Not paying for ER visit

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I think prices should be posted but they should be the non discounted price. Those numbers are all available from someone but getting the info is nearly impossible.
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EctopicFetus said:
Thats naive. Good insurance is insurance that contracts with the docs and specialists YOU want to see. It also relates to what you have to pay.

Here is a REAL life example for you. I had kid #1 my TOTAL out of pocket cost.. $10. Kid #2 no real problems my out of pocket cost was about $5,000.

Do you see the difference now? I hope that made it clear for you.

Another example is when patients come to the ED becuase their insurance wouldnt pay for something (happens all the time).

5oboy11, I hope that helps you.
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No, that didn't really help at all, but thanks anyway. I do understand the basics of health insurance...
 
EctopicFetus said:
We can debate Emtala but say you are having a giant heart attack. Who should be doing the wallet biopsy before we decide to intubate and activate the cath lab?

Hospitals do compete for business. You might not realize it but they do. I dont know where you live but just about anywhere they advertise their services. Why do you think they do this if they dont have competition?

Using the post prices model (which I am for) would be great. I dont think everyone should be charged the same. If you did that wouldnt you just put the hospitals in the poorest areas out of business? Think about that.
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Thanks for pointing out the ridicuousness of our first analogy so quickly. One can choose not to drive. One can not choose not to have a heart attack. How anyone in your shoes cannot recognize the necessity of a mandate if we as a society have decided that everyone will get a certain level of care (which EMTALA dictates) is beyond me.

As you or others have alluded to, some are charged far more for services to subsidize those who pay less or don't pay. Really efficient system. Very "capitalist" too.
 
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coachB said:
Thanks for pointing out the ridicuousness of our first analogy so quickly. One can choose not to drive. One can not choose not to have a heart attack. How anyone in your shoes cannot recognize the necessity of a mandate if we as a society have decided that everyone will get a certain level of care (which EMTALA dictates) is beyond me.

As you or others have alluded to, some are charged far more for services to subsidize those who pay less or don't pay. Really efficient system. Very "capitalist" too.
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CoachB, I dont need big brother. People choose to make the decisions they have. If you somehow think it is efficient for me to buy someone elses insurance like our current mandate dictates then you must define efficiency differently than I do. The difference is how this gets subsidized. Right now even those who dont make a lot of money but have insurance through an employer subsidize this. The alternative is to have the money pass through the idiot criminals in DC. I prefer the current system. Also you should look into how its treated Mass. Total Failure.

My shoes tell me people should be allowed to decide how they spend the money they earn. Obamacare puts a lot of this burden on young people who choose to risk it and not be insured. As a group who dont make lot of money this is not a terrible gamble. It is more like playing the lottery in reverse. You hope not to have a catastrophe and know you can cover some basics on your own.

Regarding different charges you should take a look at the spread people pay for cars or businesses pay for items. The bigger the business (Walmart) the cheaper the item. An individual pays more for this item.
 
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Fiveoboy11 said:
No, that didn't really help at all, but thanks anyway. I do understand the basics of health insurance...
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Your prior post showed a complete lack of understanding of what good health insurance is. I was trying to bridge your knowledge gap.
 
EctopicFetus said:
Your prior post showed a complete lack of understanding of what good health insurance is. I was trying to bridge your knowledge gap.
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Oh? How is that? Try to actually give me some good information because I went to school too you know (I'm a PT), do you really think I'm a complete idiot when it comes to insurance? Have a good one. BTW I was being sarcastic in the post you're talking about.
 
Fiveoboy11 said:
Oh? How is that? Try to actually give me some good information because I went to school too you know (I'm a PT), do you really think I'm a complete idiot when it comes to insurance? Have a good one. BTW I was being sarcastic in the post you're talking about.
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Tough to get your sarcasm in written form. I never made mention of your profession but I guess you want to make that an issue. Ill pass on that. I was simply trying to explain what good insurance looks like to a consumer.

I dont know you so I dont know if you are an idiot when it comes to insurance but the initial post on this looked that way.
 
EctopicFetus said:
Tough to get your sarcasm in written form. I never made mention of your profession but I guess you want to make that an issue. Ill pass on that. I was simply trying to explain what good insurance looks like to a consumer.

