A simple idea for Health Care Reform
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Posted by Steve Craddock (+2738) 12 years ago
Warning - Long post ahead. But MAN O MAN - do I feel better after getting this off my chest. It was better than any medicine! hehe

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For the second time in as many years I was caught totally by surprise by the cost involved in running what I thought were going to be some simple tests.

Last year I felt a bit foolish because the tests were anything but run-of-the-mill. I should have known there was going to be a fairly high bill to pay. Still, $2,200 for two hours worth of tests seemed bit steep.

This year I don't feel quite so stupid. I simply had a few (OK, four!) tubes of blood drawn after visiting my NP (btw: my NP is wonderful!). I really didn't think much of it this year because everything seemed so standard and typical.

Then the bill arrived. $633!!! Yikes! Nothing typical about that. Except that it is. Huge bills from hospitals that take the patient totally by surprise has become the norm, and it's one of the reasons people avoid getting medical attention when they need it. It certainly was for me. I went for months knowing something was wrong but ignoring it and minimalizing it because I didn't what exactly what I got - a ridiculously large bill that will upset my budget for months.

All this has got me to thinking: Is there anything we buy besides health care where we have NO IDEA what the cost is before we purchase the good or service being offered?

Lawyers provide you with a fee schedule and contract in advance.
Accountants inform you of what it will cost to prepare your taxes.
Optometrists tell you what an eye exam will cost and prices on frames and lenses are stated up front.

Why do hospitals and medical labs get a pass when it comes to informing consumers prior to the purchase what the price is of what they are buying? I mean, how are we supposed to be "responsible consumers" of health care services (as Rick K. frequently advocates) if we don't know how much things cost before we agree to buy them?

So, here's my suggestion for a provision in the health care bill. We can call it the McDonald's Amendment.

Every hospital, clinic and lab has to display in a prominent location the prices for their various services, just like McDonald's posts its price list on a big illuminated sign above the cash registers.

If that's a bit too "fast foodish" for the country clubish medical set, then perhaps we can offer a substitute - the Rib N' Chop Amendment (fitting for the health care bill, isn't it?) that would allow the prices to be published in a nice leather bound menu. If the patient isn't given the menu and informed of the price beforehand, then they receive the service FREE.

All those in favor say "Aye!"
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Posted by howdy (+4950) 12 years ago
Had a cardiac ablation recently...was $42,000.00....Who the heck can afford that stuff?? Thankfully our insurance paid it due to our having already fulfilled our "out of pocket" costs...what about folks that aren't that fortunate?? What are they suppose to do?? Go bankrupt??

AYE!!
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Posted by julieinmc (+512) 12 years ago
Aye! Next time I come over for a visit with your Mom, remind me to tell you about an appointment I had with a new doctor after mine retired.
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Posted by uno21 (+72) 12 years ago
That would be an amazing concept!! Imagine deciding with your doctor what tests to run or what to check for based on how much it costs. I think we should know how much it costs. What's to hide? Other than they are raking the insurance companies, which leads to higher premiums, which leads to higher healthcare, which leads to higher premiums.........
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Posted by David Schott (+17532) 12 years ago
I was just billed $787.00 for 1.5 hours in a dental chair while getting 2 single-surface and 1 double-surface composite fillings. Lucky me I got 5% off for paying cash... $747.65.

I wonder what the minimum payment is that the dentist accepts when an insurance company is paying that bill. What do you want to bet it's quite a bit less than $747?

Nothing like screwing the cash customers...

But I'm with the G.O.P. Best damn healthcare system in the world and don't you dare touch it.
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Posted by howdy (+4950) 12 years ago
Plus many doctors are paid a percentage of the tests and procedures they have run...I think that is a giant conflict of interest...
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Posted by tom regan (+2756) 12 years ago
I recently took a job with Kaiser Permamente here in Denver. I was a bit surprised to find out that the health plan part of Kaiser is not for profit. Of course this does not mean they can't make any money, they just spend in more constructive ways than dividends to stock holders.

I was also pleasantly surprised to find out the the doctors are salaried and not payed on a per patient or per procedure basis. They can focus more on the health of their patients than how many patients they need to cram into their schedule during the day to make some extra money.

