WhiteCoat

Healthcare for Some

On one hand, times like these try mens’ souls.

On the other hand, times like these can show you the goodness in people’s hearts and the desperation that some patients face with medical illness.

As the number of rural health clinics has fallen from 500 to 316 in Texas, here’s a story about a small group of docs who do their best to care for patients in rural Texas. They even have a van packed with portable medical supplies that they use to perform house calls on patients too frail to make the trips into town.

The story is both somber and heartwarming.

Then there is another story about a group called Remote Area Medical that organizes events to provide free medical care to uninsured and underinsured patients.

In Tennessee, the lines for free health care begin the night before the doors open. A school serves as the venue. Bleachers are full of patients waiting for care. Patients get evaluated and treated in classrooms. Dental chairs fill the gymnasium floor.

Most patients either need to see a dentist or an eye doctor. But as the dentists evaluate patients, they note that some have medical problems that must be addressed first. One has a blood pressure of 200/120.

Insurance doesn’t do much for patients who cannot afford – or who are unwilling to purchase – medications. Many patients who are “unable” to afford basic prescriptions for as little as $4 a month have packs of cigarettes sticking out of their shirt pockets.

In two days, the volunteer staff evaluated 701 patients, extracted 852 teeth, performed 345 eye exams, and provided 87 medical exams. The total cost of the “free” care provided in two days amounted to $138,370.

Think things will change with the current health care bill? Think again. Dental and vision care are not covered for adults under the current House or Senate bills.

As the article states, “to fix health care inequities, expanding insurance alone may not be enough.”

“May” not be enough? Try “will” not be enough.

“Insurance” doesn’t equal access and it doesn’t equal health care.

Never has. Never will.

59 Responses to “Healthcare for Some”

  1. steve says:

    It is always sad to see people forgo treatment or something that they really need because they “can’t afford it,” only to see them spend their money on things like alcohol and cigarettes. I have a friend who is like this and I try to help him, but a lot of times it seems like he doesn’t really want to help himself.

    With that said, the services that small time clinics, like the ones you describe, are very important and I wish there were more like them. There are a few clinics like that were I live, where you can have some emergency dental work done or other care, but often they will not help people unless they are enrolled in their program, which can take months…

  2. CrankyProf says:

    The current health insurance reform will do exactly what it is intended to do: transfer wealth out of the middle class and in to the pockets of .gov. Oh, the poor might get some of it, but not much.

  3. I just read an interesting local article about how our dentists are suffering financially because of the loss of insurance by a patient, loss of job by a patient, or priorities of how they are spending their money in these hard times. Makes me glad I have such job security in the ER, yes?!

    Enjoy your weekend.

  4. throckmorton says:

    I wish our Congress would spend one night in out ED and see the uninsured. They would then see that the uninsured always have smokes and the latest Iphone or Blackberry with 3g data packages. These patients will spend thousands on rims to bling out their car but wont spend a cent for their healthcare. It is not that they cant get insurance, they know that they are going to be seen regardless of their ability to pay, so why pay? These are the uninsured.

  5. Matt says:

    Why would Texas have fewer clinics when physicians have been crowing about the doctors flocking to Texas? Yet another example of physician PR about access and reality not being the same. Physicians go where the wealthy are, which is why the more affluent areas of the country are overstocked w/ physicians and the rural poorer areas aren’t. And all the screwing of injured patients and guaranteeing of insurer profits and empty promises about how necessary that screwing is to improve access (as WC so often claims) in the world won’t change that.

    • throckmorton says:

      Matt:

      Did you ever notice that there are more lawyers were there are more wealthy people? Perhaps we can do a study to see if there is a correlation between where people want to work with where they will get paid. I can not help but think that most people would gravitate to places where they can make a living.

      I could be wrong, but I dont see attorneys flocking to rural texas to handle the legal problems of illegal immigrants.

      • Matt says:

        Are there? You claim this is true but is it? Immigrants are typically good clients in my experience.

