For those of you who are new here, on 14 January I fell on the ice while carrying my dog and managed to land in such a way that I dislocated my shoulder, shattered my glenoid in multiple places, wrecked my labrum, detached my bicep, and basically decimated my shoulder. I had surgery close to six weeks ago to have everything rebuilt and pins inserted, my labrum rebuilt, and all the damaged material scoped out of the joint, and now that my brace is scheduled to come off and I am starting to really feel better, it is time for the bills to come in. And mind you, I am not complaining, just highlighting how expensive everything is. I’ve added up the cost of the emergency room visit (including x-rays, mri, pain meds, and the elaborate brace), the outpatient visit to the specialist to schedule surgery, the actual surgery and the overnight hospital stay, and the rehab I have attended already (I have a bunch more to go to), and the total dollar value on a bionic shoulder in West Virginia is:
About $28,000.
To be honest, I thought it would be much, much more, so even though I was charged $900 bucks “room and board” for my overnight stay (I’ve never stayed in a hotel that cost more than 175-200 bucks, and then only because of a conference), I still think it is very reasonable. And because I have great insurance with reasonable deductibles, if I add up the parts of the bill I am responsible for, all the co-pays I’ve paid, all the drugs and other stuff, as well as the things I could never have predicted but had to have any way (maid service, about 70 bags of ice over a 2 week period, etc.), I’m only personally out a couple of thousand dollars. And considering the magnitude of the injury, I think that is very, very reasonable.
There are a couple of things to keep in mind. The $28k price tag is because I have insurance. If I did not, there is no doubt in my mind that the total bill would be closer to 100k. As we know, those without insurance are basically robbed by hospitals and charged double, triple, and even quadruple what this with insurance are charged.
Second, if I did not have insurance, there is a solid chance I probably would not have 100k lying around to replace my shoulder. So I could probably get my surgery done, and then would choose between being in debt my entire life or declaring bankruptcy. But would I get the same care I got? I very seriously doubt it. I saw the best surgeon in my area, a member of the American College of Surgeons and a specialist on shoulder injuries. I got fantastic overnight pain management and monitoring of my condition at the hospital. I am getting excellent therapy at a premiere rehab place. Would all that be true if I were uninsured and broke?
Third, I don’t know how much of that $28k is inflated to help allay the hospital costs incurred when they have to treat uninsured. Every single one of us pays for the uninsured already, which is a portion of the current HCR debate which seems to be getting very little play.
Finally, I wouldn’t wish what I went through on anyone. I’m not a “tough guy” brawler type, but I have a pretty decent pain threshold with al ot of experience with pain- I’ve dislocated my other shoulder a number of times, had multiple concussions, broken every finger and both big toes, broken my clavicle, I’ve been through two windshields, fallen off a tank onto a frozen dirt road, fallen off a two story roof, bitten a molar in half and had to live with an exposed root for two days before the dentist could operate, and had a large number of very painful things in my life. But the pain I experienced on the day I fell and had to drive to the hospital and the pain I experienced the day after surgery when the nerve block wore off made me seriously recalibrate my concept of pain. And in both cases, I was very seriously medicated to the point of being stoned to the bejeezus on percocet. And I was still in agony beyond anything I have ever experienced.
I simply can not imagine having to go through that kind of pain while also worrying whether or not I will be able to pay for the surgery, or if it means I am going to lose my house, or the shame of declaring bankruptcy (and yes, the Bush era bankruptcy laws were, in large part, exercises in shaming the consumer), or any of the other things that the uninsured and the underclass in our society have to deal with every single day.
I know the current HCR bill is flawed, but for christ sakes, pass the God Damned bill already.
Mr Furious
No comments are necessary. I’d even suggest shutting them off so this doesn’t turn into some fucking BTD pissing match thread.
You made your point. We can all absorb it.
Become whole again and feel better soon, John.
BTD
Hope you are feeling better.
Hope you are right that the Senate bill would start us on the road to fixing the problems you identify.
Pass the bill. Why not? It can’t hurt.
qwerty42
Word.
I don’t care how much I think could be better. It can be fixed later. It has to start now.
Oh, and very glad to hear you are on the mend, John.
mellowjohn
the cast for my collapsed navicular-cuniform joint comes off a week from monday (after 13.5 weeks, and i have to say you got off cheap. the hospital bill alone for day surgery at northwestern memorial hospital in chicago (about 4-5 total hours) was over $40,000.
yeah, we don’t need any reforms, do we?
geg6
Steve Austin LIVES!
And yes, pass the goddam bill already.
mellowjohn
p.s. glad you’re on the mend. i had a hard time feeding my cats when i was on crutches.
Cris
I’m really, really surprised by this. I assumed it was exactly the opposite. I figured that care providers would charge the insured patient more for the same procedure, because they know the insurance company has the means (if not the will) to pay.
beltane
A friend of my mother’s, a teacher in her 50’s, with terminal breast cancer was in the horrible position of knowing her COBRA benefits were about to expire at the end of the month. She had already given up on the chemo and other treatment, but needed to have fluid suctioned out of her chest cavity every few days in order to breath comfortably. Her big fear as she was dying was that she would outlive her health insurance and be unable to pay for this. She died two days before her benefits did.
It’s bad enough people have to die in pain. To die in pain worrying that you won’t be able to pay for any relief at all is a torture I wouldn’t wish on anyone.
RedKitten
And you being out a couple of thousand dollars is STILL wrong, IMHO. This wasn’t elective. Every single thing that you got was medically necessary, and it’s obscene that you have to pay any money out-of-pocket in order to get treatment for a medical necessity.
Face
What’s the point of a hospital billing an uninsured person $100K? Anyone besides Bill Gates or Buffet got that kind of cash just sitting around? Instead of a bill, why not just send said person a letter informing them of some quality bankruptcy lawyers in their area?
Violet
Have all the EOBs arrived? Because in my experience, even when the insurance says they’ll cover it, they don’t always. And then you spend hours and days on the phone with lower-level insurance representatives whose entire job consists of telling you untruths and trying to get you to go away so the insurance company doesn’t have to pay your bills.
If there is something they don’t cover, even if you aren’t sure they should, be sure to contest it. Google around to find the exact wording to use to put it in writing to challenge it. Chances are they might cover it if you just send them a letter. That worked for a friend of mine and saved her thousands of dollars. Lastly, you can appeal to whatever committee is in charge of making insurance decisions at your organization. Have done this too. Takes months, and you might have to pay out of pocket to keep the bill collectors at bay, but hopefully they’ll decide in your favor in the end.
All it takes is one serious brush with your health insurance to realize how effed up it is. The whole system is crazy and designed not to pay or cover anything and to cost as much as possible. We really ought to be able to do better.
beltane
@Cris: In my state the providers tend to charge everyone the same. However, when I lived in New York, the doctors and hospitals were real scumbags about this (sorry, but it’s true). Many providers won’t treat you at all unless you have insurance.
Rick Massimo
Silly man. Mitt Romney says emergency rooms are “absolutely free care“!
Don’t you know anything?
Mako
“I’m really, really surprised by this. I assumed it was exactly the opposite.”
Well it was a 60 Minutes story he linked to and they never get anything wrong, always unbiased and never sensationalist. On the other hand, my personal experience, it’s always more expensive with insurance than without.
BTD
@Mr Furious:
A pissing match? Seems you are the one interested in that.
I certainly did not start one.
MikeJ
The insurance companies say, “here’s what we’re going to pay you, take it or leave it.”
With the uninsured, hospitals tell the patient pony up or we have bill collectors calling you day and night, destroy your credit, garnish your wages which will will probably cause you to get fired and make you unhirable, and you’ll pay any obscene amount we decide on. Want another $50 aspirin?
John Cole
@Violet: I’ll deal with it when the situation arises.
Pasquinade
@John Cole – Any ridiculous charges on your hospital bill, assuming that you received an itemized statement?
http://moneycentral.msn.com/content/Insurance/Insureyourhealth/P74840.asp
John Cole
And, not surprisingly, you are wrong. Here’s a Johns Hopkins report.
Violet
@Cris:
Just out of curiosity, are you only now aware of this issue from John’s post? I’m shocked that it isn’t better known. Having no health insurance is playing Russian Roulette with bankruptcy. Eventually something is going to happen and you’ll lose everything because you simply cannot pay the enormous prices you’ll be charged.
To be clear, the insurance companies charge the same for everyone. They accept different levels of payment from various people depending on what their negotiated rates are with their insurance companies, or if they don’t have insurance.
Mako
@RedKitten:
Food is a necessity. Wish someone would just give it to me for free. Possibly a ham sandwich? Or, alternately, a stuffed porkchop.
John Cole
@Pasquinade: Umm, it is widely known that the reason you pay 50 bucks for an aspirin and the kind of stuff you are talking about here is how hospitals recoup their losses from insured patients to cover the uninsured they have to treat.
Folks, this has been discussed in detail and is not mythology. And there is no point being pissed at the hospitals. Even the not-for-rpofits have to do this, because hospitals simply can not operate at a loss.
I’m not making shit up.
Stephen
My daughter was born 3 months premature. She was in the NICU for 9 weeks. Our bills were f’n nuts. For fun, we added it all up – she cost us a little under $300,000, and is still seeing specialists.
Luckily, I have the highest-level plan from my employer and the majority of the spillover was covered by Medicare.
We *thankfully* only paid $64 out of pocket for her delivery.
I couldn’t believe the price gouging that went on for simple things like diapers or formula. The markup on preemie diapers was in the ballpark of 5 – 6x what I could buy them for at a retail store. The formula – even though you’d get free formula on your way out of the hospital with a normal delivery from Simulac or Enfamil – was 12 – 15x what I could have bought it for in the store.
But they charge that much because they know that someone will pay for it – either the insurance company or the poor bastards saddled with the bill.
BTW, first time commenting here. Been a long-time reader. I should do this more.
Mr Furious
@BTD: Fair enough, BTD. I don’t want a pissing match, and I regretted singling you out almost immediately and wished I used “firebagger” instead.
It was wrong. My apologies.
Violet
@John Cole:
Best of luck with it. Be sure to comb the EOBs thoroughly, cross-check against your bills, and keep a spreadsheet of charges and payment.
