« Fake Your Way to the Top! | Main | JetBlue’s Corporate Meltdown »

February 15, 2007

Comments

Anarcissie

BE: '... The odd thing is that many politicians and pundits believe that the only way to control health costs is to get consumers to limit their consumption of health care – as if an appendectomy, for example, was a kind of self-indulgence. ...'

It isn't the work performed that is the indulgence, it's the money spent on it. Someone, somewhere, somehow has to limit the money supply for any product or service, or the price will expand without limit. If consumers / clients / patients won't or can't do it, then the role will pass to authorities like insurance companies or the government. But the insurance companies and government personnel often have more in common with those taking the money than with those putting it up, as we can see from the grotesque charges mentioned in your story, and our insurance bills. This is why many people fear government medical insurance: it's Blue Cross with guns. You can choose not to buy the insurance, but you can't choose not to pay taxes.


Hattie

Our family is on the slipshod Kaiser plan. By today's standards it is not expensive, but we have to monitor everything they do.

Megan

Like Hattie, my family and I have found that we have to closely monitor all bills from our insurance company (Aetna for my parents, a branch of Aetna that covers university students for me). What infuriates us is that often a simple inquiry, like what I assume your son did initially to obtain an itemized bill, results in dropped charges. Like if you push them at all, all of a sudden their story changes. Which just makes me feel like I, and all the other clients (individuals and hospitals), are perpetually being ripped off. Which we probably are.

Anarcissie

It is not probable, it is just about certain. Several years ago when I went to pay for a minor medical procedure, they asked me if I was paying for it myself or using insurance. When I said "myself" they cut the bill to one-third of the nominal amount. I didn't fight it too much.

The question is what we're going to do about it besides say "Bad, bad."

Stephanie Anagnoson

A friend of mine had an appendectomy at a different hospital in LA last year for a mere $30K. I wonder what the itemized charges looked like.

Chris B

It is astounding that more people do not realise that they are getting a bad deal - somehow the line (from the AMA and others) that 'public health care will cost more' is allowed to stand in the face of the irrefutable evidence provided by Europe/Canada etc. Until the people are able to challenge this entrenched assertion, and counter the big money that is spent propagating it, there can be no change.

Anarcissie

The evidence from Canada and Europe can be refuted by pointing out that Canada and Europe have different cultures, internal conditions, and especially different "social contracts" from the U.S.

Tim Worstall

"One of your own orthopedic surgeons advised me to use another hospital."

That's why you don't want a single provider system like Canada or the UK. With competition between providers you actually do have somewhere else to go.

barbsright

Bens' bill sounds more like a new car 'sticker' that has a load of 'fake' items to push the price up. Mr. Issei must have started out as a new car salesman!

Anarcissie

Tim Worstall: 'That's why you don't want a single provider system like Canada or the UK. With competition between providers you actually do have somewhere else to go.'

That doesn't seem to work very well either, as the discussion here shows. Although we can't necessarily import the Canadian or German system, the fact that the people of those countries pay half per capita what we do for better service is a telling critique.

The situation is somewhat mysterious because one would think competition between providers of medical care and insurance would lead to better, cheaper products. But one should not forget that there is a great deal of authoritarianism in the form of state intervention and mystification in the medical system. That's how you find a bottle of saline solution costing $105, and pay for it, too. (You may not be buying it for yourself, but you're buying it for other people if you have insurance or pay taxes.)


realpc

Barbara E. wants to leave everything up to intelligent, wise, enlightened government adminstrators. Find some smart, greed-free individuals and let them figure out the correct prices. Simple.

She thinks the free market is evil, so we can't rely on that.

I know of examples where these problems did not occur, where insurance covered most of the bill. As long as hospitals are private and do not have a monopoly, patients can avoid the ones that cheat.

As the letter says "One of your own orthopedic surgeons advised me to use another hospital." Doesn't that answer her question:

"But where are the regulatory agencies that should or could be watching for this kind of thing?"

The regulatory "agencies" are freedom and information, and laws preventing monopolies.

realpc

I agree with Anarcissie, only competition can help prevent these abuses. The evil free market is the lesser of the other evils.

Ron Davison

We have no free market forces to lower prices. We have no government regulation or oversight to lower prices. Rather, we have insurance companies that chase after individuals who generally care little about comparing prices and are not in a position to do much about it if they could. (And of course, folks without insurance.) It is as though we’ve designed a system that takes the worst from market and regulations and pasted it together. Odd.

But we must be doing something right. We're in terrible shape and yet living longer than we have at any time in history.

chris

An American friend of mine developed cancer while living in England. After an initial diagnosis and considerable counseling on what to expect from the British socialized medical system, my friend and her English husband came to the US for treatment.

They made this decision despite having NO HEALTH INSURANCE. They had money in the bank. But no insurance.

They met with every doctor who treated her and explained the situation. They asked for each doctor's most favorable rates for each procedure.

In the end, her surgery and post operative care cost them $140,000. That figure was about HALF the retail cost. HALF.

Every doctor accepted compensation below his/her stated rates. They challenged every hospital bill.

Healthcare is expensive because Americans want every conceivable ailment covered in full. Yet MOST people between the ages of 15 and 65 don't have too many serious health problems. And we don't reward good preventative health practices -- like no smoking, minimal drinking, healthy eating and exercising.

It was hardly a shock or surprise when a colleague of mine keeled over dead a couple of years ago. He was way overweight, a huge drug and alcohol abuser who never exercised and he smoked. He was about 45 when he croaked.

