Oh well then. So long as your doctor felt pity and undercharged *your *uninsured self, I guess there’s no problem then. I’m sure all doctors will charge the uninsured less. Every single one.
Problem solved, pack it up. Good night everyone!
Oh wait. Even at less than the medicare rate you could get charged tens of thousands of dollars for a serious medical issue. It’s almost like this whole line of debate is completely meaningless.
This is a bit misleading. I have seen this as well, but the price you get quoted when you have insurance is not what the insurance actually pays. One of two things happen: If you pay no out of pocket except co-pays, then the doctor/dentist/hospital bills the insurance company, and then they pay what they had previously agreed and the rest is written off. If they pay a percentage, or have maximum allowable coverage for certain things (common for the dental coverages I have had) then the insurance will pay part and you are on the hook for the rest. Medical “prices” are pushed up because if they list the price the insurance negotiated, then they will just try to negotiate lower next time.
Jonathan
Wow…why the hate? I was just answering Sam Stone’s inquiry. :rolleyes:
I think his larger point was the preversion of the market rates for medical care. Why don’t you go back and read what he wrote? It’s the post right above mine…
This is correct, but I have an HSA, which means I pay cash. There is no co-pay nor any insurance in the equation.
I wasn’t trying to bring the hate, I retract the snippy. But if you have a HSA, doesn’t that mean you have a High Deductible Health Plan? Doesn’t that get price discounts like normal insurance does? I’m actually asking, I’m not familiar enough with the specifics of a HDHP.
Maybe - my deductible is $10,000 for the total family out of pocket, after that it covers 100%. I haven’t hit that amount yet. It costs me about $200 per month, and I put an additional amount per month into the HSA. I also pay an additional $90 a month into AFLAC-like plans that cover cancer, car accidents and ICU care, which are the things that we decided that are the greatest threat to us.
We started looking into this when our contribution to my husband’s insurance started going up - it was a crappy plan for our money, with no dental or vision (which is what we need the most), and had something like 80/20 payment.
All of our insurance/HSA/AFLAC costs still totalled less than what my husband’s company took out of his paycheck every month for Anthem coverage. And they just jacked the monthly paycheck deduction by $200 per month for each employee.
There are several reasons why a doctor might charge less to uninsured people.
One reason is that the doctor’s office saves a ton of paperwork if they don’t have to file an insurance claim. So some of that savings gets passed on to the consumer. Nothing wrong with that.
The other reason is that the doctor is practicing price discrimination - He’s charging what the market will bear, and the insurance market, with its distant oversight and inflated fee schedules, will pay more than the individual in front of him who looks like a potentially bad credit risk and who can’t afford to pay the rates insurance companies pay.
The last one is really a form of fraud. The insurance companies are told a treatment costs X, but in fact what’s happening is that insurance companies are being charged inflated prices to subsidize the uninsured who can’t afford the real price. In the most extreme cases, the doctor may actually be building a clientele in competition against other doctors by intentionally under-charging them and offloading the cost onto other people’s insurance plans.
The simple fact is that third party payments are inefficient. To paraphrase Milton Friedman, there are four types of financial transactions:
In the first case, you have an incentive to get maximum value for your dollar. In the second case, you want to spend as little as possible, but you don’t care as much about the quality of the goods or services. In the third case, you want maximum quality, but you don’t care as much about how much it costs. In the fourth case, you don’t care as much about how it costs OR how good the service or product is.
Government transactions fall into the fourth category. Bureaucrats spending taxpayer’s money for the benefit of someone else. Private insurers fit in the second category - they are spending their money for your services. They have an incentive to cut costs, even if it means cutting your benefits. But as that system becomes more regulated, it begins to look more and more like #4.
This is really at the heart of the inefficiency of health care. The incentives are screwed up. Doctors have little incentive to control cost, because their customers aren’t paying the cost. Customers have little incentive to control the amount of services they get, because someone else is paying. Insurers have an incentive to cut services. Government has little incentive to control cost OR provide quality service, other than through the indirect route of voter dissatisfaction. But in the U.S. system, the people who have most political control over local services are at the least amount of risk for not controlling costs.
At every step in the process, incentives are messed up. So the government’s only possible course of action is to replace incentives with regulations and bureaucracy. So you get government bloat, market distortions, inefficiency, and eventually the miserable system collapses. Britain’s NHS is in crisis. Medicare is in crisis. Medicaid is in crisis. Canada’s health care system goes from crisis to crisis and is now being reformed and to some extent privatized to avoid the worst defects of the government-run system.