One more nice little perk is most the employees that work for Kaiser are union. I don't think its a coincidence that Kaiser was just voted the #1 health care plan in Colorado.

Get the "for profit" out of health care and it gets much easier to control costs.
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Posted by Levi Forman (+3707) 12 years ago
You get bills like this because the system is broken in so many ways.

1) Since most people have insurance or medicare, they are completely divorced from the actual cost of these services. They don't care because they think insurance/government will take care of it, without considering where that money actually comes from.

2) Steve will probably pay the bill. If he was an insurance company, he would negotiate the price down to a much lower figure. If he was a poor person, he would just not pay the bill. Thus, the cost of those people gets tacked on to Steve's bill because he's going to pay it without negotiating. The fact that the burden of the poor who can't afford to pay falls on the hospitals is kind of unique to the health care industry. In almost any other area of crucial services (food, housing, etc), there is some sort of government subsidized progressive system for the poor.

3) Did Steve really need that test? Could he have just been given a vitamin D supplement and waited to see if the symptoms got better? Because of the fact that the patient does not (usually) see these bills, it's in the best interest of the hospital to give him every imaginable test because they are money makers. The patient who thinks that the price is the insurance company's problem is all for the "spare no expense" approach to health care. After all it's their health at stake right? Maybe, maybe not. (I have no idea in Steve's specific situation, it's just an example).

One of the biggest problems is the employer based health care model. The average person thinks that their health insurance is "free" because their employer pays for it. Of course they could pay you a lot more if they weren't giving you health insurance. It's part of your compensation, YOU are paying for it. If people were writing a check to their insurance every month they would be more picky about it and demand value for their dollar. They would also probably have insurance that was more in line with the best bang for the buck for them.

For example, at my old job I had great insurance. I had no deductible, just a $15 co-pay each time I went to the doctor. Once I moved back to the ranch and started paying for my own insurance, I realized that my current plan which has a $2000 deductible cost almost $4000 a year less than my old plan. I had been paying nearly $4000 a year in order to avoid having a $2000 deductible if I got sick or hurt. Now that made a lot of sense eh? But most people try to get their employers to give them the best insurance that they can get. Now that I pay it myself I realize it would be idiotic to pay for that Cadillac insurance.

In addition, if health insurance was divorced from the employer, people wouldn't have to deal with losing their insurance every time they change jobs and possibly becoming uninsurable because of pre-existing conditions. On top of that, it would allow American companies to compete better in the international arena where they would not be handicapped by having to pay for health insurance when their competitors do not.

I am kind of rambling now but the fact is that the system is fundamentally broken, but the proposed health care reform does very little to fix it. It will get more people into it, which is a good thing but it's really just kicking the can down the road. A public option may help, but I'm not holding my breath. Government doesn't usually compete very effectively with private industry and the government provided insurance will probably lose tons of money and provide subpar service (speaking as a former government employee).

I would totally not read this post if someone else made it.

[This message has been edited by Levi Forman (11/24/2009)]
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Posted by Bob L. (+5101) 12 years ago
End the antitrust exemption for health insurance companies.
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Posted by Steve Craddock (+2738) 12 years ago
Levi, I not only read your post (finally you posted something longer than - or at least as long as - most of mine!), but I think you hit the nail on the head (as you usually do, both literally and figurately). You're right about insurance insulating the patient/consumer from being concerned about costs.

I probably wouldn't have written this post had my insurance paid the bill. And that is a big part of the problem. In fact, like you, I never used to see the bill. I'd write a check for my $20 or $30 co-pay when I walked thru the door and that was it.

So, thanks for illuminating a big part of the problem.
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Posted by Wendy Wilson (+6172) 12 years ago
I completely agree, Steve. Hospitals and doctors should be forced to publish their fee schedules. One of the problems with this, though, is that the doctors and hospitals often have many different prices for the same procedure depending on the HMO or PPO they are contracted with. If you don't have any insurance your price will be different than for someone who does. It's ridiculous.
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Posted by polar bear (+516) 12 years ago
I have been treated at a place where doctors were salaried. The care was outstanding and they took all the time needed to do an exceptional job.
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Posted by Denise Selk (+1665) 12 years ago
I'm in complete agreement. $662.00 for a well-child visit that lasted 15 minutes, with ONE set of immunizations (and how many immunization sets do kids receive by the time they are two?). This particular set happened to be a visit at two months of age. Ridiculous.