Fortunately, he didn't run up a lot of healthcare bills on his way to his sudden death. He simply croaked and that was that.

A Canadian

The Canadian healthcare system isn't perfect but if I need medical care I know that the cost to me will be minimal. I may have to pay for a private/semi-private room, but that's about it. The only drawback to the Canadian system is that you are put on waiting lists for surgery etc., and the wait can be pretty long. My friend was postponed at least 4 times for surgery for breast cancer. No system is perfect, but at least in Canada ALL OF US have access to health care regardless of whether you have insurance or not. Of course we pay for it with taxes (which are pretty high, especially in Quebec where the money is spent on the language police rather than on "important" things like health care and education). Either way i'm willing to pay the price for peace of mind when I get sick.

Steve St-Laurent

Canada's focus is not on having a single provider of health care. Increasingly it's on having a singler payer, which is where the benefit of scrutiny comes into play. Interesting to note that a kidney transplant costs less here than an appendectomy does there. And the daily rate for a bed at St. Paul's [Vancouver, BC] is about half that at St. Vincent's, fully paid by the public system. I guess you have to pick your saints carefully – and thank heaven I was lucky to be born in a country that sees something as basic as health care as too important to be left in the hands of the pathological "free markets."

Anarcissie

Ron Davison: '... Rather, we have insurance companies that chase after individuals who generally care little about comparing prices and are not in a position to do much about it if they could. ...'

People could do something about it -- the middle-class ones, at least, could form cooperatives to operate HMOs, or even make the market work for them on the private insurers. But not more than a small minority seem willing to break out of the passivity, ignorance and dependence of the patient's role in the present medical system. The kind of people who will ask why a bottle of saline solution costs $105 and make trouble about it are few and far between. But the price of saline solution will rise until someone does make trouble about it, or at least stops buying it.

I don't see how having the state act as the single payer is going to solve this problem.

AnnS

"$154 for each of twelve one-liter bags of sugar water"

Those are maade by Baxter Travenol - they have about 95% of the market in the world.

The price for those when my husband was in house counsel with them several years ago was $1.98. Giving them some for inflation, BT would now be at about $2.65 a bag. That is the delivered to the door of the hospital and stocked price.

I once had a client who lacked insurance and was being sued by the hospital. As part of discovery, I demanded an itemized bill. I then demanded and recieved the wholesale cost of the items which the hospital had paid. I then informed the hospital's counsel that we would go to trial over the amounts charged since when one went in the door, one did implicitly agree to pay a reasonable amount for services but that did not mean $35 for a Tylenol nor $15 for box of kleenex or $100 for an IV bag which cost them $2.

To say that my opposing counsel was terrified of the idea of trying to explain such charges to a jury was an understatement. They promptly agreed to settle for basically 15 cents on the dollar - and take very low payments for the next 5 years.

____

By the way the idea of the consumer 'negotiating prices' or comparison shopping for healthcare is a joke in most areas of the country. How does one 'negotiate' with the only hospital within 70 miles about the cost of a broken ankle or appendicitis?

Anarcissie

AnnS: '... By the way the idea of the consumer 'negotiating prices' or comparison shopping for healthcare is a joke in most areas of the country. How does one 'negotiate' with the only hospital within 70 miles about the cost of a broken ankle or appendicitis?'

Through collective action beforehand -- by forming, for instance, a cooperative medical insurance company or HMO. What built and administered the hospital was a form of social organization. It can be replaced by a different kind of social organization.

Joanna

I believe that some hospitals pad their insured patients' bills to pay for the costs they incur from treating uninsured patients. Then, of course, there are the massive salaries and junkets for board members (recently revealed in a number of cases here in Minnesota).
The idea that someone who has to go to the ER for appendicitis, or symptoms of a heart attack for that matter, can comparison shop beforehand, is a sick joke. What happens in fact is that people without health insurance DO comparison shop: go to the doctor or eat? go to the doctor or pay for child care? then we end up bearing the costs when their illnesses have to be treated through the emergency room.
When my daughter, who has Spanish citizenship, has needed emergency health care in Spain (stitches, a broken bone) or routine care for ear and throat infections, we have always received prompt, excellent care for free. Free. Spanish care is so good that Swedes are known to establish Spanish residence in order to get knee replacement surgeries done there because it is better. Yes, there are issues of waste, or complaints to be made there as here, but if you are unemployed in Spain you do not need to WORRY about your health care. Think what a difference that would make to the lives of so many millions of people here.

KateCoe

IF Ben was "researching" surgery for his "friend", why did she end up getting free care at an overburdened County-USC emergency room? How long did she wait between breaking her ankle and her "emergency"? Here's his op-ed in the LAT:
http://www.latimes.com/news/opinion/la-oe-ehrenreich14feb14,0,6987237.story?coll=la-opinion-center

J. X. Rodriguez

I believe he said the girl friend didn't have either the money or the insurance (several thousand dollars?) to cover the medical care involved. Not much of a mystery there.

Mel

I had the same sort of experience recently. It never occured to me to write to the hospital and complain. I guess hospitals bank on people like me who just accept the fact that a hospital can charge us 10 even 20 times the retail value of things we can get at the pharmacy. In my case, it was a pregnancy test costing in the three digits. :(

realpc

Why are insurance companies willing to pay inflated hospital prices?

Anarcissie

They don't. _You_ do.

Amy Alkon

I believe he said the girl friend didn't have either the money or the insurance (several thousand dollars?) to cover the medical care involved. Not much of a mystery there.

