One problem is that medical care is highly regulated and it is very expensive to become a doctor. If you think that local auto repair shops charge too much to replace transmissions and that a mechanic could stay in business charging 70% of what the current garages charge, it’s not terribly hard to open up your own shop that charges 80% of the old going rate and that starts swiping business, leading other garages to lower their prices etc. If you think that hand surgery is too expensive, how are you going to do it for cheaper? You’re looking at years of medical school and $100k just to become barely qualified.
More or less. If the bypass surgery was considered urgent in a life or death manner, they would do it. One problem with the system is that it specifically does not cover preventative care, even if said preventative care would be a lot less expensive. So you get diabetics who can’t afford insulin and go for several months without until they go into glycemic shock and end up in the emergency room and run up a $20k bill there even though regular insulin might not be more than $200 a month. Once the patient gets a life-saving injection of emergency insulin in the ICU, they get set loose with no care until their net trip to the emergency room later that year for another $20k bill. Soon they owe a quarter mil they can never pay and file bankruptcy. The doctors who didn’t get their $20k then have to overcharge other customers to cover their costs and people wonder why healthcare is so expensive.
Just an anecdote: I’ve seen reports of people who had been envenomated by a snake or scorpion. Antivenom is expensive! From several thousand per vial to 10K, and it might take any number of vials to treat depending upon the severity of the bite.
When my sister’s lung collapsed and she needed surgery to prevent it from happening again (I don’t remember the medical details) the hospital was blunt with her (no insurance) in saying:
- Come up with a 10% down payment for the surgery.
- Stiff us on the rest.
So she came to me for the $15k down payment, took the credit hit of stiffing them on the rest, and eventually the hospital took a write down or got reimbursed through some insurance pool or something.
Don’t know what would have been done if she hadn’t been able to come to me for the $15k.
(To contribute anecdote in place of data)
You obviously missed the scene in which Mr. Burns was willing to send Marge a free ham b/c he thought Homer was dead.
It isn’t up to the hospital to determine whose fault it was. If the other driver admits fault or if it is clear on an accident report, send the bill to their insurance company to get your money back. I can’t tell you how often I get patients who have no health or auto insurance and want us to bill the party that was “at fault”. It isn’t that easy. Insurance adjusters aren’t big on approving medical payments for parties that are probably going to end up suing them anyway.
IIRC the Moore film episode was this - the fellow accidentally cut his two fingers off with a circular saw or table saw(?). He put them on ice and took them to the hospital. The cost to reattach one (ring?) was significantly higher than the other, and he could only afford the cost of the operation to re-attach one, not both. The hospital thouhfully gave him the option, something like “attach the ring finger for $10,000 or the pinky for $5,000”.
the problem in the OP is - how badly off do you have to be to “need” a bypass? If you arrive in that condition, and they obviously haven’t seen you there before, they’ll first send you for tests to figure out exactly what the problem is and how serious. Bypass is for relieving angina, according to Wkipedia. This I assume means it is more for relief of ongoing symptoms, rather than something that suddenly happens?
Since 1986 most hospitals in the United States have been required by the Emergency Medical Treatment and Active Labor Act to evaluate and stabilize emergent patients.
If a patient’s condition is serious but not emergent and he is not insured (or is under-insured) then he may end up spending down his assets before he can qualify for his home state’s Medicaid plan. He can retain certain assets (usually including a home, car, and possibly some retirement accounts), but each state sets its own rules.
That is basically what happened to my brother. He spent down his modest assets but was able to keep his truck and home. His treatment continued with the same doctors. He was not stuck with huge bills.
[political rant]
My brother had really good insurance, Blue Cross Blue Shield. He played by the rules. And he got screwed. And nothing in the current health care reform has changed that would have made this any better.
My brother had osteosarcoma which later metastasized to his lungs and ultimately killed him.
He had been working as an over-the-road truck driver for a small motor carrier when he was diagnosed. After chemo, and later a AK amputation of his leg, there was no way he could continue working.
His insurance transferred to COBRA. He sent checks to his employer every month as required under COBRA. His employer cashed the checks every month. His employer pocketed the money and failed to forward payment to the insurer.
Of course this was a criminal act on the part of his employer, but that was little solace when my brother’s insurance was cancelled for lack of payment in the middle of a round of chemo.
The reform I would like to see but which has not happened would be to remove the former employer from the situation. Allow former employees to engage an individual policy of insurance with the same carrier on a guaranteed issue basis at the same as the COBRA premium. Have the insured pay the insurer directly.