You cannot tell me that this is remotely the cost of immunizations, or community health care clinics could never keep their doors open.

It reminds me of a pharmacy, to remain nameless, I dealt with some time ago. For some reason (although I later found out that it was because the plan ID number had been changed and new cards not yet mailed out), my prescription card was not working when input. The tech tried several times for me. I finally became frustrated and told her to just tell me the amount due and I would pay her cash. She smiled, and then whispered to me that it was cheaper if I paid cash than if it was submitted to insurance. Ugh!
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Posted by Gunnar Emilsson (+17752) 12 years ago
You are all a bunch of socialists. Don't you have a cell meeting to go to????



Rick....Richard....Jim....Heath.....WHERE IS THE VOICE OF REASON????

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Posted by JLB (+217) 12 years ago
Okay, I skipped through a few of these so sorry if this is a double post. A friends son needed some dental work done and at the time did not have her insurance. She called to see what the cost would be if she didn't have insurance and had to pay out of pocket. She was quoted a price in the upper hundreds of dollars ( I can't remember the exact procedure) but I thought she had mentioned around 600 dollars) She decided to wait another month or so until her husbands insurance became effective. Once in effect the procedure was done. The dental office billed her insurance and a few weeks later she recieved her EOB (explanation of bennefits) in the mail. The procedure that was going to cost her hundreds of dollars was now charging the insurance almost 2,000 dollars. She could not believe what they were trying to scam from the insurance. She ended up calling the insurance and explaining the conversation she had had prior. I really don't see how this could be a legal or ethical form of practice. Not sure how facilities can get away with this, I would imagine this is part of the whole health care mess we are seeing now. I am sure this isn't the only place that practices this way.
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Posted by Lorin Dixson (+591) 12 years ago
JLB The experience I have had and observed from others is the opposite of the experience you quoted. In almost all cases the insurance companies pay much less than a individual paying cash, because they have a much better negotiating platform than an individual does
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Posted by Chuck Schott (+1291) 12 years ago
Let me guess France? Am I right Donna I meant Polar bear.
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Posted by mtpatriot (+83) 12 years ago
Has anyone here thought that you as a individual who pays for health insurance that you can take responsibility for your health care. You pay the DR. You pay for the insurance, that puts you in the drivers seat. If tests are recommended, you dont have to have them but ask questions on why they may be needed. Use common sense. There were times I did not have health insurance, I went when it was necessary, but not much. I have insurance now, and still feel the same way, go when necessary. I dont believe a government run option which will cost 1.2 trillion dollars after year 10 and oh we get to pay into it 4 years prior to it even being implemented. We have had a small sneak preview on what the care would be like being rationed. When a Government Panel decided that a woman does not need a mamogram now until 50 then every couple of years. Guidlines have been get a base line mamogram at 40 and have one yearly after that. This has saved lives, including mine. But in order to cut costs the government panel now says 50, and now were not sure if a person has insurance if they will now cover a yearly mamogram. Again people do your research. Do you want over 50% of what you earn to go to the government so the "wealth can be spread" There are far better alternitives than this 1300 page health care elephant. Did you know that they also will fine you if you dont eat properly? They want a person to be lean and fit no matter what. If you are overweight you pay extra. If you drink and smoke, well there is another one. These are choices we as americans should be making for ourselves not our government. Do you want our government telling us we cannot eat meat? Elderly people would not be able to get that hip replaced, or if there is cancer well the cost of treatment may outweigh the cost of a life. Should Louisina get $300,00.00 more for medicaid program down there, it actually was offered to her so she would vote yes. Should we pay for that. Plus if it is so great then why did the politicians that have "crafted" this bill exempted themselves out of it. There are a few good things in it, but the bad definatly outweighs the good, there are other options, and those options would not cost what this one is going to cost. People will just love going to the Dr and then sitting and waiting for the "group" to assemble so you can all go in togehter. Sounds like a jim dandy rooney fine time to me. People at this time are not going without. There are plenty of Charitable Hospitals out there and Holy Rosary is one of them. You cant pay, apply for financial aid. The income guidlines are actually pretty high, so people who think they make to much money actually do not. This applies to people with or without insurance. These are tax right offs for the hosptial. If a hospital is run efficently then it can stll be profitable.
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Posted by polar bear (+516) 12 years ago
No, Chuck. Seattle, WA.

mpatriot, then how do you explain that the majority of bankruptcies in the last 5 years have been due to medical bills people could not pay?