Glad you are feeling better and had access to excellent care. That really is what matters right now.
MikeJ
@John Cole: Except they aren’t operating at a loss on insured patients, they simply aren’t making as much as they would like to. So they aren’t recouping a loss, they made a bad business deal with one party so they make up the difference in price negotiations they’re holding with people who are bleeding to death.
21cdb
You would have been much better off with a capital gains tax cut and no estate tax.
Betsy
Good Christ, man! You’re either cursed or motherfucking clumsy.
beltane
@Rick Massimo: It must be nice to be Mitt Romeny with unlimited funds and a personal secretary to pay the bills. Since people like him never have to pay for anything themselves, it’s all free to them.
Mr Furious
@MikeJ: I’m not sure that’s fair. they don’t have the freedom to not treat indigent patients in the ER. That’s not a bad business decision.
mr. whipple
Dood, that is dirt cheap. So cheap, WV could become a HC tourism destination spot.
When my mom had bypass and valve surgery at the Cleveland Clinic, the surgeon’s bill alone was $27,000. Not a bad 4 hours work, eh?
Paddy
Chronic eye issues led to an emergency operation for a detached retina. Outpatient surgery, in the hospital from 11a-4p, 1p-3p in the actual surgery, the rest pre and post op. Doctor was a personal friend of the family (we have a history of cataracts etc) and charged approx $1k for surgery and post and pre care. Anesthesiologist bill $900. Hospital bill (note- a supposedly non profit Catholic place) over $17,000. Of course no insurance, and as I support myself by doing any damn thing I can now with a second cataract in the other eye (right eye cataract removed at the age of 33) they’ll be waiting a bit for payment in full.
Mako
@John Cole:
Wrong how? In my assertion that 60 minutes is never wrong or sensationalist or that in my experience surgery is less expensive without surgery?
Thanks for the link.
demo woman
John, I am so glad you are healing. Beltrane’s story about his mom’s friend is all to common. Congress needs to stop the pissing contests and act.
Mr Furious
@Paddy: That’s fucking ridiculous. I concede MikeJ’s point.
John Cole
@Betsy: That really isn’t that big of a list for someone who played competitive contact sports for years, did a number of years in the military, and was born without any common sense.
A Mom Anon
My husband had two heart attacks last year,one in August,the second at the end of October. The total for both was 98K. Two angioplasties and a total of 6 days in the hospital for both. Had we not had insurance,it would have killed us finanacially. I just finished paying off the bills(3K)right before he was laid off. Now that he’s unemployed,his meds are going to be stupid expensive. The Plavix alone is nearly 200 a month. The stupid company still hasn’t sent us the COBRA stuff so I have no clue what that will be,even with a 65% subsidy. It’s really frightening,and just plain wrong you have to worry about any of this when you get sick or hurt. I get disgusted with my fellow Americans who think healthcare is a privledge,not a basic human right.
John Cole
@Mako: I thought you were being facetious about 60 Minutes. I may have briefly confused you with Makewi.
My profound apologies.
mr. whipple
“Folks, this has been discussed in detail and is not mythology. And there is no point being pissed at the hospitals. Even the not-for-rpofits have to do this, because hospitals simply can not operate at a loss.”
John, they aren’t charging $50 for an aspirin to make up for the 50 free ones they gave away to people with no money.
They are charging $50 an aspirin to pay for the heated parking garage for the drs, complete with car washing services, and to be able to pay for the new MRI machine they bought because the other hospital across town had one, too, and to pay the CEO 1.2 million a year.
Sue
A young college student I know broke her ankle and had no insurance. The hospital gave her massive discounts and worked with her as much as possible. She’ll be paying for it forever, but she did not have the classic experience I’ve heard about. That said, the reason the Democratic party is going to lose an entire generation of young voters is because they are currently ignoring them in the current health-care (and everything else, actually) debate. When you elect people with the idea that you might be able to benefit from their promises, and find yourself more screwed than ever, what’s the point of going back to the polls next time?
My only big experience with insurance just finished up after a large claim was finally approved. I was in tears and terrified by the time they decided to cover it; oh, and that’s with getting all the proper pre-approvals.
cat48
I agree about cheaper w/insurance. My EOMB always shows me how much I saved by using a PPO provider. It is stunning at times the amount I could have been charged.
Speaking of hcr, President McCain and his aide Graham have already attempted an amendment today to kill hc which didn’t work so he goes with this:
burnspbesq
@Violet:
And you start out with live rounds in five out of six chambers.
Elroy's Lunch
Found out earlier this week that a dear friend has a rare condition that if it is not corrected soon, she will become deaf in one ear and have very serious issues with balance. Permanently. She will need fairly complicated ear surgery to correct this problem.
She’s a single mother with a child in college, self-employed. And no healthcare. She’s already on the edge financially. This will not be good. She thought that it might be in the $100,000 range but is hoping that it will be less.
Pass. The. Damn. Bill.
Pangloss
It’s a good thing you had a Medical Savings Account.
Seriously, if McCain had won and implemented his wacked out health plan, I would be dead right now. Dead.
Morbo
@Violet:
And this is the great deception in quoting health care polls which indicate that a sizable majority are happy with their current coverage. A sizable majority have never had this brush. There are some people who no doubt are genuinely satisfied with the service they receive when they do have an injury or illness properly covered. The poll that should be run is a poll of how satisfied people who have had a major claim in the last five years are with their insurance. I’d love to see those numbers.
chopper
@BTD:
it’s a beige alert!
freelancer
This post should be thrown in the face of every single moran who cries “Sociali$m!” (HAHAHA! This still put me in mod) to fear monger about HCR. Er, hey idiot! There’s nothing more Sockalistic than INSURANCE! The company pools people together so that revenue from healthy members of the pool offset the cost of taking care of those in need of care. The only way to not have it be Sockalistic would be to have everyone pay the full costs of medicine alone.
At least that is how it is supposed to work, but instead of a constituent accountable government run system, the way it works now is a corporate sockalist ponzi scheme, in which the insurance companies are constantly slicing up the pool of customers with a scalpel to try and eliminate their sicker customers from receiving their benefits.
It is a scheme that stacks the deck in favor of the corporate gatekeepers, and leaves their consumers out to dry with little or no recourse.
PTDB.
joes527
@RedKitten:
I disagree.
John had bad fortune. He clearly makes enough from his blogging empire to absorb this bill without dire consequences. Everything worked.
Insurance should be there to make sure that treatment is available (it was) and that the bills shouldn’t result in bankruptcy (from John’s comments, they won’t)
If John was living on the edge and the couple of thousand dollars would push him onto the streets, then I’d be with you, but there *is* a difference between a safety net and a nanny state. In this situation, insurance was all net, and that’s how it should stay.
This case is a poster child for how things ought to work. We need HCR so that folks who do not sit on top of a vast blogging empire can get the same breaks, (perhaps a badly chosen word) NOT to insulate folks from misfortune.
Rob in Denver
@Stephen: I can back you up on this (not that you need it). My preemie kid was six weeks early with zero complications — his neonatologist called him a boring patient — and the bill my insurance company paid was more than $180,000. Generally speaking, one day’s charge for the NICU is about $9,000… give or take $1,500 depending on the kid’s needs.
pcbedamned
@RedKitten:
Ah, sweetie, that is your ‘sochalist Canadian’ coming through.
I too was reading this, and as I saw $ amounts, my jaw was close to hitting the floor. We really don’t (well, I do, as I’m sure you do) realize just how good we Canadians have it. Even though my husband’s and my business is falling through the floor right now, at least the one thing I NEVER have to worry about is when either of us or our kids are sick, or if God forbid, there is a catastrophic emergency. I seriously don’t know how most Americans can think that the way they do things (re: health care wise) is ok in any sense. One more reason to be profoundly glad I live NORTH of the border :)
Betsy
@John Cole:
I suspect it’s the third issue that’s key here. ;) I know folks with both the sports and the military experience (though the latter was perhaps not as long as yours), and while they inevitably ended up with a concussion or broken bone or dislocation and one even had shrapnel wounds, none ended up with a list that looks like yours.
Guster
John: Could you tell us what kind of insurance do you have? From where, I mean? I’m self-employed, and I’ve got shit insurance that I can’t afford. I’m trying to find some new options, but no luck yet …
Paul L.
How is HCR better than Medicare?
My mother spent a week in the Hospital for hip/back pain.
They diagnosed that the cause was her blood sugar being way out of wrack (500 mg/dL)
A week later after being released she fell down and broke her hip.
When they operated to replace her hip, they found bone cancer in her back/hip/leg.
She just got a bill from the Hospital for $18K+ for the first visit. She is 70+, retired and on Medicare.
Right now my faith in the Health care system (Government and Private) is now zero.
:Libertini
First, glad you are this far down the road to recovery, John Cole. This place is my little oasis of sanity in a vast and menacing desert of crazy.
Second, we need more stories like this out there. If you were being treated for cancer, your $28,000 tab and $1,000 out of pocket would have been for about a MONTH. My Mom spent an average of $10,000 a year for 10 years for what her insurance did not cover in her fight against breast cancer. And THAT was after spending untold hours on the phone fighting with them over errors and things they initially rejected to cover, but were supposed to cover based on the policy statements.
I am currently uninsured, and I expect that if I am diagnosed with cancer at some point in the future, I will refuse treatment in order to avoid the stress (and shame) of the financial ramifications. I would rather spend two years dying than to live 10 years under that kind of stress.
chopper
and just think, john, this was from an accidental fall while out walking your dog. this is the sort of thing that can happen to anyone, and indeed happens to people all the time.
without insurance you can be one slip and fall away from bankruptcy.
madmatt
Fuck you for being so lucky…thanks for rubbing it in to those of us who can’t afford insurance!
Robertdsc-iphone
So, with the new arm it’s official you can throw better than Big Ben?
Heh.
Seriously, I’m glad you’re feeling better and I agree, PTDB.
Corner Stone
@Betsy:
I’m glad you said it because I was thinking something similar. IIRC, he’s not old enough to have the wound history of a WW I veteran.
