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So Im watching "Sicko" by micheal moore and whaaaat!? Apparently if you are uninsured and have no coverage, the hospital will charge you 60,000$ to retake the top of your index finger, OR 12,000$ for the other one.
Whaaaat!? Thats more then twice as much the average family makes in a year! Is this outrage true? If people tried to charge this much up in Canada they'ld b a riot.
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Actually, the median household in America has an income of $48,000. Interestingly, when researchers asked people what they believed the median household income in America was, the median answer was only $40,000. Link.Posts: 2409 | Registered: Sep 2003
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quote:Originally posted by Blayne Bradley: Apparently if you are uninsured and have no coverage, the hospital will charge you 60,000$ to retake the top of your index finger, OR 12,000$ for the other one.
I can't comment on whether this is true because I have no idea what it means to "retake the top of your index finger".
Posts: 2069 | Registered: May 2001
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Mr Moore would NEVER engage in exaggeration, or cherry pick his data in an effort to inflame his audience.
Posts: 7085 | Registered: Apr 2001
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quote:Originally posted by Blayne Bradley: So Im watching "Sicko" by micheal moore and whaaaat!? Apparently if you are uninsured and have no coverage, the hospital will charge you 60,000$ to retake the top of your index finger, OR 12,000$ for the other one.
Whaaaat!? Thats more then twice as much the average family makes in a year! Is this outrage true? If people tried to charge this much up in Canada they'ld b a riot.
The "average" person in the US can afford insurance. It's the below-average folks that might need some assistance. Certainly not the entire population. That seems like a waste, to me.
Posts: 433 | Registered: Feb 2005
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I haven't seen Sicko, so I don't know if it's covered in the move, but here's the real reason that this happens (at least the real reason as far as I understand it ... and I always reserve the right to be wrong)
Those ridiculously high charges are like the "rack rate" at hotels. They are there for a reason but it's not really expected that people will pay it.
Insurance companies have set amounts that they'll pay doctors/hospitals but these amounts aren't really enough. So the provider sets a rate that is higher than this. In some cases this rate is the "real" rate and in some cases it's probably a little higher.
Either way, though, since the insurance company pays less than this rate the difference is a loss. The provider then claims this loss on their taxes and pays less taxes, helping to offset the fact that the insurance companies don't pay enough.
There are several ways to "fix" this such as establishing set fees for services or mandating/providing universal health care.
quote:Originally posted by Jhai: Actually, the median household in America has an income of $48,000. Interestingly, when researchers asked people what they believed the median household income in America was, the median answer was only $40,000. Link.
Right, but Blayne didn't say the median household income, he said the average, which I believe is somewhat lower. Not $30,000, though, I think that might be the average individual income for wage earners instead of household. But I don't care quite enough to go look it up.
Posts: 7954 | Registered: Mar 2004
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quote:Originally posted by Blayne Bradley: So Im watching "Sicko" by micheal moore and whaaaat!? Apparently if you are uninsured and have no coverage, the hospital will charge you 60,000$ to retake the top of your index finger, OR 12,000$ for the other one.
Whaaaat!? Thats more then twice as much the average family makes in a year! Is this outrage true? If people tried to charge this much up in Canada they'ld b a riot.
The "average" person in the US can afford insurance. It's the below-average folks that might need some assistance. Certainly not the entire population. That seems like a waste, to me.
Not that Sicko should be considered gospel in terms of truthfulness, but in the documentary all his stories and case studies are of people who DO have health insurance, not the people who do not.
Posts: 14316 | Registered: Jul 2005
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quote:Originally posted by Blayne Bradley: So Im watching "Sicko" by micheal moore and whaaaat!? Apparently if you are uninsured and have no coverage, the hospital will charge you 60,000$ to retake the top of your index finger, OR 12,000$ for the other one.
Whaaaat!? Thats more then twice as much the average family makes in a year! Is this outrage true? If people tried to charge this much up in Canada they'ld b a riot.
The "average" person in the US can afford insurance. It's the below-average folks that might need some assistance. Certainly not the entire population. That seems like a waste, to me.
Not that Sicko should be considered gospel in terms of truthfulness, but in the documentary all his stories and case studies are of people who DO have health insurance, not the people who do not.
It's not a matter of having health insurance or not. It's a matter of having good, reliable and ethical health insurance or lousy, unreliable and "screw the customer" health insurance.
quote:Originally posted by Blayne Bradley: So Im watching "Sicko" by micheal moore and whaaaat!? Apparently if you are uninsured and have no coverage, the hospital will charge you 60,000$ to retake the top of your index finger, OR 12,000$ for the other one.