[This message has been edited by polar bear (11/24/2009)]
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Posted by mtpatriot (+83) 12 years ago
there is a difference in could not pay and would not pay. Yes there have been bankruptsies over health care, also from over stretching on credit cards, loans at the banks, ect ect ect. Buying to much house than one could afford, or buying a home where you only pay the interest just so you can have way more home than one can afford. We have lived in a society that has forgotten the main principle of money management. When I did not have insurance I went out and got a second job to pay the bill, and then a 3rd job. Plus raising my kids because I was divorced, and doing chores as I lived on a small horse ranch. Yes there are times when there may not be the above options, again there are charitable hospitals. There are some different programs that help. What I found was you cannot help those that will not help themselves. Some people cannot even take the time to fill out the paperwork to see if they even qualify for any kind of help (I worked in the eligibilty field at a hospital). I agree the insurance industry does need reform, but what the Obama administration is cramming down our throats is not it.
By the way always go over the bills line by line as mistakes are made, also make sure it has been billed out to insurance properly if you have insurance.

[This message has been edited by mtpatriot (11/24/2009)]

[This message has been edited by mtpatriot (11/24/2009)]
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Posted by Denise Selk (+1665) 12 years ago
People at this time are not going without. There are plenty of Charitable Hospitals out there and Holy Rosary is one of them.


And what do you do when the service that you require is not available at a charitable institution?
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Posted by Heath H (+647) 12 years ago
Run about willy nilly asking those who work and do for themselves to work and do for you, too. Because you are entitled. Because you were born in Canadathe United States.
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Posted by Denise Selk (+1665) 12 years ago
I'm asking a serious question Heath. What do you do when a charitable organization does not supply the service you require and despite being one of "those who work and do for themselves", you cannot afford the $100,000, or more, procedure? This question is in response to your statement that no one does without in this country. Be honest please.
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Posted by Lorin Dixson (+591) 12 years ago
He can't be honest, he is registered Wingnut, it is against the bylaws
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Posted by David Schott (+17532) 12 years ago
Heath/mtpatriot, how do "charitable hospitals" recoup their losses on charity care?
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Posted by Heath H (+647) 12 years ago
Denise,
What do you do? You make an effort. You do whatever you need to do. Whatever you can do. What you don't do (or shouldn't do) is expect or demand anything from anyone.
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Posted by Denise Selk (+1665) 12 years ago
What do you do? You make an effort. You do whatever you need to do. Whatever you can do.


Die? That would be what you could do.

Your response to this question would lead one to believe that there is a for-profit hospital at every corner ready to believe in you because you did "whatever you can do". Many treatment centers will not perform a procedure unless you have all, or at least a sizable portion, upfront. Trying as hard as one might, coming up with hundreds of thousands of dollars is impossible. This is not kindergarten. For-profits don't give you a gold star and a pat on the back for effort.
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Posted by Rick Kuchynka (+4458) 12 years ago
Let me put it to you this way, Heath.

Bad things happen, therefore government.

It can't be argued with.
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Posted by Heath H (+647) 12 years ago
Beat me to it.
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Posted by Rick Kuchynka (+4458) 12 years ago
mpatriot, then how do you explain that the majority of bankruptcies in the last 5 years have been due to medical bills people could not pay?

I've heard that argument quite a few times before. But when you dig into it, what you find out is the majority of bankrupt people just report having medical bills. Not that it was the main cause.

The advocates citing those stats usually twist a contributing factor into the only cause.
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Posted by Denise Selk (+1665) 12 years ago
Bad things happen, therefore government.


If you would read carefully, you would see this is not at all what I was arguing. I was only responding to Heath's comment that no one in this country goes without. There are plenty of people in this country who do go without, despite being hardworking, contributing members of society.

It is not black and white like Heath proposes. In his world, you work hard and contribute to society, you can pay your bills and have access to the medical care you need. If you cannot pay your bills or are denied access to the care you need, you obviously do not work hard enough or are not diligent enough.

