Thank you for the story, Ms. Boylan... I could FEEL the anxiety of getting that bill.
I use a provider that guarantees no out-of-network charges. Also, with Medicare + Supplemental Plan F, I have, so far, been 100% covered.
Everyone should have this 'peace of mind'... and every American can have it with Medicare for All. America COULD have the best healthcare in the world. I simply can't understand why so many Americans are resistant to something that is clearly in their self-interest. Take it from someone on Medicare... this is something that you should all want, for yourself and your kids.
70
Amen, Jennifer.
19
The reason Americans are afraid of Medicare For All is FOX NEWS and CNN and NYT.
29
"Which makes you think."
I overheard this recently, "Damn socialists best not mess with my Social Security and Medicare. They've messed every thing else up." The speaker was was wearing a red maga hat...
“...what we spend on medical treatment — and what the government spends for us — does not have a clear connection to how healthy we are and how long we live.” Ross Douthat 2/12/2014 NYT
Of course not. With medicine and insurance being for-profit endeavors, how anyone expect anything different?
31
Good article but no mention of Bernie Sanders advocacy of Medicare for all although Warren is mentioned. Am I paranoid or is this another symptom of the NYT dislike of Bernie?
25
You almost had a giant bill...but didn’t?
This isn’t a hot take, NYT. There has to be someone better qualified to write whatever this was supposed to be.
29
Lima beans. Yes. Colonoscopies. Absolutely. Jelly Fish. Childhood nightmares. Healthcare. Total necessity. Insurance companies--much like lima beans and colonoscopies.
6
Denial of care is a profitable business.
40
Someone please explain where all the extra Doctor, laboratory, and Hospital capacity to suddenly serve tens of millions more people will come from???
7
Apparently, Americans vote more on feelings than logic: the "feeling" that black people getting healthcare is bad, rather than the "logic" that government run health insurance works.
And Democrats, scared of their own shadow, keep siding with the Insurance Scam, rather than with Americans.
20
Very well put. Thank you.
7
I am from Florida. My Sen. Marco Rubio sponsored the amendment that finally killed Obama Care. I have never forgiven him for that. And never will. It helped make up my mind about who i am going to vote for.
50
And yet Canadians, Citizens from the U.K., when they want the best medical care without delay, they come to the US!If you have an emergency like a triple bypass, just one example,and time is of the essence in one of the above countries and are told to wait in line, what do you do?Hobson's Choice: government run health care may be free, but without the financial incentive, care may turn out to be less than satisfactory, and may even cost you your life. Randy Weingartner, former head of the UFT and an unconditional 0BAMA supporter, urged rank and file to sign up for ACA but teachers, all 25,000 of them rejected her proposal in favor of the "cadillac"plan that had been negotiated. When ACA passed, over 100 businesses in Pelosi's c,d,asked for and received exemptions.If you want to be a parent, adopt a dog from an animal shelter. They will end up costing less and will be more grateful,loyal.
5
The author is wrong to consider The United States a civilized country. It has been obvious for a very, very, very long time that there is little about your country that the rest of the western world considers civilized. You are amazing consumers, some of the best in the world but in all other areas you are so far behind. And the worst part is that so many of you will die rather than admit that a good education for all is important. That good health care for all is important. That homelessness is bad. That corporations paying taxes is good. The list goes on. And Trump and his cronies!!!!
53
Great Article! You said it sister!
9
What procedure cost $145,000?!
6
Insurance companies are increasingly committing yet another type of fraud: reneging on coverage for already-approved procedures.
https://khn.org/news/prior-authorization-revoked-patients-stuck-with-bills-after-insurers-dont-pay-as-promised/
American capitalism’s biggest enemy is American capitalists. Not Sanders or Warren.
24
I have doctor friends who are completely burnt out, not from caring for patients but by insurance company paperwork. Think how much more streamlined this could be. Health insurance as it exists in the US is completely stupid because insurance companies have no incentive to actually do their jobs.
31
RIP OFF is US. Vote Blue, no matter who.
23
We live in a country where the most leftist idea is "people will have healthcare and won't go bankrupt".
America abandoned any moral high ground long ago in favor of a few dollars for the .0000000001%
23
At least the USA is a better place to live than Honduras.
6
Just don’t pay!
7
Vote Bernie or Warren and end this crazy healthcare system of ours!
14
When everyday Americans, who have health insurance, are begging for money on Go Fund Me to help cover health expenses, we have a problem.
37
I know I'm a terrible cynic, but I really believe many Americans reject the idea of "socialized medicine" because they resent the fact that "not real Americans" (the tired, the poor, the huddled masses, the wretched refuse, the tempest-tost) will be entitled to the same lamp-lit golden benefit as they are.
31
Yet again, the rest of the western world shakes its collective head at Americans' rejection of universal health care.
28
All people have a right to receive medical treatment, provided they contributed to our society to the best of their ability.
If you are able bodied,drop out of school, live on your parents or partners earnings or welfare and never or hardly ever work a day in your life, do we owe you anything? Maybe we do, but certainly not the same as we owe to hardworking people. Medicare for all would give you the same.
It is the lack of incentives, that made Communism fail
8
Oh, our insurance companies ARE filled with terror by the prospect of losing us. That's why they lobby so ferociously to keep the status quo.
14
My family is currently fighting against these ridiculous surprise bills that adds up to about $35,000 from the delivery of our first son and his treatment at birth. Here, the amount doesn’t matter at all. I would call any bill, regardless of the amount, a surprise bill if it’s something that I did not expect to receive.
The fact of the matter is, the insurance and healthcare industry in US is beyond absurd. As an immigrant who benefitted from the single-payer coverage provided by the government, US healthcare system is intentionally designed to rig its citizens, and the politicians are the enablers.
I’m currently paying almost $1,000 a month (my company pays $3,000 more) for my family and i still have to find out the network?the coverage?co-pay of $25/$40/$75 every visit?maximum out of pocket amount??co-insurance?
$1,000 is something that a whole family pays annually for health insurance. And here, i pay ridiculous amount of monthly premium, find in-network providers, deal with bills that are not being take care of in timely manner by my insurance, have to fight and negotiate for settlement.
WHAT A JOKE...
Politicians argue that choices are good thing when it comes to an insurance. Well, only if we can choose to get diseases/illnesses covered by providers within my network who can explain the cost and benefit of getting treatments. Great...I have choices.....
Blame your ignorance, not the system. The system is just doing its job at the finest: max profit, min coverage.
26
This to me is one of our top two biggest issues. What else is there if you don't have your health? And why should your health be tied to having a job? Everyone who claims to be so happy with their insurance could have it taken away in a second, if they lose their job or change jobs. Doctors won't even talk to you unless you provide your insurance information. What a sick, cold society America has become. Meanwhile, insurance companies and Big Pharma get rich from our misfortunes. I don't think that's making America great.
25
An American friend living in Germany not only got life-saving care for over a year but was treated within three days of his diagnosis. His siblings couldn't believe the speed and quality of the care he got for no direct payment whatsoever. But it didn't stop them all from voting Republican.
38
Amen, sister.
Trump supporters (like me) would probably benefit most from national health care. What's our problem?
5
I don't understand how my fellow Americans tolerate this broker system. Here in Germany workers pay a 7.9% tax on earnings. For that you get no annual deductible, no lifetime limit, no existing condition refusal, no co-pays for office visits, specialists, outpatient and a modest co-pay of 5 Euros for meds. For hospital stays there's a token 5 Euro daily charge.
Why aren't you people on the streets with pitchforks and torches?
67
How will underfunded medicare for all solve your issue? We have single payer right now for Indian's. It's a national disgrace. A monopoly on either side of the equation isn't an answer. We need more competition, including a public option, not less.
3
The four pillars of rural health care:
1) Transparent, universal, cost-effective, risk adjusted (John Wasson's HYH - How's Your Health) Direct Primary Care with no middlemen between the primary care doctor and patient + catastrophic "wrap around" health insurance via a MUTUAL insurance company + progressively subsidized Health Savings Accounts (HSA's) that begin on conception, are tax free in and tax free out + incentives for fitness & wellness + HSA Bank that supports safe investments
2) Continuity of Care from conception to inpatient stay & to signing of death certificate. TEAM support of the Biopsychosocial model of interaction, intervention and outcome improvement over time with the TEAM derived from the counties of care e.g.: Psychiatric Social Workers, Midwives, Physical & Occupational Therapists, Community Pharmacists, Tele-Self-Care Nurses, Comparative Effectiveness Study & Continuity of Care Facilitators, Mesh-networking & AI-programming Specialists, PCPs, Clinical Medical Assistants, Community Health Workers, Caregivers, Nutritionists....
3) Integration of Healthcare with Energy Production & Distribution, Agriculture, Climate Stress Control, Transportation, Manufacturing, Housing, Education, Infrastructure....
4) Community-centered Entrepreneurship with purposeful targeting such as the continuous improvement of pregnancy outcomes defined by miscarriage, premature birth, infant mortality, maternal morbidity / mortality, ASD birth....rates, disparity in outcomes.
3
The root of the problem is that we don't see the value in other people. We still think we're living in the Wild West, where life is one big free-for-all, and it's kill or be killed.
As we can see through the lens of US "healthcare", this sort of rugged individualism mentality is literally killing us.
18
"I have no idea how these bills will fare in the Republican-controlled Senate......"
I have a very good idea, unfortunately.
9
All I have to say to you is, MEDICARE FOR ALL. Enough already!
16
The health insurance industry is a parasite. One theory of the Rod of Asclepius, which symbolizes medicine (conflated with the Cauceus of Hermes), is that the snake wrapped around the staff represents a guinea worm wound around a stick - the means of extracting the 2-4 foot long worm from a patient's body. We need to carefully extract the gouging, care-denying health insurance parasite from the American citizenry by binding it to firm laws, and then destroy it.
15
This is so awful, and I totally believe that "...doctors had assured us that the total cost would nevertheless require nothing but a modest co-payment." It sounds stupid but they absolutely do that. I'm pretty sure I was almost a victim of this same circus but luckily my procedure was voluntary so I opted out. The hospital gave an estimate for a doctor to perform an endoscopy, but would not provide an estimate for anything else involved (anesthesiologist, room price, knowing them probably the cost of tissues in the room). Based on these horror stories I was sure they'd drop in other specialists who were out of network. They tried pressuring me into sign the admit papers and when I called their bluff that a "financial specialist" was available to talk if needed, I ended up waiting over an hour for them to also have no clue. Enough is enough. They're all complicit here.
8
"It would be nice just once if our insurance companies were filled with terror by the prospect of losing us."
They probably are. That's why they redirect some of the money they steal from you and me to Mitch McConnell, who tries to ensure that all health reform measures die in the Senate.
It's a nice racket, this "legal" method of using consumers' money against them.
13
Spent 3 hours in observation in the ER following a concussion. The bill? $104,000!! Privatized medicine isn't working.
23
Everyone who wants to understand why healthcare seems like it is rigged for the Doctors, Drug Companies, Hospitals, and Health Insurance Plans should read “The Price We Pat” by Marty Makary, MD. This is one of the clearest and easy to understand descriptions of what happens when you put profits ahead of people.
6
This piece is quite inadequate. It does not tell us what was the monetary division of the inflated invoice in the end.
3
You need to ask yourself was the service provided worth the amount of the bill? Most likely it was. If so why should someone else pay it for you. At least you got the service regardless of whether or not you could pay.
As long as we allow our politicians to be bought off, we will be victims.
7
Don’t our Congressmen and women have free premium healthcare for themselves and their families. Their callousness, especially Republicans, is truly startling. Make them pay like the rest of us, a taste of their own medicine.
8
The stories continue to pour forth (even while politicians indulge in the fantasy That Americans “like” their health insurance companies) and yet nothing will change in this backward, hypocritical, deluded, unequal, embarrassing country until we REALLY drain the swamp and put the radicals who believe that health care is a right in such a rich country!
5
Please.
Did you enter into a contract with said physician? If not, she can only secure - after suing you - the “reasonable value” of her services. Ask for a jury; no MD will take that kind of bill before a panel of people making $45K per annum.
Query why you went to an “out of network” MD?
The solution to this problem is to apply the same standards to (non-emergency) medical care that we apply to auto repair and legal services: written contract, with price precisely laid out.
Incidentally, where is your outrage that just last December, the Democrats voted to repeal the ACA? I missed your column on that.
But they did.
Well, they repealed the taxes which would have (partially) paid for it. They retained the handouts.
What makes you think that Warren is any more likely to actually pay for Medicare for All than she was the ACA, or, indeed, Medicare for Some, which is $40T in the hole? The policies which truly unite the left are identity, envy, and irresponsibility. Here, you extol Medicare's triumphs (not mentioning that the ACA cut it by almost $1T). Paying for it? Pshaw. Responsibility is for Republicans.
If you aver that government does good things, why are leftists so adamant about not paying for them?
3
Every time you touch the healthcare system, you stand a fair chance of being sued into homeless destitution.
EVERY TIME.
5
I was driving in Mexico two years ago about 4 hours from the US Border and began to have chest pains, real bad chest pains. A cab driver led us to the Red Cross EMS station. I was immediately taken in, questioned by a nurse. seen by a doctor, given an EKG and taken back to the doctor. He said not a heart attack. Definitely not a heart attack. Gave me some muscle relaxants, mild pain killers and sent me on my way. The bill, $8 USD. Some people call Mexico an uncivilized country, not me.
15
You said that the $145,000 bill was "fixed". What does that mean? (We don't have that term in Canada)
2
You must be dreaming that the GOP funded by the ultra rich will actually send the bill to Trump and the great man will sign it !
I am not sure where do you get your optimistic views.. when most people are barely surviving the thought of another 4 years of "Trump"
5
With hedge funds in healthcare what hope is there?
3
Your first mistake, not going to your Insurance provider. If a Doctor can not give you a referral to an in-network provider use another Doctor.
My surprise is usually the other way around. Using in-network providers I am amazed at how economical great healthcare can be if you just do your homework. Plus it helps to have Doctors in the family.
My only terror these days is that Bernie if elected will take away coverage from 180,000,000 Americans to replace it with regression to the mean medical care.
3
So, explain to me again why Medicare for All is such a terrible idea.
13
Excellent point about our collective fear of losing health care. Joseph Campbell, the renown antropologist and mythologist, had a great insight that a culture's relationship with spirit is reflected in who owns the tallest building in town. From our early settlers until the great depression, the tallest building was a church - and, the church eased the pain of sickness, disaster, and death. Following the New Deal, the tallest buildings were owned by the government which provided secure jobs and social security. However, since the 1960's the tallest buildings have been owned by insurance companies and one's sense of personal and collective safety is tied to one's health, life, and disability insurances. Are you covered?
17
Just one insurer, Floridablue health insurance, has over twenty different provider networks which have overlapping combinations of doctors and facilities. There is no justification for this complex arrangement other than to trap policyholders into needing to go out of network and sticking them with the bill. Fixing this problem would be easy. Simply make provider networks illegal under federal law. Period.
25
I'm a private practitioner in relatively affluent Connecticut and have always strongly supported Medicare for all. Five years ago 80% of the physicians in the United States were opposed to "Medicare for all' and now 80% are for it. The numbers speak the volume.
38
But they (the medical insurance companies) are terrified of losing us. That's why they bribe our elected representatives to maintain the very profitable status quo.
26
How about $145,000? Seems high. Bet it would be 30% of that in Europe. We need to focus not only on who pays for healthcare, but how much it cost. We're paying in some cases double or triple what they pay overseas, and getting no better results.
6
A dear friend was recently hospitalized for a serious illness requiring her to be transferred from one hospital to another—-a distance of about three miles. The ambulance came, she loaded herself in and ten minutes later, she was in the other hospital. No big deal, right?
Then the bill came—-$8,000 and change. It was insane the amount billed for the distance. No one was on life support or critically injured. It was a simple transfer.
Why so much? No one knew except just because they could. It went off into insurance land and eventually Medicare paid $800. But if she wasn’t protected by Medicare, she would have been stuck with the difference.
This is just one small example of everything that is wrong with the American healthcare system. A bill for $8,000 but $800 will be ok. They must get lucky from time-to-time and get the full $8,000. Go figure.