Whaaaat!? Thats more then twice as much the average family makes in a year! Is this outrage true? If people tried to charge this much up in Canada they'ld b a riot.
The "average" person in the US can afford insurance. It's the below-average folks that might need some assistance. Certainly not the entire population. That seems like a waste, to me.
Not that Sicko should be considered gospel in terms of truthfulness, but in the documentary all his stories and case studies are of people who DO have health insurance, not the people who do not.
It's not a matter of having health insurance or not. It's a matter of having good, reliable and ethical health insurance or lousy, unreliable and "screw the customer" health insurance.
I've had both.
Oh I'm with you on that. That's why I think privatized insurance does not work. Any corporation that wants to maximize profits will be unable make patient care their top priority. I feel similarly about car insurance as it's mandated by law, I do not think it's right to give car insurance companies that sort of market security, where they can gang up and raise prices. I think non profit car insurance managed by the government should also be implemented along with universal health care. But I'm willing to give up car insurance for the universal health care.
Posts: 14316 | Registered: Jul 2005
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quote:Originally posted by BlackBlade: Oh I'm with you on that. That's why I think privatized insurance does not work. Any corporation that wants to maximize profits will be unable make patient care their top priority.
The above statement is false. A corporation trying to maximize profits in the short term might not make patient care their top priority. In the long term, the health care providers that provide the best care have patients should be commanding the highest rates.
But I agree with regards to the current healthcare structure--it doesn't work. A three-party system (patient, provider, payer) will have some conflicting interests. A more binary system (provider/individual) seems like it would align incentives for everyone.
What are the barriers preventing the private sector from offering reliable, high-quality healthcare at a reasonable price?
Posts: 433 | Registered: Feb 2005
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quote:Originally posted by Fusiachi: What are the barriers preventing the private sector from offering reliable, high-quality healthcare at a reasonable price?
I think you've just identified the old choose two of these set.
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The hyper-rich help skew the mean upwards, so it makes sense.
Which is why in cases like this it makes more sense to talk about the median...
And why the term "average family" is a tough one - the average family is *not* the family that makes the average income, just like it's not the one that actually has a fractional child...
quote:The above statement is false. A corporation trying to maximize profits in the short term might not make patient care their top priority. In the long term, the health care providers that provide the best care have patients should be commanding the highest rates.
You are assuming that one of the larger providers is willing to take a short term lose in profits in order to steal customers from the other HCP (health care providers.)
Or that it's impossible that big business could meet together and agreeto keep prices artificially high. In this instance pharmaceutical companies have successfully kept medication made in other countries out of the US, thus keeping prices high. People typically have to seek health care in their own country so prices can be set excessively high. More and more rich people are actually saving money flying to other countries, getting surgery and flying back.
People who actually collect from insurance often find they are dealing with an adversarial model of insurance, where they are denied health care until they prove they really need it. And in order to even sign up for insurance you have to prove you don't need it.
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What I really don't understand is why doctors are willing to take a significant amount less from an insurance company than they are from in individual without insurance. My insurance company pays maybe half of what the total billed amount is on doctors bills. Often less than that. But if I was trying to pay out of my pocket I would be expected to pay the entire amount. If doctors are willing to take say $1250 for what they claim is a $2500 service, then it can't really be costing $2500 or no doctor or hospital would be able to stay in business. Do they charge such a high amount to individuals because they don't expect payment in full, or are they just gouging the consumer. Is it a combination of the two? What gives?
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quote: You are assuming that one of the larger providers is willing to take a short term loss in profits in order to steal customers from the other HCP (health care providers.)
Well, it would be a competitive strategy. Not only do you attract new customers (who are dissatisfied with previous service), but your own clients live longer. (Although, I suppose, if they're healthier, they might not need your services as frequently. I guess this model works much better within a paradigm of 'improving health' versus 'curing disease'.)
quote: Or that it's impossible that big business could meet together and agreeto keep prices artificially high. In this instance pharmaceutical companies have successfully kept medication made in other countries out of the US, thus keeping prices high.
Antitrust legislation should prevent this, no? Government interference via legislation aside, a healthcare provider that offered increased transparency in the process would be adding some value to the product. And lowering your price would give you a competitive advantage. There are too many incentives to 'cheat' cartels or otherwise under-the-table arrangements. If there are no barriers to entry, one competent competitor can bring the system down.
quote: People who actually collect from insurance often find they are dealing with an adversarial model of insurance, where they are denied health care until they prove they really need it. And in order to even sign up for insurance you have to prove you don't need it.