I have never advocated for government-sponsored/provided health care.
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Posted by Wendy Wilson (+6172) 12 years ago
I was only responding to Heath's comment that no one in this country goes without. There are plenty of people in this country who do go without, despite being hardworking, contributing members of society.


My family spent 2 hours this morning boxing up and passing out turkey dinners for 8000 people. Yes, 8000 people. The agency we were helping stated that 50% of their clients this year were new and many, many more were people who had lost their jobs or are considered the working poor, people with jobs but who can't meet their expenses. You are absolutely right, Denise.
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Posted by Heath H (+647) 12 years ago
Wendy,

Good work, but are we talking about Thanksgiving dinner. or health care?
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Posted by Rick Kuchynka (+4458) 12 years ago
The ironic thing is that the "insurance for everything" approach drives up cost and makes things even harder on those who slip through the cracks.

Then again I get a chuckle every time I hear the phrase "Medicare for all"

What does that mean? Bankruptcy by 2016 for everyone?

It's the great unspoken issue of the reform debate. I'm not sure how some people can point to a financially doomed institution as the best solution to all our problems. I guess they're hoping maybe they can Bernie Madoff the whole scheme off onto the next generation.
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Posted by Rick Kuchynka (+4458) 12 years ago
One other thing Tom said reminded me of another point, for those people claiming its all the "for profit" insurance companies destroying the market.

I'd be willing to bet Kaiser's 'non profit' employee insurance fund is actually self-insurance. Another thing that's never talked about in this debate is that most large employers in this country self-insure their employee health funds.

So there is no "for profit" motive in those cases. At least not in the name of increasing premiums. In fact, if you combine this market with the various existing government markets, honest-to-goodness "for profit" insurance companies comprise a small minority of health plans. Yet they're getting all the blame for cost?

That doesn't make sense.
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Posted by Steve Craddock (+2738) 12 years ago
While I was in Colorado over Thanksgiving a story broke in the media regarding a young girl from Denver who got a huge splinter in her finger while hiking in Rocky Mountain National Park. The splinter was in deep and causing the girl substantial pain.

Her mother did not have a first aid kit handy or even a sewing kit(first mistake). She understandably didn't want to put up with a crying girl all the way back to Denver, so she stopped in at the local medical clinic in Estes Park to have the splinter removed. Like so many of us, she did not ask what the service would cost prior to authorizing the treatment (second mistake), assuming that her insurance would cover the bill (third mistake).

According to the mother, the treatment consisted of a medic swabbing the affected area with alcohol and then removing the splinter with a needle. According to the mother, the total time with the medic was less than two minutes, and the entire episode at the clinic lasted approximately 15 minutes.

You can imagine her surprise when a bill for over $800 arrived a few weeks later. She thought there must be some mistake, so she called the clinic. No mistake, they said. That was the standard charge for a SURGERY! Yep, using a needle to remove a splinter qualifies as "surgery" under the clinic's coding system.

Things got worse. Because it was a "major medical procedure," the woman's insurance wouldn't cover the expense until she had met her $2,000 deductible. So, she got "stuck" with the entire bill.

Something tells me if they had been advised of the cost before the "surgery" was performed, even the daughter would have said, "Hey Mom, it's not worth it. Let's wait until we get home."
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Posted by Brian A. Reed (+6115) 12 years ago
Under JoshRathCare, the icky girl with cooties shouldn't have gotten the splinter in the first place.
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Posted by Heath H (+647) 12 years ago
Sh*t happens, Steve. Why would anyone not be capable of removing a splinter from a child's finger?

She missed the chance to teach the child some coping skills.
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Posted by Steve Craddock (+2738) 12 years ago
Hey Heath. I should have known that the Man-Who-Knows-It-All would have the answer.

The rest of us thought maybe the splinter might be very large and therefore causing inordinate pain. No details about the size or type of splinter were given in anything I've read. Obviously you don't need any facts before finding fault.

And some of us considered that perhaps the girl might be too young to justifiably expect to just "tough it out" during a two hour or more ride back to Denver. Or she could be developmentally disabled and unable to understand such comforts. But there is no need for you, a bona fide Know-It-All, to consider anything like that, is there? How nice for you.

