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Nor have I. The untold story in US health care is the second you say you are uninsured the bills magically evaporate. When my wife was pregnant and on a priva

Nor have I. The untold story in US health care is the second you say you are uninsured the bills magically evaporate. When my wife was pregnant and on a private policy (where I live there are 0 private policies that cover pregnancy or at least none that we could find at the time) she went to the doctor's office an explained the situation the bills went from several hundred a visit to a fixed $1400 for all visits and the delivery. My mom worked for a heart surgeon who had done open heart surgery on an old guy on fixed income he paid $5 a month for about 3 years and the office decided to call it even. Every doctor's office and hospital I know of has insurance rates and private pay rates, and most have a sliding scale on top of that for the truly poor.

jacquesm 17y ago
That's very interesting, so, if I read you right essentially the system is either purposefully screwing the insurance companies in order to be able to give care to those who need it but can't afford it, or they're willing to do that out of their own expenses, and they fudge the budget on things like overhead and so on to make it all work out. That's a miniature health care system all by itself, only on the local hospital level instead of something larger or more formalized. One problem I see with that approach (as much as I like the guerrilla tactic feeling it has) that it will have a certain arbitrary element, some hospitals will have a lot more room to play with than others in this respect, so it'll be luck of the draw where you end up.
- ams6110 17y ago
  What the providers bill the insurance companies, and what the insurance companies pay, are two different things. Ever read those "explanation of benefits" statements? I happen to have one here that lists the doctor's submitted fee for a covered service as $179. The insurance "contracted fee" was $50. So really the doctor got $50; I don't know what happens to the other $129, probably a tax write-off of some sort.
  - joe_the_user 17y ago
    Bingo! Medical billing is essentially a fishing expedition. No hospital in the US publishes it prices. Even more, the standard price is just "what we'd like to get". The indigent pay less than this but the insurance companies pay even less still. But the hospital's full prices are certainly still used - it allows them say they gave someone umpteen thousand dollars in medical care when the person winds-up not paying and they can charge them for things like voluntary plastic surgery, when they can truly clean-up.
- jerf 17y ago
  "if I read you right essentially the system is either purposefully screwing the insurance companies in order to be able to give care to those who need it but can't afford it," Yes; this has been discussed several times in the recent healthcare debates, but it tends not to get much attention. The private health care system is already subsidizing the public one above and beyond what has already been documented. I have a friend who is a social worker. Privately-insured clients pay something like 60-70 dollars an hour. Government insurance pays barely enough to cover the cost of the office for that time. I find it ironic that this person is in favor of the current health care plan as it stands in Congress, as the evidence is that it would simply put this person out of business entirely. (You are free to vote against your self-interest and in what you believe is the collective's self-interest, which I have done before, but I don't think that's the cause here; I think it's an unexamined assumption that once the government is in charge, it will for some reason magically decide to pay more, an idea that I find rather unlikely personally.) This happens all the time, everywhere, and is one of the reasons the idea that switching over entirely to government health care is going to solve all our problems is a complete joke. It looks to me like removing the private insurance subsidy that almost nobody talks about or acknowledges existing could very well crash the system overnight (as in literally the day the private insurance was disbanded), as I doubt my friend would be the only person who discovered they could no longer afford to practice, at all. I'm guessing because hard numbers are hard to come by, but it's not hard to come by enough information to see how pervasive this is; bits of it show up on every medical bill I get. The real, fundamental problem with the health care system is that all the price signals are terribly distorted, and the government's proposed solution is to completely break them. That's not going to work for health care any more than it works anywhere else.
  - joe_the_user 17y ago
    Extending this existing government programs certainly will break the present health care system. So will just about any plan which extends the current trends. It is that bad. Socialized medicine, ie, clearing the decks and having a single payer, could be a completely different animal, though not one we're likely to see until whatever doomed-to-fail plan is approved and, uh, fails. Then who know?
Nwallins 17y ago
> The untold story in US health care is the second you say you are uninsured the bills magically evaporate. I have the exact opposite experience. I had no health insurance for about 2 years, and despite my pleas, I paid 3-4x what I expected, and certainly at least 2-3x what insurance would have paid, for even simple procedures like dentistry, fever, etc. Forget the Emergency Room. Going without health insurance in the U.S. is basically not an option if you have any hope of affording such.