        But I agree with you that people go where the money is. At least you and I, if no others, can put aside the silly claim that limiting damages has an effect on access.

        I actually have been to rural Texas and traveled much of the state. Your claims are wholly unsupported. In fact, texas’ physician growth still trails population growth. And, of those physicians coming to Texas, a good percentage are coming fr California, which make no sense if liability climate is the issue.

        The facts don’t support the propaganda. That much is obvious.

      • throckmorton says:

        Matt:

        First, illegals generally dont pay for their healthcare. Secondly, I support my claim that physicians are moving to the state in large numbers and this is backed up by the State Licensing Board.

        Given that before all factors were the same, and then something changed that resulted in an increase of physicians moving to the state, I think we can agree that the reform measure have had an effect.

        As to California, I dont know where you got that number but I think that you should look at it. The states that physicians are coming from are New York, West Virginia and no the biggest is Michigan. There are physicians from California, but these are right out of residency. California has more residency positions than the state has jobs.

        The problem with facts is they dont go away.

      • Matt says:

        Throck, I meant your claim about attorneys. As to physicians moving into Texas, that is (or was a couple years ago when they were crowing about the numbers), true, there are more coming. Of course, that’s not surprising given Texas’ population gain and the corresponding number of new hospitals that came online in the early-mid part of the last decade. The fact is that Texas physician growth trails its population growth. Why is it amazing to you that a place which is growing has more physicians? Particularly when that place is doing relatively well despite the recession? Do you really believe that’s attributable to liability laws? If you do, how do you explain California losing physicians to Texas? The fact is the access argument doesn’t hold water. Particularly when rural clinics in Texas are CLOSING.

        All factors were the same before? Really? How do you know? How many available jobs were there before in Texas? What was the physician population growth over the last 20 years in Texas? I realize you guys like to pick one short time span to make your case, but you know that’s not really an honest comparison. Kinda like when the insurers want to tell you how much they lost one year when they hike rates, but don’t really want to say much about how much they made the 20 before.

        As to California move ins, I got that from the Texas Medical Board’s site. It listed where the physicians were coming from. Cali was the 3rd most . As to New York, if you look at physicians per capita, it is WAY overserved anyway so again, would it surprise you physicians are moving to states that also have a lot of wealthy people like Texas? And Michigan is losing population and jobs probably worse than anyone, so would it surprise you that people are leaving there, including professionals in service areas like physicians? You want to take normal economic trends and say they’re all due to liability laws.

        You say the physicians from California are right out of residency? How do you know? Please, point me to that proof.

        You’re right facts are king. But your beliefs are not facts, no matter how much you might want them to be.

      • Bill Alexander says:

        There are other reasons to leave California than just the med-mal situation. The state government is a mess and the tax rates are some of the highest in the nation. The state government does a lot to discourage small businesses as well. (Without proof) I suspect Ca. has more medical schools than some other states, so we may have students come here to become doctors who have no intention of staying.

      • Matt says:

        Bill, I agree. There are certainly numerous other factors at work in the distribution of physicians per capita. That’s why I think it’s silly to put all perceived good at the feet of liability protection (particularly when the “good” doesn’t survive actual scrutiny) and all perceived negatives at the feet of a lack of liability protection. It’s pretty clear that has little to do with the overall fitness of a place when it comes to deciding where to go.

      • joe says:

        “As to New York, if you look at physicians per capita, it is WAY overserved anyway so again…”

        Problem is Matt you are looking at an overall state statistic without understanding the situation within the state itself. Which is fine except when you use it to make a point that is in reality based on ignorance. The reality is that the NEW YORK CITY metropoliton area is overserved. In reality the majority of upstate New York is underserved. In fact the New York’s southern tier and north country has a severe and worsening shortage of doctors.

