An Inconvenient Truth

This thread made quite a strange progression. From Al Gore to health insurance, to NFL players getting paid too much.... Wow.

You're a salty vet, you know how these things go.

I believe the numbers if you want to just use a #. 10 million of those are very temp. while people are changing jobs. So if I quit one job on 3/05/07 and then take a week off between jobs I'm counted on that list. If I'm a younger person who decides I do not need health insurance. I'm on that list. From those two things from what I've read the number would drop to around 25 million. Now how many of those drive new cars have HBO, Cell phones and everything else and just don't buy health insurance? I'd say that number is around 5 to 10 mill easy but no one knows the answer to that part. Now we are down to around a real number of 20 to 15 million uninsured Americans because I do not count the above. That is still a big number but now I'd have to get into the poor and all of that stuff which I will avoid getting into.

The reason doctors do not want to deliever babies is they are always getting sued. Malp. Ins is way up and the doctors and Hosp. just don't want to deal with it anymore. Its a shame.


That's somewhat misleading. Lots of independent contractors and/or sole proprietors don't have health insurance, they simply cannot afford it. Im 34, and the last quote I got for health insurance was $650 a freakin month! I cant afford that. People take for granted health insurance provided by their employers. In addition, I think its crap that an insurance company pays such a reduced amount, while someone without insurance gets stuck with the full bill. There was a Dateline story on this recently. Someone without insurance goes in for surgery and gets hit with a $100k bill, but when someone else who has insurance goes in, their insurance company pays like half that amount. Shouldn't the guy without insurance get at least as good a rate as the insurance company when its coming out of his own pocket? Just doesn't seem fair.

That's somewhat misleading. Lots of independent contractors and/or sole proprietors don't have health insurance, they simply cannot afford it. Im 34, and the last quote I got for health insurance was $650 a freakin month! I cant afford that. People take for granted health insurance provided by their employers. In addition, I think its crap that an insurance company pays such a reduced amount, while someone without insurance gets stuck with the full bill. There was a Dateline story on this recently. Someone without insurance goes in for surgery and gets hit with a $100k bill, but when someone else who has insurance goes in, their insurance company pays like half that amount. Shouldn't the guy without insurance get at least as good a rate as the insurance company when its coming out of his own pocket? Just doesn't seem fair.
I have never heard this but if its true than something needs done about it. That sure sounds like discrimination(sp?) to me.

This the little thread that could. Almost aweek and only 72 replies but constantly on the front page.

I have never heard this but if its true than something needs done about it. That sure sounds like discrimination(sp?) to me.

No actually it's called fee scheduling and it's 100% legal.

There is an agreed upon rate for medical services, medical equipment, etc.

Insurance companies never pay the full amount, I guess you can say it's a bulk discount rate.

Or you could look at it from the other side and say medical providers are overcharging those without insurance. Don't always be so quick to blame the big bad insurance companies.

That's somewhat misleading. Lots of independent contractors and/or sole proprietors don't have health insurance, they simply cannot afford it. Im 34, and the last quote I got for health insurance was $650 a freakin month! I cant afford that. People take for granted health insurance provided by their employers. In addition, I think its crap that an insurance company pays such a reduced amount, while someone without insurance gets stuck with the full bill. There was a Dateline story on this recently. Someone without insurance goes in for surgery and gets hit with a $100k bill, but when someone else who has insurance goes in, their insurance company pays like half that amount. Shouldn't the guy without insurance get at least as good a rate as the insurance company when its coming out of his own pocket? Just doesn't seem fair.

Pssst... little secret from the corporate guy who works at a major urban hospital chain...

If you don't have insurance and you need surgery, yes we would charge you way more than we'd get paid by Blue Cross or Aetna if you were covered. But guess what, we'd be very happy if you came to us and said listen clowns, there's no way in hell I'm paying $100K for that surgery. But I will pay you whatever Blue Cross or Aetna would have paid you ($25,000). We'd take that in a heartbeat, because we know you're like 90% likely to skip out on the $100,000 bill anyway. I mean if your credit is going to be ruined, why pay any of that insane bill, right? We'd never see a dime in most cases. But if you negotiate, we'd drop the charge down and keep your credit free and clear if you paid us a negotiated rate.

Little secret of the healthcare system.

No actually it's called fee scheduling and it's 100% legal.

