still employed, I was treated for prostate cancer 20 months (age 66) ago under a Blue Cross/Blue Shield Medicare Advantage plan; my statements from BC/BS for radiation therapy typically indicated, for example (rough memory as to amounts):

        Billed:  144,000
        Paid by insurance: 20,000
        My share:  120

        This was the typical gap between what the provider (Cancer Clinic) billed and what the insurer actually paid.  (This is in the Bay Area.)

        I mentioned this to my oncologist, a wonderful doctor... he just kind of chuckled.

        Returning violence for violence multiplies violence, adding deeper darkness to a night already devoid of stars... Martin Luther King, Jr.

        by ceebee7 on Sun Mar 10, 2013 at 06:18:18 PM PDT

        [ Parent ]

        •  Was recently astounded to see similar figures (6+ / 0-)

          on the surgery bill for a relative of mine.

          Figures are approximate (because I'm too tired to go dig out the bill right now):

          Billed:  $41,000
          Paid by insurance: $9,500
          Patient's share: $450

          Now what, pray, happens to the uninsured? Would they owe that extra $31,000? While for my insured relative, that money is just written off?

          No wonder your oncologist chuckled, ceebee7. You've got to laugh; otherwise you'd scream.

          •  An informed person who was uninsured (1+ / 0-)
            Recommended by:
            UnionMade

            would be able to negotiate the cost to something in the neighborhood of what the insurance would have paid - but only if they were familiar with ICD codes and what insurance payouts would be in their area. It takes a lot of research and prior negotiations.

            And sometimes,it's just cheaper to be uninsured.

            I have insurance ($500 a month in premiums, $100 co-pay, $5,000 deductible), but it's cheaper for me to go to one of those walk-in clinics and pay $75 for a doctor visit.

            Plus - at a walk-in clinic, you actually get seen by a doctor in a timely fashion.  If you have insurance and call for an appointment, the average wait time to see the doctor is 9 weeks.

            So - a 9 week wait to see a doctor where you have to pay the $100 co-pay, plus whatever part of the deductible you haven't yet met or $75 to see a doctor immediately...decisions, decisions....

            All knowledge is worth having. Check out OctopodiCon to support steampunk learning and fun. Also, on DKos, check out the Itzl Alert Network.

            by Noddy on Mon Mar 11, 2013 at 06:36:34 AM PDT

            [ Parent ]

        •  The big question is if you really needed (0+ / 0-)

          that treatment. Did you have a watch and wait period?

          Most prostate cancer is so slow growing that the person is unlikely to die from it. But the tests, retests, treatments and of course treatments for the after effects of impotence and urinary incontinence all are very profitable.

          I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

          by samddobermann on Tue Mar 12, 2013 at 03:29:41 AM PDT

          [ Parent ]

  •  The recent cover story of Time: Bitter Pill (17+ / 0-)

    Steven Brill tried to explain the large discrepancy between what hospitals charge and what medical services actually cost. Jon Stewart interviewed him, but I can't get it to embed here, she here's the link: The Daily Show with Jon Stewart

    Here's Time's video synopsis:

  •  Mandatory reading for all: (24+ / 0-)

    the Time magazine feature by Steven Brill,  "Bitter Pill, Why Medical Bills are Killing Us."

    Time devoted the entire issue to his reporting and it is a searing look at our crippled and crippling health care "system."

    http://healthland.time.com/...

    I bought two copies on the newsstand, one for me and one to give away.

    It's the Supreme Court, stupid!

    by Radiowalla on Sun Mar 10, 2013 at 04:16:49 PM PDT

  •  Fortunately, my wife's renal failure (12+ / 0-)

    did not occur until she had moved onto Medicare/Medigap. The bill for 6 month dialysis and six years with a transplanted kidney, including very expensive rejection drugs = $0 out of pocket, aside from. Unfortunately, not all of us can postpone illness until 65.

    •  Note, though, that end-stage renal disease (1+ / 0-)
      Recommended by:
      kareylou

      (ESRD) automatically qualifies you for Medicare, regardless of your age (and the combination of needing dialysis and qualifying for a kidney transplant is, by definition, ESRD).

      I am aware, though, that the determination of qualification based on ESRD can take too long for someone whose kidney function is going rapidly downhill. That's, at least in theory, fixable (make someone who's determined to need dialysis for at least X number of months automatically covered and (maybe) withdraw future coverage if that someone has recovered (for reasons other than receiving a kidney transplant) and no longer needs dialysis; that's not what I'd consider to be the Best Of All Possible Worlds, but it would be a major improvement over what we have now).

      Writing in all lower-case letters should be a capital offense

      by ebohlman on Mon Mar 11, 2013 at 01:02:57 AM PDT

      [ Parent ]

  •  Indeed it is (0+ / 0-)
    It is a shame that others are not so fortunate.
    You've emphasized that to us time and time again.

    "Mitt who? That's an odd name. Like an oven mitt, you mean? Oh, yeah, I've got one of those. Used it at the Atlas Society BBQ last summer when I was flipping ribs."

    by Richard Cranium on Sun Mar 10, 2013 at 04:37:51 PM PDT

  •  "Who pays" is a big issue, of course (5+ / 0-)

    But "what it costs" is at least as important.  Health care is much too expensive.

