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  • Bitter Pill: Why Medical Bills are Killing Us

    Bitter Pill: Why Medical Bills Are Killing Us | TIME.com

    an absolutely stunning-- but not surprising-- expose of US hospital bill costs.

    i've had my own experience with the system about four years ago. one night i woke up with ghastly pain in my abdomen, like a series of heavy punches that left me breathless.

    my spouse barely got me into the taxi and we sped to the GWU hospital; after producing my insurance, i was put into a hospital bed and then promptly ignored for about an hour. after my spouse complained, loudly, a doctor finally came out to see me, and then put me through a battery of tests: multiple x-rays, CAT scan, blood drawing, urine testing.

    the pain got so bad that they eventually injected me with a painkiller, and i passed out. the doctor later told me that the tests all came back negative, and they could only guess that it was acute viral gastroenteritis...and that they couldn't do anything about it, because it was a virus. he then apologized for all the tests, saying that i probably didn't require that many x-rays for them to determine that there was nothing (otherwise) wrong with me. i was released, with the only thing of benefit being the painkiller (which i couldn't/didn't want too much of, as it was an opiate).

    for this one harrowing night, i was charged $12K. thankfully i had topflight insurance (kaiser permanente; always great) and complained loudly to the hospital; between kaiser and myself, i got the charge down by half, and after kaiser paid for most of it, i was left paying $800.

    so for my night of pain, where i was on a hospital bed for five hours, got about 10 min of time with a doc, a painkiller injection, and tests (some of which gave me a nice dose of radiation which turned out to be unnecessary)...i paid $800, and considered that a great deal.

    i'm seeing a lot of the same issues here. what hospitals in effect do is charge like a monopoly, knowing that you're not likely to negotiate or turn down services...which you can't price-shop for.

    makes me sick reading about it, and no pun intended.
    There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "My ignorance is just as good as your knowledge."- Isaac Asimov

  • #2
    Almost sounds like an indictment of a frozen, marketless service that is free to ignore the needs and wants of its primary consumers.

    -dale

    Comment


    • #3
      indeed.

      Unless you are protected by Medicare, the health care market is not a market at all. It’s a crapshoot. People fare differently according to circumstances they can neither control nor predict. They may have no insurance. They may have insurance, but their employer chooses their insurance plan and it may have a payout limit or not cover a drug or treatment they need. They may or may not be old enough to be on Medicare or, given the different standards of the 50 states, be poor enough to be on Medicaid. If they’re not protected by Medicare or they’re protected only partly by private insurance with high co-pays, they have little visibility into pricing, let alone control of it. They have little choice of hospitals or the services they are billed for, even if they somehow know the prices before they get billed for the services. They have no idea what their bills mean, and those who maintain the chargemasters couldn’t explain them if they wanted to. How much of the bills they end up paying may depend on the generosity of the hospital or on whether they happen to get the help of a billing advocate. They have no choice of the drugs that they have to buy or the lab tests or CT scans that they have to get, and they would not know what to do if they did have a choice. They are powerless buyers in a seller’s market where the only sure thing is the profit of the sellers.

      Indeed, the only player in the system that seems to have to balance countervailing interests the way market players in a real market usually do is Medicare. It has to answer to Congress and the taxpayers for wasting money, and it has to answer to portions of the same groups for trying to hold on to money it shouldn’t. Hospitals, drug companies and other suppliers, even the insurance companies, don’t have those worries.
      There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "My ignorance is just as good as your knowledge."- Isaac Asimov

      Comment


      • #4
        Another bubble that has been growing for a long time. Starting with fees for medical college, salaries for doctors, gifts from pharma companies...

        Someone has to pay all those bills.
        No such thing as a good tax - Churchill

        To make mistakes is human. To blame someone else for your mistake, is strategic.

        Comment


        • #5
          If only the government could take over our health care...

          Indeed, the only player in the system that seems to have to balance countervailing interests the way market players in a real market usually do is Medicare. It has to answer to Congress and the taxpayers for wasting money, and it has to answer to portions of the same groups for trying to hold on to money it shouldn’t.
          Seems...like a key word in that statement.

          It seems to make sense.

