The Tyranny of Medical Bills in America

[Rob C]

Medical Insurance.

For a variety of historical/technical/legal reasons, my wife and I had private medical insurance here in Spain at the same time as we were both legally able to use the National Insurance system.

One Sunday morning, she fell and broke her hip. I took her to the local emergency centre (PAC) where she was offered an ambulance ride either to the private hospital she'd been using for previous ops, in Palma, about 60+ clicks away, or the much shorter trip to the local, public hospital in Inca. Because of the pain, she opted for the local service.

Once there, they scanned her, gave her an an operation time for a day or two ahead. As they were getting her ready, they discovered cancer had returned. The encologist said that he wasn't prepared to wait more than ten days to have her operated for the fifth time. In those ten days she was given a new hip (a German surgeon did the job) and the cancer removed.

The treatment was so good that she said we had no further need to spend so much money on private care, so we cancelled, saving two pensioners €3600 a year.

She walked out of that local hospital without a limp, without crutches or even a single stick, and an enormous smile. Six months later she was gone. On the other side, I can give you a horrific report of her lying in the operating theatre of a private hospital, and listening to an argument next door about her insurance...

In my view, life has to be divided into priorities, and the greatest of these is health. I do not find it strange to expect that any government, irrespective of colour, should be obliged to care, above everything else, for its own citizens' health.

FWIW, I would put that up right at the top of the agenda along with national defence. Foreign aid? Really? Where does that go - we have just seen another African 'president' being prosecuted for having millions in his bank accounts without any means of justification... it goes on and on. If you have to bribe to get international trade and contracts, that's the way of the world; don't pretend it's 'aid', be upfront and call the effing spade a spade. Why else would most politicians choose the job? Altruism? Yeah, right. I listen to a Louisiana music radio station most nights over the Internet; the advertisements from various politicians running for office are unbelievable on two counts: the smearing of rivals, and the clear belief in the credulousness of the presumed local audience. As for our own lot back in the UK, nothing to learn from anywhere else, and much more time to have perfected the art.

(I do not conflate state medicine with state hand-outs; don't waste your time in ad hominems and trying to make it appear so. I may report you, which would be a new departure for me, as I have a natural dislike for running to teacher's skirts.)

Rob C

[tom b]

I used to have painting lessons with Fred, a highly successful travel agent who was quite wealthy.

I've taught in inner city high schools with mainly newly arrived immigrant students.

We got along very well. Our core belief was we wanted a better life for ourselves and others.

One thing that we were in complete agreement was that governments should forget political point scoring. They should be working together to make our lives better.

Something for Americans to think about!

Cheers,

[hjulenissen]

In my view, life has to be divided into priorities, and the greatest of these is health. I do not find it strange to expect that any government, irrespective of colour, should be obliged to care, above everything else, for its own citizens' health.

One might think that "love" is one of lifes greatest priorities, yet not one that government should care about?

Being effectively a "social democrat" by birth, I find it somewhat surprising that government health care cause so much anxiety (and downright hostility) among some, while a range of other government spending and government involvement in individuals activities cause a lot less noise. I think that it is a lot better to have authorities fix my broken leg (even if that means paying taxes rather than insurance companies), than authorities tracking my emails or spending billions of money and endless human suffering on wars based on lies or incompetence?

There is a debate over here on how to best organize things. Should roads be built by government organizations? Or should a thin layer of government arrange the finances, while subcontracting the actual work to private companies*)? Should roads be self-financing (loan the money in a bank, pay the bank by toll), if so, what is the fundamental difference between a government road and a private road? Is this primarily a question of ideology ("big state is bad", "corporations are bad"), or is it a question of merit (whatever works the best)?

In the case of health, it seems that other countries get more health for less spending than the US**). From a superficial (non-economer, non-politician) view, this might cause US people to instantly copy whatever system is deemed to work the best. As this kind of pragmatism does not seem to be as popular as one might think, I wonder what is the real "drive" behind things.

Rather than criticize a system that I have only superficial knowledge about, I'd offer my view on how e.g. unions argue for a larger state over here. One of the most popular slogans is "a call for bid on grandmother". In this lies a deep mistrust for how commercial actors would rationalize care for our parents (do as little as possible for as much as possible), while the prevalent system of government care supposedly is rooted in a real care about the elderly. Interestingly, this view only center on the organization doing the care, no-one suggests that the individual nurses etc should do their services for free (rather, these employees should be paid more for the effort they are doing). Thus, one might suspect that these arguments and slogans (that resonate well with a large number of voters) are really about securing the jobs and pay for healthcare personell, which may well be sensible and the right thing to argue for a union, but not what the arguments are disguised as in public.  

