A Doctor Delivers Bad News--today's LA Times.

[CaliforniaPeggy]

A well-written look at today's health care mess:

http://www.latimes.com/opinion/op-ed/la-oe-jones-healthcare-buyer-beware-20160508-story.html



A good friend of mine recently found herself between jobs, with a gap in her health insurance and a recurrence of her kidney stones. What she needed were fluids and pain relief, fast. I'm a gastroenterologist, and hoping to minimize the financial impact, I went with her to our local ER and had a conversation with the attending physician. Maybe we could pass on the CT scan and extraneous lab work?

The attending was in her room for less than two minutes and never examined her. But the CT scan and blood work were ordered. My friend received intravenous fluids (about $1 worth), pain meds (about $5 worth of dilaudid), and a $10,000 bill from the hospital. To add insult to injury, the bill from the ER attending was for service at the highest billable level.

My friend had the good sense and gumption to call the ER group's practice manager to point out that billing at that level was fraudulent. The ER group had the good sense to reduce the bill by half.

[pnwmom]

1. This is the kind of problem that Medicare-for-all won't fix. Our health care costs

are out of control.

[elleng]

2. It SHOULD fix it

IF the payer, the govt, negotiates price and services, as does the The Federal Employees Health Benefits (FEHB) Program, a system of "managed competition" through which employee health benefits are provided to civilian government employees and annuitants of the United States government.

Federal Employees Health Benefits Program - Wikipedia, the free ...
https://en.wikipedia.org/.../Federal_Employees_Health_Benefits_.

[CaliforniaPeggy]

3. Thank you for this excellent post, my dear elleng...

I was unaware of this program, until you mentioned it.

[elleng]

6. It's the best, Peg.

I've benefited from the best insurance in the country (imo) ever since I moved to DC for a government job, in 1978.

[bigbrother05]

90. It's the program we thought ACA would use as a backup

Instead of the patchwork of local/state exchanges. The GOP in Congress knew if the general public ever got access to FEHB, private insurance would dry up.

Anytime I go to a new doctor and they ask about insurance, they hear BC/BS then smile when I add Federal. They negotiate prices, but pay quickly and are quite efficient.

[elleng]

105. Right.

And of course 'federal' means then ask which carrier under 'federal,' with whom they negotiated. I've used bc/bs-federal forever.

'They'd' never allow EVERYONE to benefit from such a good program, because they'd have to negotiate everything for everyone and prices could be rational for everyone. We do have a 'tiered' system; nothing wrong with that, but it still requires insurers, tho; is NOT 'single payer,' as ACA is not either.

[Eleanors38]

109. I second that!

[pnwmom]

5. But that's not how Medicare works. Millions of seniors would object to changing the system,

which is working well for them, since they're not having to personally pay most of the bills. And so would their doctors.

So there's the question of having the political will for a major upheaval of the system.

[elleng]

8. The question of 'upheaval' is always with us;

NO ONE likes change. (I'm also a Medicare beneficiary, I pay premiums for both. FEHB covers my prescription medications, at VERY good rates, and covers just about anything Medicare doesn't cover.)

[pnwmom]

10. But Medicare isn't getting very good rates because Congress refused to pass a law

allowing Medicare to negotiate prices with the drug companies, as Canada does.

[elleng]

12. Exactly.

The system needs change.

FEHB DOES negotiate with drug companies. AND hospitals, and doctors, and other providers.

[ErikJ]

24. I was talking to a 79 yr old full-time RV'er this morning

Last edited Sun May 8, 2016, 06:47 PM - Edit history (1)

and he said his meds would cost him $22,000 for a yr supply here in the US but only a couple hundred in Mexico. So he gets them when he winters down in AZ.

[elleng]

39. Good he's able to get them.

[ErikJ]

40. Yes he's got bronchitis and emphysema and has to be on

oxygen half the day I guess. Real nice old guy. Prob doesnt have too much longer with the RV life tho.

[passiveporcupine]

68. I'm currently paying 122 a mo for two asthma rescue inhalers

I use two because I can't afford the Pulmicort that would help control my asthma.

Somewhere across the Ocean (forgot which country), for the exact same inhaler (HFA) I use (Ventolin), the price was $7 a couple of years ago...so now it's maybe up a bit...maybe $10? $20 a month compared to the $122 I'm paying now at WalMart. And this is for a name-brand inhaler, because when they switched to HFA, they got their inhalers repatented. No more generics.