Why didn't they? Even at my most struggling as a freelance writer, when I was so down and out I was forced to take a job for $5/hr for an all-girl moving company, and when I couldn't afford a bed (I slept in a sleeping bag on a door propped up on two milk crates) I had health insurance. Why? Because I would be horrified at the thought that somebody else would have to pay for me. A pity more people don't feel that way.

An HMO or high-deductible health insurance can be had for not a terrible amount of money. In my 20s, I paid $100-something a month -- maybe $130? -- for Kaiser Permanente HMO. At 42, it costs me $258.

If you're dirt poor, that's one thing. If you decide to gamble the money you could be paying for health insurance on, say, new shoes...well, that's another thing entirely.

Ms. Ehrenreich, as long as you're "blowing the whistle on medical larceny," how about blowing the whistle on those who use the emergency room for apparent non-emergencies and use the rest of us to fund their health care instead of paying for it themselves?

Amy Alkon

This first bit I posted above, a previous comment from J.X. Rodriguez, should have been in quotes:

"I believe he said the girl friend didn't have either the money or the insurance (several thousand dollars?) to cover the medical care involved. Not much of a mystery there."

I believe I tried to italicize it. Either I forgot or you don't have HTML enabled for comments.

Anarcissie

Amy Alkon: '... If you're dirt poor, that's one thing. If you decide to gamble the money you could be paying for health insurance on, say, new shoes...well, that's another thing entirely. ...'

If you don't know the financial condition of the people you're talking about in detail, you're out of place criticizing them.

In any case, the unwise or even unethical allocation of personal funds by other people doesn't really alter the fact that many medical charges are grotesquely out of line, nor does it suggest a solution to the problem, so I don't know why you introduced it.

Amy Alkon

I didn't "introduce the problem," Ben Ehrenreich did by doing an op-ed in the LA Times about it. Furthermore, his premeditated attempt to get non-emergency care at the overburdened county USC emergency room is disgusting. According to his op-ed, her circumstances: "She was between jobs and between health insurance plans."

Again, when I was "between jobs," I didn't gamble that I wouldn't have a medical condition, nor did I expect others to pay my way. I worked really bad jobs out of a sense of personal reasponsibility and paid my health insurance, as I do now. See the bit about my $5/hr job as a mover above.

"We couldn't afford the thousands of dollars the surgery would have cost at a private hospital." Translation: "We'd rather not pay the price of her gamble that she could go without paying for health insurance, so we're going to sneakily make other taxpayers pay instead by going to an emergency room for trauma patients with a pre-existing condition."

I'm guessing Ehrenreich didn't mention the girl's name in the paper because he doesn't want them to send her a bill, which they should. How is what they did not theft?

What's most disgusting is that his own mother apparently thinks nothing of this. The day I brag to my parents that I've gotten my significant other free medical care "on the dole"...well, I'd be hearing about it for decades, and not approvingly.

Van der Leun

"how the medical system shamelessly gouges us. Yes, we need universal health insurance, and United Professionals, the new organization I helped create, energetically advocates for it. "

Well bully for you. "Gouges?" In case you haven't noticed it takes a lot of hands to run a 24 hour ER/Hospital and nobody has yet figured out how to automate it. Health "Care" involves a lot of handicraft on the human body. You want to cut the gouging? Cut out the hands that are needed.

What do you think costs more, a factory made coffe cup or a hand-thrown, hand-glazed mug?

Feel good groups going about advocating that people other than you and your son reach for "their" wallets so you don't have to are not the answer.

You need money for health care but don't want to shell out for it? Reverse mortgage.

taloo

I always thought the Americans who don't have health insurance didn't because it was so expensive. If you're driving a new vehicle around town and you could walk, bike or rapid transit the trip, buying new books by the armload, have a house that is big enough for six with a half-acre property I see why you don't have health insurance. You've got the money, you just chose to spend it on something else. Here, even though my province isn't supposed to charge a premium for Canada's universal health care it does. And I pay, before I buy anything that is not an absolute necessity; which means rent on a studio apartment, food of the basic cook it yourself genre, and manage without cable. Since I work at home, I need the internet. But Americans, yo are too damn spoiled. If I am healthy and my neighbour is not, my taxes pay for his chemo. That's the way a democracy works. Someone up thread noted how good American health care is (more of less those words). I know you're one of the ones who can afford it then, because it isn't good for 50,000 of your fellow Americans. Here, healthcare is better than yours (UN) and that's for everyone.

Amy Alkon

" You've got the money, you just chose to spend it on something else."

Exactly. Kaiser Permanente is very affordable.

http://www.kaiserquotes.com/

Many people just choose to gamble, then expect others to pay for them. Like you, my health insurance is what I've always paid first.

Barbara E

Amy: You have to go through the ER if you want to have surgery at LA County. Although I think not being able to walk and being in terrible pain probably does count as an "emergency" anyway. And believe me, this young woman has not been "choosing" to spend her money on things other than health insurance -- what a privileged perspective!

Thena in Maine

Yeah, if you're choosing to spend your money on things other than medical insurance, chances are it's because you're choosing to spend it on things like rent, groceries, utilities and transportation. (Note to urban dwellers, public transit is great but it's not a universal option, and in areas where it's nonexistant or woefully inadequate, an old beater car that requires frequent repairs and guzzles expensive gas may be practically unavoidable.)