      • WhiteCoat says:

        And to think that I was starting to miss Matt’s constant stream of calumny …

        First of all, Matt tries to generalize his experiences with legal clients as an assertion about all medical patients. My kids have better reasoning skills than that.
        Do emergency departments charge retainers for their medical care? Can/would emergency departments refuse services to clients that don’t pay? Does your practice agree to represent every client that walks through your doors regardless of the strength of their case and regardless of their ability to pay? Maybe we need to enact ELRALA after all. At least try to compare apples to apples before making strawman arguments, Matt.

        Second, try to imagine a Venn diagram with multiple intersecting circles. In the center is the willingness of physicians to practice in a certain environment. You repeatedly assert that because California has tort reform but less than adequate access to medical care, it should be used as an example of why tort reform does not affect access. Essentially, you are arguing that the intersecting circles of willingness to practice and tort reform in the Venn diagram are one and the same. That is either a horribly uninformed or an intentionally misleading assertion. The imaginary state of LaLaLand pays physicians less than minimum wage, costs tens of thousands of dollars in licensing fees, has no patients to treat, has unconscionable administrative burdens, and has facilities that make patient care dangerous. According to your logic, physicians should still flock there if it has “tort reform”! Woo hoo!

      • Matt says:

        Joe, you’re absolutely right, which only further serves to make my point. Liability laws have little to do with access. People who live in rural areas are underserved regardless. Especially if they’re poor. Incidentally, underserved is probably a bad term since we’ve yet to establish a baseline we’re trying to achieve. But the physicians seem to like it so we’ll use it.

      • Matt says:

        WC, you need to read for content. The reference to legal services was Throck’s, not mine. Your “criticism” makes no sense directed at me.

        As to your second paragraph, while an interesting example, it is still woefully short of facts, like most of your opinions on this issue. It’s YOUR claim that tort reform is a key driver of access, yet you’ve never shown it to be true by any objective measure. Your strongest “facts” consist of surveys of physicians. All nonpartisan studies refute most of your claims, from disappearing doctors to access claims. But hey, at least you’re consistent!

      • Matt says:

        “Does your practice agree to represent every client that walks through your doors regardless of the strength of their case and regardless of their ability to pay? ”

        Such a silly question. The answer is no, although there are some legal practices analogous to your own, like Legal Aid groups and the Public Defender, that do. They too rely primarily on government (or third party) money, just like your ED and the tradeoff is taking all comers who qualify. You’re the one making the foolish comparisons. Of course, no public defender or attorney working for Legal Aid make even 1/2 of what the average physician does, or 1/4 of the average surgeon.

      • Matt says:

        “Essentially, you are arguing that the intersecting circles of willingness to practice and tort reform in the Venn diagram are one and the same. That is either a horribly uninformed or an intentionally misleading assertion.”

        I like these sentences because they essentially dispute all you and your colleagues’ “reform is necessary” propaganda. And I wonder if you even realize it.

    • throckmorton says:

      On a more serious note, there are more docs moving to Texas, so much so that there is a backlog in the states processing of new and returning licensure. The issue here is clinics. It is financially hard to open a clinic in a county of only 1000 or less, so docs congregate in areas that allow access from surrounding areas. If you have been to rural texas, you would know what I mean. Texas is now getting Obs and other specialists in these smaller areas and acess is improving, if only to say you have to drive 100 miles instead of 200. We still have a long way to go and reform has helped, but like all other aspects, you get what you pay for. If there arnt enough people there to pay you, you cant keep the doors open.

      • Matt says:

        There are 254 Texas counties. Less than 15 have fewer than 1000 residents. I look forward to you sharing with me how many counties have what specialties as of say, 1995, 2000, 2005, and now. That will give us a nice idea as to what effect, if any the legislation has had. If you don’t know, then you are merely guessing as to access, and should just be honest that yours is a faith-based conclusion.

