An Inconvenient Truth

[firstdown]

Originally Posted by Schneed10

I don't doubt that Al Gore is right about global warming, it's just that I care a lot more about the poor people in our country getting health insurance than I do about global warming.

If forcing companies to be greener costs them money, they're going to respond by either:

1) Cutting back on benefits
2) Charge the employees more for health insurance
3) Or just flat lay people off or hire fewer people

Our country has a lot more important things to worry about than global warming. Al Gore, do you seriously think I'm going to listen to your bitching and moaning about the environment when we have much more pressing economic challenges at hand? Get your effing priorities straight.

By what you said I guess that you believe that over 40,000,000 Americans cannot afford health care?

[Schneed10]

Originally Posted by firstdown

By what you said I guess that you believe that over 40,000,000 Americans cannot afford health care?

I suppose you are quoting the estimates that say 40 million people in our country are uninsured or underinsured.

Yes I do believe those numbers. If you want to argue them with me, be my guest, but I have to warn you you're stepping right into my wheelhouse. I'm a financial analyst for the biggest provider to uninsured/underinsured patients in Pennsylvania: Temple University Health System.

That was in the interests of full disclosure. Did you know that as of July 1 2007, there will be only 5 hospitals delivering babies within Philadelphia city limits? Obstetrics is such a financial loser that hospitals have closed the program down.

Since 2002, 9 hospitals within Philadelphia city limits have closed. No new ones have opened.

What's driving this? Underinsured patients don't reimburse hospitals; they have no money and no insurance, and consequently hospitals don't get paid. So in low-income areas, like the part of Philly I work in, hospitals are suffering financially and are forced to cut programs. The end result? Not only do these people not have the money for health care, they don't even have enough places nearby that can provide the care.

[That Guy]

Originally Posted by Schneed10

I suppose you are quoting the estimates that say 40 million people in our country are uninsured or underinsured.

Yes I do believe those numbers. If you want to argue them with me, be my guest, but I have to warn you you're stepping right into my wheelhouse. I'm a financial analyst for the biggest provider to uninsured/underinsured patients in Pennsylvania: Temple University Health System.

That was in the interests of full disclosure. Did you know that as of July 1 2007, there will be only 5 hospitals delivering babies within Philadelphia city limits? Obstetrics is such a financial loser that hospitals have closed the program down.

Since 2002, 9 hospitals within Philadelphia city limits have closed. No new ones have opened.

What's driving this? Underinsured patients don't reimburse hospitals; they have no money and no insurance, and consequently hospitals don't get paid. So in low-income areas, like the part of Philly I work in, hospitals are suffering financially and are forced to cut programs. The end result? Not only do these people not have the money for health care, they don't even have enough places nearby that can provide the care.

i do part time financial needs analysis, and from what i've personally seen, i have NO reason to doubt scheed or those numbers.

it sucks that those that can't afford basic health care can't even get preventive services, and it's short sighted. (ie, see the post's article on how a kid couldn't get a 80$ tooth extraction, needed 250,000$ worth of medical care (including emergency brain surgery) and still ended up dead. just because he had a cavity and the paperwork and willingness of practioners to deal with it was too much to ask.... for every case like that, 3124 other kids could also get tooth extractions when needed and the taxpayer still comes out ahead, as well as lower income families).

[firstdown]

Originally Posted by That Guy

i do part time financial needs analysis, and from what i've personally seen, i have NO reason to doubt scheed or those numbers.

it sucks that those that can't afford basic health care can't even get preventive services, and it's short sighted. (ie, see the post's article on how a kid couldn't get a 80$ tooth extraction, needed 250,000$ worth of medical care (including emergency brain surgery) and still ended up dead. just because he had a cavity and the paperwork and willingness of practioners to deal with it was too much to ask.... for every case like that, 3124 other kids could also get tooth extractions when needed and the taxpayer still comes out ahead, as well as lower income families).

I'm not sure what its called but the goverment does provide health insurance for children from poor families. The problem in our area is that the parents are too lazy or do not know they have to sign the children up. I'd also like to know the dentist that will do an $80.00 tooth extraction.

[firstdown]

Originally Posted by Schneed10

I suppose you are quoting the estimates that say 40 million people in our country are uninsured or underinsured.

Yes I do believe those numbers. If you want to argue them with me, be my guest, but I have to warn you you're stepping right into my wheelhouse. I'm a financial analyst for the biggest provider to uninsured/underinsured patients in Pennsylvania: Temple University Health System.

That was in the interests of full disclosure. Did you know that as of July 1 2007, there will be only 5 hospitals delivering babies within Philadelphia city limits? Obstetrics is such a financial loser that hospitals have closed the program down.

Since 2002, 9 hospitals within Philadelphia city limits have closed. No new ones have opened.

What's driving this? Underinsured patients don't reimburse hospitals; they have no money and no insurance, and consequently hospitals don't get paid. So in low-income areas, like the part of Philly I work in, hospitals are suffering financially and are forced to cut programs. The end result? Not only do these people not have the money for health care, they don't even have enough places nearby that can provide the care.

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.

[paulskinsfan]

Originally Posted by firstdown

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.

[gibbsisgod]

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.

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

[MTK]

Originally Posted by gibbsisgod

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.

[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.

[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.

[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.