35
I have formally diagnosed posttraumatic stress disorder. So I speak from experience when I say:
Fearing loss of even an abusive structure... is a sign of having been abused.
I realize many get great treatment from their insured doctors - or even like the benefits their insurance provides. A great many of us haven't.
My own father stopped talking to me the day Obamacare passed. "I'm not paying for YOUR healthcare! If you can't afford it, your problem, not mine." Except that for millions, there's no way to afford it. (And his was fully paid for by a state university, funded by taxpayers, but I digress...)
I see NO reason to punitively deny someone the opportunity to have good health. None. Who are we if that is how we see our fellow citizens?
27
You can thanks Richard Nixon for allowing non-medical professionals to own and run medical practices. They call them HMOs.
Allowing businessmen to profit from illness has destroyed the medical profession. Insurance companies, with banks of phone answerers who are not doctors or nurses, are making most of the medical decisions now, including what tests you get, and what drugs your doctor can prescribe. And there motive is not to make you better. Their motive is to profit off of your illness.
We need universal health care for all. We need to get rid of the insurance companies.
30
We were just in New Zealand where my wife broke her wrist. 100% covered. Came home to Canada and went to the hospital for follow up. 100% covered. While our system isn't perfect, people here in Canada cannot, for the life of us, understand why so many Americans reject a government health plan. For starters, cutting out the insurance companies will save a third of the costs.
49
Wait, your doctors helped protect you from this $145k Bill? You’d better make sure you protect them from a bad Bill, too! Tell Congress that whatever they do should be 1) good for patients 2) fair to doctors. Surprise bills are bad. Bad for patients, bad for doctors. The only party that benefits is the one who is supposed to provide the benefit!
12
Here's a big hug. Nobody should have such an experience, even if it works out in the end.
11
I am afraid it is not so much that people fear losing their current health care which they like, but that they fear someone else will get some care they don't "deserve".
10
I will happily dance on the grave of for-profit health insurance companies. May their executives die impoverished. I'm going on Medicare in two months and I cannot wait. And I have what is regarded as a Cadillac insurance plan by any definition because I have a good union job. At my age, many of my friends and family are already on Medicare. I don't know anyone who dislikes their Medicare. If it's great for seniors, why not everyone else?
36
Might as well add my anecdotes, though there are enough here already. We spent last year in France. Over Christmas vacation, my child tripped one night and split her chin open in an unfamiliar city. A pharmacist patched her up at no charge but said she needed stitches and sent us to the local ER. Laughing gas, stitches, pain medication. We gave them our contact information and, though we did have good travel insurance, still wondered what the bill would be. It was 88 euros — about $100. A similar 5-hour ER visit the previous year in the US was initially billed at about 50 times that.
On another evening in France, the child was sick with a high fever and vomiting. We called the local “SOS” line. At 2 am a cheerful doctor showed up at our house, checked her out, reassured us, and gave us some meds for her. We paid him right there for a visit that the French consider very expensive. Again: 90 euros, or $100. Because the French have figured out that if someone is sick in the middle of the night, maybe they should not be coming into an ER and making everyone else sick too.
Don’t even get me started on the cardiac emergency later suffered by my husband, the ambulance service for which there was no bill, the hospital care across 4 days plus cardiac surgery, for a bill that as foreigners we did eventually see part of (again: international travel insurance is a good idea) but that was many, many, many thousands of dollars less than anything comparable would have been here.
26
The fear the conservatives have, and Reagan had. Was that this 145k bill is going to fall right onto the taxpayer and instead of negotiating, the government will just pay it. Free is never free, and the further we shield ourselves from costs the worse it will get. I can see providing income based catastrophic insurance for the poor, like Jeb Bush had proposed, but the Democrats have fallen far too deep into the pockets of the healthcare industry to be trusted to put together anything that makes healthcare more affordable. The healthcare industry will keep taking from the taxpayer and we'll just keep falling deeper down that hole, that's what Reagan was afraid of.
1
A good chunk of that $145k is, frankly, robbery.
Allowing Medicare to manage payments would result in a more reasonable fee structure.
BTW, the taxpayer is already on the hook for the millions of ER visits a year that are made because people don’t have the insurance to visit a much cheaper primary care clinic.
Going to Medicare for All will immediately save us billions in fraud, surprise billing, and ER visits as primary care.
My concern with Medicare is that once it becomes a line item on the federal budget, it will become a huge target for cuts. And the excellent medical care provided in the US may suffer.
12
Well, it’s unlikely I’ll ever see a bill like that in Canada.
Such bills are largely unknown in the rest of the developed world as well since universal healthcare, in various forms, is normal.
It remains hugely puzzling to citizens of these other countries why Americans worry about the cost of introducing universal care since it appears you already pay double what everyone else does.
19
@Bobby Clobber Americans, on average, are not very bright.
4
I'm reminded the last time voters tried to change our extravagantly expensive and inefficient healthcare system, i.e. by passing the Affordable Care Act. Democrats were able to sneak this through but how many remember what happened next. The Dems were badly beaten in the next election losing control of the House and Senate. This certainly is an omen for what will happen after a Sanders victory in the upcoming election. His planned changes to our medical system are so drastic that they will very likely not gain much traction in his first two years in office. But the blowback they receive in those two years will almost certainly result in huge Democratic losses nationwide spoiling any effective changes in medical care for a long time. Far better would be a well planned and bipartisan (if that's possible) proposal.
2
But aren't you blaming the wrong group here . It was the Hospital and those nice doctors who somehow thought the bill should be 145,000 . The Insurance got the bill from the Hospital and since the Insurance company wasn't in the Hospitals or Doctors network they stuck them with the bill.
I don't think the insurance companies are fighting transparency in health care as much as the hospitals. So why didn't the Hospital tell you up front what it would cost? They should have known but they were hoping the insurance company balked and stuck you with the bill . The Insurance company looked like the bad buy when in reality it was the Hospital and The "kindly" Doctors who jacked up the price. Everyone should pay the same prices what ever is the lowest price everyone pays it.
13
I have "good" healthcare insurance, which between my employer and me costs well into the 5 figures every year. But I have no confidence it will prevent bankruptcy if something major happens. No confidence at all. ( I am financially very stable. No debts. Lots of savings. Won't make a difference. ) I would take Medicare for all and higher taxes to replace it in a heartbeat, just to remove that nagging feeling I am one medical disaster away from ruin.
37
Frankly, I think the purported fear of losing one's private insurance is ginned up nonsense. I'd love to see one of the candidates take an informal poll at a debate or campaign rally, asking everyone who has private insurance whether or not they "love" their insurance company/plan. I have a feeling it would be a real eye opener. Speaking as someone who recently went on Medicare after paying $700 a month for private insurance and having to argue & appeal every single bill, I wouldn't go back for anything. Ask anyone else on Medicare if they'd give it up to go back on private insurance, and you'll get a resounding "NO". Medical insurance companies are like a protection racket: it's expensive, but you can't afford to be without it.
17
This is an all too common situation. It is especially true when you must be seen in the emergency department of an "out of network" hospital although sometimes this expense will be covered by the patient's own insurance.
I know that you can negotiate a reduced fee under several criteria. Making payments is not much of a blessing.
I support the proposed bills you cite in your comment.
6
A few years ago we switched from an ACA exchange plan offered by a large mid Atlantic insurer (nonprofit) to a non-exchange plan offered by my employer, by the same insurer. But the insurer’s IT systems for each plan didn’t talk to each other and we kept getting billed for the ACA plan after trying to cancel it. Instead we were paying the new plan premiums. Then I had to get insulin for my Type 1 diabetic daughter and was denied coverage based on the faulty conclusion of the insurer that I hadn’t paid my premiums. We could not wait b/c without insulin diabetics die pretty quickly, horribly. So I shelled out $800 for a supply. It took me 9 months and two interventions from the Maryland AG to get reimbursed for the company’s incompetence. Plus letters to the insurance CEO. Hours and hours. Not cost effective for anybody.
Single payer, all the way!
But doctors and hospitals and medical device makers hike their prices, as do the greedy pharma companies. Medical professionals also should not assume they deserve to be rich.
24
We have it exactly backwards. Here you're required to pay whatever any doctor decides to charge. In a civilized country a doctor would be required to accept whatever a patient's plan offered to pay.
We live in a dystopian nightmare.
But, hey, that red hat looks really cool!
27
First, it's clear that consistent communication is critical, to counteract the noise from Republicans. This article and most of the comments are great stories and examples of why universal healthcare in many countries is better than what we have in the U.S., even if we have "good" private insurance through our employers.
And yes, it helps to point out that Medicare is strongly supported by seniors and that's exactly what "socialized" medicine looks like.
But I think the real fear people have is the tumult of moving from our current system to a single payer system. If you think through the logistics, it's daunting. And doctors, including those who are strong Democrats, will in many cases begin to freak out when they realize the potential implications for their income. It's SO MUCH EASIER to talk about and support a move to a "Medicare for all who want it" type approach, and if that proves to people that the cost/benefit tradeoff of a government plan is superior to private insurance, you will see a clear shift to a centralized model like Medicare.
Finally, and this is critical, people need to realize that "socialized" countries like the UK, Central Europe, Scandanavia, Canada...these are all capitalist countries, simply with greater socialization of a few items like medical care and (to a large extent) college education.
14
Honestly, this is ridiculous. How can hospitals, insurers and doctors not tell patients how much treatment will cost. especially if it is elective? I can't see any reasonable justification for this to be a norm.
We live in Sydney and my daughter needed her tonsils out. We went private. Our surgeon provided a quote with all of the items listed. I called my insurer and they told me how much of the cost they would cover and the hospital stay was covered under our insurance. BAM! Within about a 10 minute period and 1 phone call I knew exactly how much we would be paying. My insurer actually even advised that our particular doctor was quite high in the rates she charged and suggested some other......
Mind you if we had gone through the public system, using the same doctor, it would have been completely free. We just wanted the convenience of choosing the date so it coincided with school holidays.
14
I believe that a single payer system would be best but I think there should still be some system of co-payments and premiums. People do not value what is free at least not here. Even $5.00 a visit or prescription makes a difference. Those who think I’m hard hearted should meet my patients who continue to pay $50 per week for cigarettes and other garbage. If they can afford that, they can afford a modest co-pay.
17
There’s always a co-pay of some sort in universally covered insurance.
5
There’s no co-pay for Medicaid patients.
1
Uh - no.
In Australia, after paying your regular Medicare levy of 2 to 3.5% of your taxable income per annum, all and every hospital visit, doctor's visit, and surgery (excepting dental caries - yeah, we're not as clever as we think) is for free. No bill-shock, no bankruptcies, no stressors other than the actual ones pertaining to the health issue at hand.
If you don't pay income tax, it's all for free - children, significantly disabled, over 65s.
We're still here, and as free as ever.
20
In my thirty years of travel throughout the states I was never once able to convince the Americans among us the Canadian system was a better model, maybe no a superior system, but why would it be when we are a smaller population than California. The point however is quality healthcare for all, and free. Yes we pay more in taxes than you, but ironically if you add your healthcare premiums and co-pays to your taxes, we pay less and get more. It’s just a different model doing the same thing with a near identical demographic. My son in law is six months into a two year leukaemia treatment that has already included chemotherapy, radiation, a bone marrow transplant, and 100 days of hospital isolation in a privately filtrated room. Not a penny has been charged. The federal government even pays a disability income expressed as a percentage of his income without any holding charges or taxes applied. It pays his mortgage. He won’t lose his house. When he completes his treatment, he gets to step back into the life he left, not wiped out, broken, and bankrupt. Yours is the only G8 country that doesn’t provide universal coverage, doesn’t that alone make you at least challenge the thought it might be feasible? In Canada at least the DMV is scarier than the hospital.
25
This reminds me of what happened when I had a minor outpatient surgical procedure several years ago. It was scheduled in advance, everything (allegedly) in-network. I asked the surgeon ahead of time how much he thought it'd cost. His response: "I have no idea. Would you please let you know when you find out?"
And of course I got hit with a $1,000 bill for the anesthesiologist who was (surprise!) out-of-network.
9
Healthcare is not a business, physicians and nurses are not providers and patients are not clients or consumers.
Still, these definitions are part of the everyday discussion in clinics,hodpitals and other places where people's physical and mental health are evaluated thanks to the persistent push from insurance companies and healthcare administrations full of MBAs, marketing specialists, and greed.
Americans don't think about the common good, if my company provides me with good insurance, why should I care about my neighbor without insurance, declaring bankruptcy due to a neglected health condition? Sorry for his bad luck.
Medicare for all is doable, in incremental steps. ACA was a good beginning.
The biggest obstacle remain the "health" insurance companies with deep pockets capable of buying many politicians, and in these times probably all of the GOP.
15
Regarding Medicare for All, I have yet to see a specific proposal that addresses the fact that Medicare covers 80%. Jennifer’s daughter’s surgery would have cost the family around $29,000. That may be more manageable for them, but it would still be out of reach for many. Would MFA cover 100%? If not, wouldn’t that require insurance companies to exist to offer Medigap insurance?
And specifically, who is going to pay? At this Medicare recipients pay for coverage.
6
@Lawyermom
"I have yet to see a specific proposal that addresses the fact that Medicare covers 80%. Jennifer’s daughter’s surgery would have cost the family around $29,000."
No. Your 20 percent Medicare co-pay isn't based on the exorbitant billed amount. It's based on what Medicare actually pays for the procedure. There's an enormous difference. It varies of course, but Medicare might actually pay something like $15-20,000 for a procedure billed out at $100,000.
6
In your article you ask why Republicans are so opposed to Obamacare. There are a variety of reasons, but I will focus on just a few. Chief among them is Obamacare's primary focus was on increasing the number of insured. This would naturally increase the demand for healthcare, however Obamacare focused very little on increasing the supply of healthcare. If you go back to your econ 101 class what happens when you increase demand faster than supply? You get price/cost increases.
Instead we should be focusing on increasing healthcare supply faster than demand, and then implementing regulatory reforms to ensure real competition. Reforms such as mandated pricing transparency. All prices should be required to be posted online. And all bills should be required to be all inclusive, not 10 different bills from one trip to the hospital. Let the hospital bill, you, and then pay all the other providers.
If you increase supply faster than demand, and have competition, then price/costs will decrease. Thus making healthcare more affordable, not just for an individual, but for the nation as a whole.
3
Matthew. OK. Supply and demand. Everyone of us is demand. Obama care was addressing supply. Not as well as it could have. If all demand pieces have funds, supply will follow. What you are arguing is non emotional, like a commodity. I love this colloquialism: Follow the Golden Rule. Those who have the gold, makes the rules. So those citizens without gold are ruled disposable.
4
Recently had a procedure involving hours long operating room surgery, multiple doctors and an army of nurses and techs, a 12 hour outpatient day in all, at one of the best provider systems in the Pacific Northwest.
My total Medicare Advantage out-of-pocket was just over $300. Next month I will have a free colonoscopy, which I have previously paid up to $2,500 out of pocket, even though I had insurance.
We have had employer insurance, independent insurance before and after the ACA and now Medicare. I would have signed up for Medicare 40 years ago if I could have.
I understand people want a choice but to me, the choice is an easy one.
15
There is no real "health care" in America. It is sickness care. American pay thousands of dollars per year for an insurance policy "just in case". They continue to smoke, drink coke, work two jobs, and other forced "choices" which lead to illness. Exposure to pollutants increases cancer risk, we know that from 911. Global warming may effect disease transmission rates, increasing the population of pests such as mosquitos, ticks and mice. Emotional stress and emotional health problems are epidemic, but try getting an insurer to pay for weekly psychotherapy, a proven remedy. Is anyone paying attention? The health insurance industry depends of sickness. So does the "health care" profession. Laws favoring insurers are sacred, and any measure to prevent illness, such as public health, is subject to "cost saving budget cuts". Medicare for all is not the only solution. There is a robust system of public health in Great Britain, and other nations, like the Netherlands. There are plentiful measures to keep the population healthy, including quality nutrition, time off for family needs, and other health promoting measures. Legislation can protect families from untoward bills. Shame on legislators, especially Senators like Mitch McConnell, for threatening any form of protection from these zombie hospital bills. Shame on legislators for not taking time to understand the true meaning of "health care".