John Cole
@joes527:
While I personally would nationalize health care ala the Brits, I completely agree that things worked the way they are supposed to work in our current system. Truth be told, I could probably even recoup all my losses my suing my landlord for not having the ice removed and him passing it off on his insurance.
But I don’t believe in that. My landlord makes a really good faith effort to keep my sidewalk and driveway clean. Plows are out right after it starts snowing, and they shovel and salt my sidewalk multiple times a day if necessary. This was just a freak accident, with a patch of black ice developing in one spot on my sidewalk and me stepping on it. I was walking fast, I was wearing sneakers with not much traction, I was carrying my dog, an I wasn’t really paying attention. It was an accident, and if there is any blame to be had in this accident, it was mine.
I don’t make that much money (and lol at the concept of making money from the blogging empire), but I simply can not justify suing to recover money from what I think was my mistake. And besides, we all pay for it in the end. His insurance rates go up, we all get charged more rent.
Corner Stone
@chopper:
Thank goodness I don’t have a dog.
South of I-10
Maybe one of you can answer this for me. Why can we not establish at least a base range of what a specific treatment is actually worth? I had to get a brain MRI a couple of years ago. I have a high deductible plan and the negotiated rate for an MRI was $125. I see a lot of medical records in my line of work, and I have seen charges for brain MRI’s (being billed to a third party tortfeasor) ranging from $700-$1500. Is it worth $125 or $1500?
John Cole
@South of I-10: MY GOD. ARE YOU SUGGESTING THE GOVERNMENT SET PRICES?
SOCIALISM! COMMUNISM! GOVERNMENT BUREAUCRATS TAKING OVER!
Cris
Yes. And as for Russian Roulette, I think going uninsured is risking bankruptcy even if the charges were identical. When I was making $7/hour, where would I have found $28,000 to pay for the discounted shoulder surgery John Cole received?
Mr Furious
@Sue: This.
That’s why that bullshit Age 55-Medicare Buy-in shit pissed me off so much. How much more can you rub it peoples faces?
Tsulagi
@John Cole:
Didn’t know hospitals routinely charge uninsureds 2-3x more than those with coverage.
Not saying this is why, or justified, but could think of a business reason for doing so. If patient doesn’t pay (likely), or unable to recover from some gov entity or program (also likely), go for the maximum writeoff against income.
Brick Oven Bill
At least they did not make you wear a dead person’s dentures.
Nannergrrl
2 years ago for my husband: ER CT scan, followed by 13 day hospital stay, cardiac cath with angiogram, two transesophageal imaging procedures, open heart surgery, with valve replacement, valve repair, two days CICU, step down to CCU, cardio conversion procedure, cardiac rehab. Total bill – $242,000, insurance paid $189,000, out of pocket expenses – $4500.
I love my insurance (I’m a Fed) and believe that everyone deserves the benefits I have and I will gladly pay higher taxes for it (although I believe the entire process should be nationalized).
Why is it that this country requires free legal advice (care) for every citizen and not health care benefits when the former impacts your freedom and the latter merely impacts your life? South Africa can give their people free health care but we can’t? Disgraceful.
Persia
@MikeJ: What MikeJ said. That people are still arguing this is slightly mind-blowing.
Glad you’re continuing to feel better, John.
toujoursdan
Sounds like what I went through when I lived in New York City and a sebaceous cyst in my back infected, abscessed, was drained and packed in the ER and then reinfected a couple weeks later because of bad advice from hospital staff. That whole episode cost about $25,000 total. I had insurance through work, but they only paid 80%. So I was out the rest.
Being from Canada and never having seen a medical bill, the whole thing was bewildering. I received a tree’s worth of paper from the insurance company each with the header “This is not a bill” but then listing what I owed. And then the hospital kept sending me bill after bill for small amounts ($40-$400) with a demand that I return payment within 5 days, or else. I was lucky I had the money; I don’t know what would have happened if I didn’t.
If this is what even insured Americans go through I am surprised there isn’t rioting in the streets to change to a single payer system.
Barry
@John Cole:
Best of luck with it. Be sure to comb the EOBs thoroughly, cross-check against your bills, and keep a spreadsheet of charges and payment.
Violet: “Glad you are feeling better and had access to excellent care. That really is what matters right now.”
John, I’d seriously suggest getting an accountant for this. It might cost you $1,000, but if you get stuck with even trivial slices of what the insurance company should have paid for, it’d be worth it.
Mr Furious
@Corner Stone: Bullshit. It’s libtard Cole’s fault he has some elite upper east side dog that needs to be carried over the snow. If he had a real man’s dog—a conservative’s dog—he could have been riding it or have it pull him in a dog sled.
He got what he deserved. He’s lucky Sarah Palin didn’t shoot him and Lily from a copter.
:Libertini
@South of I-10:
It is worth whatever the market will bear. So it is your job as a consumer of medical procedures to shop around for the best price. If only we were all doing that (in the midst of surviving separated shoulders, brain tumors, cancer, etc.) the prices of healthcare would not be so out of control. This, according to Republicans against healthcare reform.
wasabi gasp
That collection of pain is pretty impressive. You really deserve to catch that Roadrunner at least once.
demo woman
@John Cole: What the repubs think you should do is drive around to various hospitals to get quotes before you have your shoulder taken care of. That’s the
freecrazy market..Sasha
@Cris:
Nope. Whenever I get a bill summary from my insurance, they helpfully list how much the procedure normally costs, and how much of a discount was applied because of insurance.
Without insurance, a relatively simple or routine procedure (like an MRI) would be a debilitating blow to anyone on a budget. God help them if they actually needed comprehensive care.
Amanda Hugginkiss
Glad you’re on the mend.
Regarding the issue of hospitals robbing the uninsured, I just wanted to point out that insurers can sue a health care provider if they learn the hospital, doctor, dentist, whatever is charging uninsured patients less than the “full fee.”
I’ve worked in health care for years (in Illinois, but I assume this is true everywhere) and have known a few cases recently where a provider had to get legal assistance in order to provide hardship care and not run afoul of his/her insurance contracts.
Not that we need health care reform or anything.
Colleen
I’m usually a lurker, but I’ve been following the trajectory of your injury and felt moved to respond to this post.
Nothing builds empathy like the experience you have just gone through, and I appreciate how honest you’ve been about the whole ordeal.
Add this to the equation: Imagine what it would be like if, in addition to the pain and the medical costs, you also were (like me) self-employed and completely unable to work and without income as a result of this injury. Imagine that you knew you’d be unable to return to work for who knows how long and that your savings would be eaten by your medical costs.
It’s truly terrifying how so many of us are just one slip away from disaster.
Best in your continuing recovery.
Steve V
My daughter had to spend a week or so in the NICU after she was born due to a weird rh incompatibility problem with my wife that caused her to go crazy jaundiced. A couple of months later we had got billed by the hospital because the insurance company took too long paying, and it was $88,000. I believe the insurance company ultimately paid around $36,000 for it. Nuts.
dr. bloor
Which is to say, you would have been charged much closer to what those services actually cost than the rates paid by insurance companies, who negotiate with hospitals in the same way that Walmart negotiates with its suppliers.
I’ve never worked for a hospital that wasn’t on the verge of bankruptcy. Indeed, it looks like my training alma mater and first good staff position in NYC is about to get flushed down the shitter.
Just sayin’.
South of I-10
@John Cole: I am just fed up with the whole game. Our clients have a list of how much each attorney and paralegal bills per hour, as well as any fees (copies, etc.) associated with their representation. I have asked for this information ahead of a medical procedure, and they couldn’t give it to me. How hard is it to give at least a ballpark figure on how much something is going to cost?
DougJ
Good post.
Jim Pharo
The cost figures are irrelevant. They are the product of a negotiation to which you were not a party.
Also, in what world is it fair that you should be out a couple of thousand bucks because you slipped on the ice? Perhaps that’s affordable to you, but to many others, not so much.
Glad to hear you are on the mend. Perhaps when you are fully bionic you can win a gold medal in the shot put.
Mako
@John Cole:
No worries. Of course, the whole “Hospitals are getting rich off the uninsured” bit is nonsense. Means testing is common in many hospitals.
You might enjoy this Uwe link-
http://content.healthaffairs.org/cgi/reprint/25/1/57.pdf
mr. whipple
@Amanda Hugginkiss:
My wife spent 20 very well-paid but stressful years in health care admin.
You would probably never meet a more rabid believer that the entire thing should be nationalized/socialized/razed to the ground and rebuilt.
Jager
I was hospitalized in 2000 for 5 days, all tests. (tests of every kind imaginable, I was in the CAT scan 3 times!) The bill was 32k, my share 13k. My primary care doc was outraged, he had his office manager go through the bills, she discovered 4k of over charges and got them dropped! You have to read your insurance policy with a sharp eye, because in the fine print the coverage of certain tests and procedures is much less than than the large print says it is!
BTW one of the charges she got dropped was for an MRI, I never had!
Mnemosyne
@toujoursdan:
People have been told so many times that Government Doesn’t Work that they’re terrified that any kind of government involvement in healthcare means that they’ll end up with nothing.
It’s no surprise that the people with the shittiest healthcare are often the most opposed to changes in the system. They’re convinced (not without reason) that they’re going to get screwed even worse than they already are.
eyepaddle
First off: Wonderful post.
Second–I am also glad you are well on the way to recovery
Third: I’ve had a bout of pancreatitis (about a week in the hospital) which lead to having my gall bladder removed. Looking over my EOBs the combined damage would be a shade less than $40k, but when you see “provider amount” which is presumably the amount that my insurance pays they are both around $6000. I am pretty certain if I did not have insurance I’d be looking at paying the 40.
And to think that I’ve only had a dependable job with decent insurance for the last three years….shudder….
eemom
It should be so very, very obvious that HCR needs to be passed. So simple. A no-fucking-brainer.
And yet it is fighting for its life.
I hate this country.
licensed to kill time
@John Cole:
I admire your decision re: not suing your landlord and realizing that you had an accident which was not his fault. I had a neighbor whose kid fell off another neighbor’s swing set and broke a leg. They decided to sue them because “their home owners insurance would pay for it, so why not?”. They were well able to pay the bill themselves. The resulting lawsuit ruined their friendship and swingset neighbors moved away. All because they wanted to save a few bucks.