Asthma is a very common childhood illness, and one that primary care providers can often manage without consulting subspecialists.

....So I prescribe a lot of albuterol [inhalers]. Or rather, I would if they existed. Unfortunately, albuterol inhalers per se are not currently on the market. What my patients really get are prescriptions for Proventil or Ventolin or Proair. There are, at this time, precisely zero generic albuterol [inhalers] on the market.

The reason why there are none on the market and thus patients (or their insurance companies, if they are blessed with good coverage) are forced to pay for the name brands is contained in this horrifying and infuriating article about pharmaceutical pricing in the New York Times. If it does not make your blood boil, then I congratulate you for having a more even temperament than I.

The pharma consortium...set up shop in...a major DC law firm. Between 2005 and 2010, it spent $520,000 on lobbying...The lobbying paid off. In 2005, the Food and Drug Administration (FDA) approved an outright ban on many CFC-based inhalers...In other words, pharmaceutical companies didn't just take advantage of this situation, they actively worked to create this situation.

http://www.motherjones.com/kevin-drum/2013/10/heres-why-your-asthma-inhaler-costs-so-damn-much

Here us the link to the NYT article.
http://www.nytimes.com/2013/10/13/us/the-soaring-cost-of-a-simple-breath.html?nl=todaysheadlines&emc=edit_th_20131013&_r=1

Albuterol, one of the oldest asthma medicines, typically costs $50 to $100 per inhaler in the United States, but it was less than $15 a decade ago, before it was repatented.

This repatenting is a game played by most pharmcos...whenever they can make some kind of change to the medication, they get to repantent drugs that were previously generic, and once they are repatented, other companies can no longer compete with generics.

“The one that really blew my mind was the nasal spray,” said Robin Levi, Hannah and Abby’s mother, referring to her $80 co-payment for Rhinocort Aqua, a prescription drug that was selling for more than $250 a month in Oakland pharmacies last year but costs under $7 in Europe, where it is available over the counter.

With its high prescription prices, the United States spends far more per capita on medicines than other developed countries. Drugs account for 10 percent of the country’s $2.7 trillion annual health bill

They have it in the bag.

[pnwmom]

70. I was surprised at the new price of a prescription I hadn't needed for years.

My copay was $75.

I said to my pharmacist, is this all the insurance will cover? It has to be off patent by now.

He told me I actually was getting a good deal. The new price of my formerly cheap medicine was over $900 for a thirty day supply.

[passiveporcupine]

71. I know, and I sympathize.

I complain a lot about the constantly increasing cost of my albuterol, but I'm lucky I don't need any "really" expensive meds like many people do. I have no medical coverage, so I'd have to go without. I'm not going to go bankrupt trying to stay alive. Live isn't worth that agony to me.

I had another drug (a generic drug) that just jumped from $37 to $150 and I had to quit using it. The one I'm using now that is cheaper (only about $70) is making me really nauseated all the time.

[pnwmom]

73. I need albuterol, too, alas.

But fortunately an inhaler lasts a long time for me, as long as I keep my allergies under control.

[Craig234]

38. price negotiating and the bill

Actually, the issue is not that Congress did not pass a law allowing price negotiation. No law is needed for that.

What the Republicans did, and why the Medicare Part D drug bill was Bush's #2 domestic priority after tax cuts to reward the Republicans' biggest donor industry, bit pharma, was to put language in the bill PROHIBITING negotiating drug prices.

To pass the bill, they appointed a Republican Congressman in charge of passing it. It had that prohibition that paid big pharma hundreds of billions more tax dollars, full list price for drugs.

Even some Republicans balked at how corrupt that was, and the bill failed. For the first time in US history as far as I know, the leaders simply extended the vote window all night, and walked the floor to change votes.

They offered 'incentives' and threats. One Congressman said he was told if he switched his vote, his son, who war running for office, would get $100,000 and party backing, and if he didn't, his son would be blacklisted. He changed his vote then recanted the story.

After several hours all night, they got about four people to switch and the bill passed.

The government employee in charge of estimating the cost of the program IIRC said he had been threated he'd be fired if he released the numbers.