Then there is the legitimate parental concern that splinters, especially if imbedded deeply, can cause infection and perhaps even blood poisoning. Don't tell me they can't because that's exactly what happened to my sister in her teenage years. But then again, you obviously have some divine insight to know that such a risk could not possibly have been on this young mother's mind.

I sure wish everyone could know everything without ever thinking, just like you Heath. The world would be such a simple and UNkind place.
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Posted by Steve Z (+994) 12 years ago
Polar Bear,

Are you sure the "majority" of people going bankrupt are due to medical bills, or could it be over leveraging of credit. Hospitals will allow a person to make payments to their grave. Medical is the least of my financial woes. The hospital doesn't like it, but I send a pittance each month and guess what? No legal action yet.
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Posted by howdy (+4950) 12 years ago
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Posted by Heath H (+647) 12 years ago
Crapduck,

Never mind.

[This message has been edited by Heath H (12/3/2009)]
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Posted by Bruce Helland (+593) 12 years ago
Is that a promise Heath? Wow! Now I get to disregard everything you post! Free at last, free at last!
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Posted by Rick Kuchynka (+4458) 12 years ago
So Steve...

If insurance had covered the whole thing, would that've made it ok?
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Posted by Steve Craddock (+2738) 12 years ago
Not at all Rick. This is something you and I actually agree on - at least in part. I'm surprised you haven't picked up on that from my previous posts.

You have advocated the position that people need to take more responsiblity for their health care decisions. My question is this: How can the individual/patient be expected to make a rational decision if they don't even know what the cost of their health care options are?

I recognize that most people (those with insurance) have been insulated from the pricing aspect of health care for a long time. But I honestly believe that even people with insurance would be much more prudent in what tests and treatments they opt for if they knew IN ADVANCE what the cost of their options were.

Given your experience in the health care arena, perhaps you can shed some light on one of my original questions: Why is it that health care is the one industry that gets away with NOT informing its customers of the price of service before the service is rendered?
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Posted by Rick Kuchynka (+4458) 12 years ago
I've picked up on it. The only reason I asked is because the current approach to 'fix' the problem is to expand insurance coverage.

But in reality that will only increase costs even further.

I wish I shared your optimism on people jealously guarding their insurance company's money. Let's just say I've seen far more evidence of the opposite.

As for upfront pricing, I'm not saying it couldn't be done, but the complexity of diagnosis and procedure coding, along with the non-predictable nature of treatment itself means often times even the provider doesn't know what they'll be charging until the procedure is long over.

On something as simple as removing a splinter, they could've probably ballparked something pretty close. But most people who are insured would never bother to ask.
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Posted by Steve Craddock (+2738) 12 years ago
Most people who have answered my question re: the lack of "up front" pricing by health care providers have pointed to the same problem, which is the complexity of pricing and coding AND the fact that each health insurance company negotiates a different price.

I say the complexity and variability is a problem in itself.

Why does one insurance company pay a low price and another pays a higher amount? Maybe some variability makes sense for "volume discounts" and what not, but I've heard of huge differences in prices for the same thing. It doesn't make sense.

Then there are lab tests. When a doctor orders specific tests, why can't a lab tell you exactly what the costs of those tests will be?

As for more complex matters (i.e., potential complications), perhaps an estimate would be ok, just like auto body shops and construction firms give. Or even a range of costs, from probable low to possible high costs.

Right now, people just don't have a clue. And it isn't fair to say they aren't making responsible decisions when they aren't being given the information, even when they ask for it.

As for my faith in people, I plead guilty. I'll admit that some folks with insurance won't care, but I think the vast majority of people are aware of the direct effect that the cost of their health care choices has on the cost of their insurance premiums - and they will be very apt to act accordingly if they have the information they need.

As for people with employer-provided health insurance: Even they usually pay a healthy portion of the insurance bill out of their own pocket, especially if they are covering a spouse or children. So I would think the price information would help them make better decisions, too.

I really would LOVE to see someone from the health care industry explain why patients/consumers should continue to be kept in the dark about the cost of their services until AFTER those services have been received and it's too late to do anything about it except to sell off the mule so you can pay the bill.
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Posted by Rick Kuchynka (+4458) 12 years ago
Steve, in my experience, I can't envision a time where someone (in a non-emergent situation) would've been denied the opportunity to find out what their procedures were going to cost.