I wish more people would think before reflexively suing, or rationalizing that “the insurance will pay it” so what the hell. I’m all for suing the bastards when it’s warranted and do not presume to know when that is for each person, so don’t sue me for saying this!
Violet
@Cris:
Interesting. I really thought the concept of uninsured people being charges multiple times over what insured people pay was widely known. Maybe not.
@Tsulagi:
I’m still surprised that people didn’t know until they read it here today. Glad the word is getting out, though. More people need to know this because we’re all just one lost job away from being uninsured.
@John Cole:
The British system isn’t perfect. I’ve got relatives and friends who are British and have heard their stories. For the most part they are satisfied with the NHS, but it doesn’t always work for them.
Most of them have additional insurance that they either pay for on their own or get as a perk from their employer (sound familiar?). That allows them to jump to the front of the queue or go see a private doctor.
Example from family and friends: Senior citizen woman was having back pain. Doctor diagnosed her as needing hip replacement. Under NHS they required she wait until she was unable to walk or generally function, and then NHS would cover it. This woman is extremely active, plays tons of golf, and requiring her to become housebound before doing the surgery really wasn’t in anyone’s best interests. Her quality of life would degrade and her recovery would be much longer and she’d be a burden either on her family or society for much longer.
So she used her private insurance and jumped the queue. Got surgery within a few weeks, scheduled at her convenience. Recovery has been excellent.
Additional example: High risk twin pregnancy was unable to be checked effectively with ancient ultrasound machine at local Obstetrics office. NHS doctors themselves recommended patient go to private doctor for higher quality ultrasound. Patient had private insurance to cover it, but would have been expensive without. Patient noted NHS office had signs up asking for donations for a better ultrasound machine.
There are pros and cons in every system. The British nationalized health care does make sure everyone has access to some level of health coverage. But it has it’s downsides.
freelancer
@freelancer:
Out of mod hell, thanks.
Mako
@South of I-10:
“Maybe one of you can answer this for me. Why can we not establish at least a base range of what a specific treatment is actually worth?”
google “hospital chargemaster”.
freerangesteve
not to start up the whole Canadian Health Care vs. US Health Care thing, but… well, shit. I guess I am.
It is shocking to me, the costs associated with health issues down south.
Just to give you a completely non-scientific anecdotal reference, I busted my leg (compound fracture) and with the stay in the hospital, cast, wheelchair, then back for a walking cast, crutches, rehab, etc. I paid… zero. Nothing. Nada.
Now, I did have to pay for my delicious pain pills, but it was in the tens of dollars.
So there you go. Now, maybe I need to wait a bit for a =n MRI on a sore knee, but come on… when you NEED it, you get the care up here.
And as was mentioned, you had great insurance. I shudder to think what would happen to someone with anything less.
It never ceases to baffle me that more people aren’t outraged … the US is in a pretty unique position of being able to craft a healthcare system from scratch, taking the best aspects of any of the European and Canadian models to come up with a truly great, world-class system, and instead you get… whatever.
Sad.
:Libertini
@licensed to kill time: I get your point about suing, but I just gotta point this out. The insurance industry (health, car, life, etc) seems to me to just be doing the equivalent of taking our lunch money. If you pay homeowners premiums which cover injuries that occur on your property, why does there need to be a lawsuit?? Why can you not just call your agent and say there was a covered accident on my property – pay my claim now. Perhaps in the situation you mention, they “sued” for more than the covered amount, but why is it wrong to expect insurance to pay claims on a policy you’ve paid premiums for your entire adult life? I see the same thing in auto insurance – people pay premiums their whole life, but if they have an accident, instead of getting their insurance to pay it, they pay it themselves so their premiums will not go up. Seriously, just put a line item for “give away your lunch money” in your personal budget for the rest of your life. Label it insurance premiums if that makes you feel better.
Persia
@Steve V: When my kid was born prematurely, they made me fill out the medicaid forms. They said I’d probably qualify because I wasn’t working while she was in the hospital. They were right, I did. We’d have gone bankrupt otherwise; as it was we still have pretty much zip for savings.
parksideq
I have nothing to add except that this post should be required reading for every congressman.
Pass. The. Damn. Bill.
Donald G
Around the fourth of July last year, my brother on the East Coast – a trucker who had been working for a firm for the past few years – suffered a major heart attack a few months prior to his fortieth birthday while on a run to North Carolina. He was airlifted to Raleigh and treated at two major healthcare facilities, died on the table a few times while undergoing surgeries, but was successfully revived, then forbidden to work for about eight weeks after the event.
Just as he was about to get the okay to go back to work, the trucking company fired him, just as I started to get calls from a collection agency for the hospital bills. (Dad was with him when the attack occurred, and we share a name). If he had any insurance through his employer, it was apparently inadequate to the task. If he didn’t have insurance, he’s pretty much screwed as he owes something on the order of $38,000, is twice divorced and has a baby on the way.
He has, of course, been unable to find another job, and now that he has had the massive heart attack, what insurance company would cover him under the current system?
Without HCR, he probably would’ve been better off if he had followed Alan Grayson’s characterization of the Republican Health Care Plan.
geemoney
@RedKitten: YES! A thousand times yes! It’s only because of the alternative that this seems like getting off cheap. Americans are kept ignorant about how much better it could be. All those years of fearmongering about the perils of socialized medicine have sure paid dividends, just not for the right people.
Otherwise, in the words of the troglodytes that keep blocking reform, we should just lay back and enjoy it, because really, we have the best health care in the world.
PTDB then work to improve it.
mr. whipple
@freerangesteve:
” I paid… zero. Nothing. Nada.”
Can you really say that, though? You pay taxes, right? (And pretty steep ones, judging from what my Canadian customers complain about.)
jibeaux
Sometimes I tell people that I, with insurance, have one more payment left on the deductible and coinsurance from surgery I had in October 2007 (fairly minor surgery, discharged 24 hours later). Then in about five more months I will be done paying for the post-surgical scan. And I support health care reform not because I’m whining about that, although it is a little bit ridiculous, but because I came through all of that with as much luck as a person possibly could have — fully insured, no complications (Roger Ebert and I started with the same diagnosis, so I think you can see how it could have been worse), I didn’t lose my job, only missed a week of work which I had the sick leave for, people brought me food, etc. — and I’m still paying it off, and it’s freaking ridiculous.
catclub
Amanda Hugginkiss @ 75 is the most interesting post to me.
Hospitals have to charge the standard rate to all.
But what they __accept for payment__ varies all over the map.
So South-of-I10 they could tell you what the standard price
is but that still does not yet tell you what payment they will
accept for a given service. It is clear that no-one pays higher
than the ‘standard price’, but clearly no insurance company ever pays the standard price.
Who pays the ‘standard price’? Me.
I was hit by a car ( while on my bike) and the driver
was given a ticket for leaving scene. The insurance company
basically multiplies my healthcare bills by three as a settlement. I then pay the hospital their ‘standard price’.
I can think of no-one else who pays full price.
RedKitten
Mako, last time I checked, nobody had to pay $2000 for a fucking sandwich.
And I am paying for my health insurance. I pay for it with my taxes. But there is seriously something WRONG with a system where people who are in dire medical need avoid or delay treatment because they can’t afford their co-pays.
I used to work for a private medical insurance company. I remember talking to the claims adjustors, and I remember how they would look for ANY reason, ANY excuse to deny the claim. It was all about the bottom line.
Our system isn’t perfect — far from it. But at least anytime I had a medical emergency (kidney stone) or a situation that required hospitalization (the arrival of SamKitten), I didn’t have to think “How am I going to pay this bill?” When I was screaming in agony during labour and decided to get an epidural, I didn’t have to think about how this was going to be added on to my bill.
KDP
John, glad to hear you are feeling better.
I’m curious. In all of the stories about your health insurance not covering pre-authorized procedures, are you on a PPO or an HMO. Additionally, no one discussing high out of pocket costs has mentioned the annual out of pocket maximum that is supposed to reduce the amount you pay out for chronic conditions in the course of a benefit year. Do your plans not provide maximum out-of-pocket expense limits, after which the insurers cover all costs until the end of that year?
I now have an Aetna Standard HMO in California, which I selected over my previous HMO Plus at renewal time last October to reduce the premium costs for my partner who is not offered insurance at work. The lesser plan increased his premium only 25% instead of 38%, but I have higher co-pays for everything.
My prior and current plans have no deductibles, and annual out of pocket maximums of ~5k. Fortunately, I have never hit the out of pocket maximum even with my partner’s treatment for cardiomyopathy in the fall of 2008 and two stents (one mid-Oct. 2008, the other end-Sept. 2009). I have never been billed for more than the agreed HMO copays for procedures or lab work (labs used to be free, now there is a copay).
Perhaps PPOs work differently? You get more choice in which doctors you see, but you pay a percentage of the fees (at what rate though, billed or reimbursed) and end up paying more out of your own pocket?
What I found in reviewing the EOB for his stent procedures was enlightening, to say the least. Insurers claim premium are going up, in part because of rising health care costs. Here are the approximate numbers for the same procedure, same hospital, same doctor, same insurance policy – one year apart)
end-Sept 2008
Hospital stay (nominal 23 hour stay, as an outpatient surgery so this was a $100 copay through my HMO) and procedure billed to Aetna at: 159K
Amount paid by Aetna for billed amount: 24,500 (15% of billed amount)
mid-Oct 2009
Hospital stay (nominal 23 hour stay, as an outpatient surgery so $100 copay through my HMO) and procedure billed to Aetna at: 163K
Amount paid by Aetna for billed amount: 16,900 (10% of billed amount)
Note that while the amount billed to the insurer went up slightly (4k or ~2 %) the amount the insurer paid went down significantly with the hospital being reimbursed 1/3 less for the same procedure, a year later.
It appears that in the intervening year, Aetna negotiated a significantly lower reimbursement ratio for amounts billed from this hospital against this type of plan. This is an isolated experience that cannot be extrapolated to all health care events, but because of the short timeframe and the near identical circumstances I think it illustrates what may be widespread misrepresentation by insurers for their declining levels of coverage and increasing costs to insurance benficiaries.