    You know, I sometimes think if I could see, I'd be kicking a lot of ass. -Stevie Wonder at the Glastonbury Festival, 2010

    by Rich in PA on Sun Mar 10, 2013 at 04:47:51 PM PDT

  •  It would be nice if our "healthcare for everyone" (16+ / 0-)

    legislative initiatives were oriented toward actually providing healthcare for everyone, and not merely toward keeping the insurance industry alive against the prospect (discussed in detail in John Geyman's (2009) book Do Not Resuscitate) of the health insurance industry pricing itself out of business.  The subsidies to buy Bronze Plans are nice, but it's anyone's guess as to how much there will be of them after the Grand Bargain goes through.

    "There's nothing heroic about earning profit." -Odo, from Star Trek: Deep Space Nine

    by Cassiodorus on Sun Mar 10, 2013 at 04:51:42 PM PDT

  •  Comment (17+ / 0-)

    The whole out-of-network pricing system is preposterous.

    I know that in New Jersey, many hospital procedures are paid as pre-negotiated diagnostic units.  That means your health insurance doesn't pay $1 for the loaded cost of a Tylenol.  But if you're not in a negotiated payment arrangement, you're usually on your own.  Hospitals will negotiate these down, of course (if you still have indemnity insurance, for example, the provider takes whatever they can get and writes off the balance) but you need to do so proactively, something that is difficult from the inside of an oxygen tent.

    By the way, Medicare (and most other countries, even the ones with private systems) simply won't tolerate this -- the US is behind the rest of the world in mandating outcome-oriented reimbursements.

  •  My heart breaks for you all the same. (5+ / 0-)

    Those bills are cutting into your retirement and even though you're grateful that it's not creating bankruptcy, eventually you may be faced with a lack of funds for living the rest of your lives.  


    The religious fanatics didn't buy the republican party because it was virtuous, they bought it because it was for sale

    by nupstateny on Sun Mar 10, 2013 at 05:09:56 PM PDT

    •  I don't think so. (0+ / 0-)

      Reread it: I don't think they are paying anything from their retirement. I think he was examining how he could pay the remainder of the bill if he needed to. If I'm right that should make you feel better :)

      To keep our faces turned toward change, and behave as free spirits in the presence of fate--that is strength undefeatable. (Helen Keller)

      by kareylou on Mon Mar 11, 2013 at 02:40:30 AM PDT

      [ Parent ]

  •  Rationing (2+ / 0-)
    Recommended by:
    Sparhawk, WillR
    It is effectively rationing health care by financial status.
    I often hear people say something like that, to wit, that health care is rationed by the ability to pay.  This is a conflation of two perfectly good, distinct concepts.  It has the effect of creating a muddle where previously there was clarity.

    The concept of rationing should be limited to the distribution of a good or service as determined by the government or some other third party with the authority to do so.  When the distribution of a good or service occurs because a willing seller and a willing buyer agree to a price, and the buyer has the resources to pay that price, that is simply free market activity.

    If we say that the latter is really rationing by the ability to pay, or, as you put it, by financial status, we strip the concept of rationing of all significance.  For it then follows that everything is rationed.  In other words, Rolexes are rationed, Gucci bags are rationed, and luxury yachts are rationed, which is absurd. Moreover, if we heard someone speak of gasoline rationing, we would have to ask:  “Do you mean the kind of rationing where the government decides how many gallons you get, or are you talking about the kind of rationing based on whether you have enough money or not?”

    Making distinctions leads to clarity.  Conflating them leads to confusion.

    •  Huge difference between health care and Gucci (6+ / 0-)

      One is sometimes a life or death situation, the other never is (unless someone is stealing one from you maybe). Health care is NOT an optional expense for most people. Nor is it one where you can shop around for a less expensive version or a 'knock off'. Even gasoline is NOT an essential purchase. I've not bought gas in almost 11 years, not directly anyway (public transportation, cabs, and walking). I take prescriptions every day to survive. Literally to survive, without them I wouldn't be breathing.

      So yes, it is rationing dependent on how much you make when they charge you more for it the less you make (via poorer health insurance choices if you have any at all, at which point the bill is marked up by a HUGE percentage). What other product, even a luxury item, is marked higher if you are more poor? Do you charge someone on minimum wage who saves up for several years five times as much for that Gucci hand bag? THAT's where the rationing comes in.

      "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

      by FloridaSNMOM on Sun Mar 10, 2013 at 06:22:13 PM PDT

      [ Parent ]

      •  Not in my dictionary (2+ / 0-)
        Recommended by:
        Sparhawk, WillR

        Your comment suggests the following definition:

        rationing:  a good or service that is essential for life, and for which a higher price is charged to those who are poor than to those who are rich.

        Well, that definition is certainly not in the dictionary.  So, what would be the purpose of your proposed definition?  My guess is that the word “rationing” has pejorative connotations, and you want to be able to use this word of disparagement when referring to the health care system.

        But there are better ways to express your dislike of something than by twisting words out of their ordinary meaning.  You can simply say that you dislike it.

        •  Ration: (3+ / 0-)
          Recommended by:
          Noddy, mkor7, orlbucfan

          Verb: To restrict the consumption of....

