That's all fine and I'm glad it worked out for you but the elevated costs are, in fact, to offset the inability of the uninsured to pay combined with the hospital's obligation to treat the uninsured. Insurance companies do not have the luxury of being able to bargain for lower fees so they pass that on in the form of higher premiums to those who are responsible enough to carry insurance. Your bargaining combined with others who pay even less, or nothing at all, results in higher premiums for those who do carry insurance. Those higher costs are also what prevents many people from seeking care because they simply can't afford even a negotiated price. Those same higher costs are part of the reason insurers put lifetime caps on care and drop people or refuse to insure them for preexisting conditions. The requirement to carry insurance is to create an economy of scale such that the costs are spread to a greater number of people not unlike the auto insurance system which ultimately lowers costs. I'm my view if you don't want to carry health insurance you should then be required to demonstrate financial responsibility just like with a car. Whether you want to see it or not there is a social cost for your refusal and the costs of an unforeseen surgery or extended treatment out of your control can be far greater than you could ever negotiate even a fraction of.
The notion, as others have mentioned, that services will be less readily available in a socialized system (more myth than reality) pales in comparison to those who die untreated because they can't afford premiums, care, medications or haven't figured out how to work the system as you did. In a country that prides itself on its humanitarian missions, doesn't blink at spending billions to kill tens if not hundreds of thousands of Iraqi civilians or fight useless, unwinable wars, it's a disgrace.
David Love
www.davidlovepianos.com
-----Original Message-----
From: Susan Kline <skline at peak.org>
Sender: pianotech-bounces at ptg.org
Date: Tue, 02 Nov 2010 18:45:38
To: <pianotech at ptg.org>
Reply-To: pianotech at ptg.org
Subject: Re: [pianotech] Medical costs (OT!) was:billing dilemma
On 11/2/2010 2:05 PM, David Love wrote:
> Susan:
>
> Just one question. When you negotiated that hospital bill down to 30k
> who paid the part you couldn't pay?
>
>
>
> David Love
> www.davidlovepianos.com
>
David, it was not a matter of someone paying for what I didn't pay. You
need to look at this from their standpoint. They are a nonprofit
hospital, but still they have to use some realism in their billing.
So, they bill an uninsured person. They may have to make a payment plan
by installment, at a rate that the patient can manage, more or less. And
sometimes even that isn't enough. The person has been seriously ill,
remember, and their income may be diminished. And the bills are very
high. So, what the hospital knows will often happen is that someone
starts out, pays installments for awhile, and then either dies or goes
bankrupt. Or they just stop paying, and it all has to be handed to a
collection agency, which of course takes their cut. When the hospital
bills an uninsured ("self-pay") person, they can expect that a lot of
them will never finish paying. So they pad the bill to try to get at
least some of the money before it becomes uncollectable.
I'm really impressed by how my local hospital handled this. It's full of
good and very sympathetic people. They started right in, with huge long
MRI's, a spinal tap, the expensive immunoglobulin treatment, just what I
needed, and no one said a single word about money. About my third day
there, a very pleasant woman came to my room and explored (in a tactful
manner) how I was going to pay for this. I told her exactly what my
financial situation was. After discussing it all for a few minutes, she
told me, "If you are in a position to make a lump-sum payment, you
should wait till the main hospital bill arrives, and then negotiate for
a lower price."
So, that was exactly what I did.
The main bill came several weeks after I got home. I swear they send it
out late so that the patient pays off the individual doctor bills first.
They came a lot sooner! And they showed that all these people are (ahem
....) quite generously paid. The hospital bill (roughly $40,000) was
even higher than I had predicted. I sat there, reading the details ($25
for two tylenol at night from a big bottle, on a little plastic tray??),
for four days, gathering my courage, marshalling my arguments, knowing
that the lady had been right, I needed to negotiate it. It was scary,
but I told myself that the very worst thing I could do was dither till
they sent the whole thing to a collection agency.
I phoned the customer service number. I got a real dear heart on the
other end! She got my customer number, looked at her screen, and said,
"Oh, my, that's SO MUCH! I'm SO SORRY!" She sounded like she really was!
I explained how someone with my condition could expect improvement, but
sometimes elderly people didn't get over it all, and I hoped to be able
to work later on, but there were no guarantees I could, and I had some
savings, but they were also my retirement. She sounded sad, and started
talking about setting up an installment program. And she asked if I had
filled out the financial disclosure form. I thought I hadn't received
it, but I found it later in the pack of *stuff* which had arrived and
was by then a tangled mess in my computer room.
So, I told her, "the lady who visited me at the hospital said that if I
were in a position to make a lump-sum payment, I should negotiate the
price." She gave a gusty sigh of relief, and said, "OH YES! You
SHOULD!!" There was a moment of silence on the phone, while she looked
over the itemized bill on her computer screen. Then she said, somewhat
tentatively, "$30,500?" And I said, "I ACCEPT!" Then she got my credit
union checking account data and a check number, and we set up a date for
them to withdraw the amount. I had to sell some stock first and get the
proceeds into my account.
And that is how I left the realm of fear and debt and uncertainty, and
reentered the calm light of solvency.
I think that gusty sigh of relief was partly for me, that I wouldn't
have to struggle with the bill, and partly for the hospital, since it
meant they could get enough from me to pay their true expenses, with a
very short waiting period, much shorter than if it had had to go through
an insurance company, and with no added office expense negotiating with
an insurer.
Altogether, aside from getting the damned Miller Fisher Syndrome in the
first place, I think I was very lucky how it all turned out.