There is an agreed upon rate for medical services, medical equipment, etc.

Insurance companies never pay the full amount, I guess you can say it's a bulk discount rate.

Or you could look at it from the other side and say medical providers are overcharging those without insurance. Don't always be so quick to blame the big bad insurance companies.

See here's the problem...

Hospitals get paid by basically 3 sources:

- Federal government pays decently for Medicare patients. We basically break even on Medicare patients.

- State governments pay terribly for Medicaid patients. We lose our shirts on Medicaid patients.

- Commercial insurance companies pay very well, on the whole. But the bigger the insurance company, the lower their payments. If I'm an insurance company who covers five million people in the Washington DC area, hospitals NEED to contract with me, or I'll tell my customers that they can't go to XYZ hospital because they're not part of the network. If a customer goes to an out-of-network hospital, they'll have to pay some out of pocket costs. But if they go to an in-network hospital, they pay nothing. No brainer, right? No patient would go to the out-of-network hospital. So if I'm a hospital, I have no choice but to reach an agreement with the big insurance company. I can't just do without access to 5 million lives. So as the hospital, I'm forced to take it up the rear and accept low payment rates from the big insurance company. Now, a little insurance company comes along, with say 100,000 customers, the hospital is licking its' chops. The hospital has all the leverage, they say we don't care about your 100,000 customers, either pay us a big rate, or find another hospital to deal with. And all the hospitals treat the little insurance company that way, and they have no choice but to pay through the nose.

So... since hospitals are breaking even on Medicare, and losing money on Medicaid, and barely making anything off the big insurance companies, they've got no choice but to rape the little insurance companies and overcharge uninsured patients. It's either that, or the hospital goes out of business. It's a crying shame, but it's reality.

People like to blame the hospitals, but really, show me a hospital that makes money. They only exist in the plush suburbs where median household income is 100,000 or higher. Blaming the hospitals isn't the answer, if they didn't catch as catch can, they'd all go out of business. And then nobody in the city could find a hospital when they needed it.

It's not the providers, and it's not the insurers. It's the system.

Pssst... little secret from the corporate guy who works at a major urban hospital chain...

If you don't have insurance and you need surgery, yes we would charge you way more than we'd get paid by Blue Cross or Aetna if you were covered. But guess what, we'd be very happy if you came to us and said listen clowns, there's no way in hell I'm paying $100K for that surgery. But I will pay you whatever Blue Cross or Aetna would have paid you ($25,000). We'd take that in a heartbeat, because we know you're like 90% likely to skip out on the $100,000 bill anyway. I mean if your credit is going to be ruined, why pay any of that insane bill, right? We'd never see a dime in most cases. But if you negotiate, we'd drop the charge down and keep your credit free and clear if you paid us a negotiated rate.

Little secret of the healthcare system.


Sometimes that does work, sometimes it doesn't. Ive contacted hospitals for my clients without insurance and been told to basically piss off. I guess it depends on the amount of the bill. Hospitals aren't as bad as independent docs and, of course, chiropractors, but they do have their moments.

Sooooooooo, who's at fault? We live in a country that has a health care crises. I pay $987 p/mo for my family for ...................ok coverage. A REAL KILLER.
Millions of American's go without. They become a burden for the system because they don't pay for the services they recieve. The hospitals close as a result of constant red lining? I assume the doc's have to become more creative to realize the same profits as were seen a few years ago (see more patients, with decrease in quality of care per each).

And yes Matty, the only one I can see actually benefiting in all this is the Big Bad Insurance companies. They just pass along the bad news to the insured, in ever-increasing premiums?

REALISTIC solution is?????????

Yes, Interesting thread

The problem we have in this country when it comes to healthcare is a desire to have the benfits of a market efficient system, but only if doesn't cost too much or deny care.

In an efficient market products and services are paid for by customers at a price they are willing to pay. If soemthing becomes too expensive then eventually some other guy or girl comes along and offers the same service for less. Thus balancing out the market.

The healthcare system doesn't work well in this way since there are so many barriers to entry and nobody wants to see other suffer because of market economics.

The problem is that as soon as we make it less market effiicient that motivation for smart people and innovative companies to get involved, the ones who would provide the best care and medicine, becomes too low.

It is a hard question.

I am wondering if maybe as a society we need to adjust our views and desires for the healthcare system since there in't a system that will meet all of our needs. There just isn't.