WSJ article on how screwed up our health care system is

[NUance]

The Man Who Was Treated for $17,000 Less

Bypassing his third-party payer, my patient avoided a high hospital 'list price.'

By JEFFREY A. SINGER, Wall Street Journal, OPINION, August 21, 2013, 7:07 p.m. ET

 

A gentleman in his early 60s came in with a rather routine hernia in his lower abdomen, one that is easily repaired with a simple outpatient surgical procedure. We scheduled the surgery at a nearby hospital. My patient is self-employed and owns a low-cost "indemnity" type of health insurance policy. It has no provider-network requirements or preferred-hospital requirements. The patient can go anywhere. The policy pays up to a fixed amount for doctor and hospital bills based upon the diagnosis. This affordable health-insurance policy made a lot of sense to this man, based on his health and financial situation.

 

When the man arrived at the hospital for surgery, the admitting clerk reviewed the terms of his policy and estimated the amount of his bill that would be paid by insurance. She asked him to pay his estimated portion in advance. (More hospitals are doing that now because too often patients don't pay their portions of the bills after insurance has paid.) The insurance policy, the clerk said, would pay up to $2,500 for the surgeon—more than enough—and up to $2,500 for the hospital's charges for the operating room, nursing, recovery room, etc. The estimated hospital charge was $23,000. She asked him to pay roughly $20,000 upfront to cover the estimated balance.

 

<snip>

 

He underwent his operation the very next day, with a total bill of just a little over $3,000, including doctor and hospital fees. He ended up saving $17,000 by not using insurance. This process taught us a few things.

LINK

This is a big part of what's wrong with health care in the U.S. Expecting a guy--a self employed guy with insurance--to pay $20,000 up front for a surgery that costs around $3,000. Hospitals are greedy. Insurance companies are greedy, evil and dishonest. imo.

 

This just ticks me off. It makes me want to corner our health care system in a dark alley and break a bottle over it's head. And stab it in the neck.

[rawhide]

Unlike a myriad of other corporations that count billions of dollars in net profits.

 

Granted, many don't involve your health and life.

[Junior]

The Man Who Was Treated for $17,000 Less

Bypassing his third-party payer, my patient avoided a high hospital 'list price.'

By JEFFREY A. SINGER, Wall Street Journal, OPINION, August 21, 2013, 7:07 p.m. ET

 

A gentleman in his early 60s came in with a rather routine hernia in his lower abdomen, one that is easily repaired with a simple outpatient surgical procedure. We scheduled the surgery at a nearby hospital. My patient is self-employed and owns a low-cost "indemnity" type of health insurance policy. It has no provider-network requirements or preferred-hospital requirements. The patient can go anywhere. The policy pays up to a fixed amount for doctor and hospital bills based upon the diagnosis. This affordable health-insurance policy made a lot of sense to this man, based on his health and financial situation.

 

When the man arrived at the hospital for surgery, the admitting clerk reviewed the terms of his policy and estimated the amount of his bill that would be paid by insurance. She asked him to pay his estimated portion in advance. (More hospitals are doing that now because too often patients don't pay their portions of the bills after insurance has paid.) The insurance policy, the clerk said, would pay up to $2,500 for the surgeon—more than enough—and up to $2,500 for the hospital's charges for the operating room, nursing, recovery room, etc. The estimated hospital charge was $23,000. She asked him to pay roughly $20,000 upfront to cover the estimated balance.

 

<snip>

 

He underwent his operation the very next day, with a total bill of just a little over $3,000, including doctor and hospital fees. He ended up saving $17,000 by not using insurance. This process taught us a few things.

LINK

This is a big part of what's wrong with health care in the U.S. Expecting a guy--a self employed guy with insurance--to pay $20,000 up front for a surgery that costs around $3,000. Hospitals are greedy. Insurance companies are greedy, evil and dishonest. imo.

 

This just ticks me off. It makes me want to corner our health care system in a dark alley and break a bottle over it's head. And stab it in the neck.

 

I linked to an article along these lines a while back. Shocking what hospitals charge for tylenol and the like.

 

http://www.time.com/time/magazine/article/0,9171,2136864,00.html#ixzz2M7DxFCeb

[BigRedBuster]

LINK

 

 

What I took from this article is literally how uninformed the American population is about major issues that should affect how they vote.

 

It is scary that these people actually vote in this country.

 

Ignorance of Obamacare exchanges threatens plan's success

 

 

With just 38 days to go before the opening of Obamacare insurance exchanges, public ignorance about those marketplaces remains sky-high, threatening the very goal of offering affordable health care to the uninsured, several studies show.

 

And according to a troubling conclusion in at least one study earlier this year, awareness about the new health-care law had declined among some groups more than three years after Obamacare was signed.