Anarcissie

Five dollars an hour take-home times 40 hours a week times 4.2 weeks in a month adds up to just $840 a month, which barely makes the rent in most places these days. Say you got a studio for $600, then you'd have about $60 per week for food, transportation and clothing -- and you couldn't go too cheap on them because you'd have to get to that sweet $5-per-hour job. I don't see where the money for medical insurance (I pay $280/month) would come from, even if you were really, really efficient about squeezing every nickel.

Amy Alkon

"And believe me, this young woman has not been "choosing" to spend her money on things other than health insurance -- what a privileged perspective!"

Why doesn't she get a job? Maybe she can't get a great job -- maybe not in "Ethnic Studies," if she is who I think she is -- but there certainly are jobs for those who can work. See above, when I wanted to work as a writer, but was forced to take a job as a mover.

Again, it's a personal responsibility thing.

FYI, Anarcissie's not taking the facts into account. Here's a little more info: I made $5/hr when I was in my 20s, and it was an anomaly, and I'm now in my 40s, so it was about 20 years ago. During that time, I worked my worst job ever -- dressing up as a chicken and handing out flyers to hostile NYC pedestrians.

Furthermore, I didn't have a bed at that time -- I slept on a door propped up on two milk crates with a sleeping bag on top. I rode my bike to get around to save money on transportation, and ate beans a lot. But, I paid my health insurance, and I'd never expect anyone else to pick up after me.

So, why can't this girl work? Or is she just too cool to take a job as a barista? I believe Starbucks pays health insurance for their employees who work over 20 hours a week.

Amy Alkon

"A few weeks later, I was doing a little research to find out where to send a friend who had broken her ankle in New Mexico and needed surgery in Los Angeles. "

Sounds real urgent to me. She came all the way back from New Mexico, gave him time to figure out where she could get other people to pay for her care, did more research about the best time to get other people to pay for her care, and then got to the inner city emergency room in a private car...clogging it up for inner city people who might come in with something a little more urgent; say, a gunshot wound. How long was the period between the time when she broke her ankle and got to the "emergency" room?

Anarcissie

Amy Alkon: '... FYI, Anarcissie's not taking the facts into account. ...'

Neither are you, however. I suspect that neither one of us know what the facts are in this case. However, if you're making $840 a month and paying $600 in rent, which isn't unlikely, you couldn't buy medical insurance even if you ate out of a dumpster. Things are not as they were in hippie days -- I was there, too. At one time I made ninety cents an hour and turned down a nice basement dwelling (no windows, but lots of heat) because the landlord wanted $50 a month. Too rich for my rather short pockets!

I thought the interesting thing in Barbara's story was the price of medical care. Doesn't seem to pique _your_ interest a bit. Own stock in a big pharma company these days, or what? There'll always be chiselers; why not look for the big ones?


Glaurung

"I believe that some hospitals pad their insured patients' bills to pay for the costs they incur from treating uninsured patients."

In addition, the hospital has to pay for the cost of billing and paperwork. Even for insured patients, since most American insurance plans don't cover 100% of services, and don't pay 100% of those they do cover. The hospital has to send out bills and paperwork to each patient's insurance company, wait for payment, then send out a second bill (with more paperwork) to the patient for the residue. If the patient has some kind of medigap coverage, then that's a third set of paperwork and a third set of bills. All this to-ing and fro-ing adds up; the statistic I remember seeing was that about 40-50% of healthcare costs in the US go to billing and administrative overhead. Compared to Canada, for example, where administrative and billing costs are under 10%.

I live in Canada but am not a permanent resident so I don't qualify for the government health insurance. When I've had to get health care up here, I've noticed that the bills are almost always lower than what I would expect to pay in the US, even for services that aren't covered by the government insurance. People who think government-run health insurance would necessarily be less efficient than private insurance need to take off their ideological blinders.

Amy Alkon

"I suspect that neither one of us know what the facts are in this case."

That's because Ben Ehrenreich is keeping the woman's identity a secret. I know her identity -- her initials are O.C. I've e-mailed both her and Ben, and Ben's e-mail says he's out for a month, and she hasn't picked hers up.

"However, if you're making $840 a month and paying $600 in rent, which isn't unlikely, you couldn't buy medical insurance even if you ate out of a dumpster."

In my 20s, in the 80s, I made $5/day once, working as a mover. I made much more, another day, working as a chicken. The point is, I took personal responsibility to earn money to pay for my health care, rather than sucking off the public trough.

I find that utterly disgusting, and I wasn't raised that way. Apparently, Ben Ehrenreich was, and has zero shame about doing this.

What could she have done? Pay the price of her gamble that she wouldn't need health insurance, and pay it off over time.

Ben, likewise, doesn't think to negotiate down the prices. It can be done -- if you're not too busy wussily complaining about them instead.

And as Glaurung points out, there are overhead costs.

Furthermore, about that "free" medical care in France, a friend of mine who lives there, married to a French woman, pays 65% of his income in taxes. That's not free health care, that's exceptionally expensive health care.

As for Canada, I particularly liked the story above of the woman who got rescheduled for breast cancer surgery a bunch of times. That's got to be great for your mental health!

Again, as a middle-class newspaper columnist, I have Kaiser Permanente HMO. It's not Cadillac care, but then I'm not paying Cadillac prices. I could pay less than the $258 I do, but I pay only $25 per office visit, and $25 for six months of medication that would cost $360 if I just went to a drugstore. I have an excellent doctor, because I researched who was the best doctor in my area, and campaigned to be her patient (even though she wasn't taking new patients). Moreover, when I had a primary care physician who denied me care I thought I needed, based on family history, I appealed her judgment (I wrote her two letters and spoke to her on the phone) and she agreed to send me to a specialist. When you don't have Cadillac care, sometimes you have to be a little more engaged in your medical care, but I accept that. I use the money I save to pay decent wages (plus paying for lunch, gas, and bonuses) to an assistant -- instead of doing something too many socialist types do: having an intern, which I consider unethical.