      • throckmorton says:

        Matt:

        To suupport an orthopod, it takes a population of 15 thousand, 45 per neurosurgeon, etc. A PCP needs about 5 to 7 thousand. This is the simple economics of demand. When overhead increases, so does the need for a bigger population to maintain the practice. This is just looking at the financial costs. If you look at where Texas is increasing its population, you will see it is not in the rural areas. In fact, the rural population is decreasing.

      • throckmorton says:

        Matt:

        Here is the breakdown of Texas doctors/county and their specialties. I will leave you to do your own analysis. The data is for each year, county and specialty.

        http://www.tmb.state.tx.us/agency/statistics/demo/docs/d2008/0908/0908stats.php

      • Matt says:

        So do the stats support your claims or not?

        As to your first post, it seems that you would agree with me then – liability laws have little to do with access. Glad we sorted that out.

      • throckmorton says:

        Matt:

        Did you look at the data? The number of new docs getting licenses went up 25% the year the reforms were enacted and that number has continued. This is a very easy analysis to do, a student t test works great and you will see that the p is less than o.o5.

      • Matt says:

        Throck, I couldn’t find the historical data – can you give me a more direct link?

        I did find this from the Texas Dept. of State Health Services, however, which lists the total number of practicing physicians in Texas year over year back to 1990 and then in several more years back to 1975. The total number of physicians would seem to be the most accurate measure of access, don’t you think?

        http://www.dshs.state.tx.us/chs/hprc/PHYS-lnk.shtm

        By that measure, the most dramatic growth was 1997-2000, which given your position makes no sense. In fact, rates of growth were average to below average after the “reform”.

        Now, I realize this is surprising to you, because you really believe this is all about access. A naive position to be sure given modern politics, but understandable if you’re an optimist rather than a realist. Tort reform is about money, and limiting the ability of those who are injured to take it from the parties who contract to insure those who negligently injure. It’s basically saying “Yes, insurers, we know you insure risk, but we’re going to limit your risk legislatively.” Financially we taxpayers would probably be just as well off to simply have the government pay all the costs of malpractice, and eliminate the insurers altogether. But again, it’s not about what makes the most sense financially for anyone but the insurers.

      • Matt says:

        “If you look at where Texas is increasing its population, you will see it is not in the rural areas. In fact, the rural population is decreasing.”

        So why do we have to hear about all these rural areas not having specialists as the reason we need tort reform? You and I are agreeing here – liability issues have nothing to do with it. It’s about money. If you live in the sticks, you don’t get a neurosurgeon down the street. All the liability changes in the world aren’t likely to change that.

        Let’s just agree that “access” has nothing to do with reform and move on. Almost everything you’ve cited makes that point.

      • throckmorton says:

        Matt:

        Here is the direct link for all the demographics. Docs per year/ docs per county/docs moving in and out of the state. It is all there.

        http://www.tmb.state.tx.us/agency/statistics/demo/docs/docdemo.php

      • Matt says:

        And does it support your claim? It is, after all, YOUR claim. Yet you expect me to prove it for you. You should probably stick with the faith based beliefs if you’re not going to do the research.

    • jb says:

      I’ll tell you why? I am Family Practice trained.I worked for six years in rural East Texas. Very few people paid their bill, substance abuse ( prescription and illicit) was rampnat. Most people were litigious, unappreciative, and demanding. There existed no work ethic whatsoever.
      From birth most people were taught to get ahead in life you just drop out of school, make babies, get on welfare, do some work for cash, and sue someone if the oppurtunity ever presented itself. After six years of this I quit. I went from being a liberal democrat, to a staunch libertarian. The welfare system destroys populations of people.

  6. SeaSpray says:

    I read the 1st story WC and it was heartwarming. I wish things were simpler for everyone. These docs are amazing and obviously love what they do to be willing to work the hours and sacrifice vacations. Their patients are blessed ..very blessed to have them.

    You can’t blame anyone for going where they can make money to support their own families. It’s a calling to go out and do something like that. Sounds like an interesting movie could be made about them. :)

    Dental work is expensive ..even WITH dental insurance if you need any big work done.

