Why we need health care reform

Image credit: whitehouse.gov

I went to the emergency department with a kidney stone yesterday.

Here's the estimate I was provided at discharge.

  • ER Level 4: $4,631.94 
  • Insurance contractual discount: -$4,154.03
  • Adjusted estimated charges: $477.91
  • Estimated insurance responsibility: -$257.33
  • Patient co-pay: $125.00
  • Patient applied co-insurance: $95.58
  • Estimated patient responsibility: $220.58

So, I paid $220.58 on my way out the door (on a credit card). I imagine I'll also be receiving bills from the ED physician and radiologist.

What really amazes me about this estimate is the fact that $4,154.03 (almost 90% of the bill) was written off because of the contract between the hospital and Blue Cross.

Keep in mind that doesn't mean Blue Cross paid this amount. It just goes into oblivion. But it was a made-up number in the first place. No reasonable person believes that $4,631.94 is an appropriate amount of money for a visit to the emergency department.

Now imagine that I didn't have insurance. What would my bill have been? $4,631.94.

So, all you folks out there that buy into the propaganda that we don't need health care reform, be glad you have insurance. The system is stacked against the most vulnerable.


  • AlmostJesus says:

    Finally! Someone who has it right. If everyone purchased insurance, the pool would be spread out and the prices would go down for everyone and the percentage of payers would increase dramatically.
    Of course, the only way we could easily do that is to require everyone to have health insurance.
    The Swiss have a great system, everyone is required to purchase a basic health insurance plan that the insurance company cannot make profit off of, they can only make profit off of the extras (private rooms, expanded coverage, etc)
    Watch Frontline: Sick Around the World, it is a great look at the issue.

  • Paul says:

    Actually the "most vulnerable" (at least around here) would have gotten the care but not the bill.  The state would have picked it up, paid it partially and, in turn, passed the cost along to the taxpayer.  The hospital would then simply charge-off the balance which would show up as a big number during the hospital's periodic reporting.  In turn, to recoup those costs the hospital passes them along to insured persons and those who they may actually be able to collect from to pay the bill (or a portion thereof).
    Do we need health care reform? Yes, of course we do.  We've needed it for years, the question is "how".  Like everything else, the devil is in the details.  Do I think the answer is "single payer" a la Europe? No, I don't because I  lived in that system for years and while it worked in some ways it's failed in so many others. Despite an national health service that  mostly works, everyone is going out and gettting private insurance, for a reason. We do need the reform, I just don't know how to get there.
    Lastly, you say that the $4631.94 is a "made up" number and that it's not an appropriate amount of money for an ED visit.  I say that "made up" is an oversimplification.  While the number is based on several estimates, like overhead (cost of utilities, all materials like linens and cleaning solutions, all the salaries/benfits of all staff in the area, equipement cost, etc.), the direct costs of providing care as well as the indirect costs (like the hospitals insurance policy, compliance burden, administrative costs, etc.).  Unfortunately, running a health care facility isn't easy or cheap and those costs get picked up by…YOU (and I).  Would a great place to start be cutting much of the abuse, waste and fraud that goes on? Would we be better off if we put a strong focus on primary care and preventive medicine?  We all that the answer is a resounding YES  but let me ask you this: how do you think the American public would react to their (percieved) right to double whoppers with extra cheese and mayo? Perhaps, their (percieved) right to be taken to the ER (of their choice) for a hangnail and the right to sue everyone they choose? Do you think that they would ever agree to pay less if they made good decisions about their health *cough* EatASalad *cough*? 
    Sadly, I have offered no solutions, just a rant…

  • Rob says:

    Imagine? Over 50 million of us don't. A higher number than the official unemployed don't have work either, adding to their stress and the likelihood they'll end up with a kidney stone, or gallstone. Or like my wife, rear-ended by some clown on his cell phone that whip-lashed her. Go the hospital? Not on your life. We're still fighting them from misdignosing her shingles last year. All kinds of machine tests, and they didn't do one simple bacteria or virus check. And 9 tries to get the IV in. I was there the whole time.
    Thankfully, the clown who hit my wife had insurance, and my Buddhist neighbor is a lawyer helping us pro-bono. So she has at least been to the chiropractor. And that payment will have to wait until the end of the case.
    Imagining isn't difficult. My opinion is single payer. The bigger the risk pool, the cheaper it is, and we already have Medicare. It removes making profit from people's illnesses.

  • Steve m says:

    Seriously move to Australia. 🙂 If you need emergency hospital care and go as a public patient, it will be basically free. If you go in as a private patient with private health insurance… You will pay. For the sake of having a room to yourself, it’s not worth it. Private health insurance is only valuable for two things here. Elective surgery, such as reconstructions etc, or child birth.
    If you have super sick kids, then it’s probably worth it too, but other than that, it’s something rich people have.
    There is a However. If you don’t have ambulance cover of about $80 a year, and you are taken to hospital by ambulance,(air or road) you will get a big bill in the mail, otherwise, your treatment is covered by the ambulance cover. Gratis. 🙂 same with fire services etc, many states include these things in the yearly car registration.
    I live here and it’s great.