I dont know you so I dont know if you are an idiot when it comes to insurance but the initial post on this looked that way.
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No controversy intended honestly, just trying to make myself clear. I was only asking what a good insurance is for a patient, from the perspective of a physician, or physician in training. Kind of like an expert opinion or something. I wasn't intend for a basic, beginner's guide to insurance as if I'm a clean slate.
 
EctopicFetus said:
We can debate Emtala but say you are having a giant heart attack. Who should be doing the wallet biopsy before we decide to intubate and activate the cath lab?
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EMTALA should be changed however. Yes, if you're having a true emergency, you shouldn't be turned away. However, the prudent layperson definition of emergency should be removed. Having, in the last few days, seen people call EMS for mosquito bites, fever (after having been seen for same 6 hours previously, but didn't give tylenol at home), and "requesting pregnancy test", I think the people who have the training should be allowed to make those decisions.
Plenty of hospitals give the medical screening exam at triage now, and if you don't have an emergency, you're welcome to be seen. You just have to pay your copay, or, if uninsured, a set fee. This truly could prevent abuse.
Of course, all it does is make sure everyone says that they have chest pain today, as well as back pain for 7 years.
 
The alternate consideration is allow physicians (and hospitals, maybe) to deduct charity care. Along with tort reform, I strongly believe we would all see doctors more willing to see patients uncompensated, and some of the insane billing would go away.
 
Apollyon said:
The alternate consideration is allow physicians (and hospitals, maybe) to deduct charity care. Along with tort reform, I strongly believe we would all see doctors more willing to see patients uncompensated, and some of the insane billing would go away.
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Yep agreed. This is one of my favorite non tort reform stuff out there. I dont know if it will fly but it should.

Regarding the post from 5, good insurance from my perspective is about timely and fair compensation for what I have done. I work in the ER so I dont stress pre-auths and stuff like that.

To McNinja the layperson standard allows us to get paid for seeing those stupid complaints. Look I would be happier if they didnt come to the ER but once there so be it. Ill see them. Consider this. 1) not a lot of hospitals are using triage to boot patients or make them pay up front. The trend has started but it is quite tiny.

2) Some of those patients have medicaid for which no matter how ******ed the chief complaint we get paid for our work.

3) IMO its not safe to have a triage nurse make these decisions but thats just me. A sore throat? Maybe its epiglottitis or peritonsilar abscess. I trust I can differentiate but I dont think the nurses can. Maybe I dont give them enough credit. A febrile infant, it is meningitis or some other less common entity like Kawasakis or what not. I would rather take a look. Also for the hospital there is little true added cost having the doc see them and taking the liability off their hands and having it put on the doc.
 
justaregularmed said:
What I find completely disgusting is this: Friend goes to hospital, gets 5 sutures, hospital charges them for supplies which could but them an ENTIRE BOX of sutures at RETAIL.

That is completely disgusting and reprehensible.

One packet of sutures, one vial of lidocane, one needle and syringe, one chuck, one betadine swab and some gauze. For the low low price of $100 dollars!

This stuff costs maybe 15 bucks retail, including hospital collective bargaining, I would estimate cost them maybe 5-7 bucks.

So only a 2000% markup.
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The price includes the people, the room, the electricity used while the sutures were placed. Until you run a business, you don't realize all of the costs.
 
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Dr.McNinja said:
Plenty of hospitals give the medical screening exam at triage now, and if you don't have an emergency, you're welcome to be seen. You just have to pay your copay, or, if uninsured, a set fee. This truly could prevent abuse.
Of course, all it does is make sure everyone says that they have chest pain today, as well as back pain for 7 years.
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What I've seen is a triple layer emergency department that has 1) Real emergencies 2) minor emergencies and 3) family medicine tracts that patients are routed through at triage.

It sounds similar to what you're describing except they literally see a GP if it is something simple in order to clear the cases in the ED.
 
McGillGrad said:
The price includes the people, the room, the electricity used while the sutures were placed. Until you run a business, you don't realize all of the costs.
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You missed my followup, there was another 300 dollar "ER Fee".
 