IIRC, you are a Canadian. How come all I hear from the Canadians in the media is how WONDERFUL your system is? And here you are telling me that it is in crisis mode?
In 1996, I was sitting in a bar in Ontario. This was right after the Clinton Health Care failure. The locals were telling me how we had just dodged a bullet. That when Canada’s system was first introduced, everything was 100% no extra charge and everything was covered. Then, slowly, some things weren’t covered and surcharges started popping up for this and that. All the while the huge tax increase enacted to pay for it was still in place and higher than ever.
Now, these were just drunks in a bar, but is there any truth to that?
More likely, he’s haggling. An insurer, by controlling many accounts, can delay payment unless the doctor knocks off some of the bill. Private health insurers know how to haggle, & do not pay the asking price. Any individual should know the same.
As to the OP, I agree that health insurance is a distraction. I favor public hospitals on a British model (which is a different approach to “insurance”) but if prices are going up, it may be for simple supply-demand reasons. Call your Congressman & demand that the government increase the supply by subsidizing more med schools, nursing schools, & plain old hospital beds. Then competition may bring prices down, even if (as seems likely) UHC does not come to pass.
(And if UHC does come to pass, we’ll find we need them anyway.)
Add to that the screwy nature of the process of becoming a doctor: extraordinary barriers to entry (very high cost training, very limited supply of med schools) and a weird extended delay on the return on your investment (residency) mean that doctors don’t start making money until a quarter of the way through their adult life, and at that point they have to make a lot of money just to pay their debt. Doctors aren’t really free to negotiate payment because they have to be able to pay this huge delayed payment.
We also need incentives that encourage R&D., which is also problematic: we want people to come up with medical miracles, but we don’t want them only available to the wealthy.
I agree that the incentives are all screwed up, but I don’t see any really clear way to fix it. But somehow employers need to be removed from the equation–it’s the worst sort of kluge and hinders small business and innovation.
Doesn’t it seem that the healthcare crisis has nothing to do with how we pay for it? People today are surviving things that would have killed them even 40 years ago, and so are undergoing more and more illnesses and treatments. Technology has made this possible, but it costs. Even if you some way get people to avoid unnecessary doctors visits, nobody is getting $100K of treatments on a lark.
Treatment is getting more efficient. At age 45 my father was in the hospital for over a month with a blood clot. At age 88 he was in 2 days with something even more serious, and could get two stents placed without open heart surgery. Here is a chart showing how the average hospital stay had declined sharply over time.
There are two problems here. The first is ensuring that all people have fair access to medical treatment without going bankrupt. Liberals want some sort of UHC or guaranteed coverage, conservatives seem to want this in the same sense that all people have an equal right to sleep under a bridge. So this part is politically driven.
The second part is how to drive down the underlying cost of healthcare given the issues I mentioned above, and lots of others. This involves evidence based medicine, automating records, perhaps reducing the number of tests by a tougher standard for finding malpractice. I’d hope this part won’t be political. If you don’t solve this one, no solution to the first one will be feasible, since you will either have a bankrupt government and/or either bankrupt or dead people.
Thoughts?
jtgain:
I know of no company that forces the employee to use the insurance it offers. It’s a perk they offer to attract good employees, but anyone who wants to work for them without taking that perk is, I’m sure, more than welcome. If someone is bothered by the notion of losing their insurance upon losing their job (though COBRA means that that won’t necessarily happen), they’re welcome to pay out of pocket for a plan that’s all their own.
I can certainly imagine a situation where a company car is one of the perks of employment, and if you get laid off, your means of transportation is denied to you. While I’ve never heard of a company offering company-paid car insurance (without the company offering the car itself) as a perk, if it would offer the company an advantage in attracting workers, I have no doubt companies would start offering that perk as well.
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Employee mandated health care (and most companies insist you get coverage from somewhere, if not from them) is the only mechanism in our society to spread the risk pool wide enough that coverage is affordable.
My company has a flex benefits plan, and if you want to use any of your benefits at all, you have to enroll in at least the low health insurance option. I think you might be able to waive it if you prove you are covered elsewhere, but I’m not sure.
This is pretty standard, I think.
It is possible you get enrolled anyway, but no one forces you to make use of the coverage.
There may be tons of truth to it, yet they STILL pay about 40% less per capita than we do.
We dodged a bullet by jumping in front of a speeding truck.
Don’t forget that employer contributions to health care are not taxed. That means the company would have to pay you 15-45% more in cash to cover insurance, even with out the group discount. Plus, employee provided insurance is the only insurance I know of that has to accept you. A individual plan can refuse to insure you with no repercussions.