Anarcissie

Amy Alkon: 'In my 20s, in the 80s, I made $5/day once, working as a mover. I made much more, another day, working as a chicken. The point is, I took personal responsibility to earn money to pay for my health care, rather than sucking off the public trough. ...'

That's terrific, but it doesn't change the laws of arithmetic. There are many people who cannot pay for medical insurance and rent at the same time, much less eat. Maybe "O.C." is one of them -- I'm not terribly interested in finding out.

You're right about there being no free medical care, regardless of whether it's paid for by the government or insurance companies or individuals. However, I don't think it's the ambiguous possibility of small-time chiseling here and there that inflates costs here in the U.S. Nor do I think it's labor costs -- the personnel don't seem particularly well-paid these days, except for higher management. It is something that better be figured out before (as I said before) we give the medical care system the power to collect all the money it wants through taxes. At least now one can elect to save money by remaining sick or dying. In the future, there'll be no escape.

Finally, I don't see your problem with interns. It's a voluntary relationship where one person is supposed to be getting paid off by exchanging work for knowledge and training. But that's off the subject.

Amy  Alkon

"There are many people who cannot pay for medical insurance and rent at the same time, much less eat. Maybe "O.C." is one of them -- I'm not terribly interested in finding out."

Since I'm a taxpayer, and thus, paid for her medical care, I'm very interested in finding out. Maybe if more people cared, there'd be less scamming, and medical costs would go down overall.

As for the "voluntary relationship," from the way you put it, I wouldn't be surprised if you have an "intern" working for you. Amazing how you rail against exploitation in one paragraph and shrug it off in another.

Amy  Alkon

I forgot to add:

I COULD have somebody work for me for free; I just don't, because I think it's wrong. As for the "training" interns get, give me a break. I mentor my assistants, and just this weekend, spent over an hour reading and commenting, in writing, on a piece my assistant wrote, then discussed it further with her on Tuesday, after my deadline. I see, as part of my job with my assistants, helping them grow out of the job. At the moment, I pay my assistant, who works for me part-time, $14/hr, and I give her bonuses whenever I do a magazine article, and when I mail-order Ristretto Roasters (gourmet) coffee, get her a bag, too. Pretty nice for a capitalist pig, huh?

How many lefties treat the people who work for them like that? How many, who make much more money than I do, have "interns"?

Anarcissie

1. I don't have any interns. However, I worked as one for an animator last summer because I wanted to learn how she does her stuff, and I consider my time to have been very well spent. It doesn't seem exploitive to me, nor does it seem to have anything to do with Left versus Right. Nor does being nice.

2. I think cheating on the part of low-income patients is a very small part of the general problem of medical costs. That is why it doesn't interest me. If you think it is, though, extracting the money from everyone by means of taxation should appeal to you -- only the rich, with clever accountants and tax lawyers, would escape.

Neither pursuing cheaters nor the rich, nor funding medical care through the government, will solve the problem of the $105-dollar bottle of saline solution. If they, whoever they are, can make it $105 they can make it $205 or $305, and if they have IRS collecting the money for them, they probably will.

Amy  Alkon

I prefer lower taxes and less government interference, and I'm for catching cheats whether they're corporate or private citizens, as it sends a message that is clearly sorely needed.

The hubris of a guy bragging about gaming the system and making the rest of us pay the cost of his girlfriend's apparent gamble is astonishing to me. I wasn't raised that way -- to suck off the labor of others, or to think it's okay. Clearly, others' mileage varies.

Antigone

Anyone who says they've never had anyone pay for them is a liar, Amy. You were once a kid, at the very least. That's "sucking off the labor of others".

Amy  Alkon

ANTIGONE SAYS: "Anyone who says they've never had anyone pay for them is a liar, Amy. You were once a kid, at the very least. That's "sucking off the labor of others".

Wow, you're scary. Or frighteningly dim.

I've also been treated to meals by friends.

It's not the same thing. Do you really need that explained to you?

Work Ethic Dropout

There is a very odd notion floating in this forum and just about everywhere else where the health care crisis is being discussed: that is the notion that a person without health insurance has only to show up at an emergency room, or maybe just show up at a hospital, and he or she will receive free care. The notion goes on that as a result of this free-riding parasite, health care prices are higher for the rest of us.

I don’t know what things are like in California or Los Angeles, and I’m sure there are many, many different arrangements for public health access in cities and counties across the country. But what is the evidence that someone can walk into any hospital--public, for-profit, or not-for-profit—and get services without getting a bill? Unless you can show an insurance card, or a Medicare or Medicaid card, won’t the hospital and doctors try to collect their fees? There are numerous other programs, too, but if you don’t qualify for a program, and if you don’t pay, won’t you be harassed by bill collectors, possibly get sued and risk having your wages garnisheed and your assets (if any) taken for payment?

The Stroger Hospital of Cook County, the public hospital of Chicago, began in 2006 to prominently post their fees and charges. As of July 2006, the list showed $2,390 per day for a semi-private room for non-critical patients, $557 for upper-gastrointestinal series exams, and other fees and charges for all manner of services. True, Stroger often bills for services according to income, but it’s anybody’s guess what the guidelines are—you would have to spend a good deal of time with a social worker or benefits manager to find out your options. If you go to this or any hospital and cannot show the proper degree of indigence—and you have to be very poor, indeed, to be eligible for Medicaid—I expect you will get a bill to pay, just like over at the Daughters of Charity. I am not buying this bizarre idea that it is the uninsured and not the cost of care that is the problem with our system.