LiberalTarian
Preach it, Brother. I’ll say Amen.
licensed to kill time
@:Libertini: Oh, I agree with you that if you’ve paid premiums forever it is not at all unreasonable to actually use the coverage when needed; but not to have to pay a penalty for that in higher premiums on down the road. I think that was the issue in the case I cited – swingset family got their premiums jacked up as a result of the claim from the other family who could have easily paid for the injury out of pocket. It just created bad feelings all around the board and was unnecessary.
Insurance is generally a scam and the companies expend serious effort in rigging the game to favor their side, like house rules in Vegas. But ya gotta have it just in case. It’s a sucky system.
jibeaux
With that all said, I think there would be disadvantages to a system in which everything was “free”, i.e. 100% funded by taxes. I think it was Ezra where I was reading that the French system involves a lot of smallish co-pays, and even many of those can be reimbursed, but it is designed to remind people that care costs money. And Americans have more procedures and more diagnostics and more “machines that go pinggg!” than anyone else, but we don’t get better results from it. For example, with prostate cancer that is caught in the early stages, a lot of experts who analzye this kind of thing say we’re not doing nearly enough “watchful waiting”. There are things you can do to lower your PSA (diet and exercise), and you can keep an eye on it and see if you can make it get better, or if it gets worse, how fast it gets worse. But because these men tend to consult with either surgeons or people who perform some other sort of interventions (HIFU) and because they then overwhelmingly pursue whatever that doctor recommends, we’re spending a lot of money on these treatments that, although they’re medically indicated, may not always be warranted at that point in time. I don’t know where I’m going with this, I guess just that I think we need to somehow incentivize preventive care and conservative treatment whenever possible.
Flugelhorn
@Violet:
Yes. Exactly what I do NOT want Lowering the standard of care for everyone to insure a relative few more. In the end, the people who actually pay the taxes for this benefit end up recieving worse care and paying more money so that people who do not pay into the system at all can get the same level of care that they would get from an emergency room visit.
We need reform, but we do not need THIS reform. The UK and Canadian NHS is crap.
Revamp the whole thing. Look at the French model for inspiration.
:Libertini
@mr. whipple:
If the amount of freerangesteves taxes that should be apportioned to his health care exceed the amount of the premium I would have to pay to get a high deductible insurance policy as a single, self-employed person, then I will eat my shirt. If you want to be on that side of the argument, you will have to do better.
On second thought, your comment here is very like the Republican minority killing an initiative that most Americans want by just spouting pithy remarks, which when examined for accuracy (truth??), do not hold up at all.
freerangesteve
@mr. whipple
In terma of what I make…
My Federal tax rates:
15% on the first $40,726 of taxable income, +
22% on the next $40,726 of taxable income (on the portion of taxable income between $40,726 and $81,452)
My Provincial tax rates (Alberta):
2%
I’m no accountant, but that’s what I found doing a quick search on the applicable government websites.
I don’t think that’s outrageous. This whole “high tax” complaint rings pretty hollow to me. I’d rather pay a bit more and get the “free” health care, thanks.
freerangesteve
@Libertini
You made the point I was going to attempt next. And much better than I would have. Cheers for that :)
trollhattan
Late to the dance, but a couple “thoughts” anyway. Most know that the insurance companies grind health providers on what they’ll pay for literally every service and product and the delta between what they pay and what the final charge is, is what the insured person pays can be quite substantial. The out-of-pocket patient is charged from a completely different rate card that is in every way more expensive than the rates negotiated by the insurers.
My self-employed bride for most of the last two decades has purchased insurance as a walk-in and as you can guess, has paid astonishingly high premiums for the sketchiest of coverage. Her biggest annoyance is the impossibility of price shopping anything related to medical care. Very few providers–doctor, lab, what have you–will price quote over the phone and those that do give numbers that have no relationship to what’s ultimately invoiced. In sum, it is not possible to shop medical care in a meaningful way.
Another pet peeve is how coding affects pricing. A dermatological procedure to remove an area of sun damage is billed at a small fraction of the same procedure if the skin area is considered pre-cancerous or cancerous. This is unrelated to biopsies, lab work, etc., just the act of removing the lesion–same doctor, same procedure, same amount of work, same tools and supplies.
I changed employers, took a pay cut, to get a job through whom I could ensure my family. It’s the first place I’ve worked where it wouldn’t cost me five figures annually to add two people.
To anybody still claiming the U.S. has the “world’s best health care”: fuck you.
Spike
Glad you’re on the mend and feeling better. I mentioned my own shattered and dislocated wrist in an earlier thread. Initial emergency room visit, two CT scans, a dozen or so X-rays, two surgeries (one to reconstruct my wrist with a bit of bone removed from my hip, a titanium plate, and nine screws, and a second to remove the hardware ten months later), several follow-ups with the surgeon, 18 months of physiotherapy, and the usual suite of painkillers and such. Total cost? $50 for the pharmaceuticals.
The difference is that I live a few miles north of the 49th parallel (and far enough west that such a distinction matters).
Comrade Mary
Another Canuck here, self-employed, who pays “nothing” for comprehensive medical care, preventative and emergency. I pay less than $100 a month on top of OHIP (the Ontario health system) to cover extras like $20K on drugs a year (10% copay), a private hospital room, physiotherapy, and vision costs. If I worked for any of the other firms I used to work for, I’d have even better supplemental health care as part of my benefits. I have never not had a Canadian job with benefits.
While my taxes are probably somewhat higher than an American working for a salary, they may be lower than those on some self-employed Americans earning the same money. (I get to deduct a lot of things, including my supplemental health insurance.)
But you know what? My taxes didn’t go up 40% last year. They aren’t going to go up 40% next year, either. We have a big pool of people up here, sharing risks and costs, and it works out pretty damn well. Yes, some things need to be improved, the same as anywhere, but you would have to pay me more than double what I make here to even consider moving to the States (which is sad, because I actually like a lot of you guys and would love to spend some time there.) And you’d have to guarantee me something like the current HCR bill as part of the bargain.
Violet
@Flugelhorn:
Well, I disagree that they’re crap. They do a good job for what they do. But they have their downsides, like every system.
I actually prefer the system in The Netherlands. Link. It combines private health care insurance, mandatory coverage, and heavy regulation of health insurance companies. There’s also public coverage available for those who can’t afford to buy their own insurance, but that’s a small group. It was rated the best system in Europe in 2008. It could be problematic in transporting it here because we’re a larger country with states and that makes it more difficult. But I think it could work.
RedKitten
@freerangesteve: Ditto. I don’t find my taxes to be particularly onerous, and I pay more sales tax than you, being out in Nova Scotia.
And at least I know that the folks at MSI (unlike those at Blue Cross) are not spending their time thinking of ways to deny me care.
Being “on the inside” of private health insurance really opened my eyes to what a racket it is.
pcbedamned
@mr. whipple:
O.M.G. (as my 15 year old would say). This is one talking point I get really tired of having to disprove over and over again.
Yes, we Canadians all know that our health care isn’t “free”. We pay for it in our taxes. But here is the difference. Americans pay taxes, as well as having to pay for insurance on top of whatever taxes you pay (and from what I have seen, monthly payments for a family of 4 can be pretty steep). We pay taxes and it covers everything that Americans pay taxes for, as well as health care. So my monthly deductions come out and that is it. I don’t have to worry about paying extra to cover my family in case someone should get sick, need to see the doctor (routine or otherwise), or as said earlier, have a catastrophic accident. I’ve never had to worry about a bill when I gave birth twice, had emergency surgery for an ectopic pregnancy, my son broke his leg at school, or even when my kids had a cold. The list could go on, but you get the picture.
Taxes are a part of life. We all have to pay them whether we like it or not. At least my taxes cover things out my control and relieve myself and other Canadians the worry about losing everything we have worked for in the case of illness or injury. And to think, I am a Conservative…
:Libertini
@freerangesteve: Cheers back at ya!! My boss and I were traveling on business in Canada when she came down with a very nasty stomach bug. We spent several hours in a Canadian emergency room and she received excellent care. They were not equipped to bill her at the hospital but took her information and our insurance paid a bill that they sent later. The bill was MUCH less than a similar bill my brother had at an American hospital the year before.
There are two sets of people for whom the American Health Care system works better than the Canadian one – those who have the cream of the crop insurance fully paid for by their employers and those who are fortunate enough never to have to use their insurance.
If I could find someplace in Canada that was relatively warm year round, I believe I would do everything possible to move there. I love America, but some of the things going on right now are absolute bullshit.
WyldPiratd
John, I feel your frustration as I experienced the same I had a heart attack last fall. I had just been laid off from my job and yet to file the paperwork for COBRA (although I was still–I thought at the time—within the window) coverage.
Turns out I had the heart attack on Nov. 5 and had one completely occluded artery cleared by stent emplacement. I stayed in the hospital a couple of days extra waiting for a surgical opening to have two other blockages cleared by bypass. I remember asking a friend while still in the hospiotal to go to my home to get Cobra paperwork, calling BlueCross/Blue Shield and having them tell me that I had “passed the deadline for application”.
I broke down in the hospital and bawled like a baby for two hours knowing the bill I was facing. I got the bill less than a week out of the hospital–70K for single stent emplacement, a couple of xrays, an echocardiogram, ultrasound on a pseudoaneurysm, and 6 day stay in the hospital.
Shortly before thanksgiving, I got the COBRA situation resolved and found that I was going to be able to get coverage after all AND—huge deal–that it was retroactive to my job loss date.
I had the second visit on Dec. 5. Three arteries bypassed and an uncomplicated five day stay. Received the bill for that and it was 68k. Grand total of 138K dollars.
Insurance ended up paying 66k with my out of pocket expenses being about $3500 to date.
Still, in all, I’m pretty fucked. No job and job prospects looking very dismal at 51 years old. Just medical expenses alone for drug co-pays and doctor visits and diabetes care run ~$300 PER MONTH. Cobra runs out in December and I’m just now feeling good enough to really delve into looking for a job.