How much money does it cost to see a GP in the ER? Probably the same as the ER doc.
 
EctopicFetus said:
How much money does it cost to see a GP in the ER? Probably the same as the ER doc.
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Yup, same fee, except you have to show insurance to be seen since it isn't urgent.
 
Yes so why do you need the GP at all? There are places here in the US that function the same way but then you see an ER doc.

based on your name I imagine it is in Canada?
 
Apollyon said:
The alternate consideration is allow physicians (and hospitals, maybe) to deduct charity care. Along with tort reform, I strongly believe we would all see doctors more willing to see patients uncompensated, and some of the insane billing would go away.
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Dang if you did this ER docs wouldn't pay any taxes! I like it.
 
EctopicFetus said:
Yes so why do you need the GP at all? There are places here in the US that function the same way but then you see an ER doc.

based on your name I imagine it is in Canada?
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UK and Canada, both.

I suppose it is meant to teach people to go see a GP instead of going to the ED.
 
hemoglobincell said:
Dang if you did this ER docs wouldn't pay any taxes! I like it.
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This idea is posited much more strongly by non-EM physicians. It wouldn't benefit the vast majority of EM docs, as they don't individually bill the patients. The group (if that is for whom the doc works) or the hospital (again, if that is for whom the doc works) does the billing. Fee-for-service docs would get hit (among whom are a rarer breed in EM, for it can be a lucrative position if one works hard). That "fee-for-service" is the model by which most office-based docs (even surgeons, who have office hours) do their business. They are the ones that would benefit.
 
wagy27 said:
So let me get this straight: You being someone who "went to school too" decided to go without health insurance at the age of 29 despite being in the medical field and knowing the risks of having one issue pop up. You then developed a condition which is normally managed as an outpatient put developed a potentially life threatening condition which required hospitalization. Your condition was managed and based on what you've posted it seems all is well from your health but you have the gall to challenge the institution that took care of you? You are responsible for that bill. Yes, the insured pay lower rates because hospitals are counting on bulk business. If I buy a 1000 of product X I'm going to get a better rate than if you try to buy 1. Simple economics. Same thing with the insured vs. the un-insured. Further, if this was such an issue you should have done your homework before you got ill and identified which hospitals would have been better for your finances. You sound like the guy who bought a car and found out someone else got the same care at a lower price and is pissed.

You failed in your responsibilities to maintain health insurance. You are now suffering the consequences. Pay the bill and be a responsibile consumer and get health insurance for the next time.
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I did pay the bill. Let me know what you think is a more responsible move, getting health insurance and maintaining it, or sucking it up and paying an outrageous inflated medical bill because you have to or face bad credit for years. What I ended up doing, to me, required a lot more responsibility than having and maintaining insurance. I agree that it was a stupid move not to have health insurance, especially because I am a PT and should have known better. At the same time that does not justify the amount of money I was forced to pay. And it doesn't make me irresponsible.

Bottom line is that hospitals overbill uninsured people and get away with it. I'm not sure what percentage of people do and do not actually pay. But the ones that actually do, responsibly, get the shaft, big time.
 
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EctopicFetus said:
To McNinja the layperson standard allows us to get paid for seeing those stupid complaints. Look I would be happier if they didnt come to the ER but once there so be it. Ill see them. Consider this. 1) not a lot of hospitals are using triage to boot patients or make them pay up front. The trend has started but it is quite tiny.

2) Some of those patients have medicaid for which no matter how ******ed the chief complaint we get paid for our work.

3) IMO its not safe to have a triage nurse make these decisions but thats just me. A sore throat? Maybe its epiglottitis or peritonsilar abscess. I trust I can differentiate but I dont think the nurses can. Maybe I dont give them enough credit. A febrile infant, it is meningitis or some other less common entity like Kawasakis or what not. I would rather take a look. Also for the hospital there is little true added cost having the doc see them and taking the liability off their hands and having it put on the doc.
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I don't trust our triage nurses to even get the vitals right. To have a feasible MSE out front you need a doc. I don't even like midlevels doing it (since they have to be overseen by someone who isn't actually there).
And even then, you would only be able to truly cut out the absolute bull**** complaints (back pain x7 years, out of methadone, etc).
The paying customers would still be there, and likely be happier because they aren't waiting behind the crack addicts.
 