I agree. The 'patient-pays-insurer-pays-provider' system is flawed.
Posts: 433 | Registered: Feb 2005
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quote:Do they charge such a high amount to individuals because they don't expect payment in full, or are they just gouging the consumer. Is it a combination of the two?
The hyper-rich help skew the mean upwards, so it makes sense.
Which is why in cases like this it makes more sense to talk about the median...
And why the term "average family" is a tough one - the average family is *not* the family that makes the average income, just like it's not the one that actually has a fractional child...
(edited slightly for clarity)
Yeah, that's why I quoted median - for questions like these the median and (to a lesser extent) standard deviation is almost always the more useful measure. Incidentally, the term "average" can refer to the mean, median, or mode. Typically people who work with data a lot will specify which average they're talking about, or, more often than not, "average" will be shorthand for "median." It's partially a field-dependent thing, though.
Posts: 2409 | Registered: Sep 2003
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quote:Originally posted by Blayne Bradley: So Im watching "Sicko" by micheal moore and whaaaat!? Apparently if you are uninsured and have no coverage, the hospital will charge you 60,000$ to retake the top of your index finger, OR 12,000$ for the other one.
Whaaaat!? Thats more then twice as much the average family makes in a year! Is this outrage true? If people tried to charge this much up in Canada they'ld b a riot.
The "average" person in the US can afford insurance. It's the below-average folks that might need some assistance. Certainly not the entire population. That seems like a waste, to me.
The average person can afford insurance? Not if they have a family and their work doesn't pay any of it (and in some fields this is the norm, there's no requirement for them to pay any part of their employees' insurance.) If you have a pre-existing condition, or are a woman of childbearing age who would like to purchase decent maternity coverage, it gets even worse. You can be making $50,000 a year and still not be able to afford coverage for everyone in your family (say, you, your spouse, and two kids) if you can't get a group rate (or sometimes even if you can.)
Posts: 21182 | Registered: Sep 2004
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The majority of America's population has insurance, which implies that the median person can afford to have it. "Afford" includes the people who get insurance through work - if your company pays for your insurance that means they're not paying you more, or giving you other work perks. If your company doesn't give insurance, and the government started to require them to do so, you can bet that salary or other perks would be going down. (Maybe wages would not actually go down, due to price stickiness, but short-term you might see some people get fired, and long-term you'd probably see wages rise at lower rates. The company would have to cut costs somewhere.)
Incidentally (I seem to be using that word a lot today), a lot (not all!) of the "problem" about real income not increasing as productivity has been over the past decade or so goes away once you count in the increasing value of health benefits and other work perks.
Posts: 2409 | Registered: Sep 2003
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quote:Originally posted by ketchupqueen: The average person can afford insurance? Not if they have a family and their work doesn't pay any of it (and in some fields this is the norm, there's no requirement for them to pay any part of their employees' insurance.) If you have a pre-existing condition, or are a woman of childbearing age who would like to purchase decent maternity coverage, it gets even worse. You can be making $50,000 a year and still not be able to afford coverage for everyone in your family (say, you, your spouse, and two kids) if you can't get a group rate (or sometimes even if you can.)
Yes, that -can- happen. I would contest, however, that the majority of families earning 50k+/year are in a position to insure 2 parents + 2 children. If you are in an area where the cost of living is higher, YMMV.
But as I've said above, I'd like to significantly diminish the role of insurance companies in the healthcare process.
Posts: 433 | Registered: Feb 2005
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quote:Originally posted by Jhai: The majority of America's population has insurance, which implies that the median person can afford to have it. "Afford" includes the people who get insurance through work - if your company pays for your insurance that means they're not paying you more, or giving you other work perks. If your company doesn't give insurance, and the government started to require them to do so, you can bet that salary or other perks would be going down. (Maybe wages would not actually go down, due to price stickiness, but short-term you might see some people get fired, and long-term you'd probably see wages rise at lower rates. The company would have to cut costs somewhere.)
Incidentally (I seem to be using that word a lot today), a lot (not all!) of the "problem" about real income not increasing as productivity has been over the past decade or so goes away once you count in the increasing value of health benefits and other work perks.
More and more companies, though, are reducing health benefits or switching to cheaper plans.