Jonathan
The Canadian system is a federal mandate, but it’s administered and financed mainly at the provincial level. So the quality of care varies widely.
In addition, health care spending rides a real roller-coaster. Here in Alberta, we’re in the process of trying to cut health care costs because they have spiraled out of control.
At times, waiting lists in some provinces have gotten so bad they have seriously affected the health of the people. For example, the survival rates of some cancers in Canada are 15% lower than in the U.S., attributed primarily to the length of time it takes to get a diagnosis. On the whole, though, Canada does pretty well in terms of cancer survival.
But those who think that European-style health care will lead to bettter treatment should look at this very scary graph.
The graph shows the five-year survival rate for people diagnosed with prostate cancer. In the United States, it’s in the high 90% range. In the U.K it’s around 70%, and in Denmark it’s under 50%. That’s an astounding difference.
Among all cancers, the U.S. has the Best Survival Rates in the World.
As for other services, Canada has only 6.7 MRI machines per million people. The U.S. has 25.9. We have 12.7 CT scanners, the U.S. has 34.3.
The U.S. performs 435.8 angioplasties per 100,000 people. Canada performs 135.9. Canada performs 73 coronary bypass operations per 100,000 people, and the U.S. performs 84.5.
As a result, the death rate for heart attacks is 37.9 per 100,000 in the U.S., vs 41.5 for Canada.
That’s really the secret of Canada’s lower cost of health care. We provide significantly less service in some major areas. That’s why we have waiting lists.
Rather than commenting on them, here’s a nice chart showing the waiting lists for various procedures in the Canadian provinces. I leave it to you Americans to decide if that would be acceptable to you.
As an example, the average wait for othopedic surgery across Canada, from time of first doctor visit, is 40 weeks. The average wait to see a neurosurgeon after your GP refers you to one is 11 weeks.
Overall, Canadians wait 8.3 weeks to see a specialist after a referral. One of the things you’ll notice is that the big waiting lists are for the things that don’t kill you, but just make your life miserable. Reconstructive surgery, joint replacements, cataract surgery, etc. Those don’t show up in the mortality stats, but they can play havoc with your quality of life. My mother was functionality blind for almost three years while she sat on waiting lists for eye surgery. My grandmother walked with a cane and a limp through her prime retirement years because she couldn’t get a knee replacement. It took her years to get one, and then she died of a stroke a year later. So those key years of retirement where she had planned to travel with my grandfather were lost.
Advocates for public health like to point out that the U.S. spends more money than most countries, yet has a lower overall life expectancy. This is a bad metric, because life expectancy has all kinds of confounding factors - lifestyle, occupation, environment, the things that are used to calculate it (differences in measuring infant mortality, for example).
A key statistic that jumps out of the data is that the U.S. has an obese population. For example, 46.8% of Canada’s population is listed as overweight or obese, compared to 67.3% for the U.S. In fact, the U.S. has the most overweight population in the world.
Obesity is very expensive. It leads to expensive, chronic treatments for everything from joint pain to diabetes to cancer and heart disease. If all else were equal, the U.S.'s population should die sooner than everyone else’s. Yet if you look at the OECD data for life expectancy from age 65 on (which removes infant mortality and accidents from the statistics), the U.S.'s is very close to Canada’s (females: 21.4 for Canada, vs 20.3 for the U.S, Males: 17.4 for the U.S. vs 18.2 for Canada).
In short, the proper measure of the effectiveness of your health care system is not found by overall life expectancy, but by the life expectancy of people once they are in the system. Cancer survival rates, heart surgery, orthopedic surgery, stents and angioplasties to improve quality of life… By that measure, the U.S. suddenly looks very good - the best in the world in many categories, despite having one of the more unhealthy populations.
The UK, by the way, is dreadful. If the NHS-like performance is possible in the U.S., you want to stay far away from it. By UK standards, both Canada and the U.S. are very good.
But the UK does not ban private insurance as you do. So the dreadful public system covers infrastructure, & private medicine can be used for individuals who see themselves poorly served by it.
I could live with that kind of dreadful.
Incorrect. You have to have insurance coupled to a HSA. It’s still insurance, even if it’s different than what health insurance was in the past.
Right, and? The statement as I read it implied that the deduction for cash had been made because my insurance had only picked up a portion. I was pointing out that my insurance had picked up zero…
Check post #26 where I go into my HSA and insurance setup in detail.