          Hospitals, drug companies and other suppliers, even the insurance companies, don’t have those worries.
          Of course they don't have anything to worry about. They just take money and treat people like crap. The government mandated that they have little or no competition. Insurance companies can't compete across statelines. Employers get huge deductions from buying group policies. Tying health care to employment was the worst thing that could have happened to us. I wonder how that happened?
          Last edited by gunnut; 21 Feb 13,, 20:59.
          "Only Nixon can go to China." -- Old Vulcan proverb.

          Comment


          • #6
            gunnut,

            did you read the article? the main impetus of the article is not on the insurance companies, but on the hospitals with the chargemaster.

            the issue with treating healthcare as another good to be shopped for on a private market is that costs are hidden and that the nature of a health scare makes it almost impossible to "pick" a cheaper option. one doesn't just start comparing costs when you're racing to the ER, after all.

            insurance companies are covered somewhat in the article as well, and the author is careful to compare a range of insurance coverage, from private to employment-covered. each has their own weakness. but this is not where the majority of charges arise.
            There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "My ignorance is just as good as your knowledge."- Isaac Asimov

            Comment


            • #7
              Originally posted by astralis View Post
              gunnut,

              did you read the article? the main impetus of the article is not on the insurance companies, but on the hospitals with the chargemaster.

              the issue with treating healthcare as another good to be shopped for on a private market is that costs are hidden and that the nature of a health scare makes it almost impossible to "pick" a cheaper option. one doesn't just start comparing costs when you're racing to the ER, after all.

              insurance companies are covered somewhat in the article as well, and the author is careful to compare a range of insurance coverage, from private to employment-covered. each has their own weakness. but this is not where the majority of charges arise.
              Have you looked at the bill everytime you get your car repaired? How about plumber? Electrician? How much does a mechanic (not even the dealer) charge for a bottle of fuel cleaner? $15? $20? You can buy this stuff for $8 on Amazon.

              Ever have the "check engine light" in your car come on? Take it to a dealer to have it fixed? Lexus charged me $900 for an O2 sensor, which I found out later cost about $15. The device to read that damn code is $20. Labor to put it in was about an hour. How do I know these numbers? Because "the insurance company didn't cover it."

              Hospitals charge what they charge because none of us ever look at the bill, because "the insurance company will pay for it." We stopped shopping for health care a long time ago. We shop for health insurance. Why?

              And why is it the congress's job to look out for us? Why can't we shop for our own health care or health insurance?
              Last edited by gunnut; 21 Feb 13,, 21:53.
              "Only Nixon can go to China." -- Old Vulcan proverb.

              Comment


              • #8
                I'm going through some issues with my knees at the moment. A regular orthopedist is covered in my monthly payments of 55NIS (~$15). A knee specialist is 22NIS (~$5) every quarter that I happen to see him. I had to get a SPECT bone scan and an MRI, I paid a total of 58NIS (29 each, ~$7), and they covered the rest. Considering an MRI costs about 5,000 NIS, and I paid 29NIS, I can't really complain, aside from the fact that the appointment was for 4:00AM in the morning.

                On the one hand, paying the monthly payment (and I pay extra for the deluxe package) when I'm healthy is a drag, but paying 29NIS instead of 5,000 when I need it definitely makes it worth it. Hell, maybe there is something to socialized healthcare.....
                Meddle not in the affairs of dragons, for you are crunchy and taste good with ketchup.

                Abusing Yellow is meant to be a labor of love, not something you sell to the highest bidder.

                Comment


                • #9
                  gunnut,

                  Have you looked at the bill everytime you get your car repaired? How about plumber? Electrician? How much does a mechanic (not even the dealer) charge for a bottle of fuel cleaner? $15? $20? You can buy this stuff for $8 on Amazon.

                  Ever have the "check engine light" in your car come on? Take it to a dealer to have it fixed? Lexus charged me $900 for an O2 sensor, which I found out later cost about $15. The device to read that damn code is $20. Labor to put it in was about an hour. How do I know these numbers? Because "the insurance company didn't cover it."

