An Inconvenient Truth

[Schneed10]

Originally Posted by paulskinsfan

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.

[Schneed10]

Originally Posted by Mattyk72

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.

[paulskinsfan]

Originally Posted by Schneed10

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.

[Hog1]

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

[FRPLG]

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.

[MTK]

Originally Posted by Hog1

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

Schneed is right, blame the system, not the players involved.

[Schneed10]

Originally Posted by FRPLG

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.

Good point on the market efficiency. If you're talking about cars or widgets or whatever, there comes a price point where the customer says you know what, that's way too high, I ain't payin it.

Trouble is nobody is going to do that with healthcare. If your father or mother or daughter or son needed surgery in a life or death situation, there's no price too high. You'd never reach a point where you'd say you know what, it's just not worth it, just euthanize my father.

That's where the adjustment in attitude is needed. People have to accept that healthcare is EXTREMELY expensive. We can argue how it should be paid for. Perhaps the government should run hospitals, but they'd have to jack taxes way up to pay for it. No matter how you cut it, that technology is damn expensive.

[FRPLG]

Originally Posted by Schneed10

Good point on the market efficiency. If you're talking about cars or widgets or whatever, there comes a price point where the customer says you know what, that's way too high, I ain't payin it.

Trouble is nobody is going to do that with healthcare. If your father or mother or daughter or son needed surgery in a life or death situation, there's no price too high. You'd never reach a point where you'd say you know what, it's just not worth it, just euthanize my father.

That's where the adjustment in attitude is needed. People have to accept that healthcare is EXTREMELY expensive. We can argue how it should be paid for. Perhaps the government should run hospitals, but they'd have to jack taxes way up to pay for it. No matter how you cut it, that technology is damn expensive.

Yup.

That's what I mean by changing our views. Do we as a society want the best healthcare for everyone or are we going to accept that that probably isn't a realistic idea?

[firstdown]

Originally Posted by Hog1

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

That seems real high too me. I'm self emp. and for my family of 4 it runs right around 525.00 through Anthen. Thats even with a daughter who rang up around 75,000 to 100,000 gand in med bills 2 years ago. She is just fine now but I thought my ins. was going to jump up in price it did some and we switched to our current carrier. Maybe its time you shop your coverage.

[Hog1]

Actually, I'm not blaming anyone. I simply pointed out that the insurance companies (at least initially) don't appear to be hurting from any of this. Do they not pass along their costs, and or losses to the insured?

The "technology" may be expensive, but it's far more complex than that. The Doc's to want to continue to nail down the large incomes that they spent 500k in med school to get. With the cost of their insurances being ridiculously high, they have to create more income. They see more patients with less quality for the patient. They're scared to death of getting sued, so to cover their own ass, they prescribe needless treatments (like the catch all, CAT scan) to accomplish that end, and prove they have left nothing to chance. Unfortunately, our court system has handed down ABSURD judgements in all things health related to help feed the monster, and make it attractive to continue to bring these types of lawsuits

Yes, it is a complex problem

[Hog1]

Originally Posted by firstdown

That seems real high too me. I'm self emp. and for my family of 4 it runs right around 525.00 through Anthen. Thats even with a daughter who rang up around 75,000 to 100,000 gand in med bills 2 years ago. She is just fine now but I thought my ins. was going to jump up in price it did some and we switched to our current carrier. Maybe its time you shop your coverage.

I agree, who are you with?

[FRPLG]

Let's not all forget that insurance companies are a business. Tbey exist to make money so of course costs get passed on to customers. Otherwise they wouldn't make money and wouldn't operate anymore. Then how would anyone afford healthcare when there are no insurance companies?

[MTK]

Originally Posted by Hog1

Actually, I'm not blaming anyone. I simply pointed out that the insurance companies (at least initially) don't appear to be hurting from any of this. Do they not pass along their costs, and or losses to the insured?

A lot of the costs they have to pass on is due to insurance fraud which is a bigger problem that most people realize.

[Hog1]

Originally Posted by FRPLG

Let's not all forget that insurance companies are a business. Tbey exist to make money so of course costs get passed on to customers. Otherwise they wouldn't make money and wouldn't operate anymore. Then how would anyone afford healthcare when there are no insurance companies?

Soooo, actually the insurance companies are.................the GOOD guys?

[Hog1]

Originally Posted by Mattyk72

A lot of the costs they have to pass on is due to insurance fraud which is a bigger problem that most people realize.

It IS a complex issue.
It is one of the MOST F..... up things in this country today. If it can be fixed, there is fault somewhere and needs to be addressed. As it is, it is a mess. Millions of Americans do without. If it can't be fixed, let's start over. Now, back to my original premise..............

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