EnumaElish said:You must be assuming that he receives the $100K treatment. In many cases he won't.
Give me an example of a single-shot procedure that costs $100K and must be supplied by a hospital, without discretion. Organ transplants?Brisar said:hospitals can't deny treatment
Or lower quality (e.g., underinvestment).Evo said:The hospital ends up eating the cost of whatever portion is not covered by anything, which of course results in higher medical costs.
Brisar said:Who should pay the healthcare costs of the uninsured?
Evo said:The hospital ends up eating the cost of whatever portion is not covered by anything, which of course results in higher medical costs.
Moonbear said:Yep, it's the reason everyone else has to pay $10 for a box of tissues if they're hospitalized.
Of course, for someone who can't afford the bill, the hospital can afford to write off things like the box of tissues that don't really cost what they're billed, and just charge for the things that really are expensive, like the anesthesia, and time for the doctors and technicians, and fees for using the diagnostic equipment. And, if that still doesn't bring it down to what you can afford, yeah, the cost just gets distributed to everyone.
SticksandStones said:So what you're saying is that if we had some form of universal health care, such that everyone had full coverage, the overall price of health would go down as hospitals would no longer have a valid reason for charing 10 dollars for a box of tissues?
Brisar said:hospitals can't deny treatment
Moonbear said:If you've survived your illness past your hospital stay, you shouldn't have to choose between filling your half dozen prescriptions that will keep you alive and buying food to keep yourself alive.
Brisar said:hospitals can't deny treatment
EnumaElish said:Give me an example of a single-shot procedure that costs $100K and must be supplied by a hospital, without discretion. Organ transplants?
Moonbear said:No, because we'd just be paying through our taxes and tacking on the inefficient government bureaucracy that would be assigned to run the system instead of paying for tissue boxes that are the current method of redistributing the cost of healthcare from those who can afford to to those who can't.
The actual costs will still remain the same, and those who can afford it will still be paying for those who can't, and the only real difference is whether you trust private insurance companies or government bureaucracy more for squandering away your hard-earned money, and which one will have the more expensive overhead.
Prescription coverage is the more limiting concern for those with low incomes and no insurance. While a hospital can't turn away someone in need of care, regardless of whether or not they can afford it, a pharmacy can refuse to fill a prescription if you can't pay for it. If you've survived your illness past your hospital stay, you shouldn't have to choose between filling your half dozen prescriptions that will keep you alive and buying food to keep yourself alive.
No need to split hairs here. It's probably unlikely to wrack up that much of a bill without the hospital checking on how it will get paid, but several tens of thousands in an hour or two is a piece of cake in case of a bad car accident.EnumaElish said:Give me an example of a single-shot procedure that costs $100K and must be supplied by a hospital, without discretion. Organ transplants?
Evo said:The hospital ends up eating the cost of whatever portion is not covered by anything, which of course results in higher medical costs.
How do you know? Maybe if the millions of people who are un- and under- insured would seek PREVENTATIVE treatment first instead of only going to seek medical treatment when it became an emergency. Emergency medicine is the least effective and most expensive form of health care. Right now there are 1.1 million underinsured children (i.e. children who do have insurance, but have insurance policies that refuse to pay for vaccinations) living in the US who do not receive all of the recommended childhood vaccinations by physicians. What would cost more, treating one of those children and the outbreak they could potentially cause if they contracted a disease that could have been prevented by a vaccination in the first place or simply offering vaccinations to all?Moonbear said:No, because we'd just be paying through our taxes and tacking on the inefficient government bureaucracy that would be assigned to run the system instead of paying for tissue boxes that are the current method of redistributing the cost of healthcare from those who can afford to to those who can't.
The actual costs will still remain the same, and those who can afford it will still be paying for those who can't, and the only real difference is whether you trust private insurance companies or government bureaucracy more for squandering away your hard-earned money, and which one will have the more expensive overhead.
Wrong, that is for anyone that is uninsured.gravenewworld said:That is only after you show that you can not afford your medical bills (like through filing bankruptcy).
Evo said:Wrong, that is for anyone that is uninsured.