                  Hospitals charge what they charge because none of us ever look at the bill, because "the insurance company will pay for it." We stopped shopping for health care a long time ago. We shop for health insurance. Why?
                  from both the article and my own experience, this type of thing has limited negotiability.

                  note how the article compares prices which the author found online and what the hospitals charge. when asked to explain the differential, hospitals either refuse to answer or come up with some BS as to how 'specialized/individualized' the treatment is.

                  we CAN negotiate with the hospital- and by we i mean both the person as well as the person's insurance company. but this comes after the fact, and makes negotiation difficult. note, too, that the mark-ups on the procedures are so much that even a 50% discount still means paying way, way too much.

                  for people with less time, less education, and ability, knowing what costs are BS and can be negotiated on is difficult. moreover, you're STILL negotiating off the hospital mark-up, with little basis for comparison (other than stuff you can find online). in my personal case, i got charged several thousand for occupying a hospital bed for several hours, and in the end kaiser had to negotiate this, not myself.

                  to that extent i'm quite glad i had kaiser on my side; one person trying to argue with the hospital bureaucracy was a nightmare for me.
                  There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "My ignorance is just as good as your knowledge."- Isaac Asimov

                  Comment


                  • #10
                    Medicare. It has to answer to Congress and the taxpayers for wasting money,
                    AHAHAHAHAHAHAHAAHHAHAAHAHAHA!!!!!!!!!!!

                    Oh, if only your buddy Zakaria had typed that...

                    -dale

                    Comment


                    • #11
                      Originally posted by astralis View Post
                      gunnut,

                      from both the article and my own experience, this type of thing has limited negotiability.

                      note how the article compares prices which the author found online and what the hospitals charge. when asked to explain the differential, hospitals either refuse to answer or come up with some BS as to how 'specialized/individualized' the treatment is.

                      we CAN negotiate with the hospital- and by we i mean both the person as well as the person's insurance company. but this comes after the fact, and makes negotiation difficult. note, too, that the mark-ups on the procedures are so much that even a 50% discount still means paying way, way too much.

                      for people with less time, less education, and ability, knowing what costs are BS and can be negotiated on is difficult. moreover, you're STILL negotiating off the hospital mark-up, with little basis for comparison (other than stuff you can find online). in my personal case, i got charged several thousand for occupying a hospital bed for several hours, and in the end kaiser had to negotiate this, not myself.

                      to that extent i'm quite glad i had kaiser on my side; one person trying to argue with the hospital bureaucracy was a nightmare for me.
                      I agree. That's why we buy insurance. The insurance companies and hospitals can duke it out.

                      We do the same with auto insurance. I hit a new Lexus GS 350 a few years ago (not my fault). Fortunately no one was injured. We exchanged insurance information and let them figure out all the cost. I paid nothing because it was not my fault. I don't know how much the other driver paid, nor do I care.

                      High hospital bills will jack up insurance rate. They are linked. And we allowed that to happen because we have insurance...

                      We get subsidized insurance through employment. We have lost our ability to shop for individual insurance. By ability I mean people's knowledge and will power. We just find a job and have subsidized insurance. We then not care about the total cost, only out of pocket expense. After 70 years, shit gets expensive.
                      "Only Nixon can go to China." -- Old Vulcan proverb.

                      Comment


                      • #12
                        Originally posted by astralis View Post
                        Bitter Pill: Why Medical Bills Are Killing Us | TIME.com

                        an absolutely stunning-- but not surprising-- expose of US hospital bill costs.

                        i've had my own experience with the system about four years ago. one night i woke up with ghastly pain in my abdomen, like a series of heavy punches that left me breathless......
                        Had a similar experience some years ago. Sitting at home minding my own business when I was overcome by vomiting & diarrhea. My heart was going crazy, I began sweating profusely & most scarily my head began spinning & my balance was gone. I live alone & the bathroom is at the back of my house. I was terrified that I was having a stroke or a heart attack or something catastrophic & that if I went down I might never get up. I managed to clean myself up & stagger to the phone where I called an ambulance. it was winter, so by the time the ambulance arrived I was sitting on my bed barely clotherd & shivering uncontrollably. Judging from the tone of the paramedic she suspected drugs - not unusual hereabouts. I was taken to hospital where I was admitted to emergency, subjected to a battery of tests & spent most of the day in a bed. Even got a fairly forgettable meal. When the tests all came back negative I was sent home. Total cost - $0.

                        I've also had several emergency admissions requiring x-rays (both resulting from being hit by cars). Also zero cost. My only out of pocket is the $35 per year I pay for Ambulance insurance. In the case of the car accidents I actually don't even need that as it is covered by government insurance anyway.