Weeks after the bill passed, the Congressman who had led it quit Congress and was made the heads of big pharma lobbying for $2 million per year.

[pnwmom]

69. Thanks for all the info. So it was even worse.

[passiveporcupine]

74. Yes, I knew this

was to put language in the bill PROHIBITING negotiating drug prices.

And I refuse to join AARP to this day because I was so pissed that they backed this bill.

I also refused Medicare part D when I was eligible for the same reason...I had no idea how much or how little it would help me in pricing when it first came out, because nobody could tell me...it was a new program and pricing info was not available, and I was so low income I didn't know if it would help me or hurt me. So I never signed up for it. Two years ago I realized drug prices were all skyrocketing so high (even old generics I'd been on forever) that I needed help, so I was going to sign up for Part D, but I found out it has a penalty of 10% of the premium added for every year you don't sign up for it, and now it costs so much I can't afford it.

I was hoping to sign on with an advantage plan this year, but we didn't get a cost of living increase and I couldn't afford to do that. I was going to use my cost of living increase to pay for it.

[Baobab]

101. The real reason why our health care is SO broken! - Must Read - You won't believe this!

Please read this paper- this will blow your mind

[Warren Stupidity]

20. millions of seniors would object to service fees going down and a real prescription benefit?

Why would they object to that? I'll be on medicare in a few months, please let me know why I should object to improvements that would reduce my costs.

Oh never mind, that is obvious horseshit. "millions of seniors" => a few wall street banksters.

[pnwmom]

31. They would object to having their doctors retire and not being replaced. And most of these costs

aren't being passed to the seniors -- they're being paid for by the government and are why the budget for Medicare is ballooning.

[Warren Stupidity]

45. lets unpack that derp, 'kay?

1. They would object to having their doctors retire and not being replaced.

There is no evidence that "their doctors would retire" if we switched to a single payer system. Other countries have done this and and there was no mass retirement of doctors, nor do they have a shortage of doctors. So that rates a solid "derp".

2. And most of these costs aren't being passed to the seniors -- they're being paid for by the government and are why the budget for Medicare is ballooning.

Wait, what? Under the current system "medicare (costs) are ballooning". Yes that's true, but we don't have a single payer regulated healthcare system. The system we have is driven by profits and collusion between government and industry to maintain those profits. Other countries regulate healthcare as a public good and keep their per-capita costs at around half of what we spend while providing measurably superior services.

Oh and by the way Part B premium rates are going up in 2016, part of the cost inflation under the current system is getting pushed onto those least able to afford it.

Again, a solid "derp".

[pnwmom]

46. There is a large group of doctors near retirement age right now. And if the government suddenly

put them on a reduced salary, that would hurry things along.

They wouldn't stick around for single payer.

[Gore1FL]

49. So many assumptions. So little data. nt

[pnwmom]

52. There actually is data.

http://www.centerforhealthjournalism.org/2014/03/10/whether-it’s-retire-or-flee-doctors-are-leaving-health-care

Apparently not. Deloitte’s 2013 survey of over 20,000 physicians notes 62% say that “it is likely that many physicians will retire earlier than planned in the next one to three years. This perception is fairly uniform among all physicians, irrespective of age, gender, or medical specialty.”

And if they’re not retiring outright, doctors say they believe physicians will “scale back practice hours (55 percent) based on how the future of medicine is changing.” None of this is surprising when Deloitte reports that “[s]ix in 10 physicians (57 percent) say that the practice of medicine is in jeopardy.”

Retirement may be more of a problem in safety net systems, and in certain types of specialties, like primary care, where both the workload and the reimbursement rates are worse than other fields of medicine. But fleeing from a field with very high burnout rates is not unique to physicians.

I don't know why I can't get the link to post correctly. It works if you cut and paste.

[cui bono]

88. I believe the apostrophe is ruining the link.

Your excerpt doesn't say anything about this being due to a change to medicare for all or single-payer health care.

.

[hedgehog]

107. If a phsycian can choose to retire early, maybe that physican is overpaid?

[pnwmom]

108. Maybe from our perspective but not from theirs. n/t

[Bigmack]

51. Single-payer/Medicare for all is useless...

... unless we have a plan for a pipeline for new doctors.

The military pays for medical education in return for X years of service.