(See also: “County Hikes Room Rates at Valley Medical Center,” The San Jose Mercury News, regarding a public hospital in Santa Clara County, http://www.keepmedia.com/pubs/MercuryNews/2006/06/07/1622430?extID=10032&oliID=21).

Monica

I don't think that getting free or less expensive care for a problem like a broken ankle is cheating, unless the person is rich but won't pay. As long as this is a real medical emergency a patient can't handle without help, as opposed to something like an annual check-up or a cold, of course the patient should be helped. The problem is that health care is a business. What I would suggest would be having salaried medical personnel paid by the government to provide free or very affordable care for emergencies. Less urgent care or anything that is merely a good idea (even things like vaccinations, now taken for granted, are not emergencies) would be provided by the private sector, and perhaps also by those salaried physicians, but for a fee. Moreover, medical personnel should be required by law to discuss with patients each and every treatment, or any other product or service that is provided and later charged. For instance, some IV flushes and transfusions may be merely helpful, or part of the standard practice, but not absolutely necessary. There is no need for $35 pants. Either the patient should be allowed to provide the pants or, if some medical reason such as making sure they are sterile exists, the hospital should consider that this is part of what it takes for the treatment and provide them for free. Prices should also be capped by law. That being said, for someone whose life was saved, owing over $3000 for that may not be that unreasonable, provided that the bill comes after and care is not refused. As for employment at Starbucks, some people may prefer other jobs, be unable to work there for some reason such as needing to sit down or not being "people persons", and it's just not fair to have to sell today's health for the opportunity to get treatment later. Or, except in moderation (and even then, accidents are possible), work is a health risk.

Needless to say, if any services, such as vaccinations, are in fact required by somebody other than the patient (by some school or employer, for example), whoever is imposing such a requirement should pay. And things like braces or birth control pills, that are really a matter of choice and convenience for the patient, should simply not be covered by insurance, unless more basic options are available at affordable rates and the patient chooses a more expensive insurance option.

Gaby

Another perspective to this is also many people's mistrust of insurance companies. How often do we hear stories of people buying insurance and when putting in a claim not get paid for some exclusion clause or another. Best current example is the the hurricane fallout from Katrina. Buying health insurance on my own would be a very frightening experience and I am sorry, I cannot see myself walking into the hospital administrators office right now to negotiate fees in case an illness or accident strikes. How absurd!

Barbara E

Amy -- I checked and you can't get any treatment for anything at LA County without going thru the "emergency" room. This is true for cancer as well as broken ankles.

PS: I've never had an intern.

Vanderleun

Well, how it works in the wastelands of Orange County for things like broken ankles or other routine medical procedures if you are too cheap to pay insurance is that you pop into the private walk-in clinics that litter the landscape around here and pay for it with a credit card, cash, or check. I wouldn't advise that for cancer, but it seems to be a reasonable "pay as you go" set-up if you don't want to just sponge off the system.

If sponging is your game, SoCal presents the would-be medical services thief with numerous opportunities to obtain fraudulent identity cards and SocSec documentation to game the ER system. That way you can get the hundreds or thousands in services for free with the bill-me gambit. Just have the invoices sent to a vacant lot in West Covina and, hey, Bob's Yer Uncle.

Amy Alkon

For those who dream of government-paid health care, let me tell you a little bit about how that'll end up working. I just got off the phone with an old-boyfriend -- a doctor who performs liver transplants at one of the best hospitals in the country. Guess how much he makes for a Medicaid patient: $30/hr. He lives in NYC. He told me, "I can't get a plumber for $30/hr."

Doctors go to school for years and go through grueling training. Who's going to do that to make $30/hr?

So, still no answer from Barbara, Ben, or the Chicano Studies lady with the broken ankle: Who is paying for this girl's care? Is it us taxpayers? And, if so, even in part, how much?

If we are paying for it, does she think it's okay to sponge off the rest of us? Do you, Barbara? Does your son?

If somebody's poor because they got cancer and didn't have the energy to crawl to work, that's one thing. If somebody's got no health care because they were too big to take a job at Starbucks...well, how about they put it on their credit card, not my tab?

Amy Alkon

I didn't read all the comments above -- just went back and read the one about how doctors should stop and discuss EVERY LITTLE IV bag.

You people should get out more -- you know, into the real world.

A couple weeks ago, I kept a very ill friend company at Cedars Sinai for a few days. Her doctor finally got to her at 8pm, exhausted, to deal with something rather serious. Like my friend making $30 for Medicaid, I don't think a doctor's time is best spent helping you haggle over whether you should pay for the cheap pajamas or crawl across the street to the 99 cent store for a better pair.

Monica

Yes, it is very well spent, considering that all kinds of things are pushed on people just because that's the standard procedure and all that costs money. A patient needs medical treatment, not pants at $35 apiece just because that's what the hospital wants. And the doctor can afford it better than a patient for whom $30 an hour is not too little but a huge salary he can only dream of.

