Universal / National Health Care Insurance

I recently had a trip to the ER.

I have fantastic insurance through my employer.

I just got the bill today.

The ER visit included the general exam / diagnosis / what-have-you, a lumbar CT scan, and a urinalysis.

Just using round numbers for ease of math in the Red Room, the total bill was about $6300.
- The "Insurance Adjustment" was about $5000.
- The insurance PAID about $1100.
- My remaining payment was my ER copay, $75 (that figure is exact).

So, the "retail price" that they billed for all this was about $6300 but they are perfectly happy to only be paid about $1200 for the whole thing.

This is a problem. This isn't good.

It's reasons like this (plus the fact that I am a human being with a heart who can't stand the idea of people suffering without recourse) is why I've become much more open to the idea of universal health care in the United States. Ultimately I think it will probably be cheaper for everyone.

Yeah, the numbers sure seem to bear that out. The US healthcare system is phenomenally inefficient.

We spend 2-4 times the amount of any other OECD advanced economy, while not covering all of our people.

I long ago came to the belief that some form of UHC would be both more humane and more cost effective.

Get rid of the middle men, see if they can find something productive to do with their time.

You have insurance that was negotiated between your employer and the insurance company.

The insurance company negotiated with the provider for services at specific rates.

Where is the free market in all this?

My belly button is an "outie." No one ever told me that this is actually an umbilical hernia and should be treated until my main quack started asking me if I had any issues with that hernia. Referred to a surgeon, the surgeon's "finance" department contacted my insurance to get "approval" for a procedure to give me an innie. WTF? Why does a doctor's office need a finance department? Why does my insurance company have to approve a procedure recommended by my doctor and confirmed by the specialist?

I have "good" insurance. It's not high-deductible.
I have a $750 "deductible up to which I pay 100%.
I have a $3000 out of pocket maximum up to which I pay 20% for "in network" surgical care. (If a service is not contracted with the insurance company to be in-network, then my insurance might pay 60%, I pay 40%).

So I can expect to pay $750 plus some unknown amount up to $3000 for my belly button. I won't know until after I get the bills how much the hospital charges, the surgeon, the anesthesiologist, and any other quack who happens to look in. I have to trust that they're all in network otherwise my insurance may pay nothing, or up to 60%.

I expect it will be somewhere around $1000 out of pocket but I really don't know (don't worry, I'll ask before the date rolls around). Most people don't have this kind of discretionary cash to pay for elective surgery no matter how much it's recommended.

My main quack says it isn't mandatory, but recommended, because if it gets worse and there are complications it will be emergency inpatient surgery vs elective outpatient.

yeah, we have the best healthcare in the world. right?

UHC is inevitable, I would say. But of course, since it's the gubbermint, it will be vastly overcomplicated and wind up being more expensive than what we have now.

Here's how it should work: It's paid for by taxes, probably an increase in Medicare/Medicaid rates. You have a co-pay set high enough to keep people from running to the doctor every time they get the sniffles but not so high that they won't go for something serious. Beyond that everything is covered. Period. What's "medically necessary" is between you and your doctor, and no-one else gets a vote.

So, you're a typical Conservative. Liberals have been saying this for decades. But, typical for Conservatives, you don't care until it happens to you.

You should go pay the hospital the rest of the 5100 just because you think poor people should have to pay. So, guess what, now you get to put your money where your mouth is.

It can't possibly be more complicated or expensive than the boondoggle we have now. there are a growing number of doctors that no longer accept insurance due to the expense and complexity of accepting it.

and there will be private medigap policies (as there are now) to cover the difference, and private insurance for those that don't want medicare negotiated coverage.

It's like you don't understand that the rest of the western world actually exists and already does countless things you believe to be impossible.

Hope you're doing OK.

Thank you. I have some issues that are getting looked into, but the ER trip was short.

EDIT: To clarify, at this time I don't have any good reason to think you'll need a Candelight Vigil or In Memoriam thread for me anytime soon. At this time.

Well, let's hope not...I will point out that when I nearly checked out a couple of years ago, I was taken completely by surprise. Take care.

After I had surgery, therapy, and all the exams when I tore my rotator cuff, I received a copy of the entire cost. It was around $43000. Workman's comp covered almost all of it. The only thing that was not approved were the antibiotics, I paid out of pocket for them. I could have applied to get reimbursed, but it wasn't worth the time to get the $3 and change.

I'm glad it worked out for you, but workman's comp is not health insurance. You had an on-the-job accident and your employer was insured.

A lot of that cost has got to be bureaucracy, and I'm not convinced that's gonna vanish when it's suddenly a US government acronym on the letterhead.

Are you willing to completely nationalize the entirety of the medical, pharmaceutical and insurance industries for the purpose of imposing standardized rate controls? Sounds like comedy gold to me. Good luck with that.

No, just insurance.

Literally every other developed country on Earth disproves your point about universal healthcare being more expensive.

Leave out the pharmaceutical bit and you have something which has been done many times.

Can you name a single example of it having failed?

The pharma bit is a sticking point. How many utopian nations benefit from our high prices and subsidies for tuition and R&D? Why do you think they don't want us importing the cheaper-sold drugs?

Yeah, let's show them by paying more.

Many nations subsidise tuition and research, although I'll grant you the US is a big player there.

As for the higher prices do you really think pharmaceutical firms pass that along to the consumer?

Does the NHS pay less for drugs as a consequence of your higher prices propping up pharmaceutical companies and making it possible?

Colour me skeptical on that score.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866602/

It is one factor among many, yes. Another benefitting from our military budget.

Your argument suggests that pharmaceutical companies will choose not to pursue profits elsewhere if they are making them on US soil.

I have to disagree there to be honest. Nationalised systems may pay less, but if they do it is a question of their very nature creating a buyer's market.

Most drugs can be bought from multiple suppliers and the sheer scale of the NHS makes it a very desirable customer. Firms compete to sell us our drugs.

As for your military?

Another discussion.

Not intentional. I'm saying they practice the same skeevy regional price-fixing as other merchants, just with extra contributing elements. And the status quo in one area depends on the status quo in distant lands. So if we start paying less, others will start paying more.

Or the stockholders will get smaller dividends.

I imagine your paying more has more to do with the fractured buying power represented by dozens of buyers to be perfectly honest.

No one buyer can threaten to walk away from a deal and decimate a seller's market share.

That and the additional marketing costs here.

Yeah but what about freedom?

Speaking as someone in the know, all that money from other nations does not go to R&D. It goes into accounts in the Cayman Islands. In reality, most new ground breaking drugs, are created by small companies and bought out by major corporations. In the 7 years my company has been in existence, we’ve bought 4 smaller companies and just purchased a major one. Hence my lack of patience lately. That one is going to take 3 years to be fully on boarded into our systems.

Whoa, whoa... around here you can suggest policies that will mean innocent people die, where employees get screwed over, where the planet gets burned to a crisp, but stockholders accepting smaller dividends is completely implausible.

They. Wouldn't. Like. It.

So it can't happen.