          It doesn't state HOW it has to be restricted. In this case it's restricted by financial access.

          The health industry is rationing access to health care based on people's income by charging them a higher price if they don't have insurance, and charging higher deductibles if they can't afford the higher priced policies.

          "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

          by FloridaSNMOM on Sun Mar 10, 2013 at 06:56:57 PM PDT

          [ Parent ]

          •  Re (1+ / 0-)
            Recommended by:
            disinterested spectator
            The health industry is rationing access to health care based on people's income by charging them a higher price if they don't have insurance, and charging higher deductibles if they can't afford the higher priced policies.
            That's not "rationing", per the grandparent post.

            "Rationing" is the government coming along and saying "you get X, you get Y, you get Z".

            Otherwise, everything is "rationed", and the word loses all meaning.

            (-5.50,-6.67): Left Libertarian
            Leadership doesn't mean taking a straw poll and then just throwing up your hands. -Jyrinx

            by Sparhawk on Sun Mar 10, 2013 at 07:05:46 PM PDT

            [ Parent ]

            •  The government doesn't have to be the one (7+ / 0-)

              doing the rationing. In this case it's the health insurance complex doing the rationing.

              If we're almost out of peanut butter with no money coming in for a week and I tell my kids they can only have two sandwiches a piece in the next 7 days, then I'm doing the rationing.

              And the attitude of a lot of the people I've seen commenting on the issue of the ACA (not on DKOS necessarily though I've seen it a bit here too) is "But if we give everyone insurance then there won't be enough doctors for me, and I'll have to wait longer to see a doctor" which is a way of trying to ration your neighbor's health care (give them less so you have more). Doing it by income doesn't change the definition of Ration.

              "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

              by FloridaSNMOM on Sun Mar 10, 2013 at 07:14:22 PM PDT

              [ Parent ]

          •  By the way: Resource link: (0+ / 0-)

            Dictionary.com

            Under Verb: number 6.

            "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

            by FloridaSNMOM on Sun Mar 10, 2013 at 07:08:44 PM PDT

            [ Parent ]

  •  When discussing health insurance options (11+ / 0-)

    I think you can separate the people with secure employer-paid insurance and those with individual or sole-properietor paid insurance .

    Those people whose employers have been footing the lion's share of the costs are pretty clueless about what the real tab is for medical care.  They are focused on co-pays and dedcutibles which are a tiny share.  Not that they are insignificant, just nowhere the near the whole picture.

    People with individual policies (or sole properietor/very small group ones) who see and pay the "employer's share" of the health insurance cost, plus the deductible and co-pays can see more about how much money is flowing info the health insurers' coffers - and out to providers.

    Our household (two adults with sole proprietor with one dependant type insurance) cost for health insurance has been over 16K annually (policy, very high deductible and co-pays) for years.  By far the most expensive item in our budget and an almost crushing load at times. And we only one or two options when seeking insurance, very little choice as almost no one offers small group insurance here.

    OTOH, though we had paid this cost for many years adn rarely made any claim, when my husband had a heart attack, the cost of his initial emergency care was over $100K; for a subsequent cardiac surgical procedure two years later it was another $145K; and last year an implanted device was over $50K.

    The insurance company contractually lowered the billed prices down to less than half of that.  Our cost during these three years was less than $50K (total), basically just the same as we would have paid anyway.

    (BTW, our insurance costs are not, and can not be, raised because of claims, since we live in a "community rated" state, NY.  That will become the law for everybody when ACA is phased in. And my husband's illness, though expensive, was no where near the category of extraordinary or unusually costly, just the garden variety really bad coronary).

    If we had not had insurance we would have been on the hook for the entire amount with no benefit from the insurance company's ability to force the providers to take less.

    This is where people w/o insurance are getting screwed by the hospitals and doctors and overall  by the system as it works today.  The providers, forced by the insurance company to accept substantially less for the care of insured people, have responded by ballooning the "street prices" for their services making any non-insured care ridiculously costly.

    If you are lucky enough to have never fallen seriously ill, you have no idea what is going on with the current cost of health care.

    When  I see people here grousing about the possibility of having to pay for insurance, to the tune of hundreds of dollars a month, I roll my eyes. If you've never been sick you have no idea what catastrophic financial risks you are blithely ignoring.  

    Health insurance costs are not cheap, and in many cases unaffordable (and, sadly, for some it will remain so even after ACA), but the real driver is the current cost of health care.  It's truly astounding.

    The ACA is only going to improve access to insurance and not, in general, doing much to lower the costs of medical care.  That's a whole other thing - with a whole other set of extremely (politically) fierce and defensive stakeholders.  When we admire Canadian, or European, or Japanese healthcare delivery and payment schemes we need to understand that their (lower) cost of care is probably as important to the success of their programs as the issue of who's paying for it.

    As important as improving access to health insurance is (because it is the only ticket to contractually-reduced health care costs), without addressing the costs of meidal care and reducing the need for health care using prevention and well-ness tools, we will never achieve the goal of affordable health care for everybody.

    Our current system, deformed as it has been by the perniscious incentives inherent in the employer-sponsored health insurance model and corporate greed has become unworkable.  It may no longer be fix-able without radical systemic change.