Why doesn't this country do that for medical education for every qualified person? The AMA would scream, but...

Why does this country have a problem with actually planning for things?

[Lydia Leftcoast]

54. That dud of a fighter jet for $2.3 trillion? (Yes, trillion)

I wonder how many medical school tuitions that could pay for.

[Recursion]

78. You said it: the AMA would scream

We have fewer doctors per capita than almost every other OECD country, and our doctors make twice as much as the OECD average. Those aren't coincidences, and the AMA loves it this way. Worse yet, we have much broader definitions of things only MDs can do than most OECD countries, for the double whammy.

[malthaussen]

91. Which raises, for me, the central question of the health care issue:

Is there enough health care to go around? I tend to see some things in simple economic terms, like supply and demand. When supply exceeds demand, prices go down. When the reverse occurs, they go up. In terms of health care, it is pretty brutally simple: if there isn't enough to go around, somebody is going to go without. All other contributions to ballooning costs, and they are legion, are nevertheless subsidiary to this simple question. To which I don't know the answer.

-- Mal

[trudyco]

95. What about Nurse Pactitioners and Physician Assistants

Doctors seem to be making money by using cheap labor to do their patients physicals and basic ailments. There are times when I don't see my doctor at all. Just like hospitals no longer use many RN's they use CNA and LPN and medical assistants.

[passiveporcupine]

67. You do realize that Medicare does not pay what most docs and hospitals charge, right?

They pay about half, if that. They do manage prices now. Not for drugs, unfortuately and the pharmcos are going nuts with this freedom.

[Baobab]

100. Single payer has to be free to the end user, (otherwise you would have to create a tiered system to

punish those who cant pay with bad medicine.

Single payer would unify all health care providers and that is the only way to fix it. the only way to dramatically save money and improve care at the same time. Hillary's alternative, globalization will either send poorer people overseas for care or throw our doctors and nurses under the bus to preserve the tiered system which adds no value and which doesnt even pay 23 of our bills, the government already does..

Sorry pnwmom.

[StarzGuy]

63. There is no free lunch

As a retired Federal worker I can tell you that I had copay's and deductibles with my health plan. Now, that I am retired and on Medicare I still have my federal healthcare benefit as secondary insurance. I still pay copay's for my medications and of course Medicare only pays for 80% so I expect to get a bill for my colonoscopy, hopefully my secondary insurance will pick up the rest... The good news is that they found nothing so I'm on the 10 year plan for another followup.

[elleng]

64. Right, there is no free lunch.

I too am a retired federal worker, and I've said (here) that I pay a premium and copays for FEHB, and a 'premium' for Medicare. My coverage (and yours, I assume,) is excellent.

Glad they found nothing.

[Recursion]

75. Sure, but look at Medicare Part D: no negotiations

Why would we think Medicare For All would be any better? Global budgeting is the answer.

[elleng]

77. Medicare, as presently set up, is NOT the answer;

changes are necessary.

[passiveporcupine]

79. Under Bernie's plan for Medicare for all

a lot of things would change. For instance, you would have dental and vision care, and prescription costs would be negotiated.

If it is a single payer plan that really works, there would be no copay or deductibles at all for the patient, which simplifies the system and saves money.

[Hoyt]

80. Actually, Medicare can't negotiate prices -- but companies that provide Part D coverage, can and do.

It would be better if Medicare negotiated prices because of their size, but some of the Part D plans -- which are administered and sold by private insurance companies -- do negotiate and are quite large.

[Fast Walker 52]

89. exactly.

[MH1]

4. Doesn't Medicare set maximum allowable charges for specific services?

That alone won't fix the requirement for unnecessary tests for basic services. But it would help control costs to some extent.

As usual, with government services, it depends how it's managed. But at least with a government service there is some chance of getting elected representatives to work on fixing it. Ordinary consumers have very little power over corporate behemoths like the for-profit medical industrial complex.

[Warren Stupidity]

21. It would be a good start.

No systems are perfect, and as always government regulations can be circumvented and corrupted by those with a vested interest in doing so. But we know what we have now is not working and we know that other countries have managed to figure this out and think we are either fucking stupid or insane or both.