    Expanding insurance the way they plan will only expand the problems. I have no faith in this bill and am greatly discouraged about it.

    Why in the world can’t this be an open process with both parties involved and do *reform* on what already exists? Yes..there will be resistance and have to get hashed out ..but at least it might be a better bill.

    What is the rush? It blows me away that the president wanted this passed in early August and then fall and now for the State of the Union Address. He wants this without knowing what is in it and obviously without understanding the long term detrimental consequences.If he or the others actually knew and understood ..and cared about the people and the good of this country ..they would not do this.

    We would never tell out kids that it’s alright to sign a contract without full knowledge of what it contained and how it would affect their future.

    WHO does that?

    And then all the bribes! It’s disgusting!

    And the health care bill will be expensive enough and in many med blogs ..you talk about how care will be compromised, equipment, availability, etc., because nothing is free and the money has to come from somewhere and there won’t be enough.

    Yet … also in the bill is millions of dollars allocated to different projects/concerns that have *NOTHING* to do with *HEALTH CARE*. How is that alright or even logical to do?

    If they already know there won’t be enough money to fund medical care as well as we do now with private insurances, etc., ..then why in the world would they steal from the new health care plan to pay off these bribes ..because THAT is what they are doing. All monies should go to health care and not somebody’s scooter park or tennis court.

    Democrat or republican ..anyone that participates ..should be voted the heck out. there are so many red flags that are obvious to the general public ..why can’t these leaders see the obvious?

    Pass that health care bill by God ..damn the consequences!

    Wc you said there won’t be dental or vision care. We have that now with our ins ..but how long before our plans are forced to change? And the president wants to tax Cadillac plans (plans that have dental and vision qualify) he wants to tax almost everything it seems.

    I am so disheartened and discouraged over this bill.

    *Can anyone say anything positive about it?* IS there any silver lining anywhere in this bill for those of us who have worked hard and paid our insurance premiums for the plans we chose because it is a good plan?

  7. HueyDoc says:

    No Dental care ? Great- I’ll still be seeing more toothaches in the ER than my dentist does in his office.

  8. Max Kennerly says:

    A great argument for single-payer.

    • Fyrdoc says:

      I think, as a group, you will find lots more emergency physicians in favor of single payer than other specialties. Our pay would go up by most estimations…

      • paul says:

        …at first.

      • throckmorton says:

        What if it was all Medicaid?

      • Max Kennerly says:

        Most doctors I know are in favor of single-payer, generally out of sheer frustration over how difficult it is to run the business part of a practice and over how much time the business part takes.

        Interestingly, even the doctors who are administrators seem to take the view that single-payer is coming one way or another. One head of a multi-hospital department (with revenue of > $20 million per year) told me single-payer was “inevitable.” He seemed sanguine about it.

    • WhiteCoat says:

      I think it makes an argument that our system needs reform, but I’m not sure that “single payer” is the correct reform. Remember the Golden Rule – he who has the gold makes the rules. If he who has the gold wants to save more gold, he will make rules to do so. Those rules will inevitably result in less care.
      The more inequities I see in patient care, the more I wonder whether some type of a “public option” may not be a necessary part of the health care reform answer.
      Things will get much worse before they stand any chance at getting better.

  9. joe says:

    I echo throckmorton here. The majority of PCP’s don’t take medicaid. Not because they are “bad” peoiple, but because they lose money on every medicaid patient they see. When a patient mix has a certain percentage or more of medicaid, the practice is no longer viable. You honestly think these fed-supported clinics are present because they make money? Honestly frydoc, if you think you are going to make “more” money off of single-payro. I think you are sadly mistaken. Max above, has already shown on this website previously that he has a very rudimentary (and incorrect) understanding of the payment mix in american healthcare.

    • Max Kennerly says:

      What’s your solution?

      Status quo both is too expensive and doesn’t provide enough care.