The uninsured are definitely not the majority, but I think we must also consider the under-insured. People who HAVE insurance and still pay out over 20% of their income each year on medical expenses, for instance, or people who have insurance but find that it won't cover them when they have a serious problem, and end up paying for most or all of it, or for instance my friend who pays $15,000 every time she has a baby-- that's HER PORTION of the cost, her insurance pays some of it.
Posts: 21182 | Registered: Sep 2004
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At one point when I was waiting tables I was paying for my own insurance. I had to maintain a policy even though I really couldn't afford it as I have certain pre-existing conditions and it was more cost effective in the long run to pay for the insurance so that when I could afford to have insurance and go to the doctor those conditions would be covered without a waiting period. Not to mention if you have to take an ambulance trip when you have no insurance your great-grandchildren will be paying for it years after you die. (OK, probate will probably take care of the remaining charges but even so.)
You'll notice though that even though I had insurance, I couldn't afford to go to the doctor. The $175 I was paying a month for insurance coverage ate up any money I would have had to go when I needed to. I couldn't afford the $20 co-pay I was so broke, so it really did me no good to have the policy in terms of the short-term. In fact I was so broke and so desperate not to pay the co-pay that I probably had pneumonia for a month before I decided that the really disgusting cough I had wasn't going away any time soon. I got the pneumonia because I have GERD and I wasn't taking my Prevacid (because my prescription ran out and I couldn't afford the co-pay to the doctor to have a new scrip written, never mind the fact that I had a $200 deductible on my prescription coverage and I really couldn't afford to pay that).
So, while long term it probably helped to have insurance coverage (although my insurance company with my new employer never asked for proof of continuous coverage when I started getting treatment for my pre-existing conditions, it might have, and I could provide it) in the short-term it really did nothing for me, except force me to come up with $175 every month that I didn't have.
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Have barely a clue as to the current figures, but the "average household income of $48,000" fits better with the "median household income of $40,000" than a $40,000 average fits with a $48,000 median.
The median is determined by ranking all of the households by income, then picking the income of the household at the midpoint in the ranking. The average is determined by adding up all of the household incomes, then dividing by the number of households.
Averaging in AlexRodriguez's income of $24million per year with a 1000 households earning $24thousand per year creates an average income of $47,952 per year. Somehow I doubt that the new average income will make Alex start pinching pennies. Or make those earning $24thousand feel any better about their monthly budget. Using the same example, the median household income would still be $24thousand per year.
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I don't know how you've done your shopping, but for a family earning the median household income or below, the monthly cost of private medical insurance will be greater than what they are spending for food, clothing, and housing. And good luck if you should get an extended illness even with that coverage. Cuz if that illness should make it impossible to earn enough to cover your monthly insurance payment, your policy will be cancelled. And if it's cancelled, your now pre-existing condition will make it impossible to buy new insurance covering that illness.
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quote:Originally posted by Dagonee on 3May06: My MRI was billed to me for $2600 when it was denied by my insurance by mistake. They billed the insurance company $325.
The amount of money charged for treatment to a patient uncovered by insurance is absurdly more than what is charged to an insurance company covering a client for that exact same treatment.
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Cobra (continuing to pay for the same health insurance policy after you leave a job so there isn't a gap in coverage) costs are the entire monthly payment to the insurance company. Whereas your employer had paid some percentage, you are now responsible for one hundred percent. For a married couple, cobra coverage for myself and nathan for one month was $853 dollars. Our rent for our apartment is $650!
I'm on maintenance medications. Paperwork for insurance coverage to be transferred to employer pay to subscriber pay can take from two weeks to a month. During this time, your policy is 'on hold' and you have to pay for everything out of pocket. Once you have coverage again (and it's retroactive coverage so there's no actual gap), you can have the insurance company reimburse you for your out-of-pocket expenses.
But during that time period, we'd already paid the $853 premium. One medication I take costs $400 to fill without coverage. Just one medication brings the cost to nearly twice what we pay in rent. For people with a chronic condition, health insurance costs and availability are a huge issue. Private insurance tends to be very expensive and tend to have very high deductibles (on top of the monthly premiums). Chronic illnesses are high-risk, and if you can find an insurer who will cover you, good luck being able to pay the premium.
Anyway, sometimes I think that people who aren't chronically ill, have never had a catastrophic illness, or are well-off financially, tend to have an entirely different sense of the health insurance crisis in the US.
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And you are a young person. My uncle's COBRA payment for him and my aunt when he lost his job last year was over $3000/mo.
Posts: 21182 | Registered: Sep 2004
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I know. They live in a nice part of Pasadena (very high-rent area) and their mortgage is less than their COBRA payment was.