.
turbo-1 said:As the network administrator, I was intimately involved with the financial side of that large practice and was tasked with trying to bring down the average age of the receivables in that practice. Receivables are insurance claims that have been filed and have not yet been paid. I quickly became aware that insurance companies are experts at denying claims based on that they call "coding errors", in which the cost of medical procedures is denied because the service provider's own standards for paying that claim have not been met because the service provider has not coded the condition and the resultant procedure in a way that meets their standards.
There is a LOT of time, money, and effort wasted by medical practices all across this country trying to be paid for medically necessary procedures that are denied multiple times through "coding errors" or "mixups" on their end. Remember that reimbursement delayed is pretty darned near as profitable as reimbursement denied. If we had a single-payer system with uniform coding standards, the overhead of most medical practices would plummet, and the cost of health car in the US could be less than that it much of the developed world. We can do better. Our politicians who suck up PAC money from drug companies and HMOs will never vote for this until we forbid PAC contributions, support public campaign finance and make bribery of public officials punishable.
gravenewworld said:You said that
"The hospital ends up eating the cost of whatever portion is not covered by anything, which of course results in higher medical costs."
and you said
I showed you that you were wrong.graveneworld said:That is only after you show that you can not afford your medical bills (like through filing bankruptcy).
Wrong again, a hospital may turn over an unpaid debt to a collection agency, but if you know that they won't take legal action and tell them to go fly a kite, they will drop it. Of course cooperating with the hospital to get government and charity funds upfront is the smart thing to do.BUT FIRST the hospital only eats the cost after all of the cost AFTER the ex-patient shows that they can't pay for a treatment. And that means that an ex-patient can't pay after they have sold their house, their car, and liquidated your entire savings.
don't pay them? NO, they will put a lien on your house and take your car first.
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1540-8159.1995.tb02498.x?cookieSet=1&journalCode=pace. Total hospital stay 16+-6 days, $72k+-$28k.EnumaElish said:Give me an example of a single-shot procedure that costs $100K and must be supplied by a hospital, without discretion. Organ transplants?
No you simply pointed out a case where the hospital was able to receive payment through a charity. This, however, is not the same as a person who leaves a hospital actually owing something, even after they may have been helped by a charity.Evo said:I showed you that you were wrong.
Wrong again, a hospital may turn over an unpaid debt to a collection agency, but if you know that they won't take legal action and tell them to go fly a kite, they will drop it. Of course cooperating with the hospital to get government and charity funds upfront is the smart thing to do.
I don't know where you are getting these wild ideas from. I know people that wracked up large hospital bills, blew off the collection agencies, and nothing more was done. The debt was written off.
Fair Debt Collection
If you use credit cards, owe money on a personal loan, or are paying on a home mortgage, you are a "debtor." If you fall behind in repaying your creditors, or an error is made on your accounts, you may be contacted by a "debt collector."
You should know that in either situation, the Fair Debt Collection Practices Act requires that debt collectors treat you fairly and prohibits certain methods of debt collection. Of course, the law does not erase any legitimate debt you owe.
This brochure answers commonly asked questions about your rights under the Fair Debt Collection Practices Act.What debts are covered?
Personal, family, and household debts are covered under the Act. This includes money owed for the purchase of an automobile, for medical care, or for charge accounts.
LOl Come on evo, debt simply disappearing without having to file for bankruptcy? YEAH RIGHT! Hospitals only get write offs from the government if a patient has shown that they can't pay.Can you stop a debt collector from contacting you?
You can stop a debt collector from contacting you by writing a letter to the collector telling them to stop. Once the collector receives your letter, they may not contact you again except to say there will be no further contact or to notify you that the debt collector or the creditor intends to take some specific action. Please note, however, that sending such a letter to a collector does not make the debt go away if you actually owe it. You could still be sued by the debt collector or your original creditor.
People WITH insurance don't seek preventative treatment either. This is more a social/lifestyle issue than an affordability issue.gravenewworld said:How do you know? Maybe if the millions of people who are un- and under- insured would seek PREVENTATIVE treatment first instead of only going to seek medical treatment when it became an emergency.