                        Pretty cool for mine.
                        sigpic

                        Win nervously lose tragically - Reds C C

                        Comment


                        • #13
                          Originally posted by gunnut View Post
                          Have you looked at the bill everytime you get your car repaired? How about plumber? Electrician? How much does a mechanic (not even the dealer) charge for a bottle of fuel cleaner? $15? $20? You can buy this stuff for $8 on Amazon.

                          Ever have the "check engine light" in your car come on? Take it to a dealer to have it fixed? Lexus charged me $900 for an O2 sensor, which I found out later cost about $15. The device to read that damn code is $20. Labor to put it in was about an hour. How do I know these numbers? Because "the insurance company didn't cover it."
                          The smart driver gets a written estimate of the cost to repair- diagnosis should be free. The cost of the parts will have some markup, especially at dealer, though by law the dealer has to sell you or the mechanic you chose the part. Shops are also free to charge what they want for labor. However, every job that can be done on a car is mapped out in the hours it will take an average mechanic to do the job.

                          In Arkansas (not exactly a consumer friendly state) the shop can legally exceed the written estimate by no more than 20% without the owners written permission.

                          Comment


                          • #14
                            Originally posted by astralis View Post
                            for this one harrowing night, i was charged $12K. thankfully i had topflight insurance (kaiser permanente; always great) and complained loudly to the hospital; between kaiser and myself, i got the charge down by half, and after kaiser paid for most of it, i was left paying $800.

                            so for my night of pain, where i was on a hospital bed for five hours, got about 10 min of time with a doc, a painkiller injection, and tests (some of which gave me a nice dose of radiation which turned out to be unnecessary)...i paid $800, and considered that a great deal.
                            .
                            13 years ago i fell off the roof of my house and shattered both my heels. After a bit of swearing and cursing the ambulance and fire brigade arrived (the fire brigade because they do all the heavy lifting) injected me with morphine and took me to the hospital. There I had temporary casts fitted in the emergency room, had two x-rays followed by a scan (they didn't believe the x-rays), inhaled lots of nitrous oxide, had some more morphine then was bundled off into a ward.
                            The next day the surgeon came round and told me there was nothing in the way of surgery he could do other than amputate, that I would never ski again (I'm instructing his daughter on a ski week in August) and that they'd hold off on the amputations until they saw how I responded.
                            They wanted to keep me in for a week or two but I bullied my way out by the simple expedient of nicking a ward wheelchair and visiting the various departments responsible for installing a ramp in my home, handrails etc along with the wheelchair department to get one specifically for me and was back home courtesy of another ambulance (and fire brigade) two and a half days later.
                            They gave me a codeine supply sufficient for one month with an ongoing prescription but I'm averse to regular drug taking so that one month supply lasted me over a year and I never bothered getting any more, I only took them when I was going to a party so I could stand and talk (and mix it with alcohol as well ;) ).
                            They paid taxi fees for two months for me to go to and from work, recompensed my work by paying 80% of my salary for the six weeks I had off (my work happily topped up the rest) and if I'd needed amputation would have paid for that and ongoing prosthetics as well, all at no cost to me.

                            I know that I do pay it via taxes, but given the disparity in costs per capita between NZ and the US, plus the insurance you have to pay anyway, I think I get a pretty good deal in comparison.

                            Gunnut, I love the free market as well, but free market policies do not always work in social situations. I hate socialism generally but in some situations, it works.

                            To paraphrase my grandma, ideology is the hobgoblin of small minds (no insult intended)
                            In the realm of spirit, seek clarity; in the material world, seek utility.

                            Leibniz

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                            • #15
                              Originally posted by Parihaka View Post
                              I know that I do pay it via taxes, but given the disparity in costs per capita between NZ and the US, plus the insurance you have to pay anyway, I think I get a pretty good deal in comparison.
                              Yep.

                              Gunnut, I love the free market as well, but free market policies do not always work in social situations. I hate socialism generally but in some situations, it works.

                              To paraphrase my grandma, ideology is the hobgoblin of small minds (no insult intended)
                              Free markets do some things very well & other things very poorly. Using them as a 'one size fits all' solution is all about ideolgy, not results.

                              .....this is usually the point in the discussion where someone mentions 'illegals' or makes some statement about Canadians flocking to US hospitals.
                              sigpic

                              Win nervously lose tragically - Reds C C

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