10
Believe it or not, your Congressional representatives can (and should) help you out with the sort of insurance crises cited here. Our rep, the wonderful Jahana Hayes, has a "caseworker on every corner" program where her staff hosts meetings in various parts of her district to help constituents. Somehow "This is the office of Congresswoman Jahana Hayes" sounds a bit more intimidating than one's personal call.
Of course, she is a Democrat, so I wouldn't have expected less.
9
There is a basic idea that Americans have to understand. Healthcare should not be a for profit business, It is a human right. Everyone should be covered and have supplementary insurance if they want it for extras like private rooms or procedures not covered by the government plan. There is no reason that the US spends multiples of what every other industrialized country spends on healthcare with dismal outcomes like its rate of maternal mortality. Yes, if you have lots of money, your care is great. But for those not in the top few percent, it isn't and your insurance company is looking for reasons not to cover what you need. Greed rules. You would pay much less in taxes to pay for a siingle payer system than you are paying now in insurance premiums for coverage that is iffy at best. The same applies to the prices paid for prescription drugs. As a senior with type 2 diabetes, my insulin is free of charge to me rather than costing thousands monthly.
This is not creeping socialism. It is reality everywhere except the US among industrialized countries.
19
USA spend 18% of GDP in Health. Switzerland 12% of the GDP. I do not know anything about the state sponsored health system in Switzerland but I bet you is not bad.
Could you imagine what this country could dot with this 6% of the GDP.....
Our system is expensive unfair and not good for the economy of the country.
The best thing about this article is that has evoked 870 comments.
9
British Columbian here. Our plan does not cover everything. Dental..very limited coverage for people who are on certain categories of social welfare and some for children...limited. Prescriptions...in BC basically some categories of welfare and low income seniors. There is some coverage for everyone for catastrophic illness. However not every medication is covered. For some medications in BC the doctor has to apply for the patient for coverage for some drugs. Some specialist prescriptions are exempt from this. In hospital physiotherapy with limits may be covered post operation for joint replacement. Long term care is connected to one's income.
The Federal NDP...4th party in Parliament..wants pharmacare for all. BC used to cover everything but through the years, coverage was cut back to basic drugs for low income seniors. This was no doubt due to expensive new medications such as biologics.
2
1. Had an endoscopy. The pre-approved anesthesiologist’s bill was rejected by my insurance (Blue X Blue Shield.) $1400. The anesthesiologist poked me for 45 minutes in unsuccessful attempts to find a vein, while I cried in pain. Eventually she gave up and sent a nurse in, but the bill came from her. I attempted to negotiate: let me pay you what Blue X would have paid plus my co-pay plus a bit more just to settle this, but they refused.
2. ER visit. Hospital took my insurance but the dr who saw me for 2 minutes did not. $550. Couldn’t pick this person out in a lineup. No clue what he did for me. Again, tried to re-submit and negotiate to no avail.
I will go to my grave with these 2 bills being my only unpaid debts of my life.
We need single payer. Not lame, ‘moderate,’ ‘centrist’ half-attempts at kicking this can down the road. Those of us who do not have government insurance or tons of money, which all of our politicians and/or candidates do (or tv pundits), are getting clobbered by the current system. Stop being surprised by the intensity of Bernie Sanders’ supporters. We really, really need help and no one else is listening.
22
Conservative opinion leaders keep insisting that any “health care for all” reform would wipe out the insurance industry.
Given that said industry appears devoted to making sure that insured people get as little actual coverage as possible, wouldn’t its disappearance be a blessing for ... well, for the very same patients the health care industry is supposed to serve?
Is this point being made during the debates?
14
I completely agree that we need universal healthcare. However, I truly believe the insurance companies have gotten a bad rap in all of this (not that they’re angels). Unfortunately years ago they paid whatever doctors and hospitals billed them so medical costs skyrocketed. Now that they’re trying to do what they should have done years ago, control costs, they are blamed for the mess. But the real problem is the consolidation of doctors and hospitals. In my state I can’t own an auto body shop because I am an insurance agent as it is a conflict of interest. So how is it not a conflict of interest when doctors own labs or other medical facilities? It’s all one huge money grab.
8
"I admit I have never quite understood the hatred Reagan had for Medicare, nor the hatred today’s Republicans have for Obamacare". It is quite simple really, Republican get campaign contributions from the medical industry including insurance companies. The Republicans have come to be about protecting the wealthy and business interests, they could care less about the nations health. Reagan feigned worry about being free while the rest of us worried about dying or serious injury or debilitating health issues. At 70 I am on Medicare, is it perfect, well no but it beats what else is available. Try it you'll like it.
12
My out-of-network story isn't nearly as dramatic. I scheduled a colonoscopy at an in-network facility using an in-network gastroenterologist. Color me shocked when I got a bill for several thousand dollars (ballpark...) for the anesthesiologist.
When I called, surprise: out-of-network. I immediately called the gastroenterologist's office and told them it was their responsibility. It's unreasonable to expect to make specific arrangements with someone few ever think about; it's the responsibility of whoever ordered the specialist to assist to make sure the specialist was in-network or had been previously cleared by the patient.
I never saw any follow up, suggesting someone ate the bill. BTW, I also made clear my willingness to pay my insurance company's negotiated rate. I think the hassle factor got this one buried.
But I now know that under the worst healthcare system in the OECD it's my responsibility to vet anyone who may walk into any future procedures.
What a mess.
7
While explaining that the giant out of network surprise medical bill was despite assurances by the doctors that the bill would not be exorbitant, despite the fact that the bills came from DOCTORS, somehow, the blame rests with the insurance companies. It's the DOCTORS!
5
Four years ago I had a accute Aortic Anurysm, we quit adding the cost when we went passed a half million.The majority was covered by insurance. My biggest bill was the helicopter ride. 13,000 for 12 miles, I got that down to 1300 over a time pay
3
I just got a $surprise 2000 medical bill and I have a good insurance policy. And this was from $16000 in charges for spending about 18 hours in the hospital with no specialized tests beyond xrays and an ekg. Similarly I got hit with $8000 in charges for spending less than 3 hours in the hospital recently for something else (fortunately I only had to pay $200 of that).
Something needs to change.
I can no longer support any candidate who does NOT support a major overhaul of the US medical system. And strict price controls NEED to be a part of it.
15
I am ridiculously needle phobic. I try to fight it but it gets the best of me. I was having my pre-op at the hospital and I mentioned I feared needles. I got dizzy at the blood test and put my head down to avoid fainting.
The technician said, "I'll get some men to help you." I thought that meant they'd take me to a quiet place to lay down a minute. Instead, they wheeled me to the emergency room. I kept telling them I was only nervous. After I lay in the emergency room for awhile, they told me I almost fainted because I was nervous, the same thing I told them!
The bill for telling me what I already knew? 4,000 dollars.
10
@Linda Thats insane
2
The choice is NOT between Medicare for All and full-on unlimited surprise billing. We need some steps right now, including ban on surprise billing and drug price controls, so our prices are on par with Canada's.
These are simple things that can be done RIGHT NOW without getting into the Medicare debate, which incites strong feelings on all sides.
6
Maybe we need to move past strong feelings and talk instead about actual facts about Medicare.
8
The highly-educated author didn't call her insurance company? Did I perhaps misread that?
Physicians know almost nothing about insurance coverage. (Trust me, I'm married to one.) What I do know is to always verify my coverage with my carrier directly and to get that in writing.
I had to have a very serious operation last month, and I went out of state to the very best hospital in the world for my condition. Although the hospital told me I was covered, I nevertheless verified with my wonderful non-profit insurance company it was (shockingly!) in network. Twenty minutes; one phone call. Easy peasy. We also did this when my wife needed surgery last fall and when my grandson needed treatment for a serious cancer battle five years ago.
The hospital bills - which are several times that of the author's -- have come in, and because I verified coverage in advance and in writing, I'm paying nothing beyond my crazy high premiums and deductibles. Admittedly, my wife and I are both self-employed, so we can choose our insurer and our good (though neither as good nor as cheap as it was a decade ago) insurance plan.
I learned and know how to use my insurance effectively. And if *I* can learn it, anyone can. You don't need a doctorate, a Phi Beta Kappa key, or tenure at a top university to do so. Leave my private insurance alone.
8
She did get the procedure pre-approved. Did you miss the part about insurance companies turning down bills they’ve pre-approved. No other transaction in American life is stacked in the hope that the consumer will give up trying to get what was agreed to. Insurance makes us fight every step of the way. Not easy when you have jobs to work and kids to raise.
18
Where did the *author* get a written approval?
She writes, “We’d consulted with the provider, who, indeed, was out of network, but our doctors had assured us that the total cost would nevertheless require nothing but a modest co-payment.” Mistake number one: don’t let the out of network provider assure you everything’s okay.
And she then relies on a hearsay statement from a doctor about a very typical billing dispute between providers and carriers. Mistake number two: never rely on a physician to be informed about the insurance system. Large bills are almost always questions because of a coding question, so a first pass rejection is all but de rigueur.
Moral: always verify coverage personally. Never rely on a doctor or a hospital seeking RVUs and money. And always get the verification(s) — I have several in my file — in writing from the insurer and the hospital.
3
People don’t always get that choice. Glad you’re so smart and have your situation handled. Good for you.
However some of us have life threatening 911-type issues where there is no time for pre-approvals and other steps to avoid surprises. It’s getting to life saving care in the closest spot.
911 Ambulance rides where we live are NOT covered by any insurance. County government based. You get a bill whereby sometimes you can plead your case and reduce the cost. Sometimes not.
Timing for critical testing - tricky to make sure you get it with your covered facility takes many phone calls between your insurance company, doctors staff, and schedulers. This can mean 1000’s of dollars. Also it requires a lot of effort on the part of the patient.
Insurance companies, hospitals, freestanding ERs and urgent care places are coining it. Pharmaceutical companies are coining it.
One insurance company here was stopped by the state from restricting access to ERs which they tried to do, but they still haven’t solved surprise billing.
It’s all about making profits off the sick. This has to stop. The USA is the #1 place where the lobbyists and PACs have bought off politicians to enable this situation.
Go look at opensecrets to see how much your favorite representative’s pockets are padded. It’s there hiding in plain sight, open public data flowing right from the government for your eyes. Imagine all the hidden influences that exist that you can’t see.
2
The author erroneously compared Obamacare to Romneycare. It isn't. I lived in Massachusetts under Romneycare and was able to keep my primary care physician and my insurer at significantly lower premiums. Under Obamacare, that was not possible. My premiums went through the roof, to the point where I could no longer afford them, and my alternative was insurance that was far worse and did not cover the physician I had had for the better part of 20 years. President Obama did an incredible disservice to those who don't have unlimited wealth or who are not on a group plan. If the president actually wanted to make health care system in the US accessible to all, he should have started by regulating the insurance industry, preventing insurers from denying coverage and recklessly raising premiums. Mid-level pencil-pushers with little to no medical training should not have a say in what procedures are allowed or denied.
13
Yes, that would have been ideal but those insurance, big med, and big pharma lobbyists and PACs wouldn’t deal.
They didn’t want to give up their greedy profits. So, they upped the plan costs to enable coverage of the high risk pools. No way would insurance companies take on pre-existing conditions for their old policy costs!
Likewise the price controls have all but disappeared in the meantime.
No more Obamacare exists today - it’s a Frankenstein now - and once the pre-existing conditions are allowed to be used to exclude coverage - we’re cooked. You think it’s bad now? Just wait if someone doesn’t begin to tame this back.
It’s a free market economy. Yet we all need healthcare. It’s not like when we choose whether to go on a cruise or a vacation where we fly and stay in a hotel. It’s not optional and is at times it’s life and death decision making.
Yet many people are forced to give up healthcare or gamble with no insurance. They know that medical bankruptcy is now common. There is often nothing they can do.
Some employers don’t hire W-2 employees because it’s too expensive. Contractors and small businesses have few options.
ACA was originally a good design that was modeled after other hybrids used in progressive democracies across the world. It was botched by our corrupt systems of political influence and greed.
Private insurance was once less expensive because insurance companies could limit their insureds or cancel policies of those who cost too much.
2
You may have forgotten that there were going to be subsidies paid to insurers as more people joined in order to prevent premiums from increasing like that. They GOP majorities in the House and Senate from 2012 on refused to pay them. So insurers passed the prices on to subscribers. The GOP has done everything they could to make the ACA fall apart. But for many people it has been a life saver. Sorry that this was not the case for most of the real middle class
5
I'm Canadian, 63 years old. Universal health care was rolled out here when I was 12. I have never paid for an essential medical treatment in my life and I never will, unless our country suffers some kind of catastrophic economic failure.
I won't debate relative US-Canada tax rates; that's one for the economists to sort out.
But I'll say that any hit on my middle-class income is quite acceptable in exchange for never having to deal with an unexpected $145,000 bill to keep one of my chidlren alive.
We managed to make this work in a country with only 20 million people back then -- surely you guys can do the same?
21
My wife had extensive radiation treatments for cancer. They were pre-approved. 10 months later - three months after she died - her insurance company decided they were not going to pay for her treatments so I got a bill for $100,000. The problem is that pre-approval really doesn't mean anything. (I was fortunate that, because the radiation oncologist's hospital had not followed the rules, they had to pay.)
7
I still don't understand the basic principle of health insurance in modern American society. It isn't like car insurance, like maybe if we're unlucky we'll be in an accident and need it. We ALL WILL need healthcare.
It is obvious we need to pool our money and risk as a larger group of people, but why have a private third party whose sole goal is profit do this? In this country, putting a companies profits v. anything, it is clear who will always win.
17
I recently had a simple procedure as an outpatient. It required three hours in total from admission to discharge.
I received a statement detailing the cost. Only $31,000!
Fortunately, Medicare paid the cost. Enough said.
11
Why can't the wealthiest nation on earth provide health care like any other civilized nation? Why can't they at least regulate the market? Other nations have health care for more than a century. In this nation the greed is overwhelming, even health care. It is a cold for-profit business only. There is not even consumer protection, people are trapped.
18
It can. It chooses not to.
4
@ARL
It's not "can't", it's "won't".
4
Just had an MRI done, and got a bill of 700 dollars out of my pocket. This is with a good insurance plan. I skip my daily coffee to save that much in a full year.
MRI in India costs about 50 dollars with no insurance.
19
I am a Canadian who was stricken with bacterial meningitis as a young infant. It was unknown whether I would survive, and it required a lengthy hospital stay, an incredible number of spinal taps, neurologist interventions, etc. My parents didn't pay a penny out of pocket for any of my care(though Mom loves to joke that I used up my "healthcare quota" in the first few months of life), and I gladly pay my taxes today knowing that somewhere out there are other babies like me fighting for life and whose care is paid for by people like me who are proud to live in a country where ability to pay is not a consideration when lives are at stake.
55
My daughter is attending the University of Roehampton in London. The tuition she is paying is comparable to our state school in Arizona. All universities in the U.K. are public. When it came time for her to sign up for the NHS, all she needed to do was register with a doctor of her choice at an NHS clinic. Her first visit for an illness was hassle free, no insurance forms or checking in/out of network, or other paperwork. It is beyond time for our country to wake up and establish a health system like the NHS and take care of all our citizens.
46
So why does the author hate her insurance company?
She went out of network and, amazingly, took the word of a doctor at the provider facility that it would mean only a modest co-payment! Really ? From doing my own asking at various medical establishments, it is pretty obvious that medical staff have no idea as to what your particular medical plan covers, does not cover, or what in the end your procedure will cost. Try getting a decent estimate for your procedure prior to it taking place.
He insurance company billed her because she went out of network. Her doctors/provider facility only intervened when they realised the patient could not pay. They then negotiated with the insurance company based on the fact both of them knew approval had been given even though the facility was out of network.
Did the author query why the procedure was $145,000? It's the medical profession which is sending costs out of the roof - the roof of their very fancy and ever more prolific clinics and hospitals.
8
@Paul, well, for starters, why do we have insurance networks? Why should your choice of care provider be determined by which insurance company your employer chose for you?
It's insane.
And if you consider the situation where you are in an accident and are taken by the first ambulance on the scene to the nearest hospital, and you're unconscious, how can you possibly stop to ask the driver if he's in your insurance network? How can you ask each and every attending person in the ER if they are in your network (hah, docs are all independent contractors!), and to ask if the hospital itself is in your network?