The health care situation in this country is tragic for some people and the ones who are “satisfied” with their care are, as others have mentioned, fortunate that they have never faced a challenge when it comes to their health care. The real truth is that the vast majority of people dance on the edge of catastrophe with their health without realizing it. All it takes is bad luck or simply bad genetics and nearly anyone can be facing the rest of their life being devastated by the costs of paying for their health care.
Mnemosyne
I’m assuming the Canadian healthcare system is “free” the same way I got all of my treatment “free” when I was injured on the job and filed for worker’s comp. I pay about $10 a week in SDI tax to the state of California and, in return, when I ripped my ACL after falling off a stepladder at work, I didn’t pay out of pocket for a thing because I had essentially pre-paid for everything with my 20 years of paying SDI tax every week.
WereBear
Glad to hear you are mending, John! Are you going to hear that sound effect when you reach for your coffee in the morning?
I’ve got pretty clear views on our insurance situation. Back in the ’90’s, first husband made his American Dream come true by setting up his own business. We couldn’t afford insurance, of course!
So when I had to have arthroscopic artery surgery, we got even deeper in debt. That was why, when he had a bad bout of flu, we waited too long to get him to the emergency room.
It wasn’t flu. He didn’t make it.
pcbedamned
@:Libertini:
Most of South Ontario is further south than the Norther States.
licensed to kill time
I want to mention another thing I noticed in insurance billing – going over horrific bills generated by an event involving my child (brain surgery) I saw the hospital charged for things like a new toothbrush and tube of toothpaste daily, at a cost of $25 per. Huge charges for dozens of small items, all itemized and recurring day after day. It just seemed like an incredible bill padding mechanism. It was a shocker to me at the time, though I have read much about it since.
I was incredibly lucky to have been covered by insurance at the time, but jeez the whole system is so screwed up.
trollhattan
@ WereBear
Good Lord, I am so sorry.
Cris
Sure, sure. But when you pay the same amount whether you utilize a service or not, employing it is effectively free. Much like complimentary services at a hotel. Yes, you paid for your room, but they don’t charge extra to get into the pool, so you consider it “free for guests.”
R-Jud
@Flugelhorn:
I’ve lived in the UK for five years now. “Crap” is not my experience. It has weaknesses and is underfunded compared to the rest of Europe, and Labour has imposed a lot of pointless targets on it that have dragged care down in certain areas.
But good, reliable basic and emergency care is available to everyone. Prescriptions are cheap, locked at about $15 for the general population, and free for those on benefits, pensioners, and pregnant women.
The NHS’s outcomes in a number of areas are much better compared to private systems in the US, and the general population of the UK is not significantly healthier than the US (particularly when you take the Scots into account).
If you’re over 60 or have a persistent physical therapy-type injury, you definitely want to pay another £30-£60 a month for private insurance. Private dental insurance is also a good idea, as the NHS only offers subsidies for dental work, not a free ride (this is part of the reason behind “British Teeth”– they figure if it’s not free, they don’t want it). However, my overall healthcare spend is far, far less than it was prior to 2005, when I had pretty good coverage from Chicago Public Schools.
As for taxes: I pay HMRC a flimsy 2% more on top of what I pay to the IRS (I have to file with both because I am a US citizen and all my clients are US based– I pay the IRS first, and then any difference owed above that to Her Majesty).
crack
The amount paid by insurance (including Medicare/Medicaid) has absolutely no relation to the amount shown on the bill. The amount on the bill is in fact what someone without insurance would pay.
The amount paid insurance/MM is a negotiated payment multiplied by a Diagnostic-Resource Grouping (DRG) code code multiplier.
http://en.wikipedia.org/wiki/Diagnosis-related_group
If two people with the same insurance are in for the same reason and it takes a hospital 30 days to fix one patient and an hour to fix the other the insurance cost is the same. If an uninsured person goes in, they hope for the hour fix. Otherwise they get all the day charges.
Amanda Hugginkiss
@mr.whipple
I’m not rabid or particularly well-paid, but I am where your wife is. Over the years at my job, I’ve arranged for a lot of free care for people in need. The stories are heartbreaking–like the kid who couldn’t get a kidney transplant because they couldn’t find a dentist who would treat a severely disabled immigrant without insurance. (Dental care being required before transplant surgery.)
Anyhow, the system is a mess. I have to think most people have experienced the mess firsthand, so I can’t wrap my head around the resistance.
No Joy in Mudville
Man, John, are you dumb. Mitt Romney just explained that you could have just gone to the emergency room, gotten everything done, and simply walked away from the bill. And apparently the hospital would have accepted your decision and never contacted you again. I know that’s what the Orange Boehner thinks happens. Or at least that’s what he tells us happens.
People should know that many hospitals will negotiate prices, but you’re right, they will charge the uninsured more — probably a lot more, since no one is negotiating on their behalf. In many cases, people who are truly without resources can have their bills reduced significantly or even forgiven, but that’s not a sustainable way to run a health care system.
Flugelhorn
@freerangesteve:
Did you forget to figure in your Provincial/Territorial Tax Rates? What about your HST/GST? What about your PST? I am sure there are all kinds of other hidden taxes as well that come in the form of fees, surcharges, permits, etc.
Canadians do pay alot in taxes.
In the UK it is even worse. In addition to similar Canadian Taxes such as VAT, etc, you pay Council taxes, Congestion charges, recurring permits and fees for an off-air TV Antennae, and on and on and on. This is what happens when the government starts taking things over. People simply pay more and more into a system where they realize less and less in returns. The agencies become more and more bloated. You NEVER see a goverment agency do anything but increase their budgets year after year. They do not fix problems. They throw tax dollars at them. (The UK NHS employs 2.5 million people, less than half are actually practitioners. This is 3rd in the world only to the Chinese army and the Indian National Rail. All of this is for a population of less than 62 million.)
A US NHS would be a nightmare.
Look to the french. They seem to have figured it out a bit better than the others.
:Libertini
@WereBear: Dear Lord, that is heartbreaking. So sorry for your loss.
Yours is among some of the most heartbreaking stories I have heard. The worst one was a couple whose baby was born premature and racked up hundreds of thousands of dollars in medical costs and then died after less than 2 weeks. Some bullshit fine print in the policy allowed the insurance company to refuse to add the baby to their policy, so they were forced into lifelong financial disaster (including but not limited to filing for bankruptcy) for an infant who did not survive. Makes me sick to think about it.
RedKitten
It’s basically a gigantic insurance pool, when you think about it. Every single Canadian citizen who pays taxes pays into it, and the initial costs are kept low because 1) a lot of medical expenses are subsidized in the first place, 2) our doctors aren’t required to pay $20-some-thousand a year in malpractice insurance like yours are, and 3) the bills aren’t padded like licensed to kill time’s example of a daily $25 charge for a new toothbrush and toothpaste (which is regoddamndiculous). Those three things, among others, are what keep the costs for care down, which is why our taxes aren’t higher than they are.
For this to work for your system, it would require a huge overhaul, including caps on malpractice suits, and end to that absurd bill-padding, and other major changes in how things are done.
WereBear
@trollhattan: Yeah, well. What can one do? I certainly have skin in this game.
Since he was Key Man (and we had no life insurance, either) I had to sell the house and give up the business and go bankrupt. My bankruptcy attorney said I was one of the most pathetic cases he’d ever had, and I gather he didn’t charge me much.
What kind of country is America, where chasing the American Dream can destroy you? The worst that is supposed to happen is that you fail.
And we didn’t.
Cris
It gets wicked cold in Edmonton, but if you stay in the pedways you’ll be safe.
eyepaddle
@WereBear:
Oh. Please accept my deepest sympathies.
toujoursdan
I also lived in New Zealand and thought their healthcare system was pretty good. You buy private insurance that covers doctor visits and you have to pay a nominal co-pay to see the Dr., but then all the heavy lifting (testing, treatments and surgeries) are done by state run regional hospitals which are paid through taxes. They did a good job at keeping the hospitals small (assisted by the country’s low population) and accessible.
Part of the advantage in NZ was that that their primary and secondary school systems were good enough that those who studied to become doctors and dentists didn’t have to retake general education courses at the undergraduate level, could concentrate on their field of study exclusively, graduate and gain experience at a younger age. They weren’t burdened by huge debt that they had to recoup from patients either.
Licenced doctors and dentists in New Zealand generally have a Bachelor’s Degree in Medicine or Surgery (which used to be a 4 yr degree but now is a 6 yr degree.)
WereBear
@all… I appreciate it. It’s ten years in the past and I’ve happily re-married since then, but it’s a sick, sad, shame it came to this for no earthly sensible reason.
Mnemosyne
@No Joy in Mudville:
My Fox-watching, Limbaugh-listening parents actually think that no doctor is allowed to ask you for proof of insurance. They actually said to me that anyone can walk into any doctor’s office and get treatment without having to prove they can pay. So, clearly, the problem is all of the people going to the doctor and not paying.
Of course, they don’t care what the truth is. They’re on Medicare. IGMFY.
kilo
@Flugelhorn:
You know, that’s such mindless drivel that it’s not even worthy of being a blog comment.
My Canadian ass picked up a tropical parasite a few years back, came home and bounced from family doc to hospital outpatient to tropical disease specialist, ran through four weeks of IV treatment once I was diagnosed, and got a whole bunch of followup care when (I thought) my athletic performance had decreased due to treatment. Total cost to me was $1,200; that being the annual healthcare premium (aka “ebil soshulist TAX!”) that my province used to charge.
We’ve been recruiting engineering professionals out of the US over the last few years as they’ve been getting laid off, and they’re shocked to find that Canadian income taxes (combined federal + provincial) are pretty similar to what they’re paying down there. Except, hey, look – that couple extra percent includes free healthcare! Zero deductible! It’s a huge win financially for them, let alone taking the fear of bankruptcy out of it. Even typing the term “medical bankruptcy” feels weird; it’s like “intelligent conservative” or “unicorn tears” up here… they just don’t exist.