[YOHABLO]

25. And doctors hate it. They can rip private insurers off, not Medicare.

[Recursion]

76. OTOH they can lobby Congress and not Aetna

Which is why the "doctor fix" was made permanent. I think that is actually a value-add private insurance brings: there's no regulatory capture potential from providers.

[Hoyt]

81. Many private insurers pay less than Medicare. Most others allow Medicare + say 10 or 25%.

The days of private insurers paying close to what docs or hospitals are long gone.

[JustABozoOnThisBus]

97. Yes, for part-a and part-b services. Part d for drugs, no maximum.

I had a procedure, and the hospital billing dept screwed up the medicare/supplemental submission. So I got a bill for "retail", a little more than 20,000.

After the insurance got straightened out, the bill was paid in full, a little more than 3,000.

The uninsured get some amazing bills.

[rhett o rick]

13. Works well for the rest of the modern world. We must get private insurers

out of basic health care.

[pnwmom]

15. In many countries, doctors are state employees. The difficulty here is persuading doctors

that they need to give up their autonomy and their high salaries -- while still maintaining quality.

[Warren Stupidity]

18. bullshit. The UK is an outlier.

Most modern developed countries have some sort of regulated single-payer or multi-payer system with physicians in private practice.

Only the UK and Spain among OECD countries have nationalized medical practices.

[rhett o rick]

19. Yes In England but I don't believe that's true in Canada, France, and Germany. nm

[Gore1FL]

50. ...

[ReasonableToo]

53. Doctors that give a damn about their patients are for single payer -

from http://www.pnhp.org:

On May 5, 2016, an esteemed group of physicians unveiled a detailed plan for single-payer health care in the United States. To read and/or endorese the proposal, please visit www.pnhp.org/nhi.

[coyote]

85. That simply is not true.

[Warren Stupidity]

17. It is exactly the sort of crapfest that a single payer system can fix.

Your candidate is running on changing nothing, you know what that will fix? That's right, nothing.

A single payer system can directly address these sorts of costs - as they do in other countries - by determining exactly what the system will pay. Heck even a well regulated multi-payer system can address service fees. We have neither. We have a corrupt shit show.

The government has to set the fee schedules. Everyone has to be in the system.

[Android3.14]

30. That's another misleading statement

The problem was that the patient couldn't afford the treatment. Medicare for all would pay for it, even if it were expensive.

Another fail in reasoning.

[Baobab]

102. We have to bow out of the trade deals we are pushing to tie our own hands.

Soon, because they are almost signed. Once signed we're really stuck.

We need to attach CARVE OUTS to all of these deals that explicitly preserve our "right to regulate" health care, education, water and other essential PUBLIC services- However they wont like this because thats the not-so-secret goal of these things is to destroy any possibility of a functioning safety net, not just here, all around the world, forever- or until the system breaks - or is broken, globally. A change in government or even a revolution in any single country wont discharge the obligations as South Africa found out with health care.

Slovakia too, recently..

[Motown_Johnny]

35. "gap in her health insurance"

Do you understand that phrase?

[Cassiopeia]

93. Bullshit.

If this person had been insured the billing rate would be 1/10th of what s/he was charged. Medicare negotiates prices just like every insurance company.

Additionally this insane uninsured rate would no longer exist because everyone would have insurance.

[Baobab]

99. yes it would fix it, and the INSURANCE INDUSTRY creates that waste BY WASTING TONS OF TIME

AND PROVIDING NO VALUE.

Meanwhile we're increasingly being trapped by bad policy.

[arikara]

104. Of course it would fix it

It doesn't happen in other countries that have medicare.

"No we can't" is not a reason to keep a broken system.

[Fairgo]

7. we've become a nation of gangsters

[Tsiyu]

9. Everybody is somebody else's ATM

It's pretty sickening how the whole system works, while so few benefit from it, and so many do without any health care at all.

[Fairgo]

11. What is telling for me...

Accepting a position in Australia gave me the freedom to risk, as my basic health care is not linked to my job. Had I stayed n my contract work in the states, I would now likely be unemployed, homeless, and thousands of dollars in debt.

[Tsiyu]

14. Most modern countries realize this

and our leaders know the system is wrong. But they are too greedy and cowed by the wealthy to change anything.

I'm glad you're in a better health care situation. While the politicians blamed the people for extravagant spending leading to all of the historic mortgage foreclosures in recent years, it has been obscene medical debt that has driven so many people to financial ruin.