      • WhiteCoat says:

        Free market.
        Disclosure of all pricing.
        Some type of mechanism to force patients to have some skin in the game. Perhaps mandatory 10% copays for all care/treatments.
        Maybe the feds have some type of safety net hospital system that provides free care to those who cannot afford it.
        We have to start thinking outside the box.

      • Max Kennerly says:

        Pure free market medicine = expensive care for some, no care for many. Keep in mind that, right now, the expensive part of American health care is the “free market” aspect.

        A bifurcated infrastructure is not, IMHO, possible. Basic services — e.g., ERs — are stretched thin as is, despite the expensive. Creating new layers of inefficiency would just make the problem worse. Less service for higher cost.

        Moreover, already have bifurcated system to some extent, and it still has (a) private insurance that’s too expensive for society and (b) government insurance that doesn’t compensate enough.

        The rest of the modern world has figured healthcare out: single-payer.

      • WhiteCoat says:

        The free market is too expensive for many because providers are trying to compensate for the losses incurred by providing care for many.
        If we spread the costs out over most patients, prices will necessarily come down. Look at things such as Lasik surgery and most cosmetic surgery where insurance issues don’t come into play.
        Necessary services such as emergency medicine may not be able to be integrated into such a system, but that is a topic that needs further discussion.
        Aren’t most other “socialized” systems bifurcated?

      • Matt says:

        Saying “free market” doesn’t mean much, nor is there any particular secret about pricing. As long as the providers continue to accept payments from the government and the health insurers, nothing much changes.

        You’re throwing out catchphrases rather than solutions. And your catchphrases contradict each other. On one hand you say “free market” and on the other you say: “If we spread the costs out over most patients, prices will necessarily come down.”

        Doesn’t make sense.

      • WhiteCoat says:

        “nor is there any particular secret about pricing”

        I call bullshit. Show me links to comparisons of the pricing of any lab testing or medical procedure at hospitals within the same territory. Of course, I know that what you’ll do in response to me challenging your statement is either ignore my challenge or qualify your statement to mean something else – your typical M.O. But go ahead and prove me wrong.

        “If we spread the costs out over most patients, prices will necessarily come down. Doesn’t make sense.”

        Right now few patients know what medical care costs and they generally don’t care because someone else is paying for the care. Currently, if a patient wants an MRI of the back, they go to their doctor, the doctor fills out paperwork, and the patient hopes that the MRI is approved by their insurance. No approval generally means no testing.
        Now let’s imagine that insurance could only cover a maximum of 80% of the cost of an MRI. Or better yet, imagine that MRIs were not covered by insurance at all. Do you honestly think that patients would just walk in to an MRI suite and whip out their credit card without concern for cost? People look at grocery ads and will drive across town to get bananas that are 5 cents cheaper a pound. Once patients have an interest in how much a procedure costs, the patients will generally find the least expensive alternative. Then MRI providers, when noting that the MRI place across town is getting three times the business, will lower their prices accordingly — or will have a lot less customers.
        Free market competition will force prices to decrease.
        Once again, even my kids understand basic economics. They go online to price Wii games before making the trip to the department store to purchase them.
        Why is the concept so difficult for you to grasp?

      • Fyrdoc says:

        Actually WC, try and get the pricing at your own facility as a physician. When I was a resident, one of my colleagues attempted to do a study to see if physicians knew what tests cost. When she tried to get the numbers from the hospital, she was told she couldn’t have them. The prices varied based on negotiations with individual insurance companies – and the “sensitive nature” of these negotiations precluded a non-administrative physician having access. She had to do the study based on the self pay numbers (obviously inflated).

      • Max Kennerly says:

        “Once patients have an interest in how much a procedure costs, the patients will generally find the least expensive alternative.”

        No, they won’t. Much like how providers artificially boost the sticker price of procedures to make up for the discounts that insurers and Medicare demand, any sort of forced-co-payment system will likely end up with a bunch of market distortions designed to avoid that.