    Araguato

    •  asdf (3+ / 0-)
      Recommended by:
      UnionMade, NoMoreLies, FindingMyVoice

      "Those people whose employers have been footing the lion's share of the costs are pretty clueless about what the real tab is for medical care.  They are focused on co-pays and dedcutibles which are a tiny share.  Not that they are insignificant, just nowhere the near the whole picture."

      I think that most people do know how much the employer is paying in premiums for employee plans, beyond co-pays and deductibles.  I know at the last place I worked each year we were 'allotted' x amount of dollars per month for insurance benefits and we had to decide what policies we wanted to participate in.  With each service/visit we would get an EOB statement detailing what was charged to the insurance, how much the insurance paid, and what was your responsibility to pay.

      With the company that I will be starting with in a week, I was given a listing of what policies were available.  In the listing was how much the employee was to pay and the employer was to pay for the policy per pay period.  There was also the listing of co-pays and deductibles.

  •  When I was getting chemotherapy for colon (8+ / 0-)

    cancer, the cost was roughly $20,000. dollars per month for my two treatments every other week.

    Mind boggling isn't it what it costs to keep a person alive?

  •  my experience has been smoke/mirrors (12+ / 0-)

    I have seen that big-insurance basically tells the hospital "here's what we are paying" - and that it's seldom the full price. YMMV.

    I'm also aware that there are "services" available - people skilled in looking at itemized bills and telling the hospital "my client is NOT going to pay $25-00 for a gauze pad, and $18 for one Tylenol tablet is also unreasonable".

    Fortunately I have not had to use such services to survive (I did see a couple of years back the egregious price-gouging for gauze, etc., but I didn't understand at the time that one could push back against this).

    A more recent experience - I went for a simple insurance cholesterol blood-test. 2 weeks later - $628 bill.

    I had an explosion, wrote the doctor, called office until they put him on the phone, called the "health" group challenged them, and also called my "health' "insurance" and had a rant (I am on HSA, so most every penny up to the first $2500 comes right out of my own HSA anyway). I told the insurance company that 7 out of the 9 items on the bill were unauthorized, and that they should be as mindful of my HSA as they are of their own money and i was contesting the charges.

    That 1-2-3 got me a call from the clinical director of the major hospital/"health" company, and he backed off all of the unauthorized charges. $628 bill became $160.

    What has happened I think is that the "health"-group may have setup their own lab and are now peppering everyone with unnecessary blood-tests - all the better to strip-mine victims.

    In any case, the message for anyone who has the strength to fight (health-scares can drain all will/resistance, I understand) is "fight back early and hard and on multiple fronts".

  •  I am wondering if the prices presented on (7+ / 0-)

    a bill paid by insurance are actually the prices paid by the insurers.

    I had two identical procedures done. One was done without insurance coverage. The second was done a year later with insurance. Same surgeon, same hospital. The "sticker price" of the second procedure was three times the amount of the first.

    In more detail:
    http://www.dailykos.com/...

    "Every now & then your brain gifts you with the thought, 'oh, that's right, I don't actually give a **** about this.' Treasure it" -- jbou

    by kenlac on Sun Mar 10, 2013 at 06:08:54 PM PDT

  •  The ACA is just a step in the right direction (12+ / 0-)

    The final destination has got to be a system without the for profit insurance companies and with some degree of cost control.

    In Canada nobody goes bankrupt for medical reasons and nobody dies because of lack of medical attention.  And everyone can go to the dentist and it all costs only 11% of GNP and not 18%.

    Call it Single Payer call it Medicare for all, that is goal.

    Daily Kos an oasis of truth. Truth that leads to action.

    by Shockwave on Sun Mar 10, 2013 at 06:18:50 PM PDT

    •  in Germany no one goes bankrupt (13+ / 0-)

      and all insurance is through private companies, but they are regulated a hell of a lot more strictly than are ours

      "We didn't set out to save the world; we set out to wonder how other people are doing and to reflect on how our actions affect other people's hearts." - Pema Chodron

      by teacherken on Sun Mar 10, 2013 at 06:20:39 PM PDT

      [ Parent ]

    •  Husband, a US citizen was hospitalized twice (1+ / 0-)
      Recommended by:
      Shockwave

      in Canada, once for a stroke (misdiagnosed there) and once for a cardiac event (look up torsade). I don't remember being hassled after the stroke, but after the cardiac event, I was being contacted by the billing office every day. And my US insurance, well, let's say that it took me three days on the phone to figure out who would cover costs of hospitalization, cath procedure, etc. I did have coverage for most stuff. But back in the USA, with more cardiac issues for him, I/we were never given any idea of what was covered. I guess I should have spent hours on phone trees to figure out what was going on.

      I never knew that my cadillac insurance did not cover most of the one-month rental of an external defibrillator until three years later. I got a bill for $3200 for a one month rental. Durable medical device.

      And no dental insurance here. When I went COBRA, $100/month for dental seemed excessive. In retrospect, it wasn't that unreasonable.

      Americans, while occasionally willing to be serfs, have always been obstinate about being peasantry. F. Scott Fitzgerald, the Great Gatsby

      by riverlover on Mon Mar 11, 2013 at 01:11:58 AM PDT

      [ Parent ]

      •  Under some plans, there is a year to file claims (0+ / 0-)

        Most likely, you should not have received that bill-did the provider file in time-was it not covered or denied because it was a charge three years old?