-h
*)If your organization is one that builds roads, how can you possibly subcontract your main activity to a third party without keeping that competence in-house? And if all you do is write documents all day, how are you going to keep that competence? Would Toyota survive if they subcontracted the "building cars" part of their organization, rather than the "all kinds of other things" part?
**)Granted, these things are hard to compare. If doing average numbers, it is not surprising that the most amount of average health per expenditure can be had by spreading the health expenditure rather evenly among the people. For systems of large inequality, some will spend a lot to achieve small health gains, while others will not be able to make small payments that would give them large health gains. It is my impression that even factoring in this inequality, the US health system is somewhat inefficient at delivering a given health for a given cost.

[AreBee]

Rob,

I do not find it strange to expect that any government, irrespective of colour, should be obliged to care, above everything else, for its own citizens' health...I would put that up right at the top of the agenda along with national defence.

The first responsibility of government is to protect the lives of its citizens.

[IanB]

"Medical Bills"? What are they?

Oops, sorry - wrong politics...

[Otto Phocus]

A bunch of years ago, The Wife Unit needed some minor surgery.  When we told the hospital that we would be paying cash for the surgery, we were amazed at how low the price suddenly dropped. It was about a quareter of what the original estimate was... when the hospital thought they were dealing with an insurance company.

Only one data point, but one that made us go hmmmm.

[mezzoduomo]

I find it interesting that posters from around the world seem to know all about America's ills, Fox News, etc.....yet often are relying on incomplete information, no personal experience, and getting all ginned-up about America, more than they logically should. Gulag's presentation of horrifying medical bills and stories is at least part fiction, and its obvious. But medical care is indeed expensive here, and the billing and insurance system is indeed a mess. Facelifts and laser eye surgery are comparatively cheap, and are getting cheaper all the time (in real terms) because doctors compete for patients who have to pay with their own money....but that's another story altogether.

What's not being talked about is the state-by-state medical safety net for the poor, which in Arizona is called AHCCCS (pronounced 'access'). It's also far from perfect, but I've personally seen it work pretty well. I've seen homeless folks that I've worked with get into that system, (once they find the right caseworker) and get good services...for free. It's messy, poorly publicized, has some strange restrictions, etc....but its there, and there are good people trying to improve it. But the fact that it and the other state systems exist and actually function doesn't fit certain narratives about 'gun-crazy, callous, uncaring Capitalist America'. The world seems oddly obsessed with scandalous headlines about America, but not the rest of the story.

Let's just close my Lula participation with this: The anti-American bias here is palpable, and ignorant, and I'm no longer interested in seeing it.

Adios.

[Rob C]

I don't think you are correct in your reading.

I, for one, know zilch about the US medical system and feel delighted that on my visits I had insurance and no need to exercise it. I would have felt happy at that anywhere in the world.

That some posters put out some 'controversial' posts in order to excite a response is also okay - IMO - because all you have to do, if it bothers you or you really give a damn, is reply and tell them where their mistakes lie.

I don't imagine anyone from the UK is totally thrilled at the state of their state system; I don't think anyone is totally thrilled at any public service, anywhere.

But rolling your eyes and walking away doesn't help anything, least of all your indignation.

Rob C

[ErikKaffehr]

Hi Slobodan,

Can you explain, we Europeans know far to little about how the system works...

Best regards
Erik

Nobody, it is written off.

[Slobodan Blagojevic]

... Rather than criticize a system that I have only superficial knowledge about...

How dare you inject such a preposterously sane premise into our debate!?

[Alan Klein]

C

Rob,

The first responsibility of government is to protect the lives of its citizens.

In a free society the people decide what they want from their government. It's in a statist  government or dictatorship where people don't have freedom that the government decides what to do for the people.  Unfortunately too many people are willing to give up their freedom for apparant safety.

[RSL]

Unfortunately too many people are willing to give up their freedom for apparant safety.

Right, Alan, and once they do that the "safety" always ends. The problem is that people are flawed and that's especially true of politicians (says the ex-mayor of Manitou Springs). Politicians try to make decisions for their people that only the people are in a position to make. That's especially true in the area of economics. As Adam Smith pointed out, a mass of people free to make their own economic decisions are guided by "the invisible hand." When the government takes over the hand becomes visible and deeply flawed.