I don't know of any state that doesn't have a program to provide childhood vaccines for free, especially those required to enter school.Right now there are 1.1 million underinsured children (i.e. children who do have insurance, but have insurance policies that refuse to pay for vaccinations) living in the US who do not receive all of the recommended childhood vaccinations by physicians.
And when is the last time you heard of this happening in the US?What would cost more, treating one of those children and the outbreak they could potentially cause if they contracted a disease that could have been prevented by a vaccination in the first place or simply offering vaccinations to all?
Having seen how government agencies and public institutions operate, I suspect it would be much more inefficient. And, without any choice, if the government says they won't cover the cost of a procedure, you don't even have an option to change insurance carriers if government provided all the medical coverage. Or else, you'll still need to pay for private insurance for supplemental coverage beyond what the government plan pays.Also, what exactly is the difference between being taxed by the government for health care vs. not being taxed but having to pay premiums, co-pays, deductibles, etc? The latter is just like being taxed. Would the government be inefficient? Who knows. But I don't see many people complaining when they get their SS checks in the mail.
Yeah *RIGHT*. Happens every day, especially if it is for emergency medical care. Unless the creditor knows they have an iron tight case against you, most aren't willing to risk losing in court. Collection agencies are hoping that they can force you to settle for some amount (never pay a collection agency what they ask for, they will always negotiate).gravenewworld said:LOl Come on evo, debt simply disappearing without having to file for bankruptcy? YEAH RIGHT! Hospitals only get write offs from the government if a patient has shown that they can't pay.
Evo said:Yeah *RIGHT*. Happens every day, especially if it is for emergency medical care. Unless the creditor knows they have an iron tight case against you, most aren't willing to risk losing in court. Collection agencies are hoping that they can force you to settle for some amount (never pay a collection agency what they ask for, they will always negotiate).
If the medical expenses were not for emergency treatment, for example elective surgery, then you agreed in advance to pay the medical bills, and that's different and they have more of a case.
Some of my clients are collection agencies.
But the family's dealings with Christ Medical were not over. That July, Margaret learned that the hospital had sued her over part of their debt, winning a judgment allowing it to garnishee her wages. (Margaret says she never received summons papers before the wage-garnishment hearing.) Soon the hospital was taking the maximum amount from Margaret's salary that state law allowed, or about $100 of the $680 in gross pay she earned every other week. Margaret says that this left her with no money for repairs when the furnace in her trailer broke down the following winter. She and her younger daughter moved to an apartment, which Margaret says she could afford only by skipping the medications she took for her asthma and high blood pressure.
When Robin Lee Kemp received emergency room care at Resurrection's Westlake Hospital in 2000, she had two young children and had just lost her job. But the only conversation about financial assistance that she recalls came while she was heavily medicated, when a nun suggested that she write a letter asking the hospital to discount the charges. According to Kemp, the next time she heard from the hospital was when she was served with a summons for an unpaid bill for nearly $9,000. (Kemp insists that she left a valid address and never received a bill.) At that time, she says, she offered to pay the collection agent $500 immediately and then monthly installments of $100, only to be told that it was too late. She ended up filing for bankruptcy.
gravenewworld said:Hospitals only get write offs from the government if a patient has shown that they can't pay.
Moonbear said:People WITH insurance don't seek preventative treatment either. This is more a social/lifestyle issue than an affordability issue.
I don't know of any state that doesn't have a program to provide childhood vaccines for free, especially those required to enter school.
Uninsurance poses a threat to the control of communicable disease by delaying the detection, treatment, and reporting of infectious disease outbreaks, which may include emerging infectious agents such as SARS and perhaps someday those linked to bioterrorism. Hospital emergency departments and health departments play critical roles both in infectious disease surveillance and in caring for low-income populations, who are more likely to be uninsured. When high rates of uninsurance make emergency department crowding worse, the capacity of the emergency care system to handle a sudden influx of patients from a natural disaster or terrorist strike is compromised. To meet the burden of caring for the uninsured, health departments may be forced to shift scarce resources from traditional population-based public health activities, such as monitoring water quality and restaurant inspections to the delivery of personal health services to uninsured persons. This can weaken the ability of local health departments to contain outbreaks of infectious disease and other public health threats.