Posts: 21182 | Registered: Sep 2004
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The guys at Kiplinger claim the efforts of states to help has actually lead to an actuarial death spiral.
quote: With state policies varying all over the map, there's no sure route to finding affordable health coverage on your own. If you happen to live in Kentucky, Maine or Washington State, you'll have few choices of any kind. In rural areas of Texas and other states, you can't always save money with an HMO because there aren't enough people to make it economical. Association plans, which sometimes offer good deals, are unavailable in several states. And your state may limit your options for raising deductibles or cutting back on coverage to lower the price.
quote: If you're on your own and in good health, you'll have the toughest time finding affordable coverage in New Jersey, New York or Vermont. Those states have guaranteed-issue laws that require insurers to cover anyone who applies, regardless of health or community rating -- which means that insurers have to charge everyone the same premiums. Such a combination adds up to little competition and high prices.
They have some excellent points, but I still haven't found the middle path. Dropping the people who need coverage most is cruel, while forcing them to be factored in with everyone else makes it unaffordable for everyone. It shouldn't just be a question of shifting the payments around. If we can't afford to pay it, then we can't afford the taxes to make the governmant pay it. The answer has to be to bring the costs down overall, but I have no idea how.
Posts: 2283 | Registered: Dec 2003
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quote: It shouldn't just be a question of shifting the payments around. If we can't afford to pay it, then we can't afford the taxes to make the governmant pay it.
Thing is, switching to a gubbamint system does bring the costs down. Our system is more wasteful by orders of magnitude.
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For the record, while I'm young, I have a rather serious chronic medical condition, and I've dealt with a year without medical insurance. And I'm not claiming there's not a problem with the health care industry in the US - just pointing out some facts that others' arguments don't seem to be taking into account.
And aspectre, check the numbers upthread again. The median household income is $48,000, and the mean household income is $66,000. The median person thinks the median income is $40,000.
Posts: 2409 | Registered: Sep 2003
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But Jhai, it's not just that you've currently been without insurance for a year, although that sucks, it's also that since you've been without insurance for a year, you'll have a waiting period of 18 months with most insurance companies for the condition once you do get insurance. They'll refuse to cover any pre-existing conditions, and the standard waiting period is 18 months. (My current insurer didn't ask for proof of continuous coverage, but they would have been within their rights under the law. I just happen to have found a job with extraordinarily good insurance benefits.) So, if you get insurance today, it's not just a matter of having to pay out of pocket for a year, but for two and a half years when you include the waiting period. And, as I'm sure you know already, out of pocket insurance costs are ridiculous.
Posts: 1214 | Registered: Aug 2005
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Actually, I currently have insurance, and I had no trouble having everything, including the pre-existing condition, be covered. It was something of a financial gamble at the time I went off insurance, without buying a private policy or using COBRA, but I knew I'd be getting insurance as a graduate student, at a university where they don't ask about pre-existing conditions.
Posts: 2409 | Registered: Sep 2003
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Mack you are totally right. My son's transplant meds cost over $1300 a month. My husband only brings home $1900 a month. Until I finish school and have a degree I wouldn't be able to make enough to cover child care, increased gas and food costs and my sons medications, not including his lab fees which are at minimum one visit a month unless levels come back too high or low in which case we go back. Some months we have to go to the lab 3-4 times until his med levels are evened out. We haven't even tried to get insurance on our own because of pre-exisiting conditions I'm sure it will be high, dh's work doesn't provide benefits because they are such a small school. Dh is trying to finish his certification classes but that also costs money that we just don't have. So my kids stay on our state's equivalent of medicaid. They just transitioned us to the program before they kick you off though....
Healthcare costs in this country are high for a number of reasons. The "rack rate" is so high because it takes into account the uninsured people who require care and can't pay for it. In my neck of the woods this also includes illegals who get needed healthcare then disappear or if discovered get sent back home.
I don't know how to fix it but fixing is definately long overdue.
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quote:Originally posted by Jhai: Actually, the median household in America has an income of $48,000. Interestingly, when researchers asked people what they believed the median household income in America was, the median answer was only $40,000. Link.
Right, but Blayne didn't say the median household income, he said the average, which I believe is somewhat lower. Not $30,000, though, I think that might be the average individual income for wage earners instead of household. But I don't care quite enough to go look it up.
The average (mean) household income is higher than the median household income at ~$60,000/year.
The median per person household income (including people who don't work like children) in 2006 was $26,036 and the median individual income was $32,140.
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