The simple truth is most people never ask... although there are definitely some who do shop it the way you suggest. But I'd guess 90% of those people are paying most of that out of pocket.

There are some improvements that could be made for pricing transparency, but there's never going to be a point where there's an extra-value-meal style pricing menu behind the admissions desk. Medical billing is complicated for the most part (and ironically in many cases due to years of government 'innovation' in health insurance), Anywho, people who aren't paying out of pocket generally don't care to worry about it.
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Posted by Steve Craddock (+2738) 12 years ago
And all I'm saying is that if price information isn't readily available, or if it is too complicated for a person of average intelligence to comprehend - then DON'T blame the consumer for failing to consider price in his or her health care decisions.

Let's face it - if you have to ask for the cost of a medical test or procedure at a time when your focus is on your or your child's ailment, chances are you aren't going to think of it.

If we really want the consumer to start exercising greater responsibility in keeping the cost of health care under control, then we're going to have to make sure the consumer is aware of the costs of health care services BEFORE making the decision to consume a particular set of services.

If the costs are so complex that such information can't be consistently, conveniently and accurately provided, then WE the consumers should not be held responsible for the ongoing escalation of health care costs in this country. But that's exactly what some very cagey persons and interest groups are trying to do - and they are doing it unfortunately they're succeeding.

What I'm saying is really very simple: It's time for the health care industry to either figure out a way to provide the consumer with cost information -- OR -- stop shifting the blame onto us.

[This message has been edited by Steve Craddock (12/3/2009)]
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Posted by Chuck Schott (+1291) 12 years ago
I had a doctor appointment this Thursday afternoon with a doctor I've been seeing for several years, it's just an appointment to talk about medication and check my vitals.

We got to talking and his concerns are that the system will be overloaded with all the new patients to the point where he feels many in the profession will get out or find other ways to practice. He currently works for Saint V's in Billings. He also makes the point that people who suddenly have insurance (free insurance) will be at the doctors for any ills unless a substantial co-pay is required. As he sees it rationing is inevitable and recommends I have (eventually) needed knee surgery before any changes take place.

My primary doctor (twenty year relation) say basically the same things concern him. They both agree something needs to be done but say the changes need to be incremental so the profession and facilities can keep up.

The doctors I have talked to think a cash customer should be given the same price break as insurance companies, credit customers pay at regular rates with 90 days interest free. This certainly would be easy enough to legislate after all the politicians have made sure they pay the lowest campaign advertisement rates available...it's the law.


Just some thoughts from the two medical professionals I have contact with.

[This message has been edited by Chuck Schott (12/4/2009)]

[This message has been edited by Chuck Schott (12/4/2009)]
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Posted by Steve Craddock (+2738) 12 years ago
Hey Chuck - nice post! You'ver raised some interesting issues and moved the discussion forward. I'm impressed. I think, tho, that there are some potential ways to deal with those problems that might also address the main problem with our healthcare system, which is it's skyrocketing cost.

Your doctor friends' concern seems to be that a flood of people will suddently be seeking medical care who previously would not have done so, overwhelming the system in the process. It stands to reason that the vast majority of those "new" patients will be presenting with illnesses are not serious; therefore, there is no reason that such patients would HAVE to see a M.D. or D.O. There are alternatives, including nurse practioners, physician's assistants, and other less decorated (and less expensive) yet highly qualified and very effective medical professionals. In fact, most patients SHOULD be seen by these highly compentent medical professionals who have come on the scene in the past couple decades. Save the limited number of infinitely more expensive doctors for the more complex and life-threatening cases. Where will they come from, you might ask. Well, we have a 'flood' of highly trained medics serving in the two wars we have going on right now. When their armed services gigs are up, I'm sure they would love to have an opportunity to use their skills in a civilian environment.

As for the patients with more serious illnesses, they deserve access to medical treatment just as much as any other American. And they will get it eventually when the illness becomes so serious that it requires more intense and more expensive treatment than would have been required had they come in earlier.