Fiveoboy11 said:
I did pay the bill. Let me know what you think is a more responsible move, getting health insurance and maintaining it, or sucking it up and paying an outrageous inflated medical bill because you have to or face bad credit for years. What I ended up doing, to me, required a lot more responsibility than having and maintaining insurance. I agree that it was a stupid move not to have health insurance, especially because I am a PT and should have known better. At the same time that does not justify the amount of money I was forced to pay. And it doesn't make me irresponsible.

Bottom line is that hospitals overbill uninsured people and get away with it. I'm not sure what percentage of people do and do not actually pay. But the ones that actually do, responsibly, get the shaft, big time.
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No doubt carrying insurance is more responsible. It is someone who is appropriately worried about the consequences of a serious condition. The 24k you paid would have cost an insurer 6k or so.

Sure you are responsible for your health but what if something happened and the bill was 250k? If you were insured and IMO more responsible you wouldnt have to worry. You would have had to file bankruptcy had that happened.
 
Also I think responsibility is preparing for the unexpected. Im young and dont expect to die in the next 20 years but to protect my family I have this. I am protecting them. Same for disability insurance.

You were less responsible because buying insurance up front offered no benefit except protecting yourself from an unforeseen disaster. Paying your bill after the fact has the benefit of protecting your credit.
 
My dentist offers a cash discount. It's 10%. We (both the docs and the hospital) offer way more than that for any bills paid within a month, I think we offer 25%. Our insurers have negotiated rates with us that are 10-70% off. Medicare pays us about 80% off what we bill, and medicaid about 90% off. Those obviously aren't negotiated.

I agree it isn't fair that the cash buyers get shafted. I wish everyone paid the same, fair rate. I'm not sure that can be legislated though. If all our customers paid us 30-40% of our billed rate, I think we'd do just fine.

But the real problem our customers have isn't our (the doctor's) bill, it's the hospital bill. It's often 3-4 times as high as the doctor bill, especially on a visit requiring labs, EKGs, and CT scans.
 
ActiveDutyMD said:
My dentist offers a cash discount. It's 10%. We (both the docs and the hospital) offer way more than that for any bills paid within a month, I think we offer 25%. Our insurers have negotiated rates with us that are 10-70% off. Medicare pays us about 80% off what we bill, and medicaid about 90% off. Those obviously aren't negotiated.

I agree it isn't fair that the cash buyers get shafted. I wish everyone paid the same, fair rate. I'm not sure that can be legislated though. If all our customers paid us 30-40% of our billed rate, I think we'd do just fine.

But the real problem our customers have isn't our (the doctor's) bill, it's the hospital bill. It's often 3-4 times as high as the doctor bill, especially on a visit requiring labs, EKGs, and CT scans.
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This is not an ER situation but (it is insurance)... I had a hip replacement last summer (oh, and insurance for it too). Most of the claims billed were paid way below the charge. For example, one was for $40K, and was paid at $6500 (a 16%!), but another was billed for $1998 but paid $8637. What?! I think my take on some of this discussion is that the insurance claims and payouts are not very comprehensible. I don't use the ER unless someone takes me in there (and haven't been in -oh- years/decades now. I do have a PCP and go to him). I guess I'd liked to have had a ballpark idea of what I would be obligated to pay, but was never told (it obvioulsy turned out not to be much, of course). Patients understand that complications arise and may incur more fees, but there is no way for us to really find out. For me most of the problem is not that the ER/docs, etc are paid too much (I mean, for pity's sake you save lives or at the least do your best to do so) its that the insurance/medicare/medicaid systems make it so unintelligible to those of us who try to do what is expected.
In any case, thanks for what you do. Most of us out here in the rest of the world really appreciate your efforts. Its a shame too many do not follow that pattern. I saw some of that myself when I worked in a public health clinic and had patients/clients who expected way more than they should.
 
If you have an elective procedure you surely do get a number. My son needed a small procedure and we paid our portion of the surgeon and anesthesia cost right up front. They told us if we didnt pay 48 hours prior to the procedure then it would be cancelled. We paid the money and that was that.