jacquesm 17y ago

That's very interesting, so, if I read you right essentially the system is either purposefully screwing the insurance companies in order to be able to give care to those who need it but can't afford it, or they're willing to do that out of their own expenses, and they fudge the budget on things like overhead and so on to make it all work out. That's a miniature health care system all by itself, only on the local hospital level instead of something larger or more formalized. One problem I see with that approach (as much as I like the guerrilla tactic feeling it has) that it will have a certain arbitrary element, some hospitals will have a lot more room to play with than others in this respect, so it'll be luck of the draw where you end up.

ams6110 17y ago
What the providers bill the insurance companies, and what the insurance companies pay, are two different things. Ever read those "explanation of benefits" statements? I happen to have one here that lists the doctor's submitted fee for a covered service as $179. The insurance "contracted fee" was $50. So really the doctor got $50; I don't know what happens to the other $129, probably a tax write-off of some sort.
- joe_the_user 17y ago
  Bingo! Medical billing is essentially a fishing expedition. No hospital in the US publishes it prices. Even more, the standard price is just "what we'd like to get". The indigent pay less than this but the insurance companies pay even less still. But the hospital's full prices are certainly still used - it allows them say they gave someone umpteen thousand dollars in medical care when the person winds-up not paying and they can charge them for things like voluntary plastic surgery, when they can truly clean-up.
jerf 17y ago
"if I read you right essentially the system is either purposefully screwing the insurance companies in order to be able to give care to those who need it but can't afford it," Yes; this has been discussed several times in the recent healthcare debates, but it tends not to get much attention. The private health care system is already subsidizing the public one above and beyond what has already been documented. I have a friend who is a social worker. Privately-insured clients pay something like 60-70 dollars an hour. Government insurance pays barely enough to cover the cost of the office for that time. I find it ironic that this person is in favor of the current health care plan as it stands in Congress, as the evidence is that it would simply put this person out of business entirely. (You are free to vote against your self-interest and in what you believe is the collective's self-interest, which I have done before, but I don't think that's the cause here; I think it's an unexamined assumption that once the government is in charge, it will for some reason magically decide to pay more, an idea that I find rather unlikely personally.) This happens all the time, everywhere, and is one of the reasons the idea that switching over entirely to government health care is going to solve all our problems is a complete joke. It looks to me like removing the private insurance subsidy that almost nobody talks about or acknowledges existing could very well crash the system overnight (as in literally the day the private insurance was disbanded), as I doubt my friend would be the only person who discovered they could no longer afford to practice, at all. I'm guessing because hard numbers are hard to come by, but it's not hard to come by enough information to see how pervasive this is; bits of it show up on every medical bill I get. The real, fundamental problem with the health care system is that all the price signals are terribly distorted, and the government's proposed solution is to completely break them. That's not going to work for health care any more than it works anywhere else.
- joe_the_user 17y ago
  Extending this existing government programs certainly will break the present health care system. So will just about any plan which extends the current trends. It is that bad. Socialized medicine, ie, clearing the decks and having a single payer, could be a completely different animal, though not one we're likely to see until whatever doomed-to-fail plan is approved and, uh, fails. Then who know?

Nwallins 17y ago

> The untold story in US health care is the second you say you are uninsured the bills magically evaporate. I have the exact opposite experience. I had no health insurance for about 2 years, and despite my pleas, I paid 3-4x what I expected, and certainly at least 2-3x what insurance would have paid, for even simple procedures like dentistry, fever, etc. Forget the Emergency Room. Going without health insurance in the U.S. is basically not an option if you have any hope of affording such.