AnonE.Mouse

I work in a busy emergency room like the one Ben Ehrenreich describes.It's not dissimilar to the assembly line that I worked on 30 years ago while attending school,one difference being that then the union guaranteed us breaks at regular intervals.Not only is the emergency room the primary provider for the uninsured population,it's also an extension of attending's offices,where they send their patients for much of the testing needed to clear insurance hurdles for admission.If Ben is dissatisfied with the subsidised care his girlfriend recieved there or the(implied)racially motivated attitudes of the staff,maybe he could emulate his mom and take an unskilled job in a busy urban emergency room and experience 8,10,or 12 hours of non-stop activity from the worker's viewpoint-they'd be the first ones to tell you there's a problem with the health care delivery system in this country.
That being said,as a provider I am 100% for the idea of single payer universal health care in the United States.As it happens,my hospital is across the river from Windsor,Ontario and,being a teaching hospital nationally recognized for some of the medical specialties provided,we recieve the occasional Canadian citizen for certain elective and mostly emergent procedures.Many of my co-workers are like the poster upthread and interpret this as a failure of the Canadian system,which I have to concede-partially.However,I remind them that if you were to double per capita spending in Canada to our level(or alternatively,cut in half our per capita spending),a different picture would unfold.I've been told(but cannot verify)that right wing advocates of privatisation in Canada have been successful in underfunding the system there.I also point out that at that lower per capita spending,Canada still insures all of her citizens,while in the US we have 33% of our citizens under age 65 uninsured and a significant number underinsured by Medicaid.Call an orthopod and see how soon you get your appointment when you tell them you're uninsured or a Medicaid recipient.
In terms of the rubber meeting the road,i.e. actual patient care,we've managed to construct the least efficient health care system in the developed world.Almost a third of the spending on private insurance is devoted to administration costs(versus approximately 7% on Medicare,the last time I checked).Of course,one downside to single payer would be the sizable number of office workers knocked out of work.Maybe they could be retrained in patient care-you know,what health care is supposed to be about.

Anarcissie

Amy Alkon: 'For those who dream of government-paid health care, let me tell you a little bit about how that'll end up working. I just got off the phone with an old-boyfriend -- a doctor who performs liver transplants at one of the best hospitals in the country. Guess how much he makes for a Medicaid patient: $30/hr. He lives in NYC. He told me, "I can't get a plumber for $30/hr." ...'

Yes, as I said before, I don't think it's labor costs that are driving up the cost of medical care. But this raises the question: Who's getting the money?

This is something the advocates of Single Payer need to address, as well as those who favor the present system of anything like it. Having the government administer or regulate anything does not tend to make it more efficient, nor does it guarantee that people will not find ways to game the system. Quite the contrary: governments, like all bureaucracies, have to operate on long lists of rules, and long lists of rules are always less clever than live human beings. In fact, most of them are less clever than a wooden post.

If, indeed, concentration in a single collector and payer of insurance was more efficient than the present Byzantine mess, then we should have seen concentration in the industry resulting in just that outcome. Why don't we? In any case, why haven't market pressures driven costs down or production up?

You all had better figure this stuff out because you're going to pay for it, one way or another. Reciting mantras like "Single Payer" or "Free Enterprise" isn't dealing with the problem.

AnonE.Mouse

Physician compensation is responsible for approximately 10% of health care spending in the US.Doctors are extremely well paid in this country compared to other developed countries(well paid over twice as much,in fact).Of course,labor costs also include others involved in direct patient care such as nurses,radiology technicians,respiratory therapists,etc.,as well as janitors,cafeteria workers,maintenence,etc.
As I alluded to previously,approximately 30% of spending in the private sector is 'administrative' versus 7% for Medicare.How exactly do you define efficient?
Costs of pharmeceuticals are also very high in the US compared to our first world counterparts,again largely due to protected markets and alot of money(30%) spent on marketing and advertising in that industry.I'm sorry,but I have no knowledge as to what percent of health care costs drugs comprise.

bpb

we definitely need a universal (socialist) health care system . . . too many people cannot afford insurance and have no way to receive medical assistance. lots of these folks may work 2 - 3 jobs and still barely make ends meet.

Anarcissie

Bob: 'we definitely need a universal (socialist) health care system . . . too many people cannot afford insurance and have no way to receive medical assistance. ...'

You are conflating socialism and welfare, but they are two different things. Socialism is the ownership or control of the means of production by the workers. Welfare is the provision of a good or service to people who cannot afford it as a government service. You can have one or the other, or both, or neither, and they can be done well or badly, but they are not the same.

All other things being equal, the main effect of raising welfarized medical care in the U.S. to middle-class levels and "socializing" it would most likely be to increase the charges for the middle-class payers, since I assume, based on report and direct observation, that the poor are presently underserved or not served at all. Some may feel that this improvement would be proper but many of those middle-class payers might not agree. This is in fact one of the major political problems of Single Payer.

Some people hope that by centralizing medical care payment we can make it more efficient and thus cheaper. However, centralizing things does not always make them more efficient. If there are already a lot of leaks in the system, and I'd say the story that begins this section describes plenty of leaks, these may well be carried over into a system paid for out of taxes.

(By "efficient" I mean obtaining the best ratio of value to cost. Since people's values differ, their notions efficiency will also differ. However, I think our notions of medical care and payment efficiency are probably fairly similar.)

barbsright

The real problem in healthcare is systemic. It is very hard to compare prices, and quality. Imagine how much we would pay for food if we could not compare prices, and quality? I am working on my healthcare system reform proposal, and will send a copy to Barb when it is complete.

Anarcissie

I am curious as to why there are no cooperative HMOs or other medical insurance - medical care organizations. Except, I believe, in Wisconsin.