My mother in law had back surgery and it was the same thing. She paid up front and not a penny more.
 
Fiveoboy11 said:
I did pay the bill. Let me know what you think is a more responsible move, getting health insurance and maintaining it, or sucking it up and paying an outrageous inflated medical bill because you have to or face bad credit for years. What I ended up doing, to me, required a lot more responsibility than having and maintaining insurance. I agree that it was a stupid move not to have health insurance, especially because I am a PT and should have known better. At the same time that does not justify the amount of money I was forced to pay. And it doesn't make me irresponsible.

Bottom line is that hospitals overbill uninsured people and get away with it. I'm not sure what percentage of people do and do not actually pay. But the ones that actually do, responsibly, get the shaft, big time.
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Why do people with bad credit scores have to pay more for loans than people with good ones??

Let's say the "actual" (notice quotation marks) of your hospital stay/workup was $10,000. Hospitals know that if you have insurance, 100% of the time, they will be reimbursed, and therefore charge your insurance $10,000 (of which you have some deductible).

Unfortunately for you, you're lumped into another category - those with out insurance. Like it or not, it puts you in a group where maybe less than 50% of the patients pay their bill. Guess what? That group is being charged $20,000 for the same services because only 50% of the time does the hospital recover the charges.

You said you wanted to protect your credit by paying your bill. Smart move. You know that a bad credit score will ultimately cost you more money in the long run and to protect it, you paid in full. Hospitals (like any institution offering a line of credit) have a right to charge more to people less likely to pay them back. The only difference is, hospitals aren't loaning you money to buy that sports car or over priced flat screen TV, they're "loaning" you the resources to save your life and don't turn you down.
 
alreadylernd said:
Why do people with bad credit scores have to pay more for loans than people with good ones??

Let's say the "actual" (notice quotation marks) of your hospital stay/workup was $10,000. Hospitals know that if you have insurance, 100% of the time, they will be reimbursed, and therefore charge your insurance $10,000 (of which you have some deductible).

Unfortunately for you, you're lumped into another category - those with out insurance. Like it or not, it puts you in a group where maybe less than 50% of the patients pay their bill. Guess what? That group is being charged $20,000 for the same services because only 50% of the time does the hospital recover the charges.

You said you wanted to protect your credit by paying your bill. Smart move. You know that a bad credit score will ultimately cost you more money in the long run and to protect it, you paid in full. Hospitals (like any institution offering a line of credit) have a right to charge more to people less likely to pay them back. The only difference is, hospitals aren't loaning you money to buy that sports car or over priced flat screen TV, they're "loaning" you the resources to save your life and don't turn you down.
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That's only a partial explanation of why this happens. You have to lump into it the fact that the hospital KNOWS that even if you have insurance, you're only likely to collect 25% of what you bill. In order to cover the hospital's costs (say $2000,) they have to PLAN to get 25% of their bill and still make a little profit (say $2500), and thereby multiply what they charge by 4. That way, to make a profit (or at least break even,) the hospital charges 10,000. Unfortunately, that's the cost that gets passed on to the people (uninsured, etc.) without the clout to say, "We're only going to pay you 25% of what you asked, take it or we'll take our 30,000 patients out of your market."

Just wait until the other services cut reimbursements to 10%. Then you get to multiply the "price" by 10 to make the same. Now your $2000 procedure costs "$25,000," unless your insurance company cares to undercut the costs again.

Mix this phenomenon with the above-quoted "spreading the cost of people who don't pay around" theory, and that's pretty much how we got into this mess. Oh... and the complete and utter lack of transparency in pricing... and the ridiculous dance we do every time the bureaucrats come around with a ruler to rap the knuckles based on JCAHO standards... Or forcing people to get EMRs even though they're poorly implemented and slow productivity with no discernible benefit to patient care, medicolegal reasons, or the sanity of those who use them...

Feel free to add more. :rolleyes:
 
The Canadian system is the best - physician determined healthcare (i.e. not socialized medicine like France), 100% reimbursement for everything you do since the government pays the bills, on a fair fee schedule negotiated at regular intervals between the docs and the government. There's some problems with health care in Canada, but it's not the health system - it's the difficulty of delivering health care to places where the population density is 2 people per sq mile.