Seriously, it's insane.
We should be able to go to the doctor of our choosing to get the recommended care without having to worry about whether the providers pay to be in your insurance network.
4
Thanks for this column.
I will avoid going out of network unless there's no other option and I have 1 foot in the grave and the other on a banana peel.
7
No reason to file BK, just dont pay it, not much they can do about it. The newer versions of Fico 9 and 10 wont even be looking to include medical collections in your credit score calculations.
1
Wrong. They are suing people now. It’s a legal niche for volume business.
7
A creditor can sue. If the creditor prevails in court the judgment can be recorded. Once recorded a lien can be filed against one’s house or a garnishment can proceed. So, bankruptcy can often be the path to resolution.
4
Great writing, thank you. I'm so glad it worked out for you. But why is our system so cruel?
5
I am so happy I live in Norway. 12 times hospitalized last 15 years. Total cost of 0 dollars, incl. ambulances (if needed).
Additional we are entitled to a healthcare exemption card once we have paid a certain amount in user fees ( p.t. max. USD 265) when receiving healthcare services (doctors, x-ray, medicines, etc.).
When we present our exemption card, we do not have to pay user fees for the remainder of the calendar year.
I really feel for you, Americans.
27
Cotard syndrome, perhaps, but for the general population I think narcissistic personality disorder applies.
I’ve spent years in two Canadian provinces and would take either’s variation of provincial health coverage over my “good” employer-based American health insurance any day of the week, if only to never have to deal with an insurance company or a billing department or - a lesser acknowledged phenomenon - a doctor’s office clearly in the business of fleecing everything possible.
American solipsism, the malignant narcissism and arrogance that disables any serious consideration of non-American places, is what’s really prevented it. Forget Denmark or Britain, there is a highly functional first-world system, with urban hospitals as good as any in Manhattan, mere hours from much of our population which manages to thrive even with the massive potential for brain drain from the American private sector.
That the Canadians did that nearly a century ago in this environment makes our current predicament quadruply embarrassing.
28
I don't know how much time the author and her wife had to spend on the phone with the insurance company, doctors, the billing provider - but in my opinion that is billable time. If they can improperly bill consumers - hoping they will just give up - then you can bill them for the time you have to spend fighting back. I am very lucky, very, very, lucky to never have faced one of these life-altering "surpise" bills, but, like most people, I have nonetheless had to waste hours fighting lesser bills that were no less unfair. While I hate that everything in life has become monetized, your time is valuable and you can and should bill for that time.
9
@OnePerson
I feel the same way, it would feel good to bill them.
No way your bill will be paid, though.
2
I think you are conflating those who have gold plated insurance coverage with the average person’s feelings about their insurer. People with exceptional coverage (usually due to union contracts) are concerned about a Medicare for All Program that causes them to have lesser benefits. I think it’s a legit concern that needs to be addressed. People aren’t afraid of losing their insurers; they’re afraid of losing their benefits advantage.
7
I’d be very skeptical if even the ‘gold-plated’ policies are that good when you have a serious illness or surgery.
7
I have a health insurance through my Union. one doctor once told me that my insurance was a "Cadillac". I have no fear of losing any benefit on a Medicare for all system. My mother has Medicare & Medicaid. it beats my union health insurance any day of the week
18
@Mary Sampson I have gold plated insurance, which I pay for myself since I am self-employed. I had well in excess of the author's bills in January alone, and my carrier covered every penny beyond my deductible, even with the out of state hospital I chose to care for me.
4
You never go by what the doctors say. They don't know the insurance side. You have to call your health insurance company and talk with them. Write down the names of the people you speak with. Get it in writing and/or have your health insurance company reference the part of your policy they are referring to. You have to do the leg work up front. Sad but true.
I've worked in health care for 19 years. This is what I do if I am going to have any type of procedure performed.
6
@CMH but you shouldn’t have to worry about the cost. You shouldn’t have to worry if you are covered or if it’s out of area. You shouldn’t have to get on the phone to your insurance company. Here in England I go to the doctors, hospitals, call ambulances etc knowing it’s not going to cost me a penny.
6
Good luck with this. Wait for hours to speak to a human. They make promises of coverage but won’t commit to paper. Charged later denied. I have not had a medical bill go through as my insurance company has promised for the last four visits. Try to call to get it fixed? Welcome to sit on hold all day.
5
just a note my Medical Mutual of Ohio said they could not guarantee that their list was correct and told me to check with the doctor. just sayin'
2
The insurance companies are filled with terror with the idea of losing us, and their lobbying is why we can’t get Republicans to do the obvious and support universal health care (it wouldn’t even be a “good deed” - it’s the obvious solution to an avoidable national crisis).
11
It is frustrating to hear stories like Ms. Boylan's. She did everything she was supposed to do, getting pre-authorization. Insurance companies play these games, adding stress to families and bureaucracy to the health care delivery system. In addition, health care providers end up having to spend significant time providing documentation and facilitating patients' claims...time for which they do not receive reimbursement.
6
In Canada under universal health care there is no network within which a doctor has to be chosen and no surprise bills like that of a $145,000. Americans are such patsy’s for financial exploitation (and yes that’s the right term) and the grifter justifications of the health insurance industry.
Vote Bernie!
27
Medicare for All is coming without a doubt. If not this election cycle, then perhaps the next. And this is why.
Two things: one, I ALWAYS negotiate my bills after I get them and worst case scenario work out a payment plan. Don't despair, call and fight.
Two, when my brother got cancer several years ago, he had my intelligent, retired father on his team. My dad tirelessly harassed my brother's insurance company ("good" insurance from my brother's corporate job BTW) weekly telling them, "I'm smart and I have all the time in the world to stay on you." And he was able to bully them out of much of their denials.
Not everyone has that luxury, but it's a good example of the fluidity of the charges and what can happen with persistence. Until we have medicare for all at least.
10
I have Medicare, supplemented by Medicaid (which is mainly for RX costs). Last year, my femur was fractured. Extended care was necessary. My medical debt is now $768,347 and compounding daily.
It is, truly, good to have any form of medical insurance in our country. It is, truly, puzzling: Why am I going into bankruptcy although I have "comprehensive" insurance?
19
The Sanders and Warren "Medicare for All" plans are no Medicare at all. Medicare, like the public healthcare laws of the universal healthcare countries in the world, pays about 80 of the costs of the patient's healthcare costs. The Warren and Sanders plans pay for 100% of all healthcare costs from the first dollar to the last. No other country has such a plan. Canada's public healthcare system, to which Bernie often compares his plan, pays about 70% of all healthcare needs, with the rest paid by the patient or supplemental insurance. European countries average about 80%. Some are single-payer systems, so are other systems, but all the other countries recognize that their public systems can't afford to pay for all of everything, I will say that Warren did attempt to explain the costs of her program, and she paid politically for it. Bernie admitted recently that he can't say what the real cost of his program is because it's unknowable. His followers don't seem to even care. Both plans have no chance of becoming law anytime in the foreseeable future, and the Republicans will make the most of the ammunition they get from a Warren or Sanders nomination.
I wish someone in the news media or on the debate stage would point out how the Warren and Sanders plans are so different from what the rest of the world has and would press Bernie for the cost of his plan and how he is going to pay for it.
6
I’m not sure this is accurate. I had to go to the ER in Scotland and it was covered in full, even though I wasn’t a citizen. I inquired about paying a bill, and the hospital didn’t even have a billing department.
14
@jas2200 sorry but this is not true. I’m British in my late 60s and have visited doctors, stayed in hospitals, needed ambulances, had X-rays, scans etc. Fathered children, who have then their own health needs, and it has not cost me a penny. Plus the care by the NHS was fantastic. Did you know that life expectancy in most European countries exceeds that of the USA?
6
I had the same experience in Germany. They had no idea how to Bill for my daughter’s surgery ( after breaking her elbow) or her physical therapy.
"It would be nice just once if our insurance companies were filled with terror by the prospect of losing us."
Just once? They are filled with terror by that prospect every day. That's why their industry hires a legion of lobbyists to woo members of Congress and their aides. Then their pet legislators faithfully obstruct changes to the law that might have any sort of negative effect on their arcane and lucrative business model.
This lobbying effort costs hundreds of millions of dollars each year. And even after all that spending, in 2018 healthcare insurers raked in nearly $30 *billion* in *profits*. Where does that money come from? You: employers, patients, and the government using your tax money. Where *isn't* that money going? To actually care for your health.
Think about this the next time a representative from your for-profit healthcare insurer says that your health is their highest priority.
20
Taiwan: a very capitalist economy. About 25 years ago they overhauled their health care system. They studied extensively the top systems in the world. They found the best to be Medicare. So they made it Medicare for all. They have the lowest administrative cost, high satisfaction, and great outcomes.
Yes, we can.
23
Cotard syndrome is an insightful representation of medical capitalism; so pervasive, along with the notion that socialism is toxic to governance.
The very principle of insurability rests solely on the actuarial axiom of shared risk, the foundation of socialism. Market capitalism has so captured our sense of what's possible that it's regraded as eternal, like the laws of gravity. It isn't and the sooner we say goodbye to its infecting our medical, the better for all.
3
@JS : You betcha.
I don't understand why people who have health insurance through an employer think they have control of that insurance and can't imagine giving it up because they want to continue that control.
That insurance, and the doctors who come with it, could disappear at any time without the input of the employee, the patient. The employer may decide to change insurance, and suddenly the doctor you are seeing is no longer in network. To continue seeing that doctor would be too costly. The insurance company decides, not the patients, which doctors are in network, and can drop a doctor, maybe your doctor, from its network. Also, your doctor may decide to leave your network. The insurance company, the employer or the doctor decide which doctors are in network. The patient, the employee, has no say.
Go outside of network, and you may receive a bill for 100s of thousands.
People who want to retain their private insurance instead of accepting Medicare for All don't realize that they have no say in retaining their private insurance and their doctor.
With Medicare for All, networks disappear. You can go to any doctor anywhere. Maximum medical charges are set. There are no financial surprises. And because everyone has the same insurance, everyone understands how the insurance works.
The goal should be affordable, simple to use, universal health care. The only medical insurance proposal that satisfies that goal is Bernie Sanders' Medicare for All.
25
@Steve C,
You're entirely correct. I think that a lot of people who "like" their insurance have never needed to actually use it for anything more than a check-up at the doctor's office.
Also, most people with employer-provided insurance are simply not aware of the true cost of premiums. They may see $50 or $100/pay period deducted from their paychecks, but they don't see the $1000/month additional that their employer pays. This is why they're afraid of a tax increase that would cover health care costs. When single-payer is finally mandated, part of the law should be that all employers who currently pay the insurance premiums should give those premiums to the employee as a salary increase. After all, the insurance coverage is a benefit in lieu of additional salary and is part of the total compensation package.
7
What makes me livid are those who ominously warn that any type of expansion in healthcare coverage for Americans will mean "You'll lose your right to choose your doctor!" I have healthcare coverage through my employer, but I don NOT have the right to choose any doctor I want. If I have a brain tumor and the best doctor in my area is not a "Preferred Provider," I cannot see him or her, unless I am able to pay 50% of the costs instead of 20% for a Preferred Provider. I also had to give up All my healthcare providers when I took this job 9 years ago, because my employer doesn't offer Kaiser, the HMO I had and loved for many years. Also, with every year, my share of the premium has gone up, along with the annual deductible and out-of-pocket maximum. I don't know what healthcare for all would be like, but it cannot possibly be worse than this.
29
In 1995 my wife was diagnosed with stage four ovarian cancer and had to have immersed surgery for a tumor. I’m retired from the military and she was covered by her work and I had insurance for our family as well so she was triple covered. I was making 7.57$ an hr and the final bill for surgery and chemotherapy was in the 450k range. If not for insurance we would have been totally wiped out. Twelve years later I got a bill from the hospital that had been sold twice that said they thought I might owe 147$ but weren’t sure and that if I sent them a check they would return it if they were wrong??? I didn’t reply and have never heard from them again
9
My one question about Medicare for All is this:
Suppose a future Congress/president decides to remove some procedure or category of healthcare (abortion or transition-related care, for example) from being covered. What will people who need that care then need to do, and will that be harder or easier than what people have to do now when care they need is not covered? The stories I've been hearing lately (this and John Oliver's segment) have been suggesting that it can't and won't get worse than what it is now... but I still don't know enough about how M4A would work to be totally sure.
2
That can happen anytime with our current system. The Trump administration is trying to get the courts to call the ACA unconstitutional! People with pre-existing issues could be in real trouble if that happens & they change jobs. The new insurance could deny coverage for the pre-existing condition... like they used to do before the ACA.
1
"We hate our insurance companies". Is there any other entity to which we give hard-earned money about which this statement is made without irony or hyperbole? We really do. It is such a strong, and intentional, use of the word hate. And 100% accurate.
18
(disclaimer - I'm a doctor)
U.S. health care financing is a nightmare, but we in the medical field are also responsible for our health care being so expensive. For generations, our medical culture has been that a good doctor is one who does (and orders) whatever is the best possible thing for the patient, with very little incentive to look at cost-effectiveness. It's hard not to spend a lot when someone else is footing the bill, and someone's life or health is potentially on the line (not to mention fear of lawsuits). Physicians overwhelmingly want to do good for their patients and for society, but the pressures and incentives are all wrong for controlling escalating costs.
In view of the expense of U.S. health care, Medicare For All is simply to heavy a lift to get rapidly enacted. However, I really believe we should gradually move in that direction, perhaps by enacting universal pediatric coverage (which would be cheap), lowering the age of Medicare eligibility to 60, and launching a public option for other citizens to buy into Medicare.
It's sort of a Catch-22 - if we somehow roll out Medicare For All, we will spend $35 trillion in 10 years, a "prohibitive" sum. But if we stick with the status quo, the cost will be $50 trillion, with the difference going to corporate profits of the healthcare, insurance, and pharmaceutical sectors.
20
@David Bruce
M4A rollout is just as you described.
Seen here in the "timeline" of link provided.
https://pnhp.org/what-is-single-payer/senate-bill/
Not sure if you know about this group, but they could give you more answers.
https://pnhp.org/about/
2
Having a provider of services tell a patient that something will, or will not, be covered under a medical plan just does not happen. Perhaps the provider’s office staff told the author the incorrect information. Providers are clueless to costs and reimbursement, as they should be.
Individuals MUST be always aware of their care coverage, read the entire plan document they have for insurance ( not only the SPD summary plan description), and get everything in writing.
Regardless of what exactly the treatments were, seeing an out of network provider was only one of many poor choices the author and her family made around this care.
Not in my experience. Had to have my hip replaced & it was my physician who had to communicate with our insurance provider. Of course I checked that hip replacement was a covered benefit — it was, when “medically necessary.” Who decides “ medical necessity?” The insurance company! How do they decide? By communicating with my doctors & asking for X-rays, previous treatments etc. They never communicated with me, the patient. There is no form to communicate with patients because we’d say “fix my hip.”
FWIW my physicians must employ several staff to do nothing but *appeal denials of preapproved procedures.* They have to do this for every insurance provider whether in network or not.
Insanity.
6
@Sally "Poor choices"- their kid was sick. Why must it be like this?
“ ... insurance companies often respond to preapproved claims with denial and delay, hoping that consumers will somehow just give up.”
Understand that this is a feature - not a bug - in the healthcare insurance industry.
16
Not long ago, we got a couple of surprise bills for care my wife had received. Nothing like $145,000, but still an unpleasant surprise.
Imagine my shock when I found out from a story in either the Times or the Washington Post that Florida, of all places, has a law against "balance billing," which is another term for what happens when you receive care from an out-of-network provider. (The hospital has a "patient liaison," who deals with such situations, and we didn't have to pay the amounts we were billed, but I found out that the reason for that liaison's existence is not customer service, but rather compliance with the law.)