        E.g., the patient will have two options:

        A) Doctor WhiteCoat, who charges $10k, knowing that you have to co-pay $3k.

        and

        B) Doctor FreeMarket, who charges $12k, but “writes off” the co-pay (and tells you beforehand she will), resulting in the patient paying $0 and the insurer paying $8k.

        The market finds a way around distortions… surely someone like you, who argues that Medicare causes inflated private insurance costs, recognizes that?

      • Matt says:

        “Show me links to comparisons of the pricing of any lab testing or medical procedure at hospitals within the same territory.”

        I mean between the third party payors. They’re all keying off the government. Sure, there are fluctuations, but that’s the baseline.

        “Now let’s imagine that insurance could only cover a maximum of 80% of the cost of an MRI.”

        Now THAT is a proposal. Currently, though, telling us the cost means little since we don’t control what’s paid. IF that’s what you’re advocating, say so. Explain how your bill works, particularly in the ED setting, and what you think the savings are. Previously you were just saying “free market” without any real explanation of what you meant. Baby steps I guess.

    • Fyrdoc says:

      “Making money” off single payer has been proven in some EDs. Look, for example, at Mount Sinai in Chicago. In the middle of gang turf, and in a very improverished area, most of their patients simply didn’t pay. Most were eligible for medicaid, but hadn’t bothered to sign up. The ED got permission to put councelors in the ED to aid the patients to sign up for MC/MA as eligible. They saw no increase in patient load, but suddenly at least saw some payment for this large portion they had previously treated for free. If your ED sees >~30% self pay, single payer will be a net positive (based on current medicaid rates).

  10. throckmorton says:

    Health reform in one sentance

    Medical care providers and facilities must bill and recieve payments from patients only.

    There it is. Simple and to the point. Right now there is no competition. If you need a ct scan, do you call around to find the best deal? Of course not. The CT place only gets paid what your insurance company contracted with them. They can try to get as many patients from that that insurance plan to come there but it certainly does not affect the price. If you dont have insurance, you can call around and I think you will be suprised at the discounts you can get. Imagine if that was for everyone. I dont think the problem is that we have so many uninsured, I think the problem is that we have so many insured.

    I propose that your insurance company gives you so much for routine health exams. You would then shop around and find out where you can get the best care for that amount. Doctors and hospitals would then advertise and try to entice you with low prices and better care to sway you to use their facilities. The same should be true with Medicaid and Medicare. Sure there are patients who wouldn’t make the effort to get insurance but now everything would be cheaper. Does auto insurance make care cheaper?

    Health insurance is like Federal Income Tax. They get the money before you see it and spend it before you know it, making money off the interest in the meantime. Dont seperate healthcare dollars from the patients, give it to them and let them decide how to spend it.

    • Max Kennerly says:

      WC raises a similar point above.

      There’s one problem: healthcare is generally prohibitively expensive.

      For a sizable chunk of the population, basic healthcare (e.g., routine checkups, a handful of ER visits, etc) is too expensive.

      For an even larger chunk, chronic treatment is too expensive.

      And for most of the population, serious medical treatment — chemo, multiple surgeries, multiple days in intensive care, etc — is prohibitively expensive.

      While everyone can dream up a bunch of examples where some degree of consumer involvement would help, those examples don’t represent the bulk of healthcare costs. The bulk of healthcare costs go towards tens or hundreds of thousands of dollars for treatment, which is unaffordable to most.

      Hence insurance. Note that there are a lot of plans out there — including mine — with high deductibles to encourage people to be frugal. And, indeed, I’m frugal. But if I get cancer then, well, you can count me out of being frugal, not just because my judgment is impaired, but because the negotiation might as well be left to the insurer anyway, since there’s no way I could pay it out of pocket. Doing something like making me pay 50% of the bill would just make it impossible for me to treat.

      Let me give you another example. Suppose a Republican ER doctor, fresh out of residency, in a free market system has an extremely premature child.

      Then what? They can’t afford the cost of a few weeks in a NICU. All they can do is buy insurance beforehand, which then pumps six figures into the treatment. Adding ‘consumer choice’ to do this situation is meaningless.

      Some consumer choice might help, but it’s a band-aid at best.

      • SeaSpray says:

        I don’t know if he is accurate but Rush Limbaugh said that because he paid cash for his medical care (chest pain in Hawaii – Hospital stay), that he saved 35% on his medical bill.

        So ..if medical care is cheaper when paying the bill without insurance ..does that mean providers pad the bills for insurance companies so they are payed fairly for their services after the ucr allowances?

        But then they still bill patients the co-pays? or is that all calculated too?

        It all seems so complicated.

      • Fyrdoc says:

        I have a PPO. Even with that, the birth of my child in October 2009, via scheduled c-section for known CPD, and normal post-natal course for mom and baby has left me with >$6000 in co-pays and deductibles. I can afford it, but I could see how, despite having insurance, having even a healthy baby could bankrupt a family.

      • Max Kennerly says:

        “I don’t know if he is accurate but Rush Limbaugh said that because he paid cash for his medical care (chest pain in Hawaii – Hospital stay), that he saved 35% on his medical bill.”

        Rush Limbaugh is a big, fat idiot. If that was true, the hospital would have already been sued for fraud by every insurer, all of which require discounts below the “cash” price of a procedure.

  11. SeaSpray says:

    6000!!!

    I have a PPO too, but never had that high of a balance unless I put a years worth of hospital stays/procedures and tests together.

    Forgive me for questioning ..but are you sure there wasn’t an insurance or billing error? Mistakes are made all the time.

    I had a high risk pregnancy/C-Section with 2nd son. 5 non stress tests that all should’ve been covered. they said only 3 were. No where in OP manual were any limitations indicated. It took someone else in the company to look into it and tell me I was right and they were covered. Same pregnancy. I received a bill for a high anesthesia balance. I told ins co this was wrong and after speaking with a few different people ..one person said they pulled up the info on it and they charged too much for a vaginal birth. I said I had a C-SECTION! case closed. Even more recently ..a hospital that I had set up payment plans with was saying I owed an additional 500.00 9 mos later. I knew they were wrong, but she was adamant I owed the money. I had her pull up every date in which I was a patient in the hospital that year. (quirky, but I remember numbers and so had the dates in my head.) It was like I was coaching HER through the math and then she finally saw that I was right.

    If something doesn’t seem right –always question the bill.

    Congratulations on your new baby!! :)

    • Fyrdoc says:

      $2000 deductible ea. plus copays. Max out of pocket after deductable is 4k per person / 8k per family. The first 4k are the deductibles, the next two split, 1500 to the wife on 80/20 copay, 500 to the kid (Total bill for wife was ~9K and 4K for baby – I was pissed about 2500 in nursery fees as we roomed in!).

      Oh well. Just another case on point.

      I’m sure our vile friend will be along soon to tell me to sue my way out of the bill… :-)

      • Max Kennerly says:

        Did you “shop around” for the best deal? Did all of that “consumer involvement” do anything to lower the overall expense?

        I’m betting the answers are “no” and “no.”

      • Fyrdoc says:

        Nope, I couldn’t (obviously). However, we WILL be changing the health insurance for our group based on this experience – so yes, market forces are in play. I, however, am in the single payer camp.

      • SeaSpray says:

        Ahh ..it’s the high deductibles you have.

        Could you challenge the nursery charges? Hospital billing departments DO make mistakes ..or perhaps the charge was erroneously entered by one of the staff. ?

  12. the Muse, RN says:

    Thank you for your post. What our Congress is telling the public they are going to get and what the public will actually receive is going to be a nasty awakening.

    …Having done both – hospital and charity care events, I think I would rather serve the lines in the rural settings.

    …at least *they’re* grateful.

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