No insurance companies, buildings and overhead, wages for bean counters, no need to employ a cadre of coders in your hospital to decipher the latest ICD-10, .... the only reason why it wouldn't work in the States is because all those lazy coders and insurance sheep would be out of work. Well, that and the fact that many physicians are against it because they can't see the forest for the trees and they cling to some misguided belief that this is somehow "Un American".

Wussies won't even debate it in this country.
 
bulgethetwine said:
The Canadian system is the best - physician determined healthcare (i.e. not socialized medicine like France), 100% reimbursement for everything you do since the government pays the bills, on a fair fee schedule negotiated at regular intervals between the docs and the government. There's some problems with health care in Canada, but it's not the health system - it's the difficulty of delivering health care to places where the population density is 2 people per sq mile.

No insurance companies, buildings and overhead, wages for bean counters, no need to employ a cadre of coders in your hospital to decipher the latest ICD-10, .... the only reason why it wouldn't work in the States is because all those lazy coders and insurance sheep would be out of work. Well, that and the fact that many physicians are against it because they can't see the forest for the trees and they cling to some misguided belief that this is somehow "Un American".

Wussies won't even debate it in this country.
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I think you may have kicked a hornet's nest my friend.
 
bulgethetwine said:
The Canadian system is the best - physician determined healthcare (i.e. not socialized medicine like France), 100% reimbursement for everything you do since the government pays the bills, on a fair fee schedule negotiated at regular intervals between the docs and the government. There's some problems with health care in Canada, but it's not the health system - it's the difficulty of delivering health care to places where the population density is 2 people per sq mile.

No insurance companies, buildings and overhead, wages for bean counters, no need to employ a cadre of coders in your hospital to decipher the latest ICD-10, .... the only reason why it wouldn't work in the States is because all those lazy coders and insurance sheep would be out of work. Well, that and the fact that many physicians are against it because they can't see the forest for the trees and they cling to some misguided belief that this is somehow "Un American".

Wussies won't even debate it in this country.
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And thats why people with money in Cananda and across the globe come to the US for their healthcare.

http://www.cbc.ca/news/canada/newfoundland-labrador/story/2010/02/18/nl-williams-surgery-190210.html
 
2 years ago I got laid off of my job and knew I was going to lose my health insurance immediately. I got insurance that day that gives minimal coverage at a decent rate (~$87/month). 1 month goes by and I end up in the hospital and have an emergency appendectomy. Hospital bill was $18000. I only had to pay my $3000 deductible of that.

Here is the ridiculous part...I called the hospital billing and negotiated a deal with them. I told them I will pay the bare minimum per month until it is paid off. The bare minimum is $10. I pay $10 a month, completely interest free for the next 20+ years. I have it set up through automatic bill pay and dont ever think about it or worry.

I tried to explain to the billing manager that they are actually losing money on this deal (time value of money) and that I told them I would pay $1500 up front to be done. They are so stupid that they denied my request and I still am paying $10/month. Afterall, interest free??? Fine with me!
 
Just to add a bit of perspective I had a plumber come to my house and install a new water heater. 2 guys, ~1 hour, $350 for installation. The cost of the heater, hoses, materials was extra.
 
Winged Scapula said:
You live in a state with a Medicaid program. Why haven't you applied or why didn't the hospital apply for you? Could it be that you make too much money or have assets which exceed the limit (which is fairly generous) or simply chose not to apply or to pay for insurance?
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In the states that I've lived in, medicaid is pretty hard to get. Where I went to medical school, it pretty much only existed for pregnant women and children. There were a few exceptions for certain specified diseases (like breast cancer but not most other cancers, go figure). In the state I live in now, there is a comprehensive health care plan, but there's a lottery to get it. We have our patients apply for the lottery, but if they're not selected (and the odds are great), too bad. I have no idea what normal is, but my personal experience hasn't shown that medicaid is some readily available thing for low income folks.
 
docB said:
Just to add a bit of perspective I had a plumber come to my house and install a new water heater. 2 guys, ~1 hour, $350 for installation. The cost of the heater, hoses, materials was extra.
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...thats the old joke....