8
American living in Canada here. I am not a permanent resident so I don't get the provincial health plan (called RAMQ), but I do get private insurance for about $1000 per year. Forget universal health care for a second and just consider tightly regulating the insurance market, which would be a great first step for the US. Here, because of price controls (the government assigns a numerical code to every medical service and gives it a price), I'm able to go to any hospital or any public clinic and get all services free of charge, no matter what they are. I get my prescription for about $6 per month (my insurance covers 80% of every pharmacy-provided medicine, 100% of all medicines administered in a hospital). If I want to, I can choose to go to a private clinic and just pay their markup; my insurance will cover up to the provincial price for services. I don't have any deductible. Obviously, everything is not perfect (for example the waiting list for a family doctor in Quebec is extremely long if you have no children), but the idea of a private insurance market doesn't even cross anyone's mind here as a potential solution. Until private insurers are reined in, tightly regulated, and forced into the business of reducing costs (instead of EVADING costs), the problem in the US will only get worse.
24
The health insurers here have campuses that make Oz's Emerald City look like an 80s-era double wide trailer.
2
Speaking of colonoscopies, back in 2012, I scheduled one and double checked with them confirming that I was totally covered. All good they said. The procedure went well and a couple of weeks later I received about $8k in bills. They said this was the amount that my health insurance didn’t cover. I refused to pay the bill. Fortunately, they decided to leave me alone and not pursue the money (from me anyways).
In 2014, my wife, pregnant with twins, was diagnosed with preeclampsia and was immediately checked into the hospital - that it was an emergency. Everything happened so fast. Same day; twins were born and were in NICU for 43 days.
As soon as I had a chance, same day or next day, I called her insurance company to let them know what was going on and whether we needed to do anything. They said that we needed to get preauthorized and that we couldn’t get the preauthorization because she/they were already were born/ admitted. I told them that it was an emergency - that she could’ve died.
Anyways, she received a $450K bill. None of it was covered, they said. We were of course exhausted, and now had to fight for the next couple of months, sifting through hundreds of documents, appeals, etc.
She/we ended up owing $0, but it was a pretty much a nightmare
Anyways, We have two very healthy and thriving five year olds ! We are grateful
19
@Mike S ...well, maybe you owed $0 on that $450K bill, but many people are paying for it in higher insurance rates...
1
As a Canadian who very "thankfully" lives in a country where universal healthcare has been in effect since 1966, all I have learned about the U.S. style so-called "healthcare" system came from relatives and/or reading about it in various publications. That was until, April 9, 2012 when on the day my mother-in-law was getting ready to leave to come home from her regular winter long visit to her vacation home in Florida she took very ill and had to go immediately to the hospital in which after "two days" of hospital treatment in which they ultimately confirmed they could do nothing more she was taken to her home in Florida and sadly, passed away two days later.
Since, unbeknownst to us, because she chose to stay a week longer, her insurance had expired and the nightmare began in which we realized what a "scam" the American style of healthcare was. We immediately received a very itemized THREE page invoice totaling $24,500 which even included the straws for her glass of water.
After a month long discussion and negotiation with the hospital conglomerate based out of Nashville, Tennessee, the amount which was ultimately agreed upon and paid was a little less than half of the original billed amount.
When I look upon some Americans who still object to a universal system because they will have to pay somewhat more in taxes, considering the debacle we went through in our Florida "experience" the Canadian system and others like it are cheap at three times the price.
27
"I admit I have never quite understood the hatred Reagan had for Medicare, nor the hatred today’s Republicans have for Obamacare"
Regan saw it in the eyes of the 1930's, just the first step towards socialism.
Today's republicans hate the fact people like health care and will vote for people who like it too.
9
As a practicing physician, I am amazed when I hear politicians speak about people loving their private insurance. The only people I know who love their insurance are people who never have to use it. Medicare is reliable, clear, pays in a timely manner (unlike many private insurers who can go two years without paying their bills), has low overhead, minimal authorization/precertification, does not lie about coverage (which private insurers do ALL THE TIME), does not retroactively change benefits (Ditto about private companies), believe me I could go on and on. I cannot even bear to calculate how much time I spend dealing with denials, scared patients, surprise bills, letters of medical necessity, on top of a full time person in the office doing nothing but that. Americans - please calm down, single payer plans will reduce much heartache and stress for patients and providers.
46
Our Healthcare "industrial complex" is way too entrenched in its way , protected by politicians from both parties to accept M4A or possibly even support the offering of a public option to Medicare. they hated the ACA even though it was a conservative thinktank, Heritage, that developed it.
Using a recent example, it disheartens me when the Culinary Workers in Nevada oppose any changes to they platinum healthcare. Its understandable because they gave up raises to get that healthcare. How do we convince them tens of millions of their fellow citizens are going without or suffering sub-standard care?
Unless voters demand some sort of universal healthcare system that is affordable, way more affordable the the ACA, we won't get it.
3
I don’t think you can convince people to give up the benefits they’ve negotiated and sacrificed for. However, I think a public option would achieve the same goal without the need to convince anyone to buy in. And a public option has overwhelming support from the American public.
The author is lamenting a lack of support for Medicare for All, but never mentions that the solution, the public option, is widely supported.
It’s not hard to achieve Medicare for All if you do it the right way. Don’t impose it on people; offer it as an option. It’s human nature to fear that someone is going to take something away from you.
1
Between my wife and myself, I have been through this about 5 times over the past 20 years. Had I not fought, I would have “owed” about $800,000 by now (based on my conservative estimates).
After fights and appeals, every time I’ve gotten it down to a few hundred to a few thousand dollars.
But what about people too sick to have the energy or unable to figure out how to navigate the system?
19
@Bob Lob
Indeed. Ins. cos. count on that. One needs to be sharp as a tack, while ill, or have a really good surrogate / advocate.
3
The funny thing about surprise bills is that they are a creation of insurance companies and hospitals. Insurance companies want to pay nothing and hospitals want to get paid. Stuck in the middle, unfortunately are patients and their physicians. Insurance companies want hospitals and physicians to be out of network so they can push the costs to the patient and increase their profit margins. The unfortunate part is that insurance companies are making billions off of peoples suffering and attempting to change the dialogue to blame physicians. Last I looked CEO's of these major publicly traded insurance companies are making salaries > 20 million. All Americans deserve healthcare at a reasonable cost, and insurance companies are keeping this from happening.
12
Like all British taxpaying citizens, I pay taxes for the NHS - but overall, tax is roughly commensurate with that paid by US citizens.
I live in Wales, UK. I have not paid as much as a single penny directly for medical coverage or procedures in 20 years, nor has my family. Nor have we filled in even a single page of paperwork in this entire time (aside from a consent form for a procedure). Prescriptions have cost us precisely nothing during this period. Parking at hospitals is free, the entire stay for a significant operation does not cost anything at all. No co-pay, no premiums, nothing.
Nobody worries about medical expenses. Nobody has gone bankrupt over medical problems. Nobody is concerned that changing a job is going to lose them cover, and nobody thinks pre-existing conditions are going to sink their medical treatment, there is no concern about lifetime limits on pay-outs. (We are, of course, free to pay for our own medical insurance and treatment should we so wish.)
This is terrible! When is someone going to provide us with the freedom Americans so obviously enjoy?
33
@glenn_uk all great experiences, and I'm sure true, but at the same time you should mention the problems the NHS is having (not inconsiderable)...no system is perfect, but many are better than the US...
2
@Jim - You are absolutely correct.
The problems the NHS is facing is entirely due to underfunding, and the partial privitisation brought about through the Tory government, which has hated the NHS from its inception.
The NHS is the nearest thing the British have to a religion, but the investor class absolutely despises it. (The last UK Health Secretary, Jeremy Hunt, said "We are living with a 70 year old mistake".)
Undermining the NHS in every way possible - while pretending to support it - is the unwritten policy of Tories. They like to hive off the easy, profit-making parts of the NHS to make their business friends rich, then claim they are spending more on it.
The principle of the NHS is entirely sound, however, and is clearly the most efficient and ethical way of running a country's healthcare system.
8
@glenn_uk ...true enough...thank you for your response...
When I hear politicians speaking about Healthcare, I cringe. I cannot, for the life of me, understand the systems they describe. Surely, we can have a healthcare system that could be run using the Medicare model, where a set amount is deducted from salaries/wages throughout a working life and an additionional Supplementary Insurance could be purchased as desired. (This is how the NHS in the U.K. and other European countries' healthcare systems are run). Jobs would be created by the need to run this system. Yes, the Insurance industry might be reduced in size but they wouldn't go out of business and those who might lose their jobs could be rehired to run the new system. In the U.K., as an example, patients may have longer waits for non-emergent surgery such as a knee repair or replacement but, have a stroke, a heart attack, or develop cancer, you're met quickly with excellent care and you don't have the additional worry of whether you'll go bankrupt. Older people who need geriatric care, in-home or in a Care Home, get that care whether they have savings or not. If they have additional Insurance or wealth they can opt to pay for luxury Care Homes. I know - my father needed geriatric care in the U.K..
The European and Nordic countries' healthcare systems are not perfect and the occasional horror stories are reported but, in the main, their citizens are happy and secure that their needs will be met. Why we can't have that same sense of security, is beyond me. Perhaps I'm naive?
17
After moving to Australia and living with government-provided medical care, I have no idea why Americans insist they want to deal with insurance companies. Our one trip to emergency here - totally paid for. Contrast that with my emergency appendectomy in Baltimore - $5500. Routine doctor visits in Aus - either totally paid for or with a modest $35 copay depending on your doctor. Complete cardiac workup in Aus- $200. US residents need to trust that there's something better out there. Woe to those who, unlike the author, don't know or don't have the means to fight the insurance companies and their nonsense 'deny everything' policy.
18
She was fortunate that the bill was forgiven. Others are not so lucky.
5
@jerseyjazz
She's lucky she knows how to fight the system. Many who get bills like that just give up, or don't know they can appeal their charges. The insurance companies count on that.
11
Need I say more....
United Healthcare's full year 2019 earnings from operations grew $2.3 billion or 13.5 percent year-over-year to $19.7 billion.
They only make money by getting more subscribers, raising premiums, limiting coverage or denying claims.
22
But I don’t believe this example falls under the usual understanding of surprise billing. The author knew the doctor was out of network. However it appears the author believed the billing advice of the doctor and doesn’t mention checking with the insurance company. The only surprise is the author didn’t do due diligence and cover all the bases. I believe surprise billing is when unbeknownst to you even though say the hospital and surgeon are in network it turns out the anesthesiologist isn’t. Surprise. Maybe I missed something though?
6
my sentiment exactly. This is not an example of "surprise" billing. She knew doctor was put of network and still proceeded
1
@Bill
In a universal healthcare system, there is no such thing as a network, I can go to any doctor, hospital or even walk-in clinic anywhere in the country.
5
@Deus...except Quebec...Quebec did not join the reciprocity agreement of the Canada Health Act. If you go to hospital or doctor in Quebec you have to pay. Ditto for Quebecers in the rest of Canada
You need to purchase travel medical insurance.Also out of the province medical does not cover everything. Out of province surgery if not emergency may require prior approval.
1
If a doctor assures me that although out of network, the fee will be modest and winds up being exorbitant, I refuse to pay it. That's happened to us several times.
8
Once my insurance company was playing the claim denial game, lasting so many months that their final reason for denial was “date of procedure was now too long ago”.
Hmm.
After getting the runaround by various insurance co. personnel, I called them mid-morning the next day, indicating that if we don’t get this resolved by 2 pm, my next call, at 2:15 would be to the Insurance Commissioner’s Office as well as to the state’s Attorney General’s office. (Massachusetts at the time).
At 1:15 I received a call from the manager of the insurance provider. She gushed that she was so happy to be able to approve the claim, expressing her appreciation of my business, and blah blah blah. I icily expressed my thanks.
I write this with the intention of offering a possible solution for some experiencing similar denial actions. Hope it helps.
p.s. I understand each insurance company employee has an industry ID number as does their office / company. Asking for those numbers might convey your seriousness. Sorry I don’t know the exact identifier, but it could help your efforts.
14
Profits cannot be the only motivation for healthcare. That is why we have hospital visits lead people with endless unnecessary diagnostic tests. That is why pharmaceutical companies would research on treatments instead of preventions and cures.
The only reasons we don't have an approved COVID-19 vaccine today are because SARS was contained 17 years ago and vaccines in general don't make a lot of money.
4
I've become more vigilant about medical costs.
I have Medicare A and private ins. I was admitted overnight to a hospital, discharged the next day. At discharge they told me I owed $875 which I stupidly paid. Over the next few months my ins company and Medicare battled it out while the hospital held onto my money. They agreed they owed me a $525 refund but wouldn't give it to me. In the meantime I visited one of this hospitals ob gyn's for a routine matter. She immediately wanted to do surgery. I refused. I got a bill from her for a copay of $55. Still trying to get my refund of $525 I didn't pay her, but she turned me over to a collection agency after 2 billings. I paid the $55. it took me 3 more months to get my $525 refund.
I would have to be bleeding from a gunshot wound to go back to them. I also just saw where this supposedly non-profit hospital donated millions to train more nurses. Nothing against nurses but if they are that flush, they should lower pricing
My neurologist, different practice wanted to put me on meds costing $1000 a month. Telling me - don't worry, the pharma company would subsidize me for a year. I declined. In a year the cost will probably increase and you can't just switch anti-seizure meds. So I stuck with the one I was taking.
I used to think doctors were to be trusted implicitly and unquestioned. No more. I question everything now up front. Yes, they are financial services, not health care anymore
9
One of my Facebook friends, a Trump supporter, recently posted that Bernie want to get his hand in everyone's pocket. In other words, Medicare for All will cost each person a lot more than our current system. If I wanted to torture myself by responding, I would say this: The medical and insurance industries are already taking huge sums of our money via high premiums and uncovered medical charges. Hidden in these are costs for uninsured people, which hospitals are obligated to treat. Addressing this in an effective manner, whether with Medicare of All or other logical method will cost everyone less, not more. But I think what those opposed are suggesting is that sick people just be turned away to die if they have no insurance.
19
Counterpoint: lima beans are delicious!
4
Agree! Fresh ones are the best!
But I hate, & I use that word with full intent, the way America’s for-profit health care industry works.
I too have lived overseas in place with heath care for all. It’s great. No mucking around getting scared with $100,000 plus hospital bills etc. etc. etc.
2
I don’t want to give up my great employer health care for Medicare for all.
1
The flip side, of course, is that you give/gave up the liberty to change jobs, go into business for yourself (innovate), relocate, retire, or, dreadfully, lose your job. Indentured servitude.
4
@Nycdweller
And what happens if you lose your job, become medically disabled, or your employer goes bankrupt? No job? After 30 days you have no insurance, unless you pay for COBRA. Very expensive.
4
Even if Medicare for All is the better deal?
3
"I admit I have never quite understood the hatred Reagan had for Medicare, nor the hatred today’s Republicans have for Obamacare (itself modeled on Romneycare, a Republican idea). Is it just that they cannot abide the idea that government sometimes — even if only as a last resort — does good things?"
The hatred stems from their patrons. Ronald Reagan was a frontman, a shill, for predatory capitalists. Same for today's Republicans. The Reagan Restoration has been a fairly successful rollback of the New Deal and government regulation, in almost exclusive favor of the plutocrats and kleptocrats backing these streetwalkers.
17
Last sentence is a jewel!
4
I wish people -- especially Republicans -- would remember this when they ask how Democrats will pay for universal coverage.
People are paying for it now. Just not everyone is included.
19
What a sad state of affairs. Negotiating for care. Anyone who has experienced this situation should want to consign health care by insurance companies to the dustbin of history. I can imagine more than a few lives have been ruined this way. And the fix, to legislate against "surprise medical bills" seems like adding insult to injury. You folks need medicare for all.
11
Social security was demonized before it passed.
Medicare demonized.
Obamacare demonized.
All labeled as the dreaded “socialism” by those connected to big money businesses.
Education is needed.
24
Well put, Jennifer! Glad it worked out and outraged that you had to go through it.
2
It is really very simple: America has the worlds most expensive and least effective health care system.
We pay more: 19% of our GDP goes toward health care. The rest of the world pays 14%, 13% or even less. In short, we waste 6 cents of every dollar spent here on health care, and don't even cover everybody.
And our outcomes are worse than middle of the pack.
AND only Americans suffer medical bankruptcy.
But the Times keeps saying Medicare4All is extreme. Every other advanced nation on earth provides universal healthcare at a reasonable cost, and Americans are too dumb to figure it out.