The management of cooperatives are highly motivated to keep prices down and quality of service up, because if they don't they may get voted out. Yet certain areas of business seem closed off to them, like banking and insurance.

chris

test tube

chris

Anarcissie, you wrote:

"I am curious as to why there are no cooperative HMOs or other medical insurance - medical care organizations. Except, I believe, in Wisconsin."

Probably because doctors, who are not selling a commodity, can find higher pay and better working conditions in venues that offer what they want.

An HMO or medical co-operative may enjoy high demand from consumers for what it hopes to offer, but the co-op may have a huge problem finding doctors to supply services at the rates such an organization would hope to pay them.

You also stated:

"Yet certain areas of business seem closed off to them, like banking and insurance."

Where did you get this gem? The biggest competition to the banking business comes from Credit Unions.

In the US there are about 2,000 savings banks, about 7,000 commercial banks and almost 10,000 credit unions.

The credit unions enjoy favorable taxation (they don't pay any) and usually enjoy enhanced access to specific and attractive groups of consumers.

Meanwhile, it seems that the hue and cry over runaway healthcare costs amounts to a plea to the gods for the deliverance of the Wal-Mart of Medicine.

Would a medical Wal-Mart face the opposition the retail version encounters?

Would consumers rebel against an organization that acquired its most important asset -- doctors -- from Caribbean medical schools, from Mexican medical schools, from the medical schools of other lagging nations?

Would consumers complain if their x-rays were read by radiologists in Mumbai? If local assistants gathered patient data while doctors in another part of the world interpreted it?

I think Wal-Mart should enter this field. If any organization could improve pricing for the benefit of consumers, it's Wal-Mart.


fedup

Insurance companies enter into contracts with doctors and hospitals. The provider will get their $$ no matter what, as long as you're insured.

Try shopping around when your are ill.

If you have NO insurance, you are screwed! You will make up for everyone else!

I know this from experience.

slapdash

Here are a couple of facts:

1. Women use far more health care then men at all stages of life.

2. Women outlive men by 4 1/2 years.

It is not an accident that feminist / socialists Like Ehrenreich want socialized medicine. It is just one more way to take money from men and transfer it to women. Progressive income tax hits men far harder and our alimony laws are stuck in medevil times (the 1950s).

I am not interested in having a yoke placed around my neck to support a bunch of post-menapasual malcontents.

PAMom

My son's fiance had to work 2 waitress jobs because neither would put her on enough hours to get benefits. Then she finally switched to a job with a national chain and benefits. When she went to a Dr. for a sore throat he sent her to a specialist and for tests. (Because she had benefits?) She paid for the initial Dr., hundreds for the specialist and 3 hundred or so for the tests to find out that she had a strep throat. Because she was "insured" she couldn't pay their sliding scale fee but had to pay the rack rate. Unfortunately the deductible was $1000 so she ended up paying around $600 plus an expensive prescription. For a sore throat! That was enough to push her finances over the edge and sour her on insurance and medicine in general.

Paul

Doctors and particularly surgeons are overpaid. This is a common fact in society, but they have the most powerful union going so nobody does anything about it.
The monopoly they run and the fees they charge are just an outrage.

Mark Mager

We have to eliminate some outrageous myths, that our neighbours in the U.S. have been fed for years, about Canada's health care system. First of all it is not "free" and it does not ensure "equal access" as some of our phony and dishonest politicians like to claim. Unfortunately, many of my fellow Canadians have bought into these big lies which even many of our American friends have swallowed. The seriously flawed docu-comedy "Sicko", by the famous comedian Michael Moore, conveniently overlooked/ignored the nastier, uglier and deadlier side of our Canadian health care "Utopia". Canadians pay approx. $55 billion dollars every year for health care that is rationed and which provides limited access to our vulnerable patient/victim population. Canadian health care is "equal" to all, only in that most Canadians are "equally" deprived of timely access and care. The wait times for various tests, like CT, MRI etc., are much longer than in the U.S., and our American neighbours have 4 times as many, per capita, of those life saving machines than we do in our Canadian medical "Mecca". In fact, various Canadian media have just reported ( Aug. 2008 ) that Canada is only average among the "wealthy" countries when it comes to access to such machines. When you consider that we have a lot more wealth and resources, per capita, than those other "average" countries, then it becomes quite clear that we should be in the lead with such medical advances, not "average". Some of our phony and disingenuous "patriots" think that by yelling and screaming, around the world, about our health care "Utopia", they will be able to hide the nastier, uglier, more dangerous and deadlier aspects of ending up at the mercy of that medical "Utopia". Canadian hospitals kill approx. 24,000 patient/victims by medical errors (misdiagnosis, negligence etc.) every year, and a further 12,000 patient/victims due to "poor hospital hygiene" (hospital "super bugs" etc.). Another 140,000 patient/victims are sickened, assaulted, injured or maimed by our "holier than thou" medical establishment. Those are atrocious numbers for a country of only 33 million people. Signed, Mark Mager of London (our medical "Mecca"), Ontario, Canada.

Sarah

I recently came across your blog and have been reading along. I thought I would leave my first comment. I don't know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.

Sarah

http://www.lyricsdigs.com

Verify your Comment

Previewing your Comment

This is only a preview. Your comment has not yet been posted.

Working...
Your comment could not be posted. Error type:
Your comment has been posted. Post another comment

The letters and numbers you entered did not match the image. Please try again.

As a final step before posting your comment, enter the letters and numbers you see in the image below. This prevents automated programs from posting comments.

Having trouble reading this image? View an alternate.

Working...

Post a comment