        You might want to check that the insurance co. did receive a claim-if they did not-you could argue you do not owe.

        There is just as much horse sense as ever, but the horses have most of it. ~Author Unknown

        by VA Breeze on Mon Mar 11, 2013 at 06:28:27 AM PDT

        [ Parent ]

        •  I did call my insurance co (0+ / 0-)

          and they said they had sent a check for $600 back near the time. Anyway, i paid the rest hoping it will help me with medical deductions for 2012.

          Americans, while occasionally willing to be serfs, have always been obstinate about being peasantry. F. Scott Fitzgerald, the Great Gatsby

          by riverlover on Tue Mar 12, 2013 at 02:16:41 AM PDT

          [ Parent ]

  •  There are systemic problems (5+ / 0-)

    I have experienced health care in Switzerland and in the US and the underlying costs in the US are insane

    CEO salaries?
    Greed everywhere?
    Medical malpractice?
    The fact that Americans are in such lousy shape?
    Our dinner plates (they have gone from 9 inch diameters to 12 inch diameters which means an 80% increase in portion sizes)?
    McDonalds?

    www.tapestryofbronze.com

    by chloris creator on Sun Mar 10, 2013 at 06:27:52 PM PDT

  •  That's a small difference (!!!). (1+ / 0-)
    Recommended by:
    FloridaSNMOM

    When my father-in-law died after spending several weeks in intensive care, the bill (without insurance) was over $200,000. With insurance (which he had), it was one-eight of that.

  •  Not sure what we need to realize about health (0+ / 0-)

    insurance, after reading this.  ????

  •  Is it possible to ask the cost up front? (0+ / 0-)

    Everybody is shocked when the bill comes in but I've never heard of anybody asking what something will cost before it is given. Hospitals will charge an outragous markup for an aspirin but before the nurse gives you one do you have the right to ask "how much will that cost me?" and if you refuse it and take one out of your pocket can they stop you from taking it? Imagine what would happen if every patient asked what every procedure would cost and had the right to haggle over the price before hand.

    •  You can sometimes do that with some things (8+ / 0-)

      If you are well enough to do so. Try haggling over the price of a breathing treatment while you're wheezing and can't get out more than a syllable at a time however. Or haggle with the surgeon after you're in a car wreck and bleeding, or unconscious. How about during a heart attack, or while you're having a stroke, I'm sure THAT would improve your health!

      Yes, you can sometimes try to find a better price for routine care and prescriptions, of course if you're on an insurance policy sometimes there are VERY limited choices on who you see for what that is covered at all. Can't go out of network or you'll be paying a LOT more. If there's one specialist in the network in a 40 mile radius you don't have a heck of a lot of choice if it's someone you're going to be seeing on a routine basis.

      "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

      by FloridaSNMOM on Sun Mar 10, 2013 at 07:21:01 PM PDT

      [ Parent ]

      •  Because of diaries here about asking for upfront (6+ / 0-)

        cost & about patient advocates, I remembered & tried to ask how much it would cost-much to the horror of family & medical staff in the room.

        Problem was I was heavily medicated, hooked up to all sorts of gadgets, surrounded by a transplant team & a what looked to be about a bazillion other doctors wanting consent for immediate surgery.  

        Without which I would die, period.  Heh, I know this only because I asked for no holding back truth about what would happen if I did not give consent.

        Sigh, sometimes there is no way to do price checking- especially when things go very wrong during typical procedures and/or just going about one's life.

        I so agree with the above fact filled comment by FloridaSNMOM.  And I am coming from a place of having had "cadillac" insurance in place from several options offered by the employer (thankfully we chose well).

        The realities most face are different from what they assume.  One sad truth is that most of us may not know what the realities are until unexpectedly faced with them.

    •  For things like elective surgeries, sure. But if (2+ / 0-)
      Recommended by:
      kareylou, worldlotus

      you're really sick you're often in no position to haggle.

    •  It's hard to get a cost up-front (4+ / 0-)
      Recommended by:
      lurker123, kareylou, Noddy, worldlotus

      I do ask, and I can't even get a ballpark figure, for planning purposes.  

      I think it comes down to two things---

      1) Until they plug in all the procedures and send the bill to your insurance company, even they don't know how much it will cost.

      2) If they say one thing and it ends up costing more, then they might be in a bind.

      Granted, you're talking about hospitals, and I never end up in one, but I suppose it'd be the same.

      Also, I'll be sure to sneak in my own tylenol.  

      Conservatives need to realize that their Silent Moral Majority is neither silent, nor moral, nor a majority.

      by nominalize on Sun Mar 10, 2013 at 10:02:42 PM PDT

      [ Parent ]

      •  I did that in a Docs office and worked at a Health (3+ / 0-)
        Recommended by:
        Noddy, orlbucfan, worldlotus

        Insurance claims office. A lot of times the Docs don't even know... And coding is an essential part of getting good payments from insurance companies and they all seem to have their own little ways of denial or exclusion so it is tuff. All this coding crap and differing amounts all over the board makes getting a handle on it very hard. I worked the insurance company for 5 weeks before my nausea at what I was being told made me walk away. There are huge numbers of people out there working to play the insurers games and to fight for the insurers to increase profits. So shutting down the insurance companies would have led to huge lay offs.