Well, I guess it's worked that way for the gop so far.
16
I’m sure Reagan used his Medicare benefits for many years as he was ill with an incurable condition until he died at age 93. Bet he didn’t turn down his SS check either.
12
Reagan didnt need Medicare. He like Congress was eligible for much better healthcare for life.
8
Eventually, the US is going to have to follow the model of the rest of the civilized world in two things: health care and guns.
9
It's lucky you got this outrageous bill reversed. But I thought one of the benefits of the ACA (Obama care) was that Insurance Companies couldn't rescind insurance coverage when an insured individual suddenly faces a large bill?
Anyway, years ago I faced a similar dilemma. I had Health Insurance, with a small private plan, that I discovered had not contracted with any hospitals in our State. And I required an 8 hour spinal surgery, cost unknown. So I could face the full Rack Rates , that Hospitals charge to the uninsured. Instant Bankruptcy ?
I decided to get a second opinion (and quote) for the same procedure at a world class hospital in Montreal. In the end I had the surgery at the Montreal Neuro, for a specified cost, that saved my US insurer 10s of thousands of dollars. My US insurer agreed to pay all the costs in Montreal, less my deductible.
I still remember, waking up at the end of the grueling procedure, in the OR, with the full team standing around me, beaming.
I have had a great recovery, and just returned from another ski trip to France, free of back pain, or the numbness in my lower legs.
7
I’ve heard many of these stories and every time I do I think. Yes... we do need Medicare for all. But remember... there are lots of reliable voters who are not necessarily motivated by this but would gladly support Medicare for More or some kind of Medicare option.
These reliable voters include:
-the over 65 Voters who already have Medicare. Please also remember that many of these folks also have some kind of Medicare supplemental policy issued by private insurance companies.
-those of working age who who have good insurance through their employment. These folks don’t wAnt to deny good insurance for those with poor coverage... but they actually like their insurance. Both I and my wife did.
ObamaCare with smarter regulation and way bigger subsidies could do it. $6000 deductibles just is not a good plan.
And bear in mind that people who qualify for Medicaid might not care.
And then there are all those small government Rs who might benefit greatly. But they are not voting for Bernie or Liz.
We can win this fight w/o Medicare for all.
1
@Roger Meyers
As long as you have the healthcare industry controlling the system, you will NEVER win the fight, that is why America is the only country that somehow, still wishes to endure a system that is just not sustainable.
7
@Roger Meyers
"These reliable voters include the over 65 Voters who already have Medicare."
Not necessarily. Many of those over-65s currently on Medicare are going to worry that expanding it to under-65s will be funded in part by cuts to their Medicare coverage.
2
How long was your child in hospital? A year?
Medicare as on option on the Obamacare exchange would be more palatable to hesitant voters. As people see how it is working, we can ease into Medicare-for-All.
4
I can fill you in how this legislation will fare in the Republican Senate:
It will die, along with the 700 other bills already passed by the people's House.
5
Don’t pay it. Donald Trump and his ilk wouldn’t. If he can do it, so can you. He’s the king, the law of the land.
2
It would be nice if they came to understand that there are worse things in the world than making people’s lives better.
Won't happen with a GOP Senate. Something like this could also make the lives of brown and black people better. Which must be avoided at all cost.
5
A few things:
-The Obama care recipients previously had no health insurance prior to this government expansion of welfare and the reason for that is they did not have jobs or otherwise pay for insurance--like those of that had (and have) private insurance do.
How old is your child and what 'elective' procedure was it?
...more important-why should the rest of us pay for it? It's not free, and where exactly is the money coming from to insure 'everyone' in your Utopia?
2
@old school Floridian: I’ll “pay” for someone else’s condition and they’ll pay for mine when something comes up. It’s a good use of my tax dollars. Beats the tax break I’m stuck with for corporations and the wealthy. And I sure didn’t put enough into Medicare to cover what I’ll get back.
14
@OldSchool Why do commenters keep asking about the procedure when a) it is totally not the point of the article, and more important, b) it is no one's business?
I like Mary Too's exchange of someone else's condition for hers when something comes up. I wish I could have recommended her post more than once.
4
@OldSchool,
Your claim that Obamacare gave insurance to a bunch of people who didn't work is nonsense.
The people who primarily benefited from Obamacare were were people who did work but their employers don't offer insurance and either made too much for Medicaid but not enough to afford private insurance or couldn't get insurance at any price due to a pre-existing condition.
2
"His understanding was that insurance companies often respond to preapproved claims with denial and delay, hoping that consumers will somehow just give up."
Right there is the tell, the hint of the source of the problem here. This isn't the first time I've heard of that "deny and delay, hope they go away" approach by insurance companies. I've experienced it myself, I've seen friends and family experience it, as a person whose job involves overseeing the employee benefits for my company, I've see it again and again.
Insurance companies are happy to take our premiums, happy to insist we stay in-network, get pre-approval for anything above and beyond the barest minimum. But even in cases where the health care services/procedures are pre-approved by the insurance company, from a pre-approved provider, for a pre-approved patient/insured person, their very first response to a claim is NO! forcing the patient, the policy holder, the service provider, everyone else to take extra steps to follow up to get a valid claim paid.
All this, in the hopes that the person will give up, that they won't have to pay.
Horrible, hateful, awful, and it should be illegal.
It certainly is immoral.
It has absolutely NO PLACE in any healthcare system.
11
I went around the country in the '80's organizing for universal health care. I met hundreds of people in dozens of towns, and most had a compelling story. The one I remember was from the farmer in Iowa. He had no cash to pay for his wife's medical care but they could not qualify for Medicaid because he had considerable assets in farm equipment. With his consent, his wife of thirty years divorced him, moved into town and applied for Medicaid on her own. Now she owned nothing, not even asking for alimony because it could exceed the Medicaid qualifying income. She wanted to leave no doubt that she was now destitute.
11
I remember those days. People still sometimes *give* their children to child welfare system
So child can get expensive health care. It’s heartbreaking.
4
One reason people move to FL is because your homestead is protected from creditors other than the IRS and property taxes (which are almost nonexistent and negotiable.)
1
@Don Wiener Just appalling (crying angry tears).
1
Anymore when I go to the doctor in the US or take my wife, I carefully read everything before signing. If there is some language like, "Patient agrees to pay for additional services that may be required during the procedure" , I draw a line through it and note that I do not agree.
I never rely on the doctor or the doctor's staff to give me accurate information about whether a procedure, lab or other clinic is covered by my insurance. They USUALLY are wrong.
I had to get an MRI on my knee last year and the doctor's office referred me to a radiology clinic and gave me the order for the MRI. I asked, is this group covered under my policy. They said, oh yes.
I got on my insurance carriers website to see if the clinic was in my network. It was not. It took the doctor's office two weeks to finally issue the MRI order to a clinic in my network.
The actual health care in the US is very good compared to the rest of the world, usually much better, even in Europe. I've lived on 5 continents and so I have a fair sample size.
But anymore, the patient had better be paying attention to every single document they sign and you cannot rely on a doctor's staff to give you accurate information about your insurance coverage. You have to dig this out yourself.
I have pushed back on unacceptable language in the various releases that they want you to sign and so far, they never challenge it or withhold treatment...so far.
Talk about caveat emptor!
4
And what about the person who doesn't have doctors that can help them and who does give up and gets stuck with that bill? And how can it even be legal for insurers to play this game? Or even worse, what about the person who has no insurance and needs that treatment but has no possible way of ever affording it? What about the person who has to choose between bankruptcy and death, pain or disability? What in the world is "great" about a country that has *zero* regard for people forced into these situations?
3
I'm a legal guardian for a disabled veteran who is frequently hospitalized. A $25,000 bill for a day and a half in the ER is routine. And you can't even use the cheapest Obamacare with $10,000 deductible. If you're so broke you have to buy the cheapest plan, you certainly can't afford the deductible. For profit medicine is a travesty.
16
It's not good enough to warn people about out of network billing. Many people don't have the time to do anything about it. If you're in a car accident and your hospital is in-network but the surgeon on call isn't, what, exactly, are you supposed to do?
I would prefer a medicare for all type system, without insurance companies, (as one person pointed out insurance companies are not in the health care business they are in the financial service business). Short of that, networks need to be eliminated. That can be done by forcing pricing standards, so that, for example, an echo-cardiogram will cost X dollars. That is what the doctor or facility gets. The medical industry can come up with reasonable standards and rates for care or someone, i.e. the government, can do it for them.
7
As long as the republicans control the senate there will never be any legislation to control surprise medical bills. The insurance industry will not allow it.
4
I got one of these surprise bills ($32,000 for a torn retina surgery) and hired a lawyer. It took months but my lawyer managed to knock it down to only a few thousand dollars plus a few more thousand for his fees.
I still can’t imagine what I would have done if I hadn’t been able to afford a lawyer.
Sometimes it feels like like the only thing I get from paying $12000 a year for health insurance is the insurance company knocking off the excess bloat the medical community charges me for having insurance.
Someone I know online got a $800 bill (knocked down from $2000) for a simple procedure, and when he demanded to know what he would have been charged had he been uninsured, he was told $100.
Last year I paid over $50,000 in income tax which paid for corporate welfare, a bloated military, and employer based healthcare subsidies that I am not entitled to since I am self employed.
My parents keep telling me I should move back to Canada. My answer that “I don’t like the cold” keeps getting lamer every year.
10
@hypo: you’re very lucky to have the Canadian backup plan. My brother in law kept a dual citizenship for that reason.
I wonder if hospitals bill for stays at dirty and overcrowded emergency rooms (like those at Weill Cornell)as if the patient was being cared for in a regular unit when they have no rooms available for anyone but VIP patients paying privately.
2
Weill Cornell does not have an emergency room; you probably went to NY Presbyterian
Thank you for this. I watched my mother fight her health insurance company. She lost and did go bankrupt. I laugh when I hear people say, "Americans love their health insurance companies". One day I hope we will look back on health insurance companies the same way we look back on snake oil salesmen of the 19th century while we enjoy universal healthcare. Go ahead and roll over in your grave Ronald Reagan!
10
$145,000 for what procedure? The idea that one procedure costs that much is in itself outrageous. And Insurers pay that bill, because they can, by simply raising the cost of insurance. This is madness that has to stop. That operation likely cost 10K in the rest of the world.
3
Universal health care is needed. A "bare bones" insurance system like Canada's works, as does a National Health system like in the UK. But Bernie has proposed platinum care insurance - the most generous in the world - that would increase the Federal budget by over 60%, from about 4.5 trillion to 7 trillion. A more moderate approach, such as gradually extending the age of current Medicare eligibility, or the public option originally proposed under the Affordable Care Act, would be more prudent, more affordable, and more politically achievable.
3
Out of network balanced billing should be illegal in every state. It happened to me 3 1/2 years ago. When you are in an ambulance on oxygen and unable to speak, you can't really discuss in network vs out of network doctors. Colorado recently passed a law to protect us from this.
7
How can we possibly get unbiased opinions and sound medical advise from the medical community if their true masters are insurance companies and their corporate bottom line?
I had a pre-authorization for a procedure for an in network thing and still got hit with an additional $2K bill!
5
The insurance and for profit healthcare lobbies are powerful.
They are currently working hard , fueling skeptical media coverage of anyone proposing Medicare for all.
Media lap this up because healthcare, insurance, medical are big advertisers.
8
"If Senator Elizabeth Warren winds up not becoming the nominee, it is possible that one reason for this was voter uncertainty about her “Medicare for all” proposal."
Warren is down in the polls as of Feb 19th, because she showed herself uninteresting in standing up for strong nationwide single payer medical insurance.
Then there was her invention about what Sanders didn't say in a private meeting in Dec. 2018.
1
The factual truth regarding America shifting from the for profit, charge as much as you can, parasites that are the health care insurance companies; to a single payer system with optional supplemental private policies, is that over a half million useless irritants will be out of work, hundreds of CEOs salaries totaling over $400 million a year will not arrive in time for this year's new Bentleys, and billions in stock investments will have to find new homes. The difference will be hundreds of dollars a month back to the consumer who will spend it on other stuff, stuff that will invigorate the economy. It will cost less over all as Americans pay twice as much as the three dozen higher quality systems world wide.
With unemployment at 10%+, Obama could not have made the jump. Now, with unemployment at well below 4%, perhaps it's time to bounce the parasites and take our country back.
9
We hate our insurances companies, yes, but it may be even more apt if we also (or primarily) hated the hospitals, medical specialists, and medical products (devices and meds) that bill the kinds of insane fees and cost the insane amounts that then get dumped (for insured patients) to their insurers in the first place. After all, insurance companies don't actually start the insane medical cost ball rolling- they're just the ones in the middle. This is not to excuse them, but to put matters in a more proper perspective.
It's often occurred to me that people primarily blame and vilify insurance companies for healthcare cost ills because for the more primitive, unconscious aspects of our psyches it likely feels safer than 'going after' the actual source of our healthcare. Again, I'm not letting insurers off the hook- but they're not the ones actually generating our astronomical medical bills.
1
My wife had an appendectomy in France. Total bill (not our share) ... $3,500.
6
good piece; any who still is not convinced that Medicare for All is worth trying should listen to the 15-minute John Oliver summary of the topic -- the 4.5 million people who've viewed it couldn't be wrong.
denying health insurance to over 20 million Americans still after the Affordable Care Act is 10 years old is just mean-spirited.
and the states -- unlike Maine -- hooray Janet Mills ! -- who have still not jumped on the "Medicaid expansion" -- 90% funded by Washington, not the states themselves -- are mean-spirited and just stupid since it's leaving free money on the table that sure would pay for a lot of hospitable staff who could then rent homes, buy groceries, pay taxes, maybe buy a book, eat out, or go to a movie once in a while... you know, have a life.
8
I live in Italy, a country with many problems, and yet, the nationalized health care system works quite well. Everyone can see a doctor. Tests and procedures cost very little. No one files for bankruptcy due to medical bills (because there aren't any). Employers have nothing to do with your health care. Doctors' offices have no "billing or credit departments." There isn't a whole other industry of sharks (attorneys, collection agencies, etc.) to pick your bones clean after you are unfortunate enough to go to a hospital. Italians enjoy some of the best health and longevity of any nation. There isn't a sense of impending doom about the whole universe of health care here (and in Europe in general).
You know why Americans will never enjoy a reasonably priced, sane system? 1st and foremost because the medical system (hospitals, doctors, specialists and pharma) make way too much money and like things just the way they are. They're doing quite well. The second reason is Americans have been brainwashed into believing that nationalized systems are "socialist" and, therefore, unacceptable. Well, too bad. There are better models that many other countries use.
18
I’m taking bets re if the senate will vote on the bill. I’m giving 100 to one odds it’s dead.
Someone pls explain to me the republican plan to replace Obamacare. Did I miss that chapter.
4
A small but odd request: please don't hate colonoscopies as the author indicates. Colorectal cancer is a viscous yet preventable disease. How? By appropriate screening and yes, a scheduled colonoscopy. Huge medical bills and human suffering can be avoided.
2
Healthscare, not healthcare!
2
Insurance companies are not the evil boogyman that the Left likes to demonize, in their feeble attempt to ram single payer down our throat. They are no more evil than your homeowners or auto policy insurer. I like my insurance company. They've paid every claim we've ever submitted, including several complex hospitalizations. Who else is going to pay for your $145,000 knee surgery, your $1 million cancer claim? Uncle Sam? If the Federal government takes it over, thereby asking taxpayers to foot these bills, the Federal government better be asking the same questions. Is it necessary? Is it urgent? It's entirely possible the procedure mentioned would not be covered at all in a different country, or you'd have to wait 2 years or longer, if it was.
2
First, American medical procedures cost much more than the same procedures in other countries. Why is that? Second, it's ridiculous to compare health insurance with auto or homeowner's. The former literally can decide whether you live or die by approving or denying a lifesaving procedure.
8
@Steve
Oh really?
Is that why my sister was bankrupted by having cancer?
And the only insurance she could get after was $1600 a month?
She died anyway.
Meanwhile my ex husband who lives in France had bladder cancer and did not pay one penny.
He’s fine 30 years later.
So explain to me how the “ left” is trying to ram affordable healthcare down anyone’s throat?
We are just trying to survive.