Despite high vaccination coverage
and low incidence rates of most vaccinepreventable
diseases,3,4 anecdotal reports
from state policy makers and clinicians
suggest that the US vaccine
financing system is under increasing
strain. Childhood vaccines in the United
States are financed by a patchwork of
public and private sources.5 Children
who are privately insured often have insurance
coverage for vaccines (BOX).
However, some children are enrolled in
private health insurance plans that do
not cover the cost of vaccines and they
are considered underinsured for immunization.
In 2000, it was estimated
that 14% of children aged 0 to 17 years
were underinsured in the United States,
requiring families to either pay out-ofpocket
for the cost of vaccines not covered
or forgo receiving vaccines.
Among clinical preventive services,
childhood immunization has been
ranked at the top in terms of health impact
and cost-effectiveness by the National
Commission of Prevention Priorities.
15 Despite the benefits of
childhood vaccination and the high coverage
rates achieved with older childhood
vaccines,3 our study demonstrated
gaps in the financing of new
vaccines for children who are underinsured
with respect to vaccination. Assuming
14% of children are underinsured
in the United States, we estimate
that 2.3 million children are unable to
receive state-purchased meningococcal
conjugate vaccine in the private sector,
and 1.2 million children are unable
to receive this vaccine even if they
are referred to the public sector. Due
to lack of funds to purchase newer vaccines
for children who are not VFC eligible,
many states have adopted more
restrictive policies for provision of publicly
purchased vaccines since 2004.
The lack of sufficient section 317 funding
and state funding for vaccine purchase
has led some states to provide vaccine
to VFC-eligible children but not
to underinsured children. Disparities
among states are worse for the most expensive
and newest vaccines, including
pneumococcal conjugate, meningococcal
conjugate, and hepatitis A
vaccines.
The public sector safety net for offering
vaccine to underinsured children
seems to be under considerable
strain. Past studies have suggested that
many private clinicians refer underinsured
children to public health clinics
for vaccination.16,17 Unfortunately, a
growing number of states are no longer
able to provide expensive vaccines, such
as the meningococcal conjugate vaccine,
to underinsured children in the
public sector. Furthermore, the proportion
of vulnerable US children
whose insurance plans either do not
cover vaccines or require families to pay
out-of-pocket for preventive care is
likely to grow. A recent article by the
American Academy of Pediatrics found
that 20% of employers are offering catastrophic
health insurance plans (highdeductible
health plans), up from only
5% in 2003, and only 30% of these plans
covered preventive care before the deductible
was met.18,19 These trends are
of concern because inadequate insurance
coverage has been associated with
forgone health care among families who
lack resources.20
And when is the last time you heard of this happening in the US?
Flareau is most concerned about diseases that are preventable because of vaccines. Small outbreaks of measles, pertussis and other once-common diseases keep cropping up because people, often those who aren't insured, don't get vaccinated.
Having seen how government agencies and public institutions operate, I suspect it would be much more inefficient. And, without any choice, if the government says they won't cover the cost of a procedure, you don't even have an option to change insurance carriers if government provided all the medical coverage. Or else, you'll still need to pay for private insurance for supplemental coverage beyond what the government plan pays.
I'm not saying the way the insurance industry runs things is great, I just don't have any reason to think government red tape would improve upon it, not the way our government is run.
Federal investigators have found that a handful of companies account for a growing share of the health insurance policies sold to small businesses in most states, leaving consumers with fewer options and higher costs.
Yes but as suggested up thread they don't actually eat the cost. You do, via $10 hospital tissue boxes.CaptainQuasar said:A friend of mine was a paramedic in New York state. She said that the EMS providers / ambulance companies there frequently simply had to eat the cost of transporting people and caring for them because the laws required them to answer calls and transport people but didn't guarantee any way for them to get paid.⚛
The US does not have a free market health care system in any sense that's its normally seen. At least 50% of all health care spending is by the government already, and in the rest of it the buyer is not the recipient. In a market the recipient must freely negotiate w/ the providerGravenworld said:Our "free market" health care system...
mheslep said:Yes but as suggested up thread they don't actually eat the cost. You do, via $10 hospital tissue boxes.