[appalachiablue]

28. +5

Bumper Sticker/Slogan!

[Tsiyu]

29. Ha!

Cafe Press, here we come?

[appalachiablue]

32. Fairgo above, 'We've Become A Nation of Gangsters', plus yours

'Everybody is Somebody Else's ATM'. Got to do this. I'm in, seriously.

Bumper stickers, ball caps, t-shirts, wristbands, keychains, Benefit Concert, the works! I see this going big!

Who's a patent attny.? there must be some here. Let's get started, no time to waste!

Maybe a movie too, "Nation of Gangsters: ATM Suckers of America".

Is Michael Moore here today I hope.

[Tsiyu]

48. This could be our big break!

I like the way you think.

Feel free to start a cafe press account and design some. I would buy!

The movies sounds like a hit too.

[appalachiablue]

62. I thought about it. Go for a Reality Show, only way to do it right. We gotta Think Big.

Let me make a few calls tomorrow and I'll check in, well before the pilot starts filming. It's a Cakewalk.

[appalachiablue]

106. On the reality show I was half way teasing, Cafe Press stuff is great! :)

[Tsiyu]

110. I am working on a show with one of my kids

and it's amazing the time involved in producing a tiny segment of video.

It's a fun time to be alive, though, because you have so many ways to get a message across.

I normally don't get a chance to DU or do much with my tasks and chores, but I finished a big project so I could take a week off.

You should definitely look into it if you have the time.

I support you all teh way appalachiablue!

[Fairgo]

86. I leave it all to creative commons

Just give me a screen credit

[appalachiablue]

98. Good deal!

[appalachiablue]

27. +5

Bumper Sticker/Slogan!

[Califonz]

43. Gangster: "Your money or your life!" Sounds about right...

"America is pacifistic and cannibalistic. Outwardly it seems to be a beautiful honeycomb, with all the drones crawling over each other in a frenzy of work; inwardly it’s a slaughterhouse, each man killing off his neighbor and sucking the juice from his bones." -- Henry Miller, Tropic of Capricorn (1935)

[Fairgo]

87. Henry Miller

Well done...

[malthaussen]

92. Jack Benny: "I'm thinking!" n/t

[zalinda]

16. Part of the problem is

that emergency rooms have to make up for those who come in and can't pay. No matter how you look at it, someone has to pay for services, and if those who have no insurance have to use the emergency room for their primary physician, well those who can afford it, pay for it, whether insurance companies or private individuals. Just take a look at "Code Black" the documentary and you can see what happens in the emergency room.

What will happen with single payer is that people can then walk into any clinic and get care. You can go into what one doctor called it, 'doc in a box' and get that rash looked at or the sore throat or whatever. We also need a lot more doctors and nurses in the system, and we should be paying for their education. We should also be going in poorer communities and earmarking kids who should be encouraged to be more than their circumstances dictate what they can be. If I would have had any type of encouragement that I was smart enough, I would have loved to have become a doctor or even nurse. By the time I realize that I was smart enough to go to college, it was too late to realize that dream of an occupation.

Right now, even Medicare or Medicare is under for profit health insurance companies. I can only get what the health insurance company allows me to have. They will pay for one medication, but not another, for example, they will pay for Ibuprofen but not Tylenol, and the list goes on. It is a dance that the doctors, or rather the doctor's insurance specialists have to do to get services for their patients.

The catch phrase of medicare for all, is only that. All you would have to do is introduce a single payer option and watch people switch over. You don't need to force them to change, just give them the option. It's called incremental change, but it's change in the correct direction, not a sideways direction.

Z

[litlbilly]

23. Thats the way to do it. It would take care of itself over time. Just put the option on the table.

[lostnfound]

42. Another part of problem is that corporations get better treatment than individual humans

The insurance corporations negotiate to get cheap prices so they don't carry the burden of the uninsured. An individual with no insurance gets exploited.

[Doctor_J]

58. "There will never, ever be single payer healthcare in the US"

- Hillary Clinton

[Duppers]

61. ^^^ Ding ding ding ^^^

[SCantiGOP]

22. We have Universal Health Care

I have argued this point for decades with people who claim we can't "afford"
universal health care. Unless we are going to let people die on the sidewalk outside of hospitals, our health care system is to force people to use the ER, which is the most expensive coverage possible. Most of those people end up not being able to pay the bill, so everyone else - or their insurance carrier - ends up paying for the service.