[tom b]

Those bastards made me pay into a superannuation scheme. Oh, I'm happy now that I've retired!

Eating some very nice food on my super!



Cheers,

The unidentified meat in the image is a very tasty double smoked ham.

[Slobodan Blagojevic]

Hi Slobodan,

Can you explain, we Europeans know far to little about how the system works...

Ah, Erik, I wish I knew. Very few people do, if anyone.

As amolitor and mezzoduomo already pointed out, the "system" of medical billing is anything but, more like a patchwork, a black magic mixed with hocus-pocus, now-you-see-it-now-you-don't, attempts by hospital administrators to:

- recoup charges for treating the uninsured or patients unable to pay by padding someone else's bill
- keep the hospital profitable
- satisfy the shareholders who insist on a continuous stock price growth
- pay million-dollar salaries to hospital CEOs

Many hospital administrators are encouraging (read: demanding) doctors to add unnecessary procedures or admit patients with ailments not otherwise justifying a hospital treatment, and actually firing those doctors that do not meet the quota.

It appears that medical practice is more and more driven by finance guys these days, not doctors. Individual doctor practices are also getting rarer these days, being gobbled by ever-growing hospitals and their beancounters.

As for my reference to "writing off" the bulk of a bill, that is what a hospital inevitably must do when everything else fails: insurance refuses to pay, the patient refuses to pay or successfully negotiates it down, they lose in court, etc. Then they move on to the next patient and pad his bill, hoping they'd get lucky this time.

Having said that, the vast majority of Americans are insured, contrary to the impression you might get in political debates. As such, they do not really care much what is in the bill, beyond their own share, which is known in advance and limited. When I go to my regular doctor, I generally know how much it is going to cost me. I really do not care how much he is charging the insurance, as I know insurance guys are big boys who can take care of themselves. When I go to a new doctor, a specialist, etc., I ask in advance how much it is going to cost me and actually shop around. You'd be surprised to learn that shopping around could lead to as much as 80-90% savings for the same service.

I am neither pleased with nor defending the system. I hate to shop around and negotiate. I also hate to spend hours negotiating the purchase of a car with sleazy car salesmen. But life generally comes as a package, good with bad, no cherry-picking, best-of-both-worlds, etc. When it comes to America, it is the preponderance of good vs. bad, that drives people to come here or those born here to be proud of it.

 

[Slobodan Blagojevic]

Australia is the place for Americans to be.. 

Oh, I can't wait for the next thread from our Aussie friends complaining how much more expensive everything photographic is down under, compared to America

[tom b]

Luckily, I'm not black!

[amolitor]

When it comes to America, it is the preponderance of good vs. bad, that drives people to come here or those born here to be proud of it.

And what is rarely acknowledged is that, insofar as we're able to keep it this way here in America, it is through a process of debate, often rancorous. It is by not giving in to any specific ideology, any specific panacea, by forcing continuous change and improvement as best we're able, that we maintain this state of "more or less good, more good than bad"

Without the debate, without the fighting, without the vicious backstabbing, there's no change. Without change, incredibly creative and motivated people will work out how to game the status quo, placing themselves as feudal lords over the starving serfs. The status quo is always bad, objectively so, because any status quo can and will be gamed by these people, who are not particularly evil, they are simply humans.

[Gulag]

Wow, Gulag!  Thanks again for pointing out how much America SUCKS! I can't tell you how illuminating this kind of information is. If you happen to be in America right now, you'll no doubt be leaving as soon as possible, since there couldn't be a worse place to be. If you're not in America, it's pretty obvious that you'll stay away forever and at all costs, as any rational person would.

PS: The documents you provided don't match up with the stories attached thereto.

For those whose indoctrination only allows them to view the world in duality, I'll keep it simple: It's not a bug, it's a feature.

[Isaac]

Can you explain, we Europeans know far to little about how the system works...

Jan. 29, 2015 What Consumers Should Know About Rising Health Care Costs

[hjulenissen]

In a free society the people decide what they want from their government.

I get that. But why on earth are people so worked up about getting health care from their goverment? I still don't get why that is seemingly the turning point of living in a "free" society vs a "non-free" one. You guys (like us, like anyone) have so many other issues that ought to inspire a lot more enthusiasm or anger.

It is analogous to photographers getting worked up over minute compression artifacts in Sonys raw files, forgetting to check if the image quality is actually better or worse than the alternatives.

-h