12
@Steve
I have many Canadian friends who have had complex Health Care issues. Hip and Knee replacements, Cancer treatments.
They never worry about your "$145,000" knee surgery bills, because the cost of their care is shared, through taxes by all Canadians. And that same knee replacement, in Canada probably only costs $5-6000. No premiums or deductibles for my Canadian friends, and they never receive a bill, or collection notice..
Meanwhile for Health Insurance here in the US, I was paying as much as $1700 a month to insure my family
The only people who have to pay $145,000 for knee replacement, are those without insurance, in the US, who are then hounded by collection agencies, or bankrupted. The patients covered by large insurers, that have contracted for lower prices pay nothing.
What a terrible , punishing system for the uninsured or underinsured.
4
even with Medicare never pay the first bills. They tend to decrease from fist thru third. The computers are set esp. by the supplemental insurance providers. Just wait...and the computer re-adjusts.
Obama was a good Republican in this way and others... and tne ACA needs to be done away with ASAP or do too many believe all the hype?
2
US healthcare insurance is a Wall St product by design helped by Republicans and lobbyists. It’s a way for a few thousand executives to get rich on the backs of workers. And to keep them scared of socialized medicine. Subsidizing Apple and Amazon, no problem. Total scam.
4
Medicare for All may make or break the election for Democrats this year. Without a doubt, some people will prefer the devil they know. I can tell you this much though from someone North of the border, whose country has had such a system for nearly 60 years now. No, it's not perfect. Far from it, there's always grumbling. Yet one thing is certain: Once this program is enacted, it quickly becomes political orthodoxy. There is no shortage of conservative politicians and voters in Canada, many of them as extreme as yours, yet not one of them says we should scrap single-payer healthcare and go back to a private system. I suspect conservatives in the US know this, and it is the basis of their fears. Once passed, this thing is never undone.
7
Stay poor and on Medicaid. I had major lung surgery 5 years ago that would have cost hundreds of thousands of dollars. It cost me $0. Over the past 5 years I’ve had good high paying jobs although I have always purchased my insurance through NY State of Health. $700 a month and nothing was really covered because I couldn’t make the deductible. Fast forward to last summer and I was laid off. Went to a navigator and got on Medicaid. I don’t know what I’ll do once it ends in 6 months. The only good thing about being broke is knowing I have the best Heath insurance you can have.
4
Taking care of our health shouldn't require jumping through hoops. Of course people should treat their bodies properly avoiding unhealthy consequences. Being human ,occasionally a functioning system needs attention. Healthcare vs. health insurance doesn't make sense the two aren't equal.Mercenaries run health insurance companies the USA. Their primary concern is profitability for stockholders, not quality of healthcare for consumers. Somethings gotta give! Every American ought to insist on the same healthcare afforded to all members of Congress, after all We the People are paying for it too.
1
Dear fellow Americans I really feel for you. When my son was three months old he was diagnosed with bladder cancer. Through the utter shock and trauma of having to live through the ordeal, I am forever thankful and grateful to the French health care system. I did never had to worry about costs. I just needed to focus on my son and his recovery. No parent should have to worry over health care costs for their child. I really hope we manage to elect Bernie Sanders or Elizabeth Warren in the next election.
7
Most developed countries have “socialized” medicine with an option to buy additional coverage through private insurance.
It’s not that difficult...
19
I had some surgery recently, and I was really pleased with the process. first the surgery center contacted my insurer to double-check on pre-authorizations, and then they got in touch with me ahead of time to let me know what my out-of-pocket costs would be. so far they've been less than the estimate. I thought that worked well, everything was upfront and I went there confident that I knew how it would turn out.
I slipped and ruptured a quadriceps tendon will hiking in California two years ago. I presented my insurance card to the EMT and was taken to the hospital. At the hospital I talked with an agent of my insurance company and was told that I was covered. Surgery was done the next day and I was held in the hospital for some tests that turned out to be completely unnecessary. Four months later I received a bill for $132,000 and because the insurance company had denied the claim. Four months and $6,000 in attorney fees later, the insurance company decided to pay.
The objective of the American health care system is PROFIT. Human well-being is a distant second.
23
Doctor's are skilled and trained to deliver medical care and advice, but they generally have very little sense about the nuances and intricacies of medical billing which is why they have support staff to assist them with these processes. Eventually, the profitcare system gets so convoluted that no one really knows what is going on. It makes sense to have a system that makes no sense at all: it's not designed for efficiency or care, it's designed to maximize profit at the expense of everyone else.
7
We may think we have it good here. We do not.
If I get seriously injured or sick, I would hope it's in India near one of the better hospitals there.
Never thought I'd say that in my lifetime. But we have enough experience with India to know there is good, reliable, affordable health care there.
Travel, people of the USA. Travel far and travel wide. Your eyes will open.
7
We took our 8 month old son to the ER when he had what built to a 104 degree fever that wouldn't go down after a couple days, and his soft spot seemed to be swollen. We of course checked that the hospital, Hackensack University Medical Center, took our insurance before going.
When we arrived, the front desk took our insurance info, admitted us, and shortly after we met with a doctor. After briefly observing him, the very nice doctor ended up telling us that nothing seemed wrong, and that he just had a bad fever and to continue normal meds. We were in and out in 35 minutes.
What a surprise when a couple weeks later we received a $950 bill for the visit, explaining the doctor was out of network. Why in the world would a hospital that advertises they take our insurance, then took our insurance info at the front desk, pair us with a doctor out of network and the perform a "gotcha" AFTER the fact? I'm sure we signed something in the discharge papers that binds us to this, but do we really have to say to the front desk and/or the doctor that we'll only see someone in network? Is it REALLY not implied when we give the hospital front desk our insurance cards that we intend to actually use a doctor in network?
I've read since then that NJ has a new law preventing this, but only for insurance from NJ employers. We're NJ residents but my wife's a teacher in NYC and we use her insurance.
How do hospitals get away with this? I take full accountability, but this is plain sneaky.
8
@Thomas - I had a similar episode a few years ago at Waterbury Hospital in Waterbury, Connecticut. Hospital in network? Check. Emergency Room services in plan/network? Check. ER doctor in network? Whoops, turns out that he wasn't, so I ended up paying nearly $1,500 out of pocket after having spent all of about 5 minutes with the doctor.
2
And be aware of the "hidden provider". I delivered twins in an in-network hospital with an in-network OB/GYN. They were born early (at 34 weeks). I didn't require surgery to deliver and the boys were fine (if tiny). They were in NICU for 4 weeks. Within a few weeks, I began getting EOBs for their care. Half showed they were denied by insurance (not uncommon, the insurance company couldn't figure out I had two kids and decided they were being double billed). Then I started getting bills directly. Apparently NICU was contracted to an accepts no insurance outside outfit called Pediatrix. Then I got a "courtesy call" asking for good faith payment on $100,000 due for the boys' 4 week stay in NICU. We threatened legal action and drilled through bureaucracy to reach corporate legal in Florida. We successfully managed to get Pediatrix to accept the insurance negotiated prices (i.e. Pediatrix billed $900 per day per child for neonatologist to oversee care and insurance only willing to reimburse $150 per day per child). It took 11 months to resolve. We were insured, had checked about networked services, and we were NEVER told that the NICU was administered by an out of network provider.
9
The insurance companies are very scared of losing 500,000-1,000,000 jobs and 100s of $1-50 mil executives.
The medical industry is the largest lobby with $4 bil/year!.
Medicare for all would cost the same as the the present system but much less useless and scary overhead and waste. 45% of health care is paid by Medicare/Medicaid/military/Indian.
Uninsured patients get their medical care via bankruptcy and then welfare.
3
The constant refrain that Americans like their health care is bogus! Every November you have to choose from a variety of options, none of which is affordable and doesn't cover everything. The coverage I have had in Spain is fine. I had a pulmonary embolism and was hospitalized for 10 days. My bill? ZERO! In Germany, you have options and I had to pay a contribution from my pay, but everything was covered. I had a small co-pay on certain medications. Did I ever wait for a pre-auth from the insurance company? No. Did I have to wait for an MRI or other diagnostic? Maybe a few days to a week. In the US, I had to wait weeks for the pre-auth and then after that in hand, wait weeks more for an appointment. So it is total nonsense that the US has the best health care and that universal coverage will cause undue burdens. Just follow the German, Swiss or Finnish models. (Sure the UK and Canada need reforms.)
5
The German system is similar to the American ACA. It is more variable and not as good as public, universal healthcare in UK or Canada.
1
Virtually every developed country and even many 3rd world countries have equal or better overall healthcare than the US. Been there, seen it, experienced it, from Europe to Cuba to Central America, etc. Nevertheless, many of these countries are experiencing the pain and dislocations of rising costs, albeit from a lower base.
We would do well to leapfrog over the various current iterations of national health care and move to a two pronged system.
First off, everyone pays out of pocket for all care up to a point determined by their income. That would reintroduce a true marketplace in healthcare, not the quasi-monopolies. Healthcare costs would drop like a stone.
Second, everyone has a centralized Federally sponsored backup plan that reimburses for all medical costs over a certain threshold, say 5% of gross annual income with adjustments up or down for various income levels. The backup plan would be funded by tax dollars and would eliminate all the myriad of programs out there, ranging from Medicaid to VA to Medicare, etc. All the billions currently going into those plans would be consolidated to pay for the back up plan.
Bottom line, everyone has skin in the game and responsibility to decide and pay for their own healthcare. A true marketplace controls costs. We as a society backstop everyone against financial catastrophe brought on by medical bills.
3
Between my contributions ($5, 500 /year) and my employers contributions ($26, 500/year) my health insurance policy costs $32K/ year AND I have the HIGH deductable plan otherwise my premiums would be 3 times more.
How is that not a tax?
BTW I've always wondered how come my health insurance policy costs about half the median american family income.
We are a family of five and only do wellness visits and have no existing 'conditions'. I insure my family against a 'catastophic' illness or event. Luckily I work for a large employer, but what if I didn't what would my premiums be?
People say they love their employer health plan-I hate mine. I pay I pay I pay for that catastophic day.
Single payer is the only conservative way to solve health care for the nation. Sorry insurance companies I will really miss you (not).
9
It never ceases to amaze the angst created by the thought of government controlled healthcare for all. My husband had a stroke, CT, MRI and five days in hospital - total cost to us $0. Ongoing costs for prescriptions $20 every three months - cost of healthcare insurance $0. Taxes have a top of 33cents in the dollar after $75000. Why don't you want that? We also have the provision for private medical insurance if we wish.
6
Insurers are currently in the process of dumping physicians like crazy to ensure that families like Jenny’s face a lot of “surprise medical bills” just in time to ensure that they support this legislation, which; no one understands: is insurance-industry friendly; propagates our current completely-unsustainable insurer-based system; which, in turn, no one understands.
Physicians, like Jenny’s, want to see your bills easily payable and without bankrupting your family, We also want to see our own salaries paid without bankrupting us. Most of us have crippling debt into our fifties. Most of us would not counsel or support our children to go into medicine. Our residents finish residency with between 100,000 and 300,000 of debt at the age of thirty: a house worth of debt, except there’s no house to live in. Rural America is actively hostile to educated people, making that a hard place to take your degree (though several of my residents have recently done so.).
Most physicians’ groups are opposed to this apparently benign, but actually incomprehensible and pro-insurer legislation. And many physicians urgently favor single payer.
6
My blood boils every time I hear a story like this, and this is not by a long short the first one I've heard. The Democratic Party needs to make sane health care a major topic in the next presidential and congressional races. This type of deceit and bad faith on the part of health care insurers has been going on for far too long. Enough.
3
Our healthcare system can be inefficient and downright cruel, BUT it also represents almost 20% of GDP. As a result, there are too many stakeholders who want to preserve the status quo. And I wish it weren't the case, but Medicare For All is DOA for the same reason.
The smart political strategy is to add a public option to the ACA, thereby putting pressure on all players in the industry to improve quality and efficiency--or they die. Let the market decide.
Finally, while many expensive health problems are tragic and not preventable, others are caused by terrible lifestyle choices (e.g., obesity, smoking, and lack of exercise). We need to elevate the civic importance of healthy lifestyles, i.e., "my health benefits you, and your health benefits me..."
@David The insurance industry will never agree to compete head-on with a tax-funded government plan on the same terms for the same customers. Their lobbyists and paid-for Congressmen will fight a public option just as hard as Medicare for All. If it made it through Congress, it would be so watered down or so expensive that it would do little good for anybody who might want it.
1
Republicans hate healthcare because they hate paying taxes- they hate healthcare until they get a bill then they love the ACA or Medicare or Medicaid but they don’t want to pay a penny until they need it
Which is why we must vote them all out- they are not working for us, they are working for donors.
No one should have to declare bankruptcy and no procedure should cost $145,000
Our healthcare pricing should match fees charged in U.K., Australia and Canada
And that goes the same for drugs
This is republicans fault and Joe Lieberman.
4
Rather than drastically scrapping the employer insurance system and going all in on universal healthcare, just raise Medicare to cover children up to 18-year-olds and all people 50 and over. This could be a start to see how the system handles all the new people in the program and go from there.
3
The most important sentence in this person's essay is this:
"I went to bed that night not knowing whether we would have to declare bankruptcy in the morning."
Our current insurance scheme (it is not really a "healthcare system") is psychological torture. How many physically sick people and their loved ones are suffering clinical anxiety and depression only because of "surprise" medical bills, a stack of medical bills they can't pay and fears of losing their homes to medical debt collectors? How many uninsured pregnant women consider suicide because they have no means of paying prenatal visits and a hospital delivery?
Financial pressure of any kind can break up marriages and provoke family violence. The stress of a major illness or an unplanned pregnancy is bad enough. Add the stress of "How are we gong to pay for it?" and that is a prescription for mental illness as well.
Our nation's medical payment system, like its medical professionals, should "First do no harm." A sinple, "no surprises," single-payer, guaranteed coverage insurance system would give every American peace of mind and improve our mental health and family stability. Please, let's do it.
9
Jared Kushner is working on a new plan to give ALL of our medical record information to big tech to manage. What could possibly go wrong with that scenario?
9
"It would be nice just once if our insurance companies were filled with terror by the prospect of losing us."
Amen!
8
“The bill was fixed, and our family is not, as I feared, wiped out.”
There you have it, but most importantly, your child got the procedure he/she needed. Once we’re all dependent on Medicare, a procedure will need to be preauthorized by Medicare to get it. You opted to have this procedure and got it. Even if you had to declare bankruptcy, your child would have gotten the procedure. Under Medicare, if you’re denied, good luck fighting the government.
1
@Mark There are now and always will be elective procedures and experimental and proven ineffective treatments that no insurances will pay for, and neither should a government plan. Not every disease can be cured by modern medicine. Still not a reason to support the terribly expensive and mind-boggling mess we have now.
4
"Fortunately for our family, my child’s doctors did not give up. The bill was fixed, and our family is not, as I feared, wiped out."
It's a totally dysfunctional system that requires this kind of extra stress and work on the part of both patient and provider. We need Medicare for All and we need it now.
6
I maintain that the idea of reform has been pitched to the public wrong. If I said we were switching your car or life insurance to a system where your coverage and price is based on the size of your employer, you'd be outraged. But that's exactly the system that evolved for health care. Your "deal" is based on your risk pool, which is defined by big employer, small employer or individual (for all those not covered by a big employer or small employer.) And if you shift between those categories -- voluntarily or due to job loss --your "deal" automatically changes even though you're the same person.
7
I was caught in a fight between the hospital/physicians and my insurer. I spent countless hours on the phone, completing and sending in forms, researching coverage and denials, etc. I finally had to threaten a lawsuit for the matter to be resolved.
I was originally going to be on the hook for well over $100K for a series of medically necessary procedures (I had a very serious accident, with trauma my surgeon said resembled that of IED victims she had worked with) and at the end of the day I received a $3000+ refund. What was all that wasted time/effort and anxiety for? Nothing. The insurance company hoped I gave up, or messed up, or died. The hospital wanted their money no matter what, and accepted no responsibility for their part in this mess.
American is broken.
11
"It would be nice just once if our insurance companies were filled with terror by the prospect of losing us."