The fact is that health care is already rationed. If healthcare services were a finite commodity, I could understand those who currently have access fighting hard to prevent any loss of the share they currently possess because there would be no way to replace it. But the fact is that healthcare services are not finite. We can create efficiencies and initiate new practices that will make MORE healthcare available. And, based on the facts and figures in other industrialized countries that have much more efficient systems than ours, it can be done without breaking our nation's bank and our taxpaying backs.
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Posted by Steve Craddock (+2738) 12 years ago
Heath said:
Crapduck,
Never mind.
(This message has been edited by Heath H (12/3/2009)}


I just learned what you wrote in your original post. You're quite a riot, Health ol' boy. If anything is "going to far" on milescity.com, it's a full grown man stalking, mocking and intimidating a little ole lady - not someone pointing out that a Know-It-All is a know-it-all. If I'm guilty of anything, it's wasting people's time and mc.com space pointing out the obvious.

Straighten up your act Heath. Then I might listen to you lecture me about going too far. Until then, I will take your advice and "never mind."

Yours truly, Crapduck
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Posted by souix (+308) 12 years ago
Sorry this is so long.

I have been thinking about the above posts for the past day and it has reminded me of the debate regarding welfare reform. The people who received public assistance were made out to be lazy and worthless. The fat black lady driving a Lincoln.you know the one who had diamond rings on each finger, oh yes don't forget the mink coat. I can't remember if she was purchasing beer, but she had a bunch of kids.

This was clever way to rally those who do not think or read for themselves to support cuts to welfare. Never mind that the average welfare recipient at the time was a white 22 year old that had 1.5 children and was on it for less than eighteen months. This worked and welfare now has more strict guidelines.

When it comes to less fortunate people we as a society want them to suffer, after all it is their own fault that they find themselves in this situation, right? However, what we fail to consider is that we need a certain number of people to fill low paying jobs in our economy. Going to college is not for everyone, neither is moving up the corporate ladder, for if this was true, we would as my father use to say "have too many chiefs and not enough Indians."

Additionally, we do not castigate those others who receive welfare from the government. Many wealthy ranchers are allowed to graze their cattle on government lands at somewhere around $1.50 a cow calf pair. The going market rate for grazing this same cow/calf pair is well over $10. In fact the government loses money on the grazing lands, as they would need to charge in the $8 to $13 dollar range to break even on the cost involved. So my question is: is this welfare? If so, why do we not decrying this?

Senator Grassley, who has served in some government position for years, receives government "welfare" for his farming operations. Yet he is the first in line to call heath care reform socialism...wonder what he calls his government check?

Why are wages treated differently than stock market gains?

I can go on all day and give examples of the government paying citizens and these payments seem fine, unless of course they go to some low income recipient.
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Posted by Amorette Allison (+11984) 12 years ago
Two years ago, a medical issue arose and I could have used some surgery to fix it. I got an approximate cost guesstimate when I asked. I couldn't afford it, with my high deductible, so I didn't get the surgery. I still have the condition (non-fatal, obviously) and am just waiting until I am old enough that it goes away on its own. Until then, I suffer, to some extent, with pain, medication side effects, and other problems, but I made the choice to go cheap and suffer rather than borrow money and solve the problem.

However, if I had NEEDED the surgery to save my life (and there was a brief moment when we thought I would) I would have had to borrow against my house to pay for it.

Question is, did I do the right thing? I have no idea. I wish the issue had been settled two years ago rather than dragging on for another several years. I wish I could have made choices based on health rather than finances. I wish I were 30 years old again and had a magic sparkly pony that pooped rainbows, too.
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Posted by Chuck Schott (+1291) 12 years ago
This point has been made I'll bet but I have no time or the inclination to read all the posts leading to this point.

I'd be willing to bet none of the providers (doctors, nurses) have any idea what the cost are for testing or procedures past the point of very common charges, but if I had to bet I'm guessing the nurses have a better handle on it than the doctors. Furthermore I'm sure it would do no good for them to learn as the chances of the prices changing soon are very good.

I wonder why the hospitals and clinics are getting a pass on criticism for raising prices. Maybe the insurance companies are not the only bad guys in this equation.

I do believe doctors are aware of cost problems and I have had my doctors ask if my insurance covers a procedure or not. In so many cases they are doing procedures just to cover their asses and that is not being adequately addressed.

I don't think anyone is going say change is not necessary but the way congress is going about it is insane and THIS health care bill has no business passing just because it can pass. In a thriving economy this would be a bad bill with good elements or a good bill with bad elements, you choose.
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