Susan Kline
> ------------------------------------------------------------------------
> *From: * Susan Kline <skline at peak.org>
> *Sender: * pianotech-bounces at ptg.org
> *Date: *Tue, 02 Nov 2010 13:36:35 -0700
> *To: *<pianotech at ptg.org>
> *ReplyTo: * pianotech at ptg.org
> *Subject: *Re: [pianotech] Medical costs (OT!) was:billing dilemma
>
> Will, you bring up one of the fatal errors in how conventional health
> insurance worked before the health care bill passed (flawed as it is
> by corporate pressures from all sides).
>
> An insurance pool, to work right, has to have the largest possible
> number of people in it. It should be affordable enough that many
> people pay in, but the catastrophes happen to only a few of them, so
> the system stays in the black. Insuring for a routine and expected
> expense is madness, because it balloons the costs to several times
> what they would be if people just paid out of pocket. I remember when
> dental insurance became common. Suddenly the fees for my dental care
> tripled, though I didn't do a single thing to cost the dentist a penny
> more than before.
>
> What we need is not more insurance. We need more health, so that major
> medical costs only happen to a few people, instead of almost all of
> them. Plus we need efficiency, with doctors on salary. They should be
> forbidden to take kickbacks for prescribing drugs, as many now do.
> They should not be paid by the procedure, since this multiplies
> procedures, some of which are dangerous and most of which are
> expensive. They should be protected from needing expensive malpractice
> insurance. Instead of victims getting huge money settlements paid for
> by malpractice insurance, doctors who are truly incompetent should
> have their licenses revoked. There could be a public fund to reimburse
> victims, so that half the proceeds wouldn't line lawyers' pockets.
>
> The "pre-existing condition" cherry picking just dumps huge segments
> of the population to fend for themselves. Often this is absolutely not
> their fault. Many of them work and take reasonable care of themselves
> and have money and are willing to fund their medical coverage, if it
> could be made efficient enough that the premiums weren't an invitation
> to bankruptcy. In the present situation, they can't find a way into
> the system.
>
> What we have now is a hodge-podge of exceptions and ad-hoc ways of
> getting people treated when they are not in the shrinking pool of
> those privileged enough to be insured (through work for major
> companies, extreme wealth, or being young healthy and employed). You
> see the disconnect? Those who most need health care are the very ones
> closed out from obtaining it.
>
> This is why every industrialized country (EVEN BRAZIL!!) has some form
> of universal coverage or a hybrid public-private setup. Adults were in
> charge. They saw that leaving people with no access to routine health
> care led to much higher expenses when they were in the final stages of
> fatal but preventable diseases. It was a lot cheaper and more humane
> just to be sure that everyone could get a certain basic amount of care.
>
> We needed the public option really badly. But people fuming from Fox
> News "entertainment" (read "tissue of lies") brought guns to public
> meetings, screamed at the top of their lungs, and all the rest of it.
> Obama and the Democrats blinked.
>
> Okay, one more point and I'll shut up about politics. I see people
> saying with fervor that they don't want to pay for the health care of
> people who have all sorts of bad habits, eat junk food, smoke, etc.
> Might I point out that they are already paying for it in the present
> system? Anyone can go to an emergency room and they have to be
> treated, though they have to go through the gauntlet of waiting in
> terrible conditions in the major city hospitals crowded with other
> uninsured people. (What are you advocating? Sending someone having a
> heart attack out to die on the sidewalk?) A universal system would
> provide a way that everyone would pay something, means-tested for the
> poorest, so that those people now crowding and stressing the system
> could be treated early in a civilized uncrowded non-emergency setting,
> and they could help pay for their treatment.
>
> On the other hand, people complain that no one should be forced to buy
> insurance. I am one of those who didn't buy insurance for thirty
> years, but if the system had been fair and equitable and efficient, I
> would have rushed to buy in. I don't imagine those who avoid being
> insured also avoid using the hospital when they have a medical crisis.
> If they had paid a little in for years before the crisis, the system
> might have been able to take care of them and still stay in the black.
>
> We heard all these arguments before Medicare was passed. But then last
> year Fox News's campaign to derail the health care bill inspired the
> elderly at town hall meetings to shout that Obama "should keep his
> hands off our Medicare!!" You can't really have it both ways.
>
> Susan Kline
>
>
>
> On 11/2/2010 2:52 AM, William Truitt wrote:
>>
>> You make me ashamed of myself, Terry. You are, of course, correct.
>> Health insurance is for 18 to 24 year old young women with no prior
>> medically disqualifying history (we’ll overlook the medical crime of
>> being born just this once) (not for men in that age group, they get
>> drunk and fall off buildings) and the very wealthy.
>>
>> My prediction is that when the wealthy can’t afford health insurance
>> either, they will become Nazi-Facist-Commie-Socialists too.
>>
>> Will
>>
>> *From:*pianotech-bounces at ptg.org [mailto:pianotech-bounces at ptg.org]
>> *On Behalf Of *Terry Farrell
>> *Sent:* Monday, November 01, 2010 10:58 PM
>> *To:* pianotech at ptg.org
>> *Subject:* Re: [pianotech] Medical costs (OT!) was:billing
>> dilemmawith pitch raises
>>
>> Nice comments Will, but one glaring error:
>>
>> On Nov 1, 2010, at 10:16 PM, William Truitt wrote: "...this is how
>> private health insurance works also. Everybody pays into a pool so
>> that the individuals who need to take from the system can get the
>> care they need when they need it, at least in theory."
>>
>> I would argue against this Will. In universal health insurance,
>> everybody pays into the pool via taxes. In private health insurance
>> only those who are healthy pay into the pool, unless of course, the
>> odd situation arises that the insurance company can't find a way to
>> disqualify someone who has a medical issue........
>>
>> Terry Farrell
>>
>>
>
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