mheslep said:The US does not have a free market health care system in any sense that's its normally seen. At least 50% of all health care spending is by the government already, and in the rest of it the buyer is not the recipient. In a market the recipient must freely negotiate w/ the provider
Here and abroad I believe its in large part because health care is so perfectly suited to the pandering of politicians: "elect me and I will get you more covered procedures, its your right!". This goes on and on until health care is 100% run by government at which point government can only control costs by limiting supply (queues).gravenewworld said:Exactly, that is what the US health care system has evolved into. You have a very few huge conglomerates controlling the vast majority of health care for the population. Even the government itself finds that this is leading to more and more higher costs and less choice for patients. Do you see it going away anytime soon if nothing is changed? I don't think so. Where is the efficiency in the system we have now? NO COUNTRY IN THE WORLD with the best of health care has a free market health care system. Why?
mheslep said:Here and abroad I believe its in large part because health care is so perfectly suited to the pandering of politicians: "elect me and I will get you more covered procedures, its your right!". This goes on and on until health care is 100% run by government at which point government can only control costs by limiting supply (queues).
There are plenty of examples of small free markets in play in the US and elsewhere. http://healthcare-economist.com/2006/04/25/markets-at-work-lasik/" , as its not covered by insurers, is a famous one. It now has the highest patient satisfaction of any surgery. 1998 price was $2200, now its $1350. But remain vigilant. Soon some politco will start yelling its your right to see as well as the next man in this society, we all must have it; Lasik will get mandated onto insurance plans. Then one day, our Original Poster will return to our forum and query: "...John Smith is uninsured, has terrible vision, gets a $100K lasik eye job ... who pays?"
mheslep said:Here and abroad I believe its in large part because health care is so perfectly suited to the pandering of politicians: "elect me and I will get you more covered procedures, its your right!". This goes on and on until health care is 100% run by government at which point government can only control costs by limiting supply (queues).
Lumping all those countries together and saying they all have 'universal coverage' is grossly imprecise. I'm only familiar with a 2 or 3 other countries shown there and of the ones I know only England (the topic of the report) has real 'universal' care: doctors, hospitals, everything run and paid for by the government. As you can see the waiting time is >six months. Other countries are moving away from failing universal plans and opening up free market health care. Government care is just another 3rd party payer system, it doesn't work either. There is no way around supply and demand.gravenewworld said:Really? See pg 3 of the OECD report.
http://www.oecd.org/dataoecd/5/27/26781192.pdf
So how is it that places like Japan spend less % of their GDP on health care, have universal coverage, and have waiting times just as long as we do in the US for health care?
gravenewworld said:LOL exactly. The first and hardest step for millions of Americans is getting insurance in the first place. On top of that, having insurance here in the US doesn't guarantee affordable health care for an individual at all.
You seem to agree w/ the premise of the Lasik example I posted but in the next post I gather that rather you believe that only an insurance system would inflate Lasik costs, but that if it were provided under a universal government program this would not be the case. http://www.hoover.org/publications/digest/3459466.html" . The real cost of producing any handout will always increase rapidly as the demand increases without check. It matters not who the 3rd party payer may be. If the 3rd party (insurer/government) stops paying the increase, the supplier will inevitably start limiting the quality of the service or good.gravenewworld said:Really? See pg 3 of the OECD report.
http://www.oecd.org/dataoecd/5/27/26781192.pdf
So how is it that places like Japan spend less % of their GDP on health care, have universal coverage, and have waiting times just as long as we do in the US for health care?
mheslep said:Lumping all those countries together and saying they all have 'universal coverage' is grossly imprecise. I'm only familiar with a 2 or 3 other countries shown there and of the ones I know only England (the topic of the report) has real 'universal' care: doctors, hospitals, everything run and paid for by the government. As you can see the waiting time is >six months. Other countries are moving away from failing universal plans and opening up free market health care. Government care is just another 3rd party payer system, it doesn't work either. There is no way around supply and demand.