There are legitimate criticisms to be made of our single-payer system, but dismissively calling it “crap” just illustrates how little you actually know.
fiona
If you lived in the UK, it would have cost you nothing, except your monthly National Insurance deductions, mine is around $230 a month, and I earn $30,000 annually for a 30 hour week.
farmette
When I worked in the disease industry medical care providers (clinics, hospitals) would bill the full charge (or close to full charge) to an uninsured patient for a procedure or care so they would have a larger dollar figure:
A) to write off as a loss,
B) when selling or transferring delinquent accounts to collection agencies
C) accumulating interest if a facility or provider allowed “pay as you can” with a fixed interest rate over a long period of time.
Generally, hospitals and clinics would discount 10% – 20% off total charges for an uninsured patient depending upon payment plans negotiated with the patient.
The current health care delivery and reimbursement system is all broken for too many and has been for years.
:Libertini
@pcbedamned: & also @ Cris – Thanks for the suggestions.
A (mostly) lifelong Texan, I have never lived further north than Virginia. So even the southernmost areas in Canada would mean climate culture shock to this southern gal. But it is still becoming more appealing every day.
Ruckus
@cat48: I wonder if McCain has Alzheimer’s? He seems to be losing contact with reality more and more every day. His short term memory seems to be the worst, which is my experience with the disease. His long term is not in great shape either but short term is becoming noticeable.
Or maybe he’s just a bitter old fart who sees that his ‘station’ in life has gotten away from him.
toujoursdan
Oh where to start.
Yes, some Americans pay lower taxes than some Canadians, but beyond healthcare, we get what we pay for and our government is fairly responsible. The government ran surpluses until the last recession. (Did yours? Didn’t think so.) Our pension plan is solvent and will be around for young people to draw on. (Is Social Security? No. Too bad!) Our schools are better funded (How are yours performing? Poorly? So sorry! How are your university costs doing? Pricing the middle class out of higher education now? Oh dear.) And our infrastructure is better shape despite being in a more hostile climate. We also don’t need to pour so much money into our military that we account for over half the world’s total military spending, while failing in actual conflict in every war since WWII.
Yes, Canadians generally pay more than some Americans in taxes, though Canadian income taxes are more progressive so our poor and middle class pay less and our rich class more. And the typical Torontonian or Calgarian still pays less tax than a New Yorker or a Bostonian. But our country isn’t facing a $56 trillion dollar debt bomb.
gratefulcub
I’m real late, and haven’t read any comments, but the $100K price tag for the uninsured is a bit correct, but not very. The entire system is screwed. The ‘prices’, or charges, mean very little. They are inflated because we do receive % of charges for a few OP contracts, but most insurance and govt payers pay outside of what is charged.
Medicare gives a flat amount for X discharge diagnosis (DRG), regardless of how long your stay is. Commercial payers usually pay a per diem, regardless of what your diagnosis is.
Now, a SP patient is probably not going to pay a dime. Their original bill will be stated at Gross Charges, why wouldn’t it? We have no contract that sets a price, so what are we discounting to?
If you happen to be a SP, and you get discharged, and you go to the business office clerk and say, “I would like to set up a payment plan to pay for my stay, and I will do so if you charge me the Medicare rate”, you will get that every single time.
The gross charges for indigent care are used to submit to states to try to get charity care dollars and other types of reimbursement for supplying free care, not because we expect anyone to pay $50 for an aspirin.
Don’t hate tha playa, hate tha game.
freerangesteve
:Libertini
If I could find someplace in Canada that was relatively warm year round, I believe I would do everything possible to move there. I love America, but some of the things going on right now are absolute bullshit.
Vancouver, baby, Vancouver.
toujoursdan
Vancouver is pretty expensive. There are some great towns on Vancouver Island though.
There is also that on-again, off-again annexation of the Turks and Caicos Islands in the Caribbean:
http://en.wikipedia.org/wiki/Turks_and_Caicos_Islands#Proposed_union_with_Canada
Allan
Have you been asked to sign anything yet certifying that none of your treatments or services rendered were for the purpose of abortion?
Because soon you will.
freerangesteve
@toujoursdan
Vancouver is pretty expensive. There are some great towns on Vancouver Island though.
Good point. Vancouver Island is fantastic, and a ferry ride away from Seattle and Vancouver (for the big city livin’) is you don’t mind dirty hippies – speaking as a dirty hippie myself :)
I would love to see a straight up comparison of taxes, let’s say Federal+Provincial+Sales Tax compared to the US Federal+State+Sales Tax+Insurance Premiums … but make it fair, compare apples to aplles, so maybe Toronto to New York, or something along those lines. I think the Americans might be a bit shocked (although I’m guessing this). I really don’t think the tax burden is that onerous on us Canucks… anyone have a source? I’ll try Google…
freerangesteve
IF you don’t mind DFHs… lousy typing skillz
freerangesteve
Source: http://www.stormfront.org/forum/showthread.php?t=506997
Copy/pasted from there:
“Since this is the ‘general discussion’ area, I wanted to throw up a thread here to kick off a discussion, and more so a placeholder for myself while I research the differences in Canadian federal/prov income tax and its American counterparts.
We, as Canadians generally feel we are over taxed, and in many areas we are rightly so as in some areas we are. But the ‘grass is always greener on the other side’ may not be as green as you think, even if their currency is
I would like to point out this one particular tax calculator I use from one of the “Big 4” accounting firms to help get an idea on what my tax hit (both fed and prov included) will be for the year, and wanted to share it with others.
http://www.ey.com/GLOBAL/content.nsf…8_Personal_Tax
What I like about this page is it gives a real quick overview, doesn’t take into account marital status, charity deductions, etc, just a gross overview, and broken down by each province and territory.
Now I tried to find a similar web page for the US, but at the time of this post I was only able to come up with this one particular web site:
http://www.yourmoneypage.com/withhold/fedwh1.cgi
I did a simple comparison, as accurate as I could of a single individual living in Alberta earning an even $100,000 vs a same single individual living in the state of California.
After tax income/tax percentage:
Alberta — $72,739 / 27.26%
California — $64,139.37 / 35.8%“
Comrade Mary
Dude, STORMFRONT? Really? (Not that I think you’re a sympathizer, of course.)
The sources that guy linked might be useful, if limited, but Alberta probably has the lowest tax rates in Canada. Ontario to California, or Ontario to New York, might be fairer comparisons.
I have no time to run numbers right now, but while I think there are some scenarios in which Canadians pay somewhat less tax, and some in which we pay somewhat more, the tax difference isn’t enough to make me risk running my own business in the States, or even to get hired by an otherwise decent company. I’ve lost track of the number of Americans who have said they would love to quit [soul-destroying job] or start their own business, but they can’t risk being without health insurance.
mr. whipple
@freerangesteve:
Thanks to you and all for answering the question. I had always assumed the Canadian taxes were quite high because all of my Canadian customers ask me to cheat for them when I ship them something from the US.
Flugelhorn
@kilo:
I know quite a lot actually and nothing you have said here in this post has refuted any of it.
You see, I and 250 million other US Citizens have insurance. We would have gotten at least as good care in the US with my insurance as you did with your “Freebie”. When I say it is “crap”, it is because compared to my insurance, it IS crap. If I were to move to Canada, my level of service and healthcare would suffer compared to what I have today with a US insurance plan.
I like your story about your tropical parasite. How about another? A former co-worker of mine who lived in Canada and worked in Detroit contracted an ear infection. He was told by his Canadian doctors that it would be at least 9 months before he could see someone to have it treated. He was also told that by that time he would probably suffer permanent loss of his hearing in the infected ear. He is now deaf in that ear.
With my insurance, I would never have to wait 9 months for anything short of a donor organ.
I have more if you would like to hear them.
My point here is this. The US system has issues. BIG issues. It needs reform to protect against pre-existing condition denials, catastrophic protections, and many, many other things; However, if we were to emulate the existing Canadian and UK NHS, we would be asking roughly 250 million insured Americans to accept lower quality services for MORE money out of their pockets. It is classic lowest common denominator theory. Bring everyone down 10 pegs to elevate 16% of the population up a peg or two. I happen to think we can do better than that.
Tax Analyst
Janaury 14th??? Jeez, it doesn’t seem like it been over 7 weeks since you hurt yourself.
But I guess it does to you. That’s a long time to be banged up and uncomfortable. No fun.
I’ve really got nothing to add to your other comments. Your points are very salient
Tax Analyst
@Stephen:
After my mother’s death in 1985 I found my older brother’s ‘Baby Book’. He was born in 1945 in the medical hospital at the San Antonio AFB. The total bill was around $6. There were several items on it that was priced in penny, nickel, and dime units. Of course he was a normal delivery and that was probably a special price for an active service member.
pcbedamned
@Flugelhorn:
So basically, you are a “I got mine, Fuck you, American”.
The one thing it seems is the major complaint of any human loving, human being, who God Forbid, gives a damn about other human beings.
Just. Don’t. Get. It…
Tax Analyst
Hmmm…not sure why my post #155 is in moderation. I didn’t even swear, call anyone a soesyourlist or anything.
Maybe it was the acronym I used for “Air Force Base”.
freerangesteve
@Flugelhorn
A former co-worker of mine who lived in Canada and worked in Detroit contracted an ear infection. He was told by his Canadian doctors that it would be at least 9 months before he could see someone to have it treated. He was also told that by that time he would probably suffer permanent loss of his hearing in the infected ear. He is now deaf in that ear.
Oh, bullshit. I’ve had ear infections more than once and I’ve never had to wait more than an hour to see a doctor, unless the ER was crazy busy. 9 months??? Come on. That kind of stuff is just ridiculous. I’m all for debating pros and cons but lets keep it in the realm of reality, ok? Since we’re on the topic, I had an ear infection in Chicago, and faced with the possibility of a massive bill if I went to a hospital there (I can’t remember the cost, it was a while ago), I drove all the way back to Winnipeg instead. Once I got back, I went to the hospital and got treated. Again, paid for nothing.
If you want to debate the issue, I’m all for it, and trust me I know the Canadian system isn’t perfect (the French one actually seems pretty damn good from what I’ve heard), but no one can have an honest debate if one side is making shit up.
toujoursdan
No. In the U.S. you might die instead.