        A good insurance biller in a Docs office can make a big difference.

        Fear is the Mind Killer...

        by boophus on Sun Mar 10, 2013 at 11:13:27 PM PDT

        [ Parent ]

      •  we could not have known (3+ / 0-)
        Recommended by:
        Noddy, orlbucfan, worldlotus

        until we had a complete diagnosis

        when we started on Sun Jan 27, the immediate reaction from the radiologist was that she had a metastatic cancer that had spread to her spine.

        That is why she was immediately admitted, starting first in the ER to get steroids into her to address the soft-tissue mass threatening the integrity of her spine, and getting a CT scan of all major organs to try to identify the source.  The original plan had been to do spine stabilization surgery the next day, but that never happened.  During the course of the first few days in the hospital things kept changing as the doctors got more information.  It was not until Thursday that we were reasonably sure it was a blood cancer and no organs were involved.  On Wednesday they had determined they could not do spine surgery and instead they got her a back brace.   Spine surgery is still in the future.

        She responded so well to first round of radiation that they decided to be aggressive and do a second while she was in first round of chemo.   That has had a real impact upon her, as we have seen this week, but may have accelerated her healing.  In the meantime, the affects of that have required some additional medication which was expensive.  

        I also insisted on a hospital bed being installed before she came home, and that added one day to the hospital stay.

        So the answer is that even when you can ask intelligent questions - and ours were guided with assistance from her sister who is a physician's assistant in primary care, her college roommate who used to be medical director of glaxo smith klein, and a friend who just retired from NIH where he worked on blood cancers - we still were dealing with a picture that was at first undefined and then was changing.

        And we know that to properly guide her treatment, we will need further MRIs at a minimum, and that at some point in the future they are going to want to go in and stabilize her back so she can live without the back brace and the hospital bed.

        "We didn't set out to save the world; we set out to wonder how other people are doing and to reflect on how our actions affect other people's hearts." - Pema Chodron

        by teacherken on Mon Mar 11, 2013 at 05:01:20 AM PDT

        [ Parent ]

    •  My family had a hospital stay last year. (3+ / 0-)
      Recommended by:
      sillia, orlbucfan, worldlotus

      It isn't just one bill. We received multiple invoices from multiple providers for the care and procedures that occurred. There was absolutely no way at all anything resembling a ballpark estimate could have been created for what took place.

      Fee for service sucks. When you go to a hospital, you're really going to a collective of independent practices in some sense.

      •  we are already in that world (3+ / 0-)
        Recommended by:
        sillia, orlbucfan, worldlotus

        1.  hospital
        2.  company that provided back brace
        3.  company from whom we rent hospital bed
        4.  company that did basic xrays and MRI
        5.  company that does CT
        6.  radiation oncologist
        7.  regular oncologist
        8.  lab company
        9.  pathologist
        10. pharmacy (pay co=pays as we go)
        11. company that provides one of chemo drugs - fed-ex to local pharmacist

        "We didn't set out to save the world; we set out to wonder how other people are doing and to reflect on how our actions affect other people's hearts." - Pema Chodron

        by teacherken on Mon Mar 11, 2013 at 06:03:39 AM PDT

        [ Parent ]

    •  You can ASK, but they (2+ / 0-)
      Recommended by:
      orlbucfan, worldlotus

      won't necessarily tell you unless they expect payment in full before they do the procedure.

      I've had doctors tell me "You don't need to know, the insurance is paying for it" way too many times.

      Even when I tell them I'm paying the deductible and therefore no, the insurance isn't paying, their response is "Well, don't you want to pay off your deductible faster?"

      No, no I don't. I want to pay what I owe, but not pay just to "get it over with".

      Not knowing the true price for procedures prevents people from shopping around for the best doctor/best price combo they can get - especially when they have to pay for a doctor's visit to even discuss the procedure.

      You call a doctor and say, "I had these tests done and they show I need this procedure done, what will you charge for this, this, and this?" You have to ask about items that are part of the procedure but not necessarily included in the price of the procedure - advance bloodwork, anesthesia (if any), x-rays, lab techs, nursing charges, equipment use, rental of the OR, bed use (even if you only need a bed for observation for a couple of hours, you may still be charged for the use of the bed), medications used, etc. etc. etc.

      They say, "Can't tell you without an exam and running our own tests to confirm you need the procedure done, maybe you need a different one."

      So then you have to pay for the tests all over again and still may not know what the procedure will cost.

      All knowledge is worth having. Check out OctopodiCon to support steampunk learning and fun. Also, on DKos, check out the Itzl Alert Network.

      by Noddy on Mon Mar 11, 2013 at 07:09:04 AM PDT

      [ Parent ]

      •  A simply way around this would (0+ / 0-)

        be Medicare multiple pricing.

        Each provider would be free to set his/her multiple up to 2.0.

        If Medicare pays $100 for something and the provider's multiple is 1.15, then the charge would be $115.

        One multiple per provider - simple.

        This would have to be posted on all the entrance doors.