THERE WILL BE NO PERFECT SYSTEM FOR HEALTH CARE. I find it extremely ethically wrong that yes here in the US we may not have to wait long for health care, but one of the main reasons why is simply because we deny 45 million of our citizens health coverage. That is not efficiency, that is simply lunacy. Also, when private insurance companies enter the market, it kills universal systems of health. I believe it is in the UK, where if you have private insurance you get to be placed ahead of people that have UH on waiting lists. This in turn motivates more and more people to buy private insurance which in the end (if enough people buy into private insurance) will increase costs and leave a big chunk of people who get 2nd rate health care service.Japan's health care system is characterized by universal coverage, free choice of health care providers by patients, a multi-payer, employment-based system of financing, and a predominant role for private hospitals and fee-for-service practice.
Virtually all residents of Japan are covered without regard to any medical problems they may have (so-called predisposing conditions) or to their actuarial risk of succumbing to illness. Premiums are based on income and ability to pay. Although there is strong government regulation of health care financing and the operation of health insurance, control of the delivery of care is left largely to medical professionals and there appears to be no public concern about health care rationing.
Like the Australian, Canadian and many European health care systems, Japan's national health insurance program is compulsory. But Japan surpasses all 24 member countries of the Organization for Economic Cooperation and Development (OECD) in life expectancy at birth and also has the lowest infant mortality rate (Appendix 1, Table 1).1 It achieves these successes at a cost of only 6.6 percent of gross domestic product, $1,267 per capita - half that of the United States (Table 1) .
Japanese-style national health insurance raises a fascinating question: how has Japan reduced financial barriers of access to medical care and achieved a No. 1 ranking on health status at a cost that is among the lowest of wealthy industrialized nations?2 In addressing this question, we begin with a comparative analysis of health care resources and the use of medical care in Japan, the United States and other OECD countries. Next, we review the financing and organization of medical care in Japan, evaluate some strengths and weaknesses of the health care system, and explore possible lessons for health care reform in the United States.
For some reason you seem to assume that supply always will remains stagnant. This is how Japan is able to control their health care costs and waiting times-by having much better supplies (per capita wise) of medical technology and hospital beds available.You seem to agree w/ the premise of the Lasik example I posted but in the next post I gather that rather you believe that only an insurance system would inflate Lasik costs, but that if it were provided under a universal government program this would not be the case. I ask you to reconsider. The real cost of producing any handout will always increase rapidly as the demand increases without check. It matters not who the 3rd party payer may be. If the 3rd party (insurer/government) stops paying the increase, the supplier will inevitably start limiting the quality of the service or good.
The post said "places like Japan". Ok to advance the discussion, please define with a little detail what you mean when you say 'Universal Coverage' so we can have some common ground. Who pays, for what services , limitations to the services, allowance for alternative coverage, etc.gravenewworld said:Where did I lump them together? I pointed out Japan as an example.
mheslep said:The post said "places like Japan". Ok to advance the discussion, please define with a little detail what you mean when you say 'Universal Coverage' so we can have some common ground. Who pays, for what services , limitations to the services, allowance for alternative coverage, etc.
The
dominance of for-profit insurance
and pharmaceutical companies,
a new wave of investorowned
specialty hospitals, and
profit-maximizing behavior even
by nonprofit players raise costs
and distort resource allocation.
Profits, billing, marketing, and the
gratuitous costs of private bureaucracies
siphon off $400 billion to
$500 billion of the $2.1 trillion
spent, but the more serious and
less appreciated syndrome is the
set of perverse incentives produced
by commercial dominance
of the system.
We're not getting anywhere as this post is a non-sequitur. Up thread I posted, and you agreed twice ala 'LOL, exactly': 1) the US health system fails, 2) the US health system is not a free market, its a 3rd party payer system. Then you reply w/ this aha! post that 1) says the US health system fails and 2) says nothing about my assertion that other countries may be allowing more private alternatives in addition to their government run systems (they are, e.g. Ireland, Canada, Netherlands).gravenewworld said:I will respond to this later after I get home from work.
So many places are now switching to a more free market based approach to health care?
Chew on this-
http://content.nejm.org/cgi/content/full/358/6/549
"Market-Based Failure — A Second Opinion on U.S. Health Care Costs"
Moonbear said:I'm not saying the way the insurance industry runs things is great, I just don't have any reason to think government red tape would improve upon it, not the way our government is run.