...my plumber gives me the bill, "what, $350 for one hour of work" I reply, "I've never billed that much and I'm a doctor"....

The plumber smiles, looks me in the eye and says, "Neither did I when I was a doctor"....

Supply/Demand (plus a bunch of crap in middle) :)
 
Doctor Bagel said:
In the states that I've lived in, medicaid is pretty hard to get. Where I went to medical school, it pretty much only existed for pregnant women and children. There were a few exceptions for certain specified diseases (like breast cancer but not most other cancers, go figure). In the state I live in now, there is a comprehensive health care plan, but there's a lottery to get it. We have our patients apply for the lottery, but if they're not selected (and the odds are great), too bad. I have no idea what normal is, but my personal experience hasn't shown that medicaid is some readily available thing for low income folks.
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You definitely do not live in New York. One of the main reasons people move to the city is the generous medical and social benefits.
 
McGillGrad said:
You definitely do not live in New York. One of the main reasons people move to the city is the generous medical and social benefits.
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I always think it's funny and sad at the same time. I live in Florida, and every few months I get a homeless person or some other "self-pay" patient who continuously complains about how they used to "have all this stuff paid for when they lived in New York." "I've never been treated like this and had to wait this long." I usually tell them they're free to go back. They don't usually like that.

Of course, it was NYC who was buying their homeless bus tickets to send them someplace else (which invariably ends up being our sunny temperate locale...), but I guess they didn't take that as personally. More like a "vacation."
 
The answer to all this is of course a single-payer system that provides free care to everyone with enormous taxes on the "rich", and that makes us (even moreso) indentured servants to society.
 
My 2 cents:

If you are currently healthy, invest in good health insurance. I had basically catastrophic insurance (max outpatient benefits was 2000, then I was on my own) when in med school. I would have never thought that to be a problem. Then I started having health issues which required a lot of outpatient evaluation. I maxed out in the first month and I found out (at least with that company) I was responsible for 100% of the bill after they paid their part. This meant I was paying as if I were uninsured plus paying monthly insurance bill just in case I went inpatient for anything.

I also found if you go to the ED when ill, if you are serious enough, no one will ask for your co-pay. They assume you will be admitted which changes things for people who are insured.

I was fortunately able to work with hospitals and doctors to bargain the bills down. Outpatient physicians I spoke to upfront about it all, and most of the time the bill was adjusted before I got it. I did end up taking much more in student loans to pay for the bills, but it was possible to do when determined to pay them.

Even when healthy, you should get health insurance. It will save you a lot of money later in life. I know from personal experience this is a huge factor. Same for life/disability insurance. I never considered disability insurance and now I am pretty much ineligible (for what I expect to need it for - looking now just to try to get something arranged for the future I can't predict). I fortunately got life insurance 1 week prior to all my issues. Cheap still because I was "healthy" then.

I am just saying all this to get people motivated to get things set up when young because you never know what is in your future.
 
GeneralVeers said:
The answer to all this is of course a single-payer system that provides free care to everyone with enormous taxes on the "rich", and that makes us (even moreso) indentured servants to society.
Click to expand...


I heard about this place, its called "Galt's Gulch". I'm looking into moving there. Wanna come with me ? :)

/ayn rand blog.
 
The current system of redundant and overlapping bureaucracy between medicare, medicate, and private insurance with each payor reimbursing for the same care at different rates is madness. The only alternative beside a single payor system is simply outlawing insurance altogether and going back to fee for service.

Adjusted for inflation, doctors make more money post Medicare than they did pre-Medicare. If all forms of insurance in general were to disappear , whether you are paid in gold or not, most doctors income will take a nose dive. People who have no money will purchase no services. The wealthy 2% will continue to be able to finance "the bowel run of the stars" but this will benefit only a very small number of physicians. People who have jobs and either have to pay out of pocket or retain some sort of healthcare savings account funded by their employer will drastically decrease their utilization when their care is no longer funded by somebody else's money.

GeneralVeers said:
The answer to all this is of course a single-payer system that provides free care to everyone with enormous taxes on the "rich", and that makes us (even moreso) indentured servants to society.
Click to expand...
 
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