PacifiCare, for example, denied a special procedure for treatment of bone cancer for Nick Colombo, a 17-year-old teen from Placentia, Calif. Again, after protests organized by Nick’s family and friends, CNA/NNOC, and netroots activists, PacifiCare reversed its decision. But like Nataline Sarkisyan, the delay resulted in critical time lost, and Nick ultimately died. “This was his last effort and the procedure had worked before with people in Nick’s situation,” said his older brother Ricky.
Cigna gained notoriety two years ago for denying a liver transplant to 17-year-old Nataline Sarkisyan of Northridge, Calif. and then reversing itself, tragically too late to save her life.
In 2008, six days before RN Kim Kutcher of Dana Point, Calif., was scheduled to have special back surgery, Blue Cross denied authorization for the procedure as “investigational” even though the lumbar artificial disc she was to receive had FDA approval. At the time of denial, which she calls “insurance hell,” Kutcher had “already gone through pre-op testing, donated a unit of blood, had appointments with four physicians.” Kutcher paid $60,000 out of pocket for the operation and is still fighting Blue Cross…
“The routine denial of care by private insurers is like the elephant in the room no one in the present national healthcare debate seems to want to talk about,” Burger said. “Nothing in any of the major bills advancing in the Senate or House or proposed by the administration would challenge this practice.”
“The United States remains the only country in the industrialized world where human lives are sacrificed for private profit, a national disgrace that seems on the verge of perpetuation,” she said
California Nurses Association: California’s Death Panels Are Here
Secondly, did your friend try another doctor or hospital, because he would have probably received a different answer if he did. The wait times vary by condition, severity and treatment centre.
Unfortunately American face simliar problems:
The health-care reform debate is in full roar with the arrival of Michael Moore’s documentary Sicko, which compares the U.S. system unfavorably with single-payer systems around the world. Critics of the film are quick to trot out a common defense of the American way: For all its problems, they say, U.S. patients at least don’t have to endure the endless waits for medical care endemic to government-run systems.
In reality, both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems. Take Susan M., a 54-year-old human resources executive in New York City. She faithfully makes an appointment for a mammogram every April, knowing the wait will be at least six weeks. She went in for her routine screening at the end of May, then had another because the first wasn’t clear. That second X-ray showed an abnormality, and the doctor wanted to perform a needle biopsy, an outpatient procedure. His first available date: mid-August. “I completely freaked out,” Susan says. “I couldn’t imagine spending the summer with this hanging over my head.” After many calls to five different facilities, she found a clinic that agreed to read her existing mammograms on June 25 and promised to schedule a follow-up MRI and biopsy if needed within 10 days. A full month had passed since the first suspicious X-rays. Ultimately, she was told the abnormality was nothing to worry about, but she should have another mammogram in six months.
Business Week: The Doctor Will See you in 3 Months
freerangesteve
@Comrade Mary
Dude, STORMFRONT? Really? (Not that I think you’re a sympathizer, of course.)
haha I have no idea… It just came up in my Google search. Bad source?
I’d really love a legit breakdown of this tax stuff, I think the whole Canada/US tax discrepancy is mostly a myth. So long as someone approaches it honestly.
Totally agree with what you said.
Mike in NC
That must be why they call him “Lucky John”.
toujoursdan
@freerangesteve:
I have lived on both sides of the border. The tax/insurance burden is far worse in the States. Also, because of all the anti-tax hysteria there, the government charges far more in “fees” which are essentially taxes under a different name, than they do in Canada.
Mike in NC
AKA a Republican. Every single one of them I know thinks this way. One was visiting Australia several years ago and needed to go to a hospital for an emergency. He marveled at the quality and price of the health care, but muttered “but of course that’s socialized medicine !” when he got home.
Comrade Mary
@Mike in NC: Or, to take off from one of my favourite jokes, a guy like that, you don’t break him all at once.
freerangesteve
@toujoursdan
Exactly what I suspected… I get really sick of the whole “you guys pay high taxes” crap and you nailed it, they never account for premiums and fees. Add it all up, and then let’s talk.
And it really drives me nuts when people (Flugelhorn I’m talking about YOU) just make stuff up – if I hear one more “my friend had brain cancer and had to wait 4 years for treatment” stories, I’ll scream. It just isn’t the case. YES, ii is triaged to a degree, YES the system isn’t perfect, but I’ll take what we have over the US debacle every day of the week.
And… how many commissions and inquiries and high level meetings have been held over the years in an effort to improve the Canadian system? There’s a genuine good-faith attempt to improve things with one caveat – when you leave the hospital you won’t get a bill in the mail.
Health care should be the birthright of every citizen.
pcbedamned
@freerangesteve:
See my comment @115. Said the same thing. I have had this ‘discussion’ with many, many rabid American winger’s, and it doesn’t matter what you say, be it a personal anecdote, or facts, the Right Wing Propaganda Machine (aka FOX NEWS) has it all covered for them. Don’t even bother wasting your typing time…
@Mike in NC – That is too funny…
Phil
Interesting to read the different viewpoints. I note that those with US style insurance cover are always touting the quality of the care, “if one can afford it”. I was under the impression that some health insurance in the US had total payment caps (I’m probably wrong). If so, when do these caps kick in?
As a Brit who’s not at all impressed by the way our NHS (that’s nationalized, as opposed to this weird “single payer” label you seem to use) is run, I have to say I’d rather break my shoulder over here than over there. Yeah, it might take an hour or two longer in A&E, and I probably wouldn’t be seen by the “fell on ice whilst holding dog & broken shoulder” guy – he’d be just a “fell on ice & broken shoulder” guy, and maybe (maybe – who am I kidding) you’d be paying for your parking at the hospital, but at the end of the day you would be treated and fixed, and you wouldn’t be worried about the bills.
Of course, if you’re talking about dragging out a terminal illness for a few weeks more than would’ve otherwise occurred for half the inheritance, you have to go private for that here.
Mnemosyne
@Phil:
It’s not total payment caps — it’s caps on what the insurance company will pay for. If you reach your cap, everything has to be paid for out of your pocket from that point on.
The healthcare bills that passed try to change that dynamic by making it a cap on how much the patient have to pay out of pocket instead of a cap on how much the insurance company has to cover.
freerangesteve
@pcbedamned:
Yeah. So frustrating. I wish people would think for themselves…
Tax Analyst
@John Cole:
Damn, I just tried to catalogue my life history of unpleasant injuries and I can’t come up with more than about half the number you’ve mentioned here, and I’m a good 20+ years older than you. I believe more than a few of mine happen when I was somewhere around +5 or +6.
kilo
@Flugelhorn:
Well, enjoy your insurance. Enjoy your premium hikes, and the fights with the payment
denialprocessing department, and the fact that you can get nuked off the rolls of the insurable at the capricious whim of a for-profit company.In the system that I’m in, I can’t go medically bankrupt, I can’t be denied care to fatten somebody’s bottom line, I can buy supplemental insurance if I want better benefits, and I can always wander off to Rochester if I want premium care. And most of the time, I can get the province and/or my supplemental insurance to cover a good chunk of that too.
I think that’s a demonstrably better system than the one that you live in, but chacun a son gout.
Tax Analyst
@wasabi gasp:
I really enjoyed the image this brought to mind.
RedKitten
Nova Scotia has fairly mild weather, too. It’s not as mild as Vancouver, but it’s also nowhere near as expensive to live there.
Tim F.
@freerangesteve: Look up “risk premium”. The unpredictability of health care costs, especially the significant probability of absolutely catastrophic expenses, explains why no minor tax advantage would ever convince a Canadian small businessperson to relocate to the United States.
Some other incentive might do it, but for any sensible businessperson your tax argument is a joke.
JWW
John,
Just a minor disagreement. My family was covered by TriCare for life until the boys age put them out. I did not however pay for any dental plan for any of us. I know that what I paid out of pocket for dental care for three boys, myself and spouse was not even close to the annual premium. They had teeth knocked out, fillings, one set of braces, and annual care. My out of pocket vs any dental plan has saved me thousands of dollars. You can not say that insurance is always better than cash. Add up all the car insuance payments you have made in your lifetime and compare that to the costs to repair the vehicles that you were found at fault for the damage. I’m sure it would turn your stomach if you are a good driver.
The Truffle
YIKES. Dude, how do all these awful things keep happening to you?
slightly_peeved
@Flugelhorn:
The NHS costs half the price per capita of the entire US medical system – private and public. Half. And John Cole’s treatment for his shoulder would have cost him absolutely nothing.
More money out of their pockets my ass.
That being said – PTDB. Keep calling your congresspeople (great work, mcc). The current proposed compromise bill is a big step towards a Netherlands-style healthcare system, which may not be as cheap as an NHS but is a pretty good alternative.
David VanHooser
you will probably think i’m a jerk for saying this, but to
me you fall into a category that is just asking for suffering:
pet owner.i’ve seen it many times, but your case is the worst
i’ve ever seen.
CodpieceWatch
Last October, it was determined that my husband needed a hip replacement. It was scheduled for last week. We have insurance that we pay nearly $800 a month for. Beginning back in October, he (as well as the surgeon) began the approval process. We have had this policy for many years, and this is the first time we have ever used it. The surgeon was located 600 miles away, and the night before we were to leave to drive up there, the nurse called to say the insurance company had not approved it yet, and to call them in the morning. By morning, they had decided to deny it, and told him he needed to begin an appeal process which usually took about 2 weeks. He called the nurse back and she said to start driving – that she and/or the doctor would try and convince them to approve the surgery. Several hours later while in the car, we got the call that they had approved it. While it was a relief, I will also say that the stress endured the day before a major surgery like that is NOT healthy. A couple of days ago, we got a letter that said even though they had approved it, it didn’t necessarily mean they would pay – so we are back to square one again, worrying if we will be paying tens of thousands. Again, not very healthy for someone trying to recover. I wrote about this on the internets, and mentioned that the health care system itself was great, but that we’d be much better off if the insurance companies cared as much about their clients as they did their CEO’s bonuses. I got pounced on by some people who told me I shouldn’t say anything bad about the industry, that I didn’t know what I was talking about, and they charged what they charged because my health care providers charge a ton, NOT because the CEO’s got bonuses. Honestly, who defends this kind of thing and system? Was it the CEO of WellPoint or Blue Cross writing under another name?
Shirley
Dog must have gotten quite a scare, how is he?