        It could be changed only on IRS quarterly estimated tax due dates [to rule out airline style pricing games].

    •  If you're under anesthetic at the time, (1+ / 0-)
      Recommended by:
      worldlotus

      there won't be much you can do to negotiate, LOL.

      My husband was under sedation for oral surgery, and during the procedure his O2 levels went down, so they administered oxygen. I believe this is standard medical procedure to a) prevent death, and b) prevent brain damage?

      Because this was at the discretion of the doctor, and because it wasn't "approved" in advance, the insurance co. billed us for it. We fought this for YEARS (not because it was huge $$ but on principle), it even went to so-called arbitration (ha, ha, ha) but the result was we had to pay the charge.

      I love it that Obama's channeling Harry Truman: "I don't give 'em hell; I just tell the truth and they think it's hell!"

      by sillia on Mon Mar 11, 2013 at 10:27:47 AM PDT

      [ Parent ]

  •  Yes, I've seen that. (4+ / 0-)
    Recommended by:
    FloridaSNMOM, worldlotus, myboo, kareylou

    Had ACL reconstruction surgery for my right knee.  The charged rates totaled up to around $60,000 (MRI, surgery, anesthesia, plus all doctors/nurses/staff).  Negotiated rate that was covered by my student health insurance plan - somewhere around $24,000.  Still a lot, but less than half of the charged rate.

    So uninsured are screwed in two ways.  They have to pay the entire bill (no co-pays, percentages, etc.) and they have to pay the charged rate because they won't get the benefit of an insurance negotiated rate.

    Devastating.

    It is done. Four More Years.

    by mconvente on Sun Mar 10, 2013 at 07:36:18 PM PDT

    •  that is what insurers DO for you. (0+ / 0-)

      or would you prefer to negotiate on your own.

      People without insurance can negotiate themselves. But effective negotiating is not a common skill.  There is a new group of professionals coming into the public eye: patient advocates,
      who will negotiate after the fact. They know how to read hospital bills and what should not be on them. They can help a lot but not work miracles.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Tue Mar 12, 2013 at 06:54:44 PM PDT

      [ Parent ]

  •  we still need (9+ / 0-)


    a Public Option

    -- one that does not sanction the 20% profit taking,

    for privilege of receiving essential health care.


    wishing you guys a fast recovery,

    and a "manageable" pile of debt, if there is such a thing.

  •  Running an insurance company "for profit" (3+ / 0-)
    Recommended by:
    mkor7, orlbucfan, worldlotus

    is like running a fire department "for profit". This is the basic problem of everything in this country. Some things just CAN'T be big profit-making ventures. Wasn't "insurance" meant to be paying in small fees to build up into a fund that could cover sudden high-expense accidents -- and then afterward continue paying small fees to recoup the big expense? Who the hell decided that this could be made into a high-profit growth business?
    Enron was the same thing. A utility company being run like an oil company. Insane greed.
    Short of violently changing how things are done in this country, all we can do is hope that eventually all major corporations crash and burn... unfortunately, so will our economy every time one does.

    Ash-sha'b yurid isqat an-nizzam!

    by fourthcornerman on Mon Mar 11, 2013 at 02:29:09 AM PDT

  •  Dear Teacherken: (1+ / 0-)
    Recommended by:
    worldlotus

    could you elaborate on this:

    We probably would not be forced into bankruptcy were we forced to pay the entire bill -  federal law allows withdrawal of retirement funds early without penalty for payment for medical expenses.  Many Americans would not have access to such funds.  
    I have a family member who was hospitalized in Dec and we are getting all the bills now and such an option would be helpful  but I had not heard of it...

    There is just as much horse sense as ever, but the horses have most of it. ~Author Unknown

    by VA Breeze on Mon Mar 11, 2013 at 06:32:19 AM PDT

    •  check provisions on IRAs for example (2+ / 0-)
      Recommended by:
      VA Breeze, worldlotus

      you were allowed to make early withdrawals without penalty for medical and educational expenses

      I know that I took money out of an IRA to pay expenses for my doctoral studies in education

      you still have to pay the taxes, but not the penalty for early withdrawal

      "We didn't set out to save the world; we set out to wonder how other people are doing and to reflect on how our actions affect other people's hearts." - Pema Chodron

      by teacherken on Mon Mar 11, 2013 at 06:54:41 AM PDT

      [ Parent ]

  •  Insurance period (0+ / 0-)

    Insurance is the only private entity everyone is required to pay for be it property and casualty (car, homeowners, etc.) or life and health.  How is it that we as in "All of us Democrat, Republican, Indenpendent......" are forced to purchase a private, corporate owned product to avoid breaking the law or being fined by a government originally designed to protect the people not prey on them?

    The joke here is that hospitals will take less money for cash up front than they charge the Insurance companies.  If you don't believe me just ask next time someone needs and MRI ask them what it would cost you if you paid cash and then compare that to what it would cost the Insurance company.

    There is a solution but it's not an easy one.  Hospitals become public service entities much like water, gas, electricity and must operate as maintenance organizations not profit orginazations.  This leaves room for shopping around for a good doctor but takes out the cost of $26.00 for a single aspirin.  

    Self-Insurance for some is cheaper than the premiums they pay.  Unfortunately citizens are not allowed to set aside their premiums in place of insurance.  Where are the rights the founding fathers wanted for us?