  • 9-ECHO-1 says:

    I really don’t think that anything is going to solve the problem until you get past the idea that everyone is entitled to complete healthcare with no amount of personal responsibility. You can say that everyone has to purchase insurance, but those with Medicaid can get past that. I have insurance that my employer provides. Until my wife finally got a job that provided healthcare, I covered her (to the tune to $550.00 every month). And our coverage had so many deductibles and co-pays, we still paid over $10,000.00 a year in health care costs. And that did not include any hospital visits or procedures. If I have a head cold, I have to go to WalMart and buy various cold concoctions to help alleviate the symptoms. I regularly transport head colds, chest colds, ear infections, and sore throats, all flashing their Medicaid card. I don’t have that luxury.
    No one wants to hear it, and no one is willing to say it, but access to healthcare services has to be controlled. We can either have a single provider system that regulates it, or we can get control who is paying for what services and what services are elective, what are sort of important, what is absolutely necessary for life sustainment. If we go with a single provider, what is absolutely necessary fo life sustainment is all that should be provided for ‘free’. If we stick with the current “insurance system”, then those who are supported by a government program have to be restricted to receiving only what is necessary for life sustainment.
    I know, people don’t like to hear that, but we cannot sustain our current delivery system.
    We have to find better ways to do things. We simply cannot afford what we are doing. All of this talk about requiring insurance is nothing more than a generic band-aid with poor adhesive. Until we get to the root(s) of the problem, we are not going to solve anything.

  • CJ Ewell says:

    Preaching to the choir, and with the same reasoning. Good to hear it again.

  • Karen says:

    Those who have no insurance either never receive a bill or receive just as big a discount as you did.  Some hospitals will ask the patient if they can pay $200.00 now the rest will be written off.  The reason healthcare is so high is because of the abuse.  Those with govenment insurance – especially medicaid/medi-cal will go to hospitals and ask for the physician to write a RX for tylenol, motrin, etc.  This way they do not have to pay a dime.  Some get what is called an indigent RX meaning the hospital picks up the cost of the RX.  These are those who walk in with I-Phones saying they can not afford a $20.00 medicine.  The only way to bring down prices is to make sure everyone pays something.   Even then I doubt it will help because medicine is big business and big business is big money for all involved.

  • BH says:

    Pretty simple question to me.  Are you willing to pay a 50% tax rate so that people won't get a bill that they had no intention of paying anyway?  Are you willing to cede control of your healthcare to the same government that gave you FEMA, the  IRS, and the VA medical system?  Do you think Medicare/Medicaid are well-run, cost-effective programs? 

  • AlmostJesus says:

    I guess it should have been assumed that this would break down into a healthcare argument and everyone would jump to the conclusion that government healthcare is bad and jump to the fallacies that the only way we can reform the system is through substantially increasing taxes.
    What we fail to realize is that the reason why healthcare costs are so high is that we are already paying for everyone else.When we get these astronomical bills, it is because the costs of non-payers along with the significant administrative costs associated with the billing process within healthcare.
    That is why I mentioned the Swiss system, we could easily base a system off of that and have insurance companies content, hospitals content, and consumers content. There needs to be a requirement for EVERY individual to have a basic health insurance that covers everything but perks or upgrades. The insurance companies would not be able to make a profit off of this, but can make profit off of selling the extras such as private hospital rooms. With this reform, insurance companies would have more incentive to cooperate and build a common billing system with the assistance of the government. This would drive down the significant administrative costs. Finally, by diluting the pool, the prices for healthcare would substantially decrease. The individuals who cannot afford or are elderly/disabled will receive premium assistance from the government, but the government would be less involved.
    I would reckon that our %GDP spent on healthcare would decrease significantly, likely to a level on par with the Swiss. Doctors, hospitals, and ambulance services would receive compensation for nearly every patient, thus, the salaries, etc likely would not change dirastically.
    While there are flaws to this system, it is an immense improvement.
    I think in the short term, more money needs to be spent on education, case management of frequent fliers, preventative care, and palliative medicine. A majority of our healthcare costs occur in the last 6 months of our life, often times in futile attempts to prolong life that would last just as long on palliative care.
    For further reading, I suggest some of Atul Gawande's New Yorker articles on case management of frequent fliers along with watching Frontline: Sick Around the World.

  • Alex says:

    As one of your readers from the UK, these types of discussions always amaze me. I know our National Health Service (NHS) isn’t perfect, but the idea of being landed with a huge bill after falling ill seems so alien. Everyone in this country would be able to use EMS, use the hospital, arrange follow ups with their family doctor, etc without money ever being mentioned.

    Speaking as someone who works for an NHS ambulance service, we don’t even have the facility to take a payment from someone. whether they’re a British taxpayer or a foreigner on holiday, all patients get whatever treatment they need with no discussion about insurance or money.

Leave a Reply

Your email address will not be published. Required fields are marked *