PPACA does not anticipate such a criminal action and the HHS rule specifies, “Loss of coverage does not include failure to pay premiums on a timely basis, including COBRA premiums prior to the expiration of COBRA coverage, or situations allowing for a rescission.”
Perhaps anyone similarly situated could appeal for a special enrollment period based upon “(e)xceptional circumstances, as determined by the Exchange or HHS” I’d rather not be left to the mercy of bureaucrats.
[/political rant]
Wouldn’t your brother have been able to buy a policy on the exchange instead of COBRA if it happened next year? As I understand, pre-existing conditions don’t disqualify you under the ACA?
Something similar happened to me, only with smaller amounts. I cooperated fully with the hospital social worker, applied for (& was denied) Medicaid and some other government programs, then went through all the steps of working out a payment plan. Then the hospital decided they were better off just writing off my balance. Of course they didn’t bother to tell me the last part until I called after never receiving an invoice. :smack:
Coal widows used to get a ham, their husbands delivered to their front porch, and a full two weeks to decide whether or not to move out of company housing or send one of their sons down into the mines.
I think you must exhaust your COBRA before you can get ACA.
However, ACA would have prevented a lot of these other bankruptcies and write-offs.
That is another thing people don’t get (a lot of US citizens don’t get it) is how even with insurance all that does is reduce the risk of running into nightmare red tape or going bankrupt. The majority of people (about 75%) who go bankrupt due to health care costs had insurance when they got sick. I wanted to get some surgery recently but was told by my insurer that the policy I have doesn’t cover it. So I’m SOL unless I want to pay out of pocket.
Its an evil system but in between the mindless nationalistic ideologues and the people who truly run this country who rake in cash hand over fist under the current status quo I don’t see our system changing. All the ACA did was mandate people buy into a failed system, which is not sustainable.
A good moral comparison would be law enforcement. In the US if you need protection from crime you pay nothing, everything is covered. You get as much police, prosecutor and prison protection as you need. If you are a victim of 20 crimes you get the police, prosecutors and prison/parole system 20 times. If you had to pay everything out of pocket that would seem pretty inhumane. If someone broke into your house, burned it down and raped/murdered your wife and on top of that you had to come up with $80,000 in police and prosecutor fees, plus $20,000 a year for the next 20 years to keep the guy in prison or else he would go free we’d consider that inhumane. I assume that is how our health care system seems to other developed nations. Other nation’s systems aren’t perfect but they are consistently better than ours by almost all metrics.
back to the OP: There are high risk pools in some states, he may have gotten onto one. But they are expensive (some are almost $2000 a month for a plan for one person, not including deductible or copays), and many have things like waiting lists or exclusions where you have to wait before something is covered.
Don’t count on them actually performing the treatment indicated in the ER.
Even with insurance.
I went in with severe anemia - hemoglobin low enough to call for transfusion.
Instead of just doing a simple transfusion, they spent an hour running tests to determine if the anemia was acute (their responsibility) or chronic (my problem).
They were almost triumphant in declaring it “chronic” and throwing me out - telling me to see my PCP if I wanted it treated.
Actually, since my insurance would have covered.any costs, they actually threw out a cash-paying customer so they had room for the poor and uninsured. This was an ER in a prosperous neighborhood, so maybe they didn’t get poor people.
But yes, the mid-low income is screwed in this country - if you are too rich for Medicaid and too poor for insurance, your life is of no interest to the medical profession.
Thank you all for your replies, I think I understand a lot better now what happens when a person with (potentially) life-threatening injuries is unable to pay for their emergency care.
This thread is showing signs of degeneration and necrosis, as predicted, and I recommend it be amputated. 
And of course after this happened, when you tell people about this, it’s all "you could have been ready to defend yourself with an arsenal of weapons the moment the guy broke in. It’s your fault for not taking care of yourself better. Your house was a burgular target, I shouldn’t have to pay to protect your poorly secured home. (as in maybe you were fat or a smoker when you got sick, therefore, it’s all your fault…)
Nope. If you have COBRA continuation health coverage, you can keep it or decide to buy a Marketplace insurance plan.
[nitpick]
They also need to provide care in the situation could reasonably be expected to result in organ dysfunction or impairment of bodily function. So if you need treatment to stop permanent liver damage, going blind, etc. they need to treat you.
[/nitpick]