[sd'sker]

This is a big part of what's wrong with health care in the U.S. Expecting a guy--a self employed guy with insurance--to pay $20,000 up front for a surgery that costs around $3,000. Hospitals are greedy. Insurance companies are greedy, evil and dishonest. imo.

 

This just ticks me off. It makes me want to corner our health care system in a dark alley and break a bottle over it's head. And stab it in the neck.

everyone is trying to game the system:

Drug Coupons Hide True Costs From Consumers

 

 

Serra, a paralegal, went to his doctor a few months ago for help with acne. She prescribed Solodyn. Serra told her he'd previously taken a generic drug called minocycline that worked well. The doctor told him that the two compounds are basically the same, but that you have to take the generic version in the morning and the evening. With Solodyn, you take one dose a day.

Serra told her that if the name-brand medicine was going to cost a lot more, he'd prefer the generic. "And then she presented this card," he says. She explained that it was a coupon, and that he should give it to the pharmacist for a break on his insurance copay.

<snip>

 

By 2007, the pharmaceutical industry had mounted its counterattack: coupons to subsidize the cost of copays for consumers, like the one Serra used to buy his acne medicine — the one that brought his copay down from $154.28 to $10.

Serra's insurance company ended up paying $514 a month for his once-a-day Solodyn. Minocycline, the twice-daily generic, costs $109 a month.

But Serra never saw those numbers. He saw a deal, and he likes deals.

An investigation by Wall Street Journal reporter Jonathan Rockoff found that in the past year, drug manufacturers have broadly expanded their subsidy programs as copays and drug costs have risen. The Journal notes that copays do affect consumer behavior. Every 10 percent rise in copays seems to lead to a 6 percent decrease in spending on drugs.

Wood says she understands the allure of the manufacturers' coupons, but she says those coupons come with a consequence. If everyone started using coupons to get the more expensive drugs, "we'd have to raise premiums," she says. "There's no question about that."

Consumers like Serra don't want to see premiums go up. But they're caught between enormous insurance companies and enormous drug companies.

[strigori]

The root of the issue is with healthcare we have the only good or service in existence where the price is not plainly available upfront. Many places will not even give a quote for a procedure.

 

Imagine if other businesses operated like our healthcare did.

 

You walk into a grocery store, get a cart and start loading up the things you want. Only there is no pricing anywhere to be seen, and asking gets you no answer. When you get to the register, at this point you are asked "How are you going to pay today?" How you pay will change your cost, but you can't see the differences upfront. So you sign a legally binding agreement to pay, before you they start ringing up your stuff. Only after you have signed, the items are rung up. You still do not get to see a price, instead the cashier says "We will bill you, expect an itemized bill in a few weeks"

 

there is no way in hell anyone lets a system like that exist on anything else. Why do we let it persist on healthcare? A very simple law requiring price listings for every procedure, medicine, doctor fee and so on, being posted would do absolute wonders in change to the system.

[Mavric]

The root of the issue is with healthcare we have the only good or service in existence where the price is not plainly available upfront. Many places will not even give a quote for a procedure.

 

Imagine if other businesses operated like our healthcare did.

 

You walk into a grocery store, get a cart and start loading up the things you want. Only there is no pricing anywhere to be seen, and asking gets you no answer. When you get to the register, at this point you are asked "How are you going to pay today?" How you pay will change your cost, but you can't see the differences upfront. So you sign a legally binding agreement to pay, before you they start ringing up your stuff. Only after you have signed, the items are rung up. You still do not get to see a price, instead the cashier says "We will bill you, expect an itemized bill in a few weeks"

 

there is no way in hell anyone lets a system like that exist on anything else. Why do we let it persist on healthcare? A very simple law requiring price listings for every procedure, medicine, doctor fee and so on, being posted would do absolute wonders in change to the system.

That is true but there are a lot of things about the health care industry that make it different. To use your analogy, you can't go into a grocery store, fill your cart then get to the checkout line and tell them you can't afford the groceries so they let you walk out without paying.

[tschu]

Obamacare is trying to fix some of this but nobody seems to understand that

[NUance]

The root of the issue is with healthcare we have the only good or service in existence where the price is not plainly available upfront. Many places will not even give a quote for a procedure.

 

Imagine if other businesses operated like our healthcare did.