Having a system to give people access to preventive care and early care for problems would obviously save the system - and those who says we can't afford to cover everyone- a lot of money. And it would save lives and make people healthier, but the non-coverage crowd isn't swayed by that argument.

[zalinda]

65. This is no longer true.

Many hospital now have a policy of patch and turf. They spend the least amount of time with a patient possible, patch them up and then take them to a county hospital, and dump them there. Some have even gone so far as patching them up, giving them some pills and dropping them off downtown. And this is true emergency cases, those that are just sick, can wait in the emergency room for over 24 to 36 hours, with staff hoping that they will just go away.

Z

[pansypoo53219]

26. medical industrial complex.

[appalachiablue]

33. +10

[angstlessk]

34. I went in for a broken collar bone, and came out with

a sling and a prescription for pain killers AND a bill for $3,000.

It was a slow night so I got a cat scan and a chest x ray besides the shoulder x ray..

Hell, I had scarfs to use as a sling, and aspirin for pain relief..the cost would have been $0.00

[Enthusiast]

36. Kicked and recommended!

[Duval]

37. My husband and I go together

We always are there to support each other and call out crap like this. I applaud your friend. This has to stop.

[Thespian2]

41. As long as the government allows

the insurance industry and big pharma to be the gate-keepers to health care (death panels), the American system will remain broken and very expensive...

[Hoyt]

82. I basically agree, but you'd never hear the end of it if the government refused to cover a drug

because the price is too high and lower cost drugs were just about as good. The only government agency that gets away with that routinely is Medicaid and similar programs for the poor. I guess it's acceptable because right wingers figure the poor would have nothing without the program. One of the problems with implementing single payer is people griping about the necessary restrictions to make it affordable. I really think the government would rather pay private insurers to handle that aspect, as well as avoid having to stuff single payer down the throats of the 40+% of people are just flat opposed to it and those who will become opposed when they see it's really not "free" and are too stupid to understand the increase in taxes offset premiums.

[Thespian2]

111. I moved to a socialist country...

getting used to medicare for all was quite easy...as a senior citizen, I pay from $5 to $15 for a month's supply of blood pressure pills, stomach pill, and pain medication...I was hospitalized for 5 days...I had full knee replacement surgery and all the aftercare...I pay no medical bills...I pay my taxes like everyone else...I do not need medical insurance...

[zentrum]

44. Half of 10K could still..

…be ruinous for a poor person.

Terrible story with a marginally better outcome. And only because she knew to fight it, and somehow had the strength to do it.

Hospitals are merging, as well and getting into massive real estate buying. Eventually they'll be real estate companies, that happen to do health care now and then.

[Algernon Moncrieff]

47. I recently had two separate discussions with conservatives who oppose Obamacare. I learned this

There is a segment of the population that isn't a bit bothered about incidents like the one in the article and the attendant huge bills, because it apparently never enters anyone's mind in this group to pay these bills. These folks basically shrug, and say "well they can't come after me if I set up a payment plan, so I make a payment plan where I send $5 a month, and that's it." So these folks don't really have any desire to pay the premiums for an actual insurance policy, much less the taxes that would support single payer.

The article indirectly brings up one thing I've told many people: medical bills are one of the few instances of the cash buyer being at a disadvantage. Cash payers pay the highest rates available for medical services. Don't be shy about getting on the phone and trying to negotiate lower figures. Reductions of 50-75% are not out of the question at all.

[scscholar]

55. The medical cartel...

always stands against the people.

[Doctor_J]

56. I read on du that Gingrichcare is an accomplishment that surpasses the cra and the VRA and

Medicare. This woman just wants free stuff like a pony!

Screw every conservative in this country. They are beyond despicable.

[IronLionZion]

57. Urgent care centers cover IV fluids and prescription pain killers

and total cost would likely be less than $100.

The ER is the worst place to go for this, especially if the gastroenterologist friend knew what she needed. If you want to minimize the financial impact, avoid the ER.

