Your money or your life

A story illustrating how messed up our health care system really is, and how much it can cost.

A woman was bitten by a raccoon or a possum while rescuing her dog from the critter. One would think that treating a minor wound and preventing possible rabies would not cost more than say, a thousand dollars or so.

One would think:

Karen Lynch rescued her dogs, Mollie and Maggie, who were being attacked by a possum or a raccoon, and was bit herself. She ended up in ER to get rabies shots, but the bill was a shocker: more than $25,000. John Walker The Fresno Bee

Read more here: Rabies: The shots don’t hurt much, but paying for them might | Fresno Bee
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Why so much?

The emergency department bill for Lynch to get immune globulin shots, a first rabies vaccine and a tetanus shot: $25,509.50. The price of the immune globulin drove up the bill – Lynch got 10 vials of immune globulin, for which the hospital charged $21,324.90.

“I was taken aback,” Lynch said. “I want people to know the cost.”
Lynch had insurance, which had negotiated rates with the hospital. The company knocked $23,089.50 off the hospital bill, and her portion of the total charges came to $2,250.89.

Read more here: Rabies: The shots don’t hurt much, but paying for them might | Fresno Bee
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So, $25 grand is the negotiated down cost.

Emergency room prices are driven up by the costs of running a department around-the-clock, by inadequate government reimbursements, unfunded legislative mandates and the costs of uncompensated care, Saint Agnes spokeswoman Kelley Sanchez said.

Seldom, if ever, does an insured patient pay the full charges, she said. Saint Agnes also does not collect full charges from patients without insurance, she said. Rabies immune globulin, for example, would be discounted by 40 percent, she said.

Read more here: Rabies: The shots don’t hurt much, but paying for them might | Fresno Bee
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There must be a better way.

Wasn't this person covered by Obamacare?

Her sister homeowners policy picked up the medical. Thank God for the private sector.

Dittohead not! said:

A story illustrating how messed up our health care system really is, and how much it can cost.

A woman was bitten by a raccoon or a possum while rescuing her dog from the critter. One would think that treating a minor wound and preventing possible rabies would not cost more than say, a thousand dollars or so.

One would think:



Why so much?



So, $25 grand is the negotiated down cost.



There must be a better way.

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There most certainly is: it's called "single-payer health care". Why? Because as long as the profit motive is part and parcel of our health care system, the health care and health insurance corporations WILL charge whatever the market will bear.

It boils down to the fact that while the profit motive is crucial to a properly-functioning economy - nobody disputes this (not even us liberals, no matter what the conservatives and libertarians claim that we believe) - but there are places in a nation where the profit motive does NOT belong, like schools and law enforcement and prisons, hospitals and the military. Yes, each of these sectors (and other such sectors where the profit motive does not belong) absolutely must deal with business, and must budget their funding appropriately. But to expect them to make a profit on their services - and all these are services for the public good - is to open the door to corruption, as we've seen with the controversies over exorbitantly-priced medications here in America...

...even though they still make a profit on the same doggone medications in single-payer healthcare systems that charge far less for those medications.

Glen Contrarian said:

There most certainly is: it's called "single-payer health care". Why? Because as long as the profit motive is part and parcel of our health care system, the health care and health insurance corporations WILL charge whatever the market will bear.

It boils down to the fact that while the profit motive is crucial to a properly-functioning economy - nobody disputes this (not even us liberals, no matter what the conservatives and libertarians claim that we believe) - but there are places in a nation where the profit motive does NOT belong, like schools and law enforcement and prisons, hospitals and the military. Yes, each of these sectors (and other such sectors where the profit motive does not belong) absolutely must deal with business, and must budget their funding appropriately. But to expect them to make a profit on their services - and all these are services for the public good - is to open the door to corruption, as we've seen with the controversies over exorbitantly-priced medications here in America...

...even though they still make a profit on the same doggone medications in single-payer healthcare systems that charge far less for those medications.

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Single payer isn't going to make anything less expensive. We'll merely be paying for the increases through taxes instead of at the counter.

Lutherf said:

Single payer isn't going to make anything less expensive. We'll merely be paying for the increases through taxes instead of at the counter.

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Really? Then why are medications so much less expensive in third-world nations, too? Do you really think that Big Pharma isn't making a profit there, too? You do realize, don't you, that third-wold democracies are generally too poor to provide ANY taxpayer subsidy for medication for the people.

They most certainly are making a profit in third-world nations...but not nearly as much of a profit as they do off the backs of American workers.

Remember, it's YOUR side, when Medicare Part D was passed under Bush 43, that included the caveat that Medicare was NOT ALLOWED to negotiate lower prices with Big Pharma. The VA could, all other parts of the government that dealt with health care could...but not Medicare. Why? Y'all believe in the profit motive...even while it drives the prices of lifesaving meds out of reach.

Dittohead not! said:

A story illustrating how messed up our health care system really is, and how much it can cost.

Click to expand...

Health care generally isn't set up to work like consumer markets in other sectors. There's a complex interplay between the hospital's charges (generally a large markup over actual cost), negotiated reimbursements from the major insurers serving that hospital's market, and the overall revenue the hospital expects to get from each payer.

The actual price (to the extent a service that everyone pays a different amount for can even be said to actually have a "price") of a given service line is almost irrelevant. What actually matters from the hospital's point of view is that in the aggregate the expected revenue from each payer, paid out at the price each has negotiated for the myriad services provided by the hospital, add up to the revenue the hospital needs to cover its overall costs and hopefully achieve a decent margin.

In other words, much of the financial picture is laid out on a large scale between the hospital and the insurers that reimburse it. From the point of view of any given case, the prices may not seem to make any sense but that's because it's not necessarily designed to make sense on a case-by-case basis, it's designed to make sense in the aggregate.

This is obviously becoming more problematic as we move more toward a consumer market-like approach on the demand side (with people moving into higher deductible plans or insurer experimenting with reference pricing and the like). For the first time, people are starting to actually care about the financial details of their particular case. But the actual amount people pay out of pocket is still such a small fraction of overall revenue that the system isn't likely to be upended soon. (What did the woman in the story actually end up contributing? $2K or so?)

Single payer wouldn't change the underlying logic of the system, it would just simplify it and perhaps insulate the consumer from out-of-pocket costs more (essentially removing the impetus to nudge the system toward a more consumer-oriented pricing model).

This issue here.. and everyone keeps missing it (though greenbeard touches on it) . Its a reflection of how messed up the insurance industries are in their reimbursements models. As he points out.. charges are almost irrelevant because at the end of the day. its what the insurance company reimburses.
Also.. its a tax game as well... since in a C corporate system... the hospital may be able to declare the write offs as a loss.

Single payer doesn't get rid of the issue.. its will simply only give one entity to blame..and might make the system worse.. since costs will not be mediated by multiple insurance companies.