 

You walk into a grocery store, get a cart and start loading up the things you want. Only there is no pricing anywhere to be seen, and asking gets you no answer. When you get to the register, at this point you are asked "How are you going to pay today?" How you pay will change your cost, but you can't see the differences upfront. So you sign a legally binding agreement to pay, before you they start ringing up your stuff. Only after you have signed, the items are rung up. You still do not get to see a price, instead the cashier says "We will bill you, expect an itemized bill in a few weeks"

 

there is no way in hell anyone lets a system like that exist on anything else. Why do we let it persist on healthcare? A very simple law requiring price listings for every procedure, medicine, doctor fee and so on, being posted would do absolute wonders in change to the system.

That is true but there are a lot of things about the health care industry that make it different. To use your analogy, you can't go into a grocery store, fill your cart then get to the checkout line and tell them you can't afford the groceries so they let you walk out without paying.

Sure, that's one factor. But how much does that affect the overall pricing scheme? Let's take the example from the article. The operation was worth $3,000. The hospital originally sought to charge the guy $23,000. How much of the extra $20,000--that's a 660% markup--was caused by folks who skipped out on paying? 10%? 20%? 50%??? So where does the other 600% of the markup come from? Plus, one of the reasons people don't pay their bills is because the if they don't have coverage the hospital charges them the $23,000 greedy bastard fee, not the $3,000 actual cost.

 

Face it, our health care system is f'd up beyond belief. I think it's mostly due to insurance companies. But I suspect hospital administrators and our own gov't partially contribute to the clusterf**k that is American healthcare.

[Mavric]

Obamacare is trying to fix some of this but nobody seems to understand that

Trying perhaps but it was rushed through too quickly and relied too much on "who wouldn't want that" and "it's the right thing to do" that it wasn't done right and well-thought out.

[Mavric]

The root of the issue is with healthcare we have the only good or service in existence where the price is not plainly available upfront. Many places will not even give a quote for a procedure.

 

Imagine if other businesses operated like our healthcare did.

 

You walk into a grocery store, get a cart and start loading up the things you want. Only there is no pricing anywhere to be seen, and asking gets you no answer. When you get to the register, at this point you are asked "How are you going to pay today?" How you pay will change your cost, but you can't see the differences upfront. So you sign a legally binding agreement to pay, before you they start ringing up your stuff. Only after you have signed, the items are rung up. You still do not get to see a price, instead the cashier says "We will bill you, expect an itemized bill in a few weeks"

 

there is no way in hell anyone lets a system like that exist on anything else. Why do we let it persist on healthcare? A very simple law requiring price listings for every procedure, medicine, doctor fee and so on, being posted would do absolute wonders in change to the system.

That is true but there are a lot of things about the health care industry that make it different. To use your analogy, you can't go into a grocery store, fill your cart then get to the checkout line and tell them you can't afford the groceries so they let you walk out without paying.

Sure, that's one factor. But how much does that affect the overall pricing scheme? Let's take the example from the article. The operation was worth $3,000. The hospital originally sought to charge the guy $23,000. How much of the extra $20,000--that's a 660% markup--was caused by folks who skipped out on paying? 10%? 20%? 50%??? So where does the other 600% of the markup come from? Plus, one of the reasons people don't pay their bills is because the if they don't have coverage the hospital charges them the $23,000 greedy bastard fee, not the $3,000 actual cost.

 

Face it, our health care system is f'd up beyond belief. I think it's mostly due to insurance companies. But I suspect hospital administrators and our own gov't partially contribute to the clusterf**k that is American healthcare.

I wasn't speaking to any specific instance, but in general.

 

Also, the author of the article was the founder of the clinic where this incident seems to have taken place. So he basically throwing his business and his employees under the bus. It would seem that if he didn't like it he could instruct the practice to stop. That seems odd to me.

[tschu]

Obamacare is trying to fix some of this but nobody seems to understand that

Trying perhaps but it was rushed through too quickly and relied too much on "who wouldn't want that" and "it's the right thing to do" that it wasn't done right and well-thought out.

And people also don't understand that Obamacare is an ongoing systemic change, not a one-time policy that is complete; it's nowhere near being a finished revamped system

[Mavric]

Obamacare is trying to fix some of this but nobody seems to understand that

Trying perhaps but it was rushed through too quickly and relied too much on "who wouldn't want that" and "it's the right thing to do" that it wasn't done right and well-thought out.

And people also don't understand that Obamacare is an ongoing systemic change, not a one-time policy that is complete; it's nowhere near being a finished revamped system

But things should be a pretty much finished product before they are made law. Not that you can't change laws but they should be more well-thought-out so they at least work as enacted.

[tschu]

You can't just change an entire system, especially one as gigantic as the healthcare industry, overnight. You have to do it in steps.

[Mavric]

You can't just change an entire system, especially one as gigantic as the healthcare industry, overnight. You have to do it in steps.

That's fine. As long as your steps are actually workable.

 

I would argue that it ObamaCare could have been been done in smaller steps.