  •  Knee Replacement: $136,500 (2+ / 0-)
    Recommended by:
    orlbucfan, worldlotus

    That was the hospital charge, and I'm still waiting to see if it is for the entire procedure (minus surgeon, radiologist, etc) or if that was only for the room.

    Yes, it sounds preposterous, but the only billing I've got is a one-liner from Anthem for 'semi-private room, 4 days'.

    Anthem paid $25,400 out of the total, which still comes out to $6,350 per day. That's what leads me to believe this is the entire hospital charge, because I cannot believe Anthem would pay that much for a simple room.

    Amazingly, the surgeon - who is a leader in his field, and an amazingly talented man - was only paid $1,700 for the surgery and hospital followup. In contrast, the internest who stuck his head in the door a couple times a day got $550.

    Thankfully, our 'platinum' insurance plan paid 100% of everything because our deductible was satisfied and our out-of-pocket maximum had already been maxed out (ironically, we didn't pay the OOP because of fraudulent activity by a surgical center last summer and Anthem's disinterest).

    Like teacherken, I feel for those who don't have good insurance.

    I watched my wife hobble around on two bad knees, waiting for them to get bad enough to qualify medically.

    So many people don't have the assurance of relief when it is needed most.

    My wife is 'fixed', but our country is broken.... on the rack of capitalism.

    When we started putting profit above misery, and stopped trying to balance them, we lost our claim to being a civilized nation.

    I doubt this can be fixed.

    Against stupidity the gods themselves contend in vain. Friedrich Schiller

    by databob on Mon Mar 11, 2013 at 09:00:35 AM PDT

  •  When did an insurance agent make anyone well? (0+ / 0-)

    In my own experience, they've only made me sick.  That's the part of our sickcare system that I've never figured out: why are they part of the picture at all.  We need health care, not "insurance."

    •  It's not really insurance... (1+ / 0-)
      Recommended by:
      worldlotus

      it's 'health care administration'.

      The difference is that when you get car or home or life insurance, to name a few, you are insuring against an unlikely event. Your chances of incurring a loss (and hence a claim) in any given year are very low, so everybody pools their money to pay for the few who have a loss.

      Healthcare is different. It is practically impossible to go a whole year without a claim. So Anthem (or any other company) merely takes in everybody's money and pays it out.

      Yes, both do the same basic thing. The difference is in the frequency, and the odds of having a claim.

      Cheers.

      Against stupidity the gods themselves contend in vain. Friedrich Schiller

      by databob on Mon Mar 11, 2013 at 09:18:05 AM PDT

      [ Parent ]

  •  Your diary has inspried me to share (1+ / 0-)
    Recommended by:
    teacherken

    Leaves and you are in my thoughts.

    Dispatch From Inside The Canadian Healthcare System

    "Growth for the sake of growth is the ideology of the cancer cell." ~ Edward Abbey

    by SaraBeth on Mon Mar 11, 2013 at 09:53:21 AM PDT

    •  Leaves has family in Canada (2+ / 0-)
      Recommended by:
      SaraBeth, orlbucfan

      and at an extended family reunion on PEI even the politically very conservative among them were more than satisfied with their health care system

      "We didn't set out to save the world; we set out to wonder how other people are doing and to reflect on how our actions affect other people's hearts." - Pema Chodron

      by teacherken on Mon Mar 11, 2013 at 09:58:16 AM PDT

      [ Parent ]

  •  I hate, hate, hate insur. co's (2+ / 0-)
    Recommended by:
    orlbucfan, worldlotus

    or maybe it's just the profit motive in general that I hate, in relation to health care.

    We also have BCBS, thru my husband's employer (state university). We pay thousands of dollars per year for this coverage.

    They generally cover most prescriptions, but everything else that comes up they just DON'T PAY. We can file claims, make grievances, etc, etc. but it does no good. They can get away with it because it's below the amount that a person would hire a lawyer to recoup--that is my theory anyway. They are crooks!!

    Throughout the ordeal of my Lyme disease treatment (3 years now) we have had to pay most of the costs ourselves, out of pocket. We have to go 'out of network' to find a lyme doctor, so we accept that a smaller percentage of those visits would be covered, however they pay ZERO ($0) of our claims. A couple of times BCBS employees have told my husband on the phone that "you can sue us" if we want more of it paid.

    That's their plan? So when is my husband supposed to organize a lawsuit between his teaching, his research and other work responsibilities, not to mention cooking for me and taking me to the doctor??? And how do you pay a lawyer to recoup a few thousand dollars? They know we can't do that, and they'll get away with it. I hate them.

    I am not complaining about my life--I feel fortunate that we have a comfortable income. I have a good doctor and I plan to recover eventually from this disease. But it seems outrageous that we are paying $15,000 a year out of pocket for my treatment that doesn't even involve surgeries or ER visits. We spent our savings, we started withdrawing from retirement, we've had cash donations from relatives.

    How do people with less resources ever get treatment???

    I love it that Obama's channeling Harry Truman: "I don't give 'em hell; I just tell the truth and they think it's hell!"

    by sillia on Mon Mar 11, 2013 at 09:53:30 AM PDT

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