This is a great line! However, I'm afraid insurance companies being "filled with terror by the prospect of losing us" is exactly why the political "argument" (if you can call it that) against Medicare-for-All is so completely disingenuous. That is, the terror of the health insurance industry somehow losing a place at the very lucrative table (or, perhaps, a trough filled with money) because of a President Sanders or President Warren has very clearly distorted the discussion and, by extension, the Democratic presidential primaries.
1
Two issues with this article
1. The writer states that if Warren is not the nominee it will be partly because of her Medicare for all proposal. Yes, Warren has slipped in the polls, significantly, but Bernie is way out ahead. And he wants Medicare for all, too.
2. The surprise bill for $145K turned out to not be a bill, after the doctor straightened it out. So she's complaining about having to pay something she never had to pay. It's the whole premise of her article, and it didn't happen.
I am not against "Obamacare" or Medicare. I am 66 and absolutely love my Medicare, and wish good insurance for everyone. It is this article I have a problem with.
4
@chrisinroch I think her point was that Warren has slipped in the polls because of attacks on her M4A position, and that the same may be in store for Bernie, too. By my reading, the author definitely seems in favor of M4A, but I don't want to speak for her.
2
The sad thing to me is that Elizabeth Warren has a plan for this (as, in fairness, does Bernie Sanders). But apparently Warren can't win because not only the Republicans but most of the other Democrats have frightened Americans away from her plan.
When it comes to health care, Pete Buttigieg and Amy Klobuchar are no more helpful than Donald Trump. They are promising a public option that won't be free and therefore affordable like Warren's and Sander's plans are, won't cover everyone, and will still have strict limits on provider choice, as well as complex enrolment, billing, and claims processes.
Americans are so worried about losing what they have—or god forfend having to pay for something for someone else—that they keep voting for plans that cost them way too much money, leave millions uncovered, and drive thousands into bankruptcy.
9
It does no good if the bill is not a surprise. It is still impossible to pay. Private health insurance is a parasite that controls access to health care, squeezes the last drop of blood out of our patients, and crushes any physician who complains. Private insurance is undermining Medicare through so-called "Medicare Advantage" HMOs that can always increase profits by denying care.
10
@Dan Woodard MD
Medicare Advantage plans also can restrict networks where the Medicare patient will be treated. Medicare Advantage plans are permitted to bill CMS more for services than traditional Medicare plans.
So Congress voted to allow these Medicare Advantage plans to permit "Free Market Innovation", but really they are just bleeding CMS of funds, costing more, and reducing coverage through denial of care, or limited networks. In other wards a scam for consumers.
My wife and I chose traditional Medicare, with a Medigap supplement.
1
Our elected officials are owned by insurance companies. Thus, we pay the insurance companies, as well as the hospitals and doctors, so that our elected officials are comfortable.
If our elected officials didn't have the coverage they're provided with, perhaps they would be more thoughtful about the citizens they represent.
4
the insurance companies are terrified by the prospect of "losing us". if medicare were available to anyone who wants it (what a radical concept), private health insurance companies would lose subscribers. like most things in our culture, it's all about the benjamins, baby.
4
The two most essential functions of an insurance company: 1) Collect premiums, 2) Deny claims.
12
@Peninsula Pirate That is America. No different serve in the military all is fine until you make a claim for injuries connected to your service. It is called use, abuse and discard. Jim Trautman
4
Insurance is besides the point in this article.
This is a situation caused by care providers working the system to avoid often reasonable limits of insurance reimbursement schedules to stick patients directly with exorbitant bills.
In terms of who receives the largesse (assuming the patient can pay), you'll usually find the doctor who actually performed the procedure way down on the list.
The entire system is set up to put profit over patient will being at every turn. The problem is runaway, unsustainable cost inflation, not that insurance is required to subsidize it.
2
The U.S. health insurance industry reported 2018 total premiums of $715 trillion. They reported payments for medical payments and hospital payments of $597 trillion. The insurance companies made a gross profit of $118 trillion for the year 2018. For 2019 the Medicare trustees reported income of $756 billion and payments of $741 billion to cover 60 million Medicare recipients. Medicare is covering their recipients for an average of $12,350 per person. If Medicare for all covered all 330 million Americans with the same level of care and expenditure of current Medicare enrollees, it would cost $4.1 trillion. Less than 10% of the PROFITS of the health insurance industry.
I was dubious about Medicare for all until I did this research. I am on Medicare. I get really good medical care. I also have a Medicare supplement policy which is a personal choice under Medicare.
The answer may be Medicare for all. The answer may be regulation of health insurance companies. But clearly cost is not a concern. That $715 trillion came from all of us paying health insurance premiums. The difference between $715 trillion and $4.1 trillion would clearly be an enormous reduction in health care costs even though we may pay to a different vendor.
(Source: National Association of Insurance Commissioners and the 2019 annual report of the boards of trustees of the federal hospital insurance and federal supplementary medical insurance trust funds)
6
I think you mean billion.
I like the taste of lima beans. I don't hate my medical insurance.
Medicare for all would be very expensive, most estimates are off the chart expensive. Note that Bernie refuses to discuss the cost. Middle class taxpayers will be soaked; that's where the money will be found. There is no way a small number of billionaires can pay the medical costs of hundreds of millions of Americans.
Quality of care will degrade. The healthcare system is already overloaded; long waits for doctor appointments and non emergency treatment is the norm. And emergency rooms are often overcrowded too. When "RomneyCare" became law in Massachusetts, experts predicted emergency room traffic would decline. In fact, emergency rooms have become more crowded than ever.
In addition, some doctors and nurses will retire early if cost control measures are implemented, further stressing the healthcare system.
Medicare for all sounds nice, yet the implications for middle class taxpayers will be painful, in two ways, a) much higher taxes, and b) degraded medical care. Despite progressives' obfuscation, please be aware that most voters won't be fooled.
1
@Stew R How do other countries do it? My sister lives in both Italy and England and their healthcare systems are wonderful. So is Canada's. So why can't the US do it? And by the way, check out Elizabeth Warren's plan.
13
@Stew R
And yet it works fine in Canada.
The sad thing is that the American voters are fooled. But not by the liberals. By the conservatives.
7
@617to416
Prosperous Canadians travel to the U.S. for medical care. I haven't heard of Americans traveling to Canada for medical care. Perhaps there is a good reason for this imbalance.
1
I’m not sure why the democrats don’t emphasize the nuts and bolts of health care since on the issue alone they would claim majorities in every branch of government. I guess that they get generous campaign “donations “ from the insurance industry, like their republican brethren.
3
I have long believed that the Republicans in Congress don't want to do anything about our crazy health care situation because it was someone else's idea first. They can't stand to admit that other countries do something better than the USA. If they are truly worried about integrating the existing employer-based insurance setup, they should talk to the people in France and Switzerland who had similar situations to us at one time, but managed to go to national, single payer systems where everyone can choose their doctors, hospitals and clinics.
3
Seems as though a call to your insurance company regarding the out of network provider would have been a good idea.
2
The idea of that is so, so scary. I somehow think death is preferable to drowning in debt.
I make a point of keeping my personal debt under tight control; try not to spend needlessly, pay off every month, I don't even have a car payment preferring to drive my beat up old 2009 to having to make that monthly payment. One thing I know, if I were to be diagnosed with a life threatening illness that, to save my life I'd have to go into mountains of debt; I'd look for the nearest Fentanyl dealer.
1
I know of a doctor in Vero Beach Florida that only will accept certain insurance, no Medicare whatsoever. Then again he does have a very expensive former flight attendant wife with a private 10 acre equestrian center to maintain.
3
I'm so sick of reading these medical horror stories. Nothing ever gets done. I'm afraid nothing ever will get done. We can count on only one thing from our government. Another war.
The American Dream: "Because you have to be asleep to believe it."
6
"We hate them more than colonoscopies."
Medical myths can be dangerous. This is off topic but it must be said. There's nothing to hate about this procedure. It can save your life, and it's painless. Avoid it at your peril.
4
I think Americans who support the current system are morons. And this isn't a jab aimed just at uneducated "deplorables" but many of the well educated and "liberal" people with whom I spend my life. Americans simply don't know how much they -- or someone else -- spends for their healthcare. We are hobbled by a kind of willful innumeracy. Thank you Jennifer Boylan for showing us what it will take for Americans to wake up to what this system costs us.
I'm lucky to have a terrific health insurance plan for which my employer pays upward of $19,000 a year. For this I contribute $540 per month (for a single policy -- for family coverage, I would be paying well over $1000 per month). The plan has become more and more expensive both to my employer and to me as an individual over the years. All totaled, my healthcare now costs me and my employer over $25,000 a year (this includes co-pays and out of plan visits).
When enacted in the 1960s, Medicare, together with Social Security, lifted a large number of elderly out of dire poverty. These programs freed families from having to take on the care of their parents and allowed them to redirect money to educating their children. Imagine the tuition cost saving for families if my university were not paying in the neighborhood of $10 million per year to insure its employees.
We have lots of examples of more cost efficient -- and excellent -- medical systems. Let's stop being stupid, do the math and make our lives better.
4
"Fortunately for our family, my child’s doctors did not give up. The bill was fixed, and our family is not, as I feared, wiped out."
Wanna bet that the outcome would have been quite different for a family without a platform at the New York Times?
6
Oops, a small mistake. Ms. Boylan wrote, "the cure for American health care is the kind of universal coverage that virtually every other civilized nation has." The word "other" does not belong there.
9
It's not just Republican Senators stalling legislation Schumer
is not supportive had to be pressured to agree
https://www.buzzfeednews.com/article/paulmcleod/surprise-billing-deal-richard-neal
Also note the part about doctors backed by Private Equity
I have always felt that receiving health insurance from an employer was like indentured service or slavery lite. If you lose your job you lose your insurance. It's great way to keep people on the plantation for life.
8
Insurance plans that are tied to a particular employer distort the economy. They encourage people to stay in jobs they hate, to refrain from starting their own small businesses, to refrain from moving to new regions to look for better opportunities, and to seek full-time work when part-time work would allow them to raise children or care for an elderly relative. It's a dumb system that is really just an historic accident.
4
Reagan hated Medicare because republicans hated to pay taxes and hate any program that taxes their wealth. The idea of shared responsibility and caring for the less well off is anathema to them.
Greed is great.
If you are poor you are less worthy as a human.
But you can be diverted from this concept if we just appeal to your prejudices.
4
Surprised? Not so much anymore. None of us is immune. The outrage is not sufficient to overcome the power of money to buy enough members of congress to allow this game to continue. We are like we are because we are like we are
3
My wife and I pay $4000 yearly in premiums for a plan that pays nothing until we spend an additional $10000 out of pocket. We pay it for the purpose of receiving some mild sense of assurance that we won't be fleeced and lose every dime we have worked for if one of us suffers a terrible accident. Forget about preventative care.
We are literally spending money on absolutely nothing. The industry has taught us to fear the possible financial consequences of unexpected heath care expenses and we pay premiums to help alleviate that fear of our life being ruined by our healthcare providers. That is truly sick.
8
@CS
I'm in for more than you annually, by a factor of 4-5 -- and I never, ever want to use my insurance.
That is the level of distrust and fear they've managed to embed in my psyche, and I would guess, a large number of 'gappers' -- anyone 50-64.999 yrs., who doesn't have employer healthcare coverage.
I have it, and we pay it, so, hopefully, if I am unable to advocate for myself and it does get put into play, my husband won't be saddled with huge bills. Yet, despite all these pro-active steps ... who knows?
2
I have never heard or experienced any doctor or specialist willing to discuss insurance coverage. The first thing they all say is "I don't know anything about coverage, that's (insert biller's name) department." So, this seems a bit naive to trust what a doctor says in lieu of what their actual insurance carrier says. Why go out of network? Just seems like they created their own disaster.
1
Trying to get costs associated with any number of medical procedures is daunting at best. With insurance costs and deductibles so high, wanting to know the price up front isn't a stupid question but a very important one that needs answers. Hospitals don't seem to have those answers readily available. Ever ask for the charge for that ultrasound? or MRI? Good luck. But you'll find out 3-4 months later when the bill arrives.
3
Years ago I was assured up-and-down by the Morgan Stanley Children's Hospital that oral surgery would not exceed $2,000 after insurance. I was very insistent and went back time and again to nail this down.
Of course, the bills started coming in afterward.
A little from this department, a little from that department, until it added up to more than double the quote. I called and everybody played dumb; suddenly no one could speak for the whole bill since it was split up around departments.
I threw them out, playing chicken with the hospital.
This went on for some months, until my well-meaning wife paid them.
They found a sucker. A month later a new round of bills came in, totalling about another $900. We threw them out and we never heard back.
My opinions about the healthcare industry and its need for reform to instill some public virtue were pretty well formed at that time, that incident etched those ideas into stone.
6
I don't know what procedure the author had, but if she had gone to the Surgery Center of Oklahoma or similar outfits that are popping up across the country, she'd have known the all-inclusive price in advance and wouldn't have had any surprises.
https://surgerycenterok.com/. When people pay for medical treatments directly, prices are reasonable and transparent. When they rely on insurers, Medicare, or Medicaid, they are not. When we buy health care the same way we buy everything else, the many problems with the system will disappear.
2
Yes, keep attacking Bernie for his crazy idea of Universal Health Care. I live in Ontario I have a card when I go to the doctor or yes, he does have to refer me out for surgery or scans, he is the gatekeeper. Show the card and it is swiped and no bill. Yes, it comes out of our taxes, but you know what Canadians don't care like in the other industrial countries. If one loses their job the health coverage continues on without missing a step. I love it how it will cost the US to much bankrupt America, interesting that it is always social programs Rand Paul. Mitch and the the robots of the Republican Party have a problem with. No problem passing a giant tax bill for the 1% who pay little now or pass a defense bill bigger and bigger and then the money that is in fact good allocated for base housing, water plants, hospitals, day care centers on the base, stolen to build a Wall that I though Mexico was paying for. Watch when Boris Johnson comes calling for a socalled "free trade" deal here is a clue nothing is "free" what he has already been told is that the National Health Service will be on the table. That lackey Farage who is always on FOX/Pravada gets $500,000 a year to lobby for Banks who is a friend of Trumps and owns health insurance companies. It is all about greed and money. But yes, lets see in three years of Trump the deficit and debt have skyrocketed and no infra structure program even, so what and who exactly did the wonderful tax bill benefit? Jim Trautman
5
Americans do not participate in a health care system because there isn't one in the USA. There is a financial care system that some lucky people have access to, but unless you can pay for it, you won't get much health care there.
8
In one month, I was denied a back procedure that a test showed would help and my doctor recommended. The test was covered (and it was painful), so why wasn't the real procedure? That same month, my son's insurance said they would no longer pay for the $3,000 a month treatment that kept him alive. What changed? All his doctors recommended it, and the treatment allowed him to go from a sickly home schooled child to attend a university full time. What changed?
You only think you have good covered until you need it. Both of our plans were the best available, I was told. In my case, I met my $6,000 yearly deductible, so the insurance was on the hook for the entire surgery. The doctor told me that lots of people were being denied at the end of the year. I wonder why...
We need to get out of a system where insurance companies make more money if they can deny your medical treatment. How can this possibly make sense?
7
I simply don’t see how you can have a for profit system when it comes to insuring people’s healthcare.
It’s fundamentally a contradiction.
Why would an insurance company ever want to pay you a dime for anything? That’s one less dime for them. And that - is not good for your health or your pocketbook.
Sadly, Progressives (as usual) have not been able to cut through the right wing lie, power & greed machine to fully educate people as to how much better off - in physical, mental & financial health they’d be with Medicare.
7
The idea that someone may be helped by the government is anathema to Republicans. Especially when the Democrats have suggested the change. It's just not the "American" way.
4
The way that US health care work is to take a benign condition and turn it into a malignant economic and mental health condition. But, we deserve the healthcare we have because we keep voting against our interests.
2
Millions more are going to get hammered by the for-profit "health care" system for decades to come. America is in public policy gridlock and even a President Sanders, should it happen, will not be able to budge the Senate, courts and states. "Moderate" Democrat candidates are already promising to do nothing by way of reform.
Some day the combination of escalating costs and escalating numbers of people bankrupted by "health care" will bring a large enough mass of the electorate to the boiling point. And then things will change. But that is not now. