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How Much Is Security Worth?

Richard Serlin left a smart comment on Monday's post outlining the $4,298 the British health-care system saves every one of the country's residents:

There are two important points you should have made.

First, perhaps you missed stating this because you're young and single, for a family of four that's $17,192 every single year.

Second, a very important point you should have made is the risk.

Losing $17,192 every year is a lot less bad than losing an average of $17,192, but most years you lose less, but you always live with the risk that your family will be financially ruined, and perhaps not get all of the health care they need, if you lose your family's insurance, or a family member get's very ill and the deductibles and lifetime limits bankrupt you.

Risk greatly reduces utility (quality of life); that's why the risk return tradeoff is a long established cornerstone of both academic and practitioner finance.

I don't know how much it's worth to never have to worry about health-care costs. I'm young, healthy, childless and protected by a large employer. I don't worry much. Surely, however, it's worth something. Particularly to people who aren't as young, aren't as affluent, aren't employed by a large and generous company, and have a family to care for.

Serlin's point about average losses is important too. Every year, I lose a certain amount of potential wages because our health-care system is overly expensive. That's a bummer. But it's steady. It's predictable. It's in my budget. When I moved from the American Prospect to The Washington Post, however, there were a couple of weeks when I went without insurance because I screwed up an HR form. If I had been hit by a car, or had stepped on a rusty nail, the costs would have been staggering, and they wouldn't have been in the budget. They would have wiped out my savings and thrown me into debt.

That doesn't happen to most people, of course, and so we don't worry about it too much. But it does happen to some people. And it destroys them financially. In Britain -- and every other industrialized country on the planet -- it happens to no one.

By Ezra Klein  |  August 18, 2009; 9:16 AM ET
Categories:  Health of Nations  
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Comments

what people need to understand is that its not the deductibles and out of pocket costs that bankrupt people. its the fact that they are not paying attention to where they are going and if where their doctor sends them participtes in their insurance plans. Most doctors offices don't care where they send you or worse yet they're sending you somewhere to line their pockets AT THE EXPENSE OF YOURS. If people in the US weren't inherently lazy a lot of this talk of out of pocket would go away and a lot of the cost would too. There's a reason insurance garners a discount for us, its because it saves us all in cost but when that flies off the track its not an insurers fault, its a patient's fault for not being aware of what's going on. Now in some instances its difficult (especially considering the situations) to always ensure you're staying within an insurance network but most times insurers nowadays will cover those instances (ER doctor, anesthesiologist) at your in network level of benefits because you weren't given the choice. Does it always work this way, no, but it should and insurers have stepped up in this area. In the past they never covered anesthesiologists for example that didn't participate in plans but they realized that their clients were getting hurt financially by doctors who as anesthesiologists and ER doctors realized about 5-10 years ago that they didn't have to accept a lesser contracted rate. These doctors don't care where the money comes from (insurer or patient) as long as they get it. Most insurers stepped up and cover that at 100% of the usual and customary rate which more often than not covers it in full.

Posted by: visionbrkr | August 18, 2009 9:47 AM | Report abuse

Happened to my brother. But this time, Wal-Mart screwed up the forms. By the time they got it fixed, he had been without insurance sufficiently long that the insurance company could claim his diabetes was a preexisting condition. He paid out of pocket for the next two years. Lost his house, and moved back in with my parents, where he still lives to this day. He's 51.

Posted by: pj_camp | August 18, 2009 9:55 AM | Report abuse

My daughter is young, healthy, childless and employed, but she, not to mention we, her parents, are worried. She works at a foreign embassy in Washington, D.C., which does not offer health insurance. Although healthy, she had an episode affecting her mental health almost 10 years ago which is considered a "pre-existing condition" and cannot find individual health insurance. She has been covered by COBRA with my husband's insurance plan, paying almost $500 a month, but it will run out before the end of the year. What is she supposed to do?

Posted by: aplrust | August 18, 2009 10:04 AM | Report abuse

*****By the time they got it fixed, he had been without insurance sufficiently long that the insurance company could claim his diabetes was a preexisting condition.*****

Isn't it illegal for GROUP plans to refuse coverage in this manner?

Posted by: Jasper99 | August 18, 2009 10:10 AM | Report abuse

in a humorous (not at the time) twist, i literally DID step on a nail earlier this year. I have the rock-solid, platinum insurance that people always complain about congress having and my out of pocket costs were still over $500! Imagine if i had been uninsured. We have got to fix this mess and soon.

Posted by: kawilson69 | August 18, 2009 10:12 AM | Report abuse

*****By the time they got it fixed, he had been without insurance sufficiently long that the insurance company could claim his diabetes was a preexisting condition.*****

Isn't it illegal for GROUP plans to refuse coverage in this manner?


------------------------------------------

It is now under HIPAA but may not have been then. I would have said that Wal Mart should have stepped up, realized their error and made sure he wasn't subject to pre-ex in that situation.

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My daughter is young, healthy, childless and employed, but she, not to mention we, her parents, are worried. She works at a foreign embassy in Washington, D.C., which does not offer health insurance. Although healthy, she had an episode affecting her mental health almost 10 years ago which is considered a "pre-existing condition" and cannot find individual health insurance. She has been covered by COBRA with my husband's insurance plan, paying almost $500 a month, but it will run out before the end of the year. What is she supposed to do?

Posted by: aplrust | August 18, 2009 10:04 AM | Report abuse
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If she has access (through a spouse??) to group insurance that is her best bet currently. New laws regarding pre-ex would help her. I would suggest speaking to an agent local to you that can help you in that area or in the area of individual markets in DC. Also the group carrier may allow her to convert her policy without being subject to pre-ex. A good resource is www.nahu.org That is a group of local agents (of which I'm a member) that has representatives across the country. There's a good tool that you could find a local agent to you that can help you in this regard.

Posted by: visionbrkr | August 18, 2009 10:16 AM | Report abuse

visionbrkr:

Unfortunately, it is not going out of system that breaks the bank for most people. It is having health bills large enough so that the 20% co-pay reaches into tens of thousands of dollars. It is having high enough bills so that they exceed the yearly and lifetime caps for coverage.

For some people it is that they lost their health and couldn't work, so they lost their insurance, then exhausted COBRA, then found they were uninsurable because of their health condition.

True, for some people having out of system charges is part of the problem, but for others the problem is that their insurance company went through their application with a fine toothed comb and found that they didn't report a minor previous health care incident, and their insurance was cancelled just when they needed it.

People need guaranteed health care, one way or the other, that covers enough to protect them.

Posted by: PatS2 | August 18, 2009 10:23 AM | Report abuse

PatS2,

the problem is that every state is different but my state of NJ does have caps even on in network levels of benefits. And i understand that when people get sick and can't work anymore the cobra laws that last forever don't work well enough. I understand and realize there is a gap and that is thankfully why insurers have stepped up and said that they'll get rid of pre-ex as long as everyone is covered within the system. That to me is a fair trade-off.

And that fine tooth combed incidents you speak of are such a small percentage of cases that the fact that everyone brings it up all the time is wrong. Its shock effect. Should it happen, NO. But again if everyone was insured then it wouldn't have to happen. That's why we need an individual mandate.

Posted by: visionbrkr | August 18, 2009 10:34 AM | Report abuse

My insurance company processes my routine annual physical exam as a diagnostic procedure every single time. Under my plan, diagnostic procedures happen to carry a higher deductible and copay. If I call customer service, they agree it should have been covered and then don't fix it until I submit a written appeal. Then, and only then, they correct the error. And, yes, my doctor knows the difference and submits the claims correctly.
If anybody believes that's an honest mistake, I have some condos in Florida for sale...

Posted by: tl_houston | August 18, 2009 10:48 AM | Report abuse

"I'm young, healthy, childless and protected by a large employer. I don't worry much."

In other words, "bad stuff can't happen to me." For your sake I hope you didn't cut any corners or guesstimate on your benefit forms, Ezra.

Posted by: BigTunaTim | August 18, 2009 10:58 AM | Report abuse

visionbrkr, why is your shtick that the bankrupting costs are the fault of the stupid patients, and that the insurance companies are merely innocent bystanders in all of this? The job of the insurance companies is to serve the patients. If they can't do that, they shouldn't be in the insurance business. If a patient gets bankrupted at the direction of the doctor and in collaboration with the insurance company that can't/won't pay, that's a sign that the system is broken. At least you're willing to be upfront that you're a representative of the insurance industry, and not someone who is interested in health coverage issues.

Posted by: constans | August 18, 2009 11:18 AM | Report abuse

"That doesn't happen to most people, of course, and so we don't worry about it too much. But it does happen to some people. And it destroys them financially. In Britain -- and every other industrialized country on the planet -- it happens to no one."

That's because we have, alone among industrialized countries, decided to have a morality play, where everybody else has a social provision.

Americans are being presented with a choice between a satisfying narrative arc, in which the good guys, the grasshoppers (prosperous, prudent, probably white-collar, probably white, period) win, and the ants get punished, and a soundtrack with lots of songs about 'freedom', and an actual, functioning social provision.

And the story's so compelling no amount of evidence about the grasshoppers going bankrupt, too, even makes a dent.

If history's any guide, we'll take the coherent story over the boring social provision, even if we would benefit in the aggregate from the social provision.

Posted by: davis_x_machina | August 18, 2009 11:25 AM | Report abuse

Don't health care providers always confirm insurance coverage in advance? Every one I've ever been to does. Do patients really get out-of-network services without the provider *and* the insurance company knowing in advance?

Posted by: tl_houston | August 18, 2009 11:27 AM | Report abuse

constans,


its only a part of it but a part that never gets mentioned. That's why I mention it. The truth is people don't understand their plans, they don't understand how to make sure their costs are as low as possible under their plans. Are there insurers out there doing wrong things, yes, but its a small amount no matter how much BigTunaTim and the likes of him scare people. Although some would argue adverse selection by insurers is a cause/effect relationship between individuals adversely selecting against insurers which happens every day. Think about it this way, your employer changes your plan as of September 1st but the paperwork doesn't get completed until say September 5th. Your new benefits aren't loaded into the system until say September 15th. in the meantime you go to the doctor, hospital, prescriptions whatever. If your copays are HIGHER which they always are insurers don't reprocess those claims. If they were the DEVIL like everyone always thinks on here then they would reprocess them.

As an example part of ARRA relating to health insurance stated that people laid off from 9/1/08-3/1/09 would not be subjected to pre-existing conditions EVEN IF they went without coverage.

So for example if someone was laid off in October, had a heart attack in December could be covered in March 2009 without any issue of pre-ex.

Actuaries have to hate this because you can't cost account for the additional risk being taken on.

Posted by: visionbrkr | August 18, 2009 11:28 AM | Report abuse

visionbrkr, it strikes me that the service you are advocating for is pretty much worthless. You keep trying to come up with these Rube Goldberg contraptions to explain how you can make health insurance *not* bankrupt you, when it fact it will simply do that time and time again, because they're not offering the service they claim to offer. And then you blame the patients for not figuring out the insurance plans clauses and stipulations. You want health care. You want your insurance plan to cover it. You go to your doctor, who prescribes treatment. If your insurance company sticks you with thousands of dollars in bills, then it isn't doing its job. If it's too complicated for the insurance company to do its job, then obviously that service model is wrong. It seems you don't understand: what you are describing is not a shortcoming of the patient, it is a shortcoming of the insurance system. If what you describe is the way that the insurance system works, *then it needs the force of law to slam the system into line.*

Let's look at a great example from above with the guy at Wal-Mart who had to pay out of pocket for 2 years. The insurance company couldn't do its job, because it refused to cover the patient. The solution was laws that prescribed legal punishment to insurance companies and insurance executives who refused to cover people. And that's what we need: strict directions and punishment to insurance companies who can't do their jobs. Blaming the patient for being too stupid to do the insurance companies' work for them is just acting as a mindless advocate for insurance companies, who are acting so incompetently and egregiously that the public is forced to pass laws like HIPAA to get them back into line.

There is no point in defending a system that requires a set of increasingly complicated decisions to me made on the part of the patients and doctors simply because insurance companies are too incompetent to figure out how to do their jobs and end up bankrupting patients. As described above, it is only when the government threatens insurers with legal punishment that they refrain from mistreating patients.

*Actuaries have to hate this because you can't cost account for the additional risk being taken on.*

Well that's a lot of tough luck for them, isn't it? Maybe they should advocate for a single payer program.

Posted by: constans | August 18, 2009 11:42 AM | Report abuse

visionbrkr --

The reason I lumped the cases of cancelling policies with the cases of people failing to stay in network as a cause of insurance disaster is because they happen with about the same frequency.

The main problems occur when insurance functions normally.

I can't speak for New Jersey, but nationally the need for much more strict regulation of insurance speaks for itself. Caps, co-pays, very high deductibles and other features that prevent insurance from doing what it should do are a very common feature. Failure of insurance companies to do anything about control of costs is another.

I would not argue that it is not possible to forge a good health care system using only or mostly private insurance. Switzerland, Germany, and Netherlands do it with great success. But our insurance system as it exists has abandoned its responsibilities. We need much more strict regulation on a national scale if private insurance is to play a part in reform, since unfortunately, as in most things in the business world, Gresham's law results in the bad driving out the good.

Before we create an individual mandate for insurance, we have to create regulations that prohibit bad behavior by insurance companies. The good companies will have nothing to worry about, since they are already behaving in an ethical way. The bad companies will have to shape up or get out.

Posted by: PatS2 | August 18, 2009 11:55 AM | Report abuse

@visionbrkr: "Are there insurers out there doing wrong things, yes, but its a small amount no matter how much BigTunaTim and the likes of him scare people."

How small is that amount exactly? If I'm scaring people by repeating common knowledge and shared experience, how about providing something of substance to back up your claim to the contrary?

Posted by: BigTunaTim | August 18, 2009 12:03 PM | Report abuse

I remember someone talking about how he'd watch park soccer matches, and every time there was a crunching tackle that took the recipient a while to get up, you'd hear people say "hope he's insured." If you're not, or you're not confident that your insurance will be there when you need it, then it's best not to play sports that carry the risk of injury. It's best not to go trail-walking. It's best not to swim in the ocean. It's certainly best not to start your own business or work as a freelancer.

I don't know if you can attach. But I'm reminded of the park soccer matches I watched abroad where Americans were playing, got banged up, and were treated quickly, well and cheaply by the ER. They told me that they felt a little bit guilty, but mostly that they experienced a wave of relief in association with healthcare than was new to them.

visionbrkr: you're basically asking people not to trust doctors. That's a big ask. I'm happy to second-guess every medical decision that's made around me because I know the influence of the profit motive, but I'm not a doctor. If you can't trust doctors, then who can you trust?

Posted by: pseudonymousinnc | August 18, 2009 12:17 PM | Report abuse

Oh, and what constans said. I have about as much sympathy for those in the American health insurance business as I have for the weeds in my garden. You're part of the problem, and this is your last chance to be part of the solution. That involves taking some responsibility.

Blaming doctors and patients isn't going to save your ass, because a healthcare system can run pretty well without private insurance sellers, but it's never going to be without patients and sorta kinda needs doctors.

Posted by: pseudonymousinnc | August 18, 2009 12:23 PM | Report abuse

pseudonymousinnc, it strikes me that a rational sort of insurance policy would cover your medical expenses, and that both the doctor and patient would be working under the presumption of being covered under almost all circumstances: eg, if a hospital is particularly good for treating a condition, one should assume, unless it is "special" that insurance covers it. Doctors should assume when they need assistance for a procedure that the assisting doctor they request has his services covered by the insurance unless that assisting doctor is "special" (eg, known to demand compensation that insurance companies don't offer). Visiobrkr's "vision" of the future is one in which each plan comes with a binder full of rules and regulations in which expected care isn't covered, leaving the patient on the hook for the bill if the patient and doctor aren't operating within those narrow parameters.

I believe that Scott Adams, the author of Dilbert, refers to these as "confusopolies."

Posted by: constans | August 18, 2009 12:30 PM | Report abuse

In the UK, you can still go outside the NHS for service and pay out of pocket. If we had the NHS price and quality in the US, we could bank that $4300 per year and go to a private hospital and pay out of pocket for that hip replacement if we didn't want to wait in the government queue. If the government did not provide coverage for treatments that were not cost effective or simply not demonstrated to be effective, then private insurers could even offer supplemental plans that would cover services not covered by the government plan.

Posted by: gdcassidy | August 18, 2009 12:38 PM | Report abuse

Let's look at a great example from above with the guy at Wal-Mart who had to pay out of pocket for 2 years. The insurance company couldn't do its job, because it refused to cover the patient. The solution was laws that prescribed legal punishment to insurance companies and insurance executives who refused to cover people. And that's what we need: strict directions and punishment to insurance companies who can't do their jobs. Blaming the patient for being too stupid to do the insurance companies' work for them is just acting as a mindless advocate for insurance companies, who are acting so incompetently and egregiously that the public is forced to pass laws like HIPAA to get them back into line.

------------------------------------------

I'll take these one by one. The issue with the Wal-Mart was WAL MART"S FAULT, not the insurer's. He admitted that Wal Mart screwed up. They should have fought Wal Mart on that if they screwed up. But its easier to blame a hated insurer than it is Wal Mart. His insurer was just abiding by the laws and regulations in the current system. You want to change that fine. Then we need an individual mandate, if we don't get that costs go up exponentially because the only people IN the system will be those that NEED care. That's insurance 101.

Fine you want single payer. how do you factor in that you currently have a shortfall of about 30,000 doctors in this country. If you add 50 million more patients then you have a shortfall of about 130,000 doctors. Then when you go to single payer and you lose a large portion of doctors and you drop down to say 100,000 doctors then you have the one doctor for every 3000 patients. Do you really think they can handle that workload? Those advocating single payer really need to come out and join us in the real world and stop living in theory.

Listen I don't care if people hate insurers. Just hate them for the right reason. Not managing cost well enough.

Posted by: visionbrkr | August 18, 2009 12:42 PM | Report abuse

Don't health care providers always confirm insurance coverage in advance? Every one I've ever been to does. Do patients really get out-of-network services without the provider *and* the insurance company knowing in advance?

Posted by: tl_houston | August 18, 2009 11:27 AM | Report abuse


-------------------------------------------

another thing people don't understand about the system. You CAN authorize a procedure on both an in network and out of network basis.

Go to your local doctor's office that you know doesn't take your insurance. Walk in and ask them if they "take" your insurance. Then walk back in and ask them if they "participate" with your insurance. They very likely are two different answers.


They confirm that you have benefits so that they'll get some sort of payment but many times they don't care if it comes from your insurer or from you.

Posted by: visionbrkr | August 18, 2009 12:45 PM | Report abuse

*The issue with the Wal-Mart was WAL MART"S FAULT, not the insurer's.*

Wrong. The insurance company has no business denying coverage of someone's pre-existing condition simply because his employer missed a deadline. Yes, I realize that there are reasons for this (you don't want people signing up for insurance just when they have an illness), but the truth is that if it's all that complicated, then people should just be automatically enrolled in a public plan insurance program by default. You keep trying to add layer upon layer of complication and rules and caveats to explain why there's *really* no problem with the health insurance industry. At a certain point, you have to wonder why we don't just tear the whole thing down. You haven't come up with a reason why the insurance industry should exist *at all*, and you've certainly made a strong case that it needs much stricter rules and regulations on it, because in the absence of the threat of legal punishment, they will bankrupt and harm citizens.

visionbrkr, you're defending the indefensible because you've made your livelihood in the industry. Go do something productive with you life, like sell used cars.

Posted by: constans | August 18, 2009 12:52 PM | Report abuse

visionbrkr --

The reason I lumped the cases of cancelling policies with the cases of people failing to stay in network as a cause of insurance disaster is because they happen with about the same frequency.

The main problems occur when insurance functions normally.

I can't speak for New Jersey, but nationally the need for much more strict regulation of insurance speaks for itself. Caps, co-pays, very high deductibles and other features that prevent insurance from doing what it should do are a very common feature. Failure of insurance companies to do anything about control of costs is another.

I would not argue that it is not possible to forge a good health care system using only or mostly private insurance. Switzerland, Germany, and Netherlands do it with great success. But our insurance system as it exists has abandoned its responsibilities. We need much more strict regulation on a national scale if private insurance is to play a part in reform, since unfortunately, as in most things in the business world, Gresham's law results in the bad driving out the good.

Before we create an individual mandate for insurance, we have to create regulations that prohibit bad behavior by insurance companies. The good companies will have nothing to worry about, since they are already behaving in an ethical way. The bad companies will have to shape up or get out.

Posted by: PatS2 | August 18, 2009 11:55 AM | Report abuse


-----------------------------------------

NJ is a very highly regulated state and its a good thing. Insurers have loss ratios that are required to be 75% for group markets and 80% for individual. Every state should have this IMO because what insurers can and do is they actuarily figure out how to get there in states with loss ratios set and they realize they can get "fat" in those that aren't. if it was nationalized they couldn't do that.


An individual mandate has to go hand in hand with an end to pre-ex. Recision shoudln't even be an issue, it shouldn't happen. But I'd also ask that no one ever lie on an insurance application. But i guess that never happens.

Back in the 90's it worked fine. Costs were at inflation and it was fine. Doctors then got greedy and now they own practices, labs, radiology centers etc. Now its not all doctors but its many. Now private equity firms own hosptials to make profits. That's wrong too. But to say insurers are the ONLY thing that's wrong with the system is just not looking hard enough at the entire problem.

Posted by: visionbrkr | August 18, 2009 12:54 PM | Report abuse

visionbrkr: you're basically asking people not to trust doctors. That's a big ask. I'm happy to second-guess every medical decision that's made around me because I know the influence of the profit motive, but I'm not a doctor. If you can't trust doctors, then who can you trust?

Posted by: pseudonymousinnc | August 18, 2009 12:17 PM | Report abuse

pseudonumousinnc,

I'm absolutely not suggesting that. I'm just stating that while doctors have your best medical outcome in their best interest they don't necessarily have your best FINANCIAL decision in their interest and they really shouldn't have to. But people should be aware of this and take the simple necessary precautions to have themselves covered as best they can or at least be aware of it.

Posted by: visionbrkr | August 18, 2009 12:59 PM | Report abuse

*The issue with the Wal-Mart was WAL MART"S FAULT, not the insurer's.*

Wrong. The insurance company has no business denying coverage of someone's pre-existing condition simply because his employer missed a deadline. Yes, I realize that there are reasons for this (you don't want people signing up for insurance just when they have an illness), but the truth is that if it's all that complicated, then people should just be automatically enrolled in a public plan insurance program by default. You keep trying to add layer upon layer of complication and rules and caveats to explain why there's *really* no problem with the health insurance industry. At a certain point, you have to wonder why we don't just tear the whole thing down. You haven't come up with a reason why the insurance industry should exist *at all*, and you've certainly made a strong case that it needs much stricter rules and regulations on it, because in the absence of the threat of legal punishment, they will bankrupt and harm citizens.

visionbrkr, you're defending the indefensible because you've made your livelihood in the industry. Go do something productive with you life, like sell used cars.

Posted by: constans | August 18, 2009 12:52 PM | Report abuse

constans,

now i'm trying to have a nice conversation with you about how to educate people to best navigate the system that is likely here to stay whether you like it or not. You are making my point for me.

You do realize that WAL MART IS THE INSURER don't you? At their size they're FULLY self insured. They may go to an Aetna or a United for a discount but they are fully paying their own claims.

Again I bring up the point that people that don't understand the process of how these things work SHOULD NOT be commenting on them.

You don't see me commenting on missle testing programs do you???

Are there problems within the healthcare industry YES. Are some of those problems directly attributable to health insurers, YES. Do they need to be reformed, YES. The problem is that its not only insurers that are at fault and its not every insurer. Doctors are at fault (not every one but some), hospitals are at fault (not every one but some) and Pharma is at fault.

Posted by: visionbrkr | August 18, 2009 1:04 PM | Report abuse

I was young, single, childless, healthy and did not worry much once. Now I am 50 with high blood pressure, high cholesterol, a daughter who had early stage cervical cancer, and a wife who had a TIA last year. We are all uninsurable.

Posted by: scott1959 | August 18, 2009 1:12 PM | Report abuse

visionbrkr, your whiny excuses translate to, "everyone is a little bit at fault, so we should do nothing." The problem was that WAL-MART was in its rights to refuse to cover the patient. Because insurance companies did that, we changed the law to make it a CRIMINAL OFFENSE to behave that way. We keep repeatedly having to pass laws to threaten insurance companies with the threat of criminal punishment because they repeatedly come up with ways to deny insurance to patients, bankrupting them and ruining their livelihoods. What's the best you have to say for yourself? "Well, actuaries don't like it." This is scratching up against "the banality of evil."

You've yet to come up with one reason why insurance companies should exist at all. If the system bankrupts people when they make normal medical decisions, then the system needs to be stripped down and rebuilt from the ground up. What it doesn't need is whiners trying to explain that bankrupting people and ruining their lives is the fault of people who went to a hospital to get treatment. If insurance companies can't pay bills from hospitals and doctors, then they are effectively committing an act of fraud by claiming to over insurance coverage while not actually doing so.

Posted by: constans | August 18, 2009 1:22 PM | Report abuse

pseudonymousinnc, it strikes me that a rational sort of insurance policy would cover your medical expenses, and that both the doctor and patient would be working under the presumption of being covered under almost all circumstances: eg, if a hospital is particularly good for treating a condition, one should assume, unless it is "special" that insurance covers it. Doctors should assume when they need assistance for a procedure that the assisting doctor they request has his services covered by the insurance unless that assisting doctor is "special" (eg, known to demand compensation that insurance companies don't offer). Visiobrkr's "vision" of the future is one in which each plan comes with a binder full of rules and regulations in which expected care isn't covered, leaving the patient on the hook for the bill if the patient and doctor aren't operating within those narrow parameters.

I believe that Scott Adams, the author of Dilbert, refers to these as "confusopolies."

Posted by: constans | August 18, 2009 12:30 PM | Report abuse

but what you don't get is that insurance is a NEGOTIATION between provider of service (doctor and hosptial etc) and insurer. Doctors aren't required to accept any insurance (including Medicare and most studies say 40% don't accept medicare).

In your utopian world there I'm assuming you mean that insurers should pay whatever price providers should ask? $10,000 for a 20 minute ER visit? How about $100,000. heck just ask for a cool million.


Your also assuming that some providers don't have alterior motives to send you to get a test done at a place they own a stake in, or have surgery at the outpatient surgery center they own. It happens all the time and you don't even know it and all it does is increase yours and my cost. I'm fine with you increasing your cost, i just don't want you increasing mine and that's what you're doing by having it affect my premiums.


While it is cumbersome it isn't so difficult in most situations to ask your provider (heck don't even ask the doctor ask the staff) to just make sure wherever they send you it's in network, wherever they send you bloodwork its in network.

If you don't feel like being bothered that's fine. Just don't come complaining to me when its not covered in full.

Posted by: visionbrkr | August 18, 2009 1:24 PM | Report abuse

constans,

WALMART IS THE INSURER.

What about that don't you get?

There is no Aetna, no United, no Cigna that's denying anything. Walmart is FULLY SELF INSURED. An insurance carrier to them only brings a network of doctors for them to buy a discount from.


The benefit of insurers is twofold. THey bring network discounts through their pooling of large populations of insureds If they were doing cost-containment that would be a benefit to them too but too many of you hate if they do any type of cost containment so they stopped that practice for some reason.

When we get to taxing people at 100% under a aystem where everything is covered then where do you propose we go???

Posted by: visionbrkr | August 18, 2009 1:38 PM | Report abuse

Happened to my brother. But this time, Wal-Mart screwed up the forms. By the time they got it fixed, he had been without insurance sufficiently long that the insurance company could claim his diabetes was a preexisting condition. He paid out of pocket for the next two years. Lost his house, and moved back in with my parents, where he still lives to this day. He's 51.

Posted by: pj_camp | August 18, 2009 9:55 AM | Report abuse


THIS IS EXACTLY WHAT HE POSTED. HE SAID WALMART SCREWED UP THE FORMS, NOT THE INSURER.

SO THEN HOW DOES YOUR POST MAKE ONE IOTA OF SENSE OTHER THAN YOU JUST LOVE TO HATE ON INSURERS???
-----------------------------------------
visionbrkr, your whiny excuses translate to, "everyone is a little bit at fault, so we should do nothing." The problem was that WAL-MART was in its rights to refuse to cover the patient. Because insurance companies did that, we changed the law to make it a CRIMINAL OFFENSE to behave that way.

----------------------------------------

so wait how was WalMart right?? Exactly what law did we change?? HIPAA doesn't save him there because he was 62+ days without coverage (i assume) so they subjected him to pre-ex. THe only thing that saves him is a FUTURE LAW that bans pre-ex. That's if the liberal democrats don't vote against the bill that doesn't include a public option. Talk about cutting off your nose to spite your face. Weiner's not dumb, he's just blowing off steam.

Posted by: visionbrkr | August 18, 2009 2:03 PM | Report abuse

Ezra, this is OK, but you miss the point on two counts:

1) the risk is a lifetime risk, and the odds that you will not be "protected by a large employer" rise toward 100% as you progress toward age 55-60. Look at the numbers.

2) the total cost problem raises that risk dramatically. Since our 16% health care burden is loaded on employment, we have millions fewer employed here than elsewhere - look at the auto industry's historical plant utilization in Michigan versus Ontario. Simply put, without strong influences lowering costs, such as a public plan, mass layoffs will continue and our employment base will continue to leave the country.

Posted by: Dollared | August 18, 2009 2:16 PM | Report abuse

visionbrkr, when Wal-Mart acts as an insurer, they are considered an insurer. Insurers seem to bring nothing to the table since, by your own admission, they are unable to negotiate with hospitals, leaving patients on the hook for costs. In many cases they do not inform the patients and in many cases over pseudo-"coverage" that does not cover the costs of expected procedures, leaving patients on the hook for the balance. Now, tell me, *what do insurance companies offer*? As far as I can tell, they *might* cover you in *some* hospitals, but you're just as likely not to be covered, and in some cases they won't bother to cover you at all if you have a pre-existing condition, unless the law threatens these people with jail unless they offer insurance.

We have a set of situations in which people are getting screwed over by insurance companies for pre-existing conditions and inability to offer basic care because someone, somewhere might be out of network. Maybe the system is all just broken. You haven't come up with any reason why the system should just be adjusted. You've come up with a great explanation why the system isn't needed at all.

If insurance can't offer a product where the expectation is that doctors and hospitals are covered by insurance, then it's not insurance at all, it's a scam. You sound a lot like a con-man trying to convince marks to stick with the scam as the mark starts to offer doubts.

Let me make this clear, visionbrkr: if your solution is to have a lot of private health insurers that may or may not offer coverage to hospitals and doctors that may treat me, and if it's my job for every procedure to make sure that all hospitals, all tests, and all attending physicians in every situation I find myself in are always in network lest I be bankrupted, then this solution isn't something I want. If the system is going to refuse me coverage because I have a pre-existing condition, then that's a symptom of a broken system. And it's a symptom that needs a public option.

The problem, you see, is not that Wal-Mart screwed up. The problem is that they denied someone coverage at all. You don't see that. You only think that WalMart should have, out of the goodness of their heart, "stepped up." That's not an argument-- that's impotent excuse making to defend a system that you make your livelihood off while providing no value to the rest of us.

Posted by: constans | August 18, 2009 2:23 PM | Report abuse

"another thing people don't understand about the system. You CAN authorize a procedure on both an in network and out of network basis."

Medical treatment shouldn't be provided on the basis of secret handshakes and magic words.

As someone who works within the system, you don't seem to understand that this is part of the problem.

Posted by: pseudonymousinnc | August 18, 2009 3:01 PM | Report abuse

"Your also assuming that some providers don't have alterior motives to send you to get a test done at a place they own a stake in, or have surgery at the outpatient surgery center they own. It happens all the time and you don't even know it and all it does is increase yours and my cost. "

So, when I said "you're asking us not to trust doctors?" and you replied "I'm absolutely not suggesting that" -- what you meant is that we're not supposed to trust doctors?

Because "trusting" includes "not assuming ulterior financial motives", however you try to finesse it.

I'm not disputing you on whether that kind of kickback-based referral happens, because it's well-documented that it does. But it seems as if you want it both ways, in defending your own role in the system. But as I also said, if it comes down to whose position is most easily sacrificed to restore that trust, you lose.

Posted by: pseudonymousinnc | August 18, 2009 3:09 PM | Report abuse

"another thing people don't understand about the system. You CAN authorize a procedure on both an in network and out of network basis."

Medical treatment shouldn't be provided on the basis of secret handshakes and magic words.

As someone who works within the system, you don't seem to understand that this is part of the problem.

Posted by: pseudonymousinnc | August 18, 2009 3:01 PM | Report abuse


YES. and that is not the fault of insurers that is the fault of doctors, unless you want to force all doctors to accept what insurers pay or force all insurers to pay whatever doctors ask for.

My God how hard is it to just simply pay attention to what is going on with your medical care!!

I understand sometimes you can't (ie emergencies) but many times you can but people are so friggin lazy they expect someone to do it for them.

Posted by: visionbrkr | August 18, 2009 3:15 PM | Report abuse

constans,

the problem is that a public option CAN'T force providers to participate. They have the same issues that insurers have when it comes to participation so that doesn't resolve your issue. The only way to resolve it is to FORCE doctors to participate and if you do that how many docs do you think will retire? How many college students do you think will still want to be doctors?? Some will, many won't. In that instance we're about 130,000 doctors short and it'd get worse. So in that case, no one gets care. Not really a great result.

Posted by: visionbrkr | August 18, 2009 3:31 PM | Report abuse

The problem, you see, is not that Wal-Mart screwed up. The problem is that they denied someone coverage at all. You don't see that. You only think that WalMart should have, out of the goodness of their heart, "stepped up." That's not an argument-- that's impotent excuse making to defend a system that you make your livelihood off while providing no value to the rest of us.


Posted by: constans | August 18, 2009 2:23 PM | Report abuse


I don't think Wal mart should have stepped up out of the goodness of their heart but because of a paperwork snafu. If he was eligible for coverage then and someone at walmart screwed up the paperwork there are ways to get excpetions made to that paperwork issue. Anything can be worked around if a big enough stink gets made.


I'd love to think I provide no value to us but I see it differently as do my clients. SOrry I'll take their word that i hear every day as opposed to a stranger posting on a website trying to put forth his agenda. In fact i just got off the phone with a client whose insurer originally didn't cover his drug for rheumatoid arthritis because he changed carriers. Do you know why it was denied? Because the doctor in this instance didn't send in the proof that she tried other drugs. YOu know the plan that is similar to comparative effectiveness research that the insurance industry calls step therapy. It saves costs whether you believe it or not but i guess with you if insurers do it its EVIL, but when government does it, its just peachy!

Oh and I saved him about $600 in cost just now because i got the prescription to be covered for him.

My God am I evil.

-------------------------------------------


Listen if you believe in your utopian world that doctors never do anything wrong and they'll gladly accept less from every single patient as opposed to being forced to accept a discounted cost for the ability to get a large patient base to choose from them I guess insurers have no place but once you come back to reality you'll realize there's a niche for insurance that has been in place for what 70 years?? Its called risk management and unless you have a couple million dollars saved up you'll need them. But i guess that's why you hate them so.

Posted by: visionbrkr | August 18, 2009 3:46 PM | Report abuse

visionbrkr--

you seem to know a lot about the industry, so i was wondering if you could answer this question (I am not being snarky here; i just want to know): We all know that the insurance companies are almost at monopoly market share in their areas (i.e. there are usually just a few companies that control almost all the insurance policies in a particular customer's region). So, why don't they negotiate more aggressively with doctors and hospitals to keep the costs lower? They seem to have the market share to do that...more market share, certainly, than a public plan would have. You mention that after the 90s doctors and hospitals 'got greedy.' Why couldn't their prices be negotiated down? I support single payer because I think that it could negotiate costs down with providers (and providers just can't keep raising prices the way they do now, health services are quickly becoming a 'luxury' rather than affordable--even for basic stuff like having a baby or an appendectomy)...but sometimes I really do wonder why the insurance companies have let them go this far up in prices this fast? why don't insurance companies negotiate more aggressively with them?

Posted by: evangeline135 | August 18, 2009 3:57 PM | Report abuse

I've stayed out of this argument because visionbrk just makes up his facts. Here is an example "most studies say 40% don't accept medicare"

If you go to MedPac, who must have the best statistics, you find that 98.6% of physicians not only accept Medicare, but they accept new Medicare patients. Persanlly I seen a lot of doctors and never came across one who would not accept Medicare. This is also in NJ.

I found his figures on the physician shortage amusing. "Fine you want single payer. how do you factor in that you currently have a shortfall of about 30,000 doctors in this country. If you add 50 million more patients then you have a shortfall of about 130,000 doctors. Then when you go to single payer and you lose a large portion of doctors and you drop down to say 100,000 doctors then you have the one doctor for every 3000 patients."

When he says we "drop down to say 100,000 doctors" does he mean that all we would have in the WHOLE country. What do they rest do? Go to work at Starbucks. My physicians tell me they spend about 20% of their time filling out forms and fighting with private insurers. We could pass to a single payer system and then, like FRance, have a simple one page for for most treatments. This would effectively increase the supply of doctors by 20%. As I wrote in reply to visiobrk ages ago:

To the point, out of the 42,000 students who apply to medical school every year, 18,000 are accepted. Furthermore a lot of good students don't apply because of cost. Even if the income of physicians goes down a bit, it seems to me it will still be an enormously desirable career especially if the costs of education are addressed.

I do not feel that this is a serious problem with a well run single payer system.

Posted by: lensch | August 18, 2009 3:59 PM | Report abuse

visionbrkr, not every doctor accepts medicare, but medicare patients never (or at least much more rarely) risk bankruptcy for their care. A public option would act similarly. Also, a public option would be much more competent that current insurance providers in making sure that patients don't get shafted because they were not familiar with thousands of pages of details of what is and isn't covered when they go into the hospital for a procedure.

This is like that scene in Office Space where I have to ask you, "So what is it exactly you DO here, anyway?" You can't cover patients, you bankrupt them, their doctors can't find them hospitals that are "in network," the insurance companies are too incompetent to negotiate decent prices with hospitals and they stick the patients with the balance of the bill. It strikes me that your industry is completely screwed up, and all you can do is whine that the patients need to adjust their behavior and start arguing with their doctors to fix YOUR industry's problems.

visionbrkr: I was not put here on this earth to make up for the incompetencies and inadequacies of the modern insurance industry and their habit of ruining the lives of patients simply because a few actuaries might not like it. If your industry can't do it, then we will go to the government and create an industry that does. You simply don't get it: I don't care whether the private insurance industry exists or not. If I realize that by signing up for them, I run the risk of getting bankrupted because they offer inadequate coverage under normal medical circumstances, then they should not be operating in this country.

Posted by: constans | August 18, 2009 4:05 PM | Report abuse

lensch: in my experience, it's never the insurance company executives, adjusters, or employees who are praising the wonders of private insurance and how the problems are all the fault of the ignorant patients for getting bankrupted. It's always insurance *brokers* and insurance *salesmen*. They don't care how well insurance works... they just want to sell you something, and if it doesn't work, they just tell you that if you really "had faith" in the product and used it correctly, then you wouldn't have any problems. This is classic con-man behavior.

Posted by: constans | August 18, 2009 4:19 PM | Report abuse

evangeline,

no problem. I get enough snarky from constans :-)

As constans mentions i'm just a broker so i'm not as privy as some to those negotiations but what I hear from those that do is that it is the providers, ie hospitals coming to insurers asking for more. Insurers could come and ask for less but then the hospital would most definitely leave the insurance networks which would result in two things happening.

1-the insurer would lose market share because employers base their medical insurance purchases on what the networks are like, ie if an important hospital to them isn't in their network they'll buy another insurer as prices are fairly consistent.

2-most states have out of network provisions that pay coverage on usual and customary fee schedules which are much greater than a contracted rate would be. For those that don't know usual and customary fee schedules are say for example what 80% of all providers charge in a given area for a given procedure. That results in a much greater reimbursement.

For example look in my area at Bayonne Medical Center. They went bankrupt several years back and are a "boutique hospital". They don't take any insurance, forgive everyone's deductibles and just take from the system.

I have another example although not within Bayonne Medical Center. A client of mine went to a doctor that participated in her insurance. The doctor wanted the procedure done at Helene Fuld Medical Ctr. They DON'T participate in her insurance but they agreed to write off whatever deductibles she had. If it was an in network situation the hospital would have been paid around $6000 ($1500 per day for 4 days). They were paid based upon UCR over $100,000. This is a great reason why costs are going up.

Posted by: visionbrkr | August 18, 2009 4:55 PM | Report abuse

"and that is not the fault of insurers that is the fault of doctors"

Last time I checked, it wasn't doctors who determined in-network and out-of-network.

Whole lotta excuse-making going on here. And I'm repeating myself, but insurers really are the third wheel in this relationship, and there's no amount of buck-passing that will change that, no matter how egregiously doctors line their own nests. That's because they're *doctors* and you're not.

Posted by: pseudonymousinnc | August 18, 2009 4:59 PM | Report abuse

lensch,


WOW. I expected better from you. Maybe you ask me where i get my figures but to go ahead and SAY that i make stuff up???

How about the NY times?

Depending on the area of the country its worse than others but feel free to persuse the attached from them. And IF a public plan goes through with a payment schedule tied to medicare care to guess how much lower that participation number goes???

http://www.nytimes.com/2009/04/02/business/retirementspecial/02health.html


What really would be sad is if we put a public plan together at reimbursement rates so low that the number of providers participating made it useless. Then we've wasted hundreds of billions on a useless system.

Posted by: visionbrkr | August 18, 2009 5:03 PM | Report abuse

"and that is not the fault of insurers that is the fault of doctors"

Last time I checked, it wasn't doctors who determined in-network and out-of-network.

Whole lotta excuse-making going on here. And I'm repeating myself, but insurers really are the third wheel in this relationship, and there's no amount of buck-passing that will change that, no matter how egregiously doctors line their own nests. That's because they're *doctors* and you're not.

Posted by: pseudonymousinnc | August 18, 2009 4:59 PM | Report abuse


ARE YOU SERIOUS??? you really don't understand how the system works do you? its doctors that ACCEPT (participate) or DENY (don't participate) the insurer's reimbursement rates.

I'll gladly admit that i'm not bright enough to be a doctor. no problem with that but to come on here day after day and assume that you know how the system works and something as blantly as that you get wrong is just bad.

No insurer KICKS a doctor out of a network unless he or she is doing something fraudulent. They close their panel sometimes (which means for those that don't know that they don't accept new docs within specialties within a given area) but that's more a function of a requirement the other docs within the network make to preserve their number of patients they can get.

Posted by: visionbrkr | August 18, 2009 5:07 PM | Report abuse

Let me defend visionbrkr a little here.

There are lots of problems with insurance, but there are also insurance people and companies who are trying to do the right thing. The big problem is that insurers are stuck in a competitive system. When one insurer engages in unscrupulous behavior, it not only damages the interests of its own clients, but makes it hard for honest insurers to do business. It is a lot more expensive to not engage in the abuses that people complain about, and that makes it hard for the honest insurers to do business in some places.

The classic example occurred in the mid-90’s. Insurers and HMO’s had begun an effort to control costs back in the mid to late 80’s, and had considerable success, actually taking the mantle of cost control from Medicare for that period. Then two things happened. First, some less scrupulous insurers began using the title of “managed care” not to engage in scientifically appropriate efforts to cut costs, but to try to reduce costs indiscriminately, based not on effectiveness but on avoiding costs. That raised the anger of the public, and resulted in “managed care” and “HMO” becoming curse words. Some insurers then reversed field and started paying claims without any effort to assure effectiveness. It became difficult for anyone to use managed care approaches, and the whole idea went away. Cost inflation rates for private insurance rose to over 50% higher than for Medicare, and have stayed there for over ten years.

Doctors, hospitals, and investors in hospitals are by no means innocent in this whole mess. While in some areas of the country (consult the Dartmouth Atlas) and in some provider systems cost effectiveness has been moderately well served, in many areas of the country and with many provider systems costs have run out of control. Part of this is due to culture, related to training and to the atmosphere in any given region, but some of it is due to pure greed. I say this being a doctor myself, and working in one of the fields that has led the escalation of costs.

To quote Milo Minderbinder, when it comes to problems in health care, everyone has a share. Getting insurance companies to behave better is important, but getting doctors and hospitals to think in terms of effectiveness and quality is important too.


Posted by: PatS2 | August 18, 2009 5:08 PM | Report abuse

PatS2,

haha thanks. I'm used to being hated though. I'm an insurance agent. We're kind of inbetween lawyers and snake oil salesmen.

I'm fine with it because my clients appreciate what we do to ensure they keep their costs in check (if they didn't then they'd simply fire me) and i admittedly am in a state that has one of the strongest reulations in the country (NJ). I've proposed that the entire country should have loss ratios of 80-85% to ensure profits are low and remain low.

Posted by: visionbrkr | August 18, 2009 5:21 PM | Report abuse

One does sort of suspect there's a bit of doctor-envy from the insurance companies and their representatives on this one. We recognize that doctors are part and parcel of health care. Your relationship with your doctor is protected by law. Some people in fact have a pretty strong attachment to the relationship with their doctor. What insurance companies want is to emulate that relationship with their clients. RNC Chair Michael Steele tried to oppose health reform saying that it would "interfere with the relationship between a patient and his insurance company." I don't *want* a relationship with my insurance company. Echoing pseudonymousinnc, the insurance company is the mother-in-law coming along with a married couple on date-night.

And PatS2, while he understands the dynamic, is basically explaining why I feel the way I do: even if insurance companies aren't purposely malicious, the system in place basically ensures they will be. Thus, the *system* needs to be torn down. So, visionbrkr, even if it's not your fault, keep in mind that a public option and ideas like single payer aren't some kind of "punishment." We don't hate the private insurance industry. It's just that they're going to have to go because the system conspires to make them useless. Don't take it personally. It's just business.

Posted by: constans | August 18, 2009 5:34 PM | Report abuse

haha maybe i envy their incomes.

I think that most everyone that goes regularly has a strong attaachment to their doctor as they should. I just suggest they realize and understand the cost implications for where they go, that's all.


But you don't tear down a system that so many people are in favor of. that's like having a bad fuel line and junking your car.

Posted by: visionbrkr | August 18, 2009 5:42 PM | Report abuse

visionbrkr-

thank you for your answer. the out of network "Usual and Customary Fees" info was very interesting, and it leaves me with a few thoughts:

1) If Bayonne med center can just forgive all deductibles out of hand, that proves that what they are listing as the "charge" of what they have done has nothing to do with the actual cost of the procedures, something i suspect about medicine generally

2) Is there a 'boutique hospital' (one that forgives all deductibles and just takes usual and customary fees, of whatever amount, from my insurance company) anywhere near me? heh! I had to pay 4000 to a hospital recently, and I'd like to know more about these 'no deductible hospitals'...there is a real incentive there for a patient to just make the insurance company pay a lot more if he/she can pay nothing! I need to look into that...even a flight to some boutique hospital in another state would be cheaper than a 4000 dollar hospital co-insurance payment.

3) I know you disagree with me, but to me this just proves that we can't win with a private system. A medicare for all system could set reimbursement based on what things really cost. I think doctors might earn a little less, but not much less, and there are medicare only hospitals that do fine...

thanks for the info

Posted by: evangeline135 | August 18, 2009 5:56 PM | Report abuse

[My previous was before I took the (figurative, generic) chill pill. The substantive point stands about how doctors, for all their sins, are indispensable and private insurers are not.]

Posted by: pseudonymousinnc | August 18, 2009 6:10 PM | Report abuse

evangeline135,

haha when i'm out of a job i can start a website, maybe understandingyourinsurance.com or something!

sorry but from my understanding you'd have to be insured to get this "boutique hospital deal" as the idea is hospitals get more from the out of network reimbursement. if you're private pay it doesn't work for them although i'd have to think that's illegal? I do know that Horizon BCBS is challenging them in court for doing that (which is why they don't put it in writing to people).

What i would say is that if you don't have insurance (not sure if you said that or not) please know and i've said this on this site before that everything is negotiable. Hospitals want to get paid something so let me tell you an example. I had a client whose daughter in law was traveling from Costa Rica and got a travel insurance medical policy from a website. none of those policies cover pre-ex. Turns out she didn't realize she was pregnant and she unfortunately had a miscarriage. In the end she got a $7000 bill and the travel insurer didn't cover it. We spoke to the hospital on her behalf and if the mother agreed to pay a total of $2000 then they would write the balance off. The mother paid it on a credit card and that was that. Again she saved $5000. But i'm the devil to some on here. Seems to me the system is the problem and if it can be reformed (which i believe it can because it was in the 90's) the system can work again but we all need to work to fix it.

I just worry that with single payer and the amount that doctors get paid now the decrease will have to be so much that you'll see a lot of older doctors retire and new prospective doctors not want to be doctors.

Posted by: visionbrkr | August 18, 2009 9:23 PM | Report abuse

visionbrkr-

just wanted to clarify, I DID have insurance, and my appendectomy/oevrectomy did cost about 40,000 to my insurance company, but I had to pay 4000 dollars of it as co-insurance. If I had made it to a 'boutique hospital', then maybe I would have had to pay nothing, but I my policy would have had to pay 100,000 or something. A better deal for me.

I'm tellin' ya people, we need to find out where these 'boutique hospitals' are! We need maps and directions to them for an emergency! :)

Posted by: evangeline135 | August 18, 2009 11:56 PM | Report abuse

Two issues:
Does NHS (alone) spend that much a person or is that the average health spending in UK, including private clinics, labs and so on? It seems too low, so maybe we're comparing apples and oranges. If true it's great, we would have plenty of room to improve and still cover everyone at about 40% discount.

Second, even those that are insured through work do pay for it dearly: you get less in pay or pay raises. Each year the health care cost goes up 8-12%, making it a raise in your employer's eyes, after all for them is the same. Of course they pay and still get a not-so-happy employee, given that all he sees is the 2%-3% or so salary raise.


"Although healthy, she had an episode affecting her mental health almost 10 years ago which is considered a "pre-existing condition" and cannot find individual health insurance."

Does your state have a limit on how far back they can go to ask for "pre-existing conditions" ? 10 years seems like a long time, some states cap that at 6 months, others at 5 years.

Posted by: Alban1 | August 19, 2009 12:31 AM | Report abuse

Vis-a-vis visionbrkr's comments on hospital discounts.

One of the things many people don't know is that many, if not most, hospitals will negotiate on debt. Part of that is due to the fact that the hospital charge is routinely much higher than they expect to get paid based on negotiated deals with private insurance and the imposed prices from Medicare and Medicaid.

If you owe a hospital a lot of money, do not wait to be sued or sent to collection. Go to the hospital and discuss your problem. Discounts in excess of 50% are not uncommon. Many hospitals have funds to cover expenses for those unable to pay. Many hospitals will except fairly low monthly payments. What you do have to do is talk with them. Be prepared to share personal financial data with them.

Doctors are another question. Some doctors are very rigid. Others, not so much. We instructed our billing agent that if someone was paying their own bills and came to talk about it, to immediately offer a discount to the Medicare rate. If people paid regular payments on their bills, we usually would forgive the balance after about one year of payments. We were much more interested in seeing evidence of good faith and honesty than extracting every last dollar.

Posted by: PatS2 | August 19, 2009 1:14 PM | Report abuse

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