The $10,000 bill is deliberately and arbitrarily high as a starting point to negotiate down. Yes, it's a shitty system and the price is designed to shock us to get us to avoid going to the already crowded ER so that it can be free for people with emergencies. But insurance companies would get that bill down to the hundreds or even less. President Reagan signed EMTALA to make sure ERs don't turn away people because back in the day those motherfuckers really would let minorities and poor people die in the street outside for inability to pay up front for emergency treatment, even if an ambulance brought them in unconscious and bleeding to death.

As other long-time DU liberals have posted on this thread, single-payer would help cover everyone but would NOT solve the problem of high cost of care. What needs to be done is transparent pricing for routine treatments. While it makes sense to us why medicare for all should have some control over prices they are willing to pay for routine treatments, you try explaining to your average american why it's OK for the government to dictate prices to anyone. We already know the GOP is going to say it's socialist rationing.

[Doctor_J]

59. So you agree that healthcare should be like buying a used car.

That the bill you get should be a "starting point for negotiations"

It's amazing much shit some people will swallow as long as the right person feeds it to them.

[IronLionZion]

60. When did you stop beating your wife?

It's good to see you Doc.

[Triana]

66. Last time I went to ER the bill was $850 WITH insurance.

That included the ambulance to get there.

If you need ER care and/or an ambulance in the US without OR with insurance, you're SCREWED.

Of course it's MUCH worse without but even with it, it SUCKS.

It's INHUMANE.

[King_Klonopin]

72. This thread is very confusing.

Medicare, as it exists now, is not single-payer and does not exist in a vacuum.
It co-exists in a mishmash of for-profit, "non-profit", private, state and federal
government delivery and payment systems. Our health care system is so
complicated that it boggles the mind. There is so much gamesmanship regarding
billing practices, price determination, and actual reimbursement that the numbers
mean nothing.

It is difficult to extrapolate how a single-payer system would fare, based on our
experiences with Medicare.

If we had single-payer, all things would become more uniform and simplified.
Health care providers would bill for a service, but no longer dictate an arbitrary
cost for reimbursement.
Removing the profit-motive would make it easier to determine true costs and fair
reimbursement rates -- no more games by the insurance, drug, or hospital
corporations.
Removing profit from the equation would mean more money is available for actual "care".

The OP example of a $10,000 E.D. bill for a kidney stone demonstrates the problem
of a lack of uniformity. The rub lies in determining the reimbursement rates of "a service".
Using the above example, $10,000 was an egregiously greedy over-charge. Alternately,
if an insurer decided to reimburse a hospital E.D. only $100 for treating a kidney
stone, then hospitals would go out of business in a hurry. Fairness lies somewhere in
the middle. The true cost (without profit) for treating that kidney stone was probably
around $3,000 (Ultrasound of kidney $1,000, labs $800, MD fee $500, plus overhead of
$700 for meds, IV fluids, and general nursing care)

I can say this from my own experience: Medicare is a better provider than the other
insurers. Medicare costs less to administrate. Customers are more satisfied. It is easier
for hospitals to manage, much less adversarial. All of us should be so fortunate.

[eridani]

83. My husband had an emergency root canal while we were biking in the Netherlands

The cost was $25 American. Of course the dentist's education was heavily subsidized by the government, so that explained the expensive German car in the reserved parking spot.

[marble falls]

84. ACA is the stop gap for Single payer.

[freebrew]

94. What the Rs refuse to acknowledge...

is that most of the higher costs of 'healthcare' goes to support the
huge over-blown administration and profits of the health-insurance companies.

The nation would save huge sums right off the top if they converted to a type of medicare.

All you need to do is to look at what the insurance company pays for the care, then look at the
'retail' cost.. guess who gets the difference...follow the $$$.

[trudyco]

96. We should have the Federal Insurance Plan

Or something good like that which has the ability to negotiate on everything (and run by the government) automatically available for everybody.

It can be your secondary or primary.

Paid for by taxes on gambling in the stock market. Hedge funds and derivatives and anything that bets on the economy or a company going down rather than up. Also an extra tax on vulture capitalists who tear a company apart or fleece its assets after they take it over. And a huge tax on inversions, and companies that ship jobs overseas.

[Gman]

103. In this particular case

Depending on when she lost her health insurance, it might have been cheaper to pay the COBRA premiums for the coverage.

Still, the article does a good job of explaining the problem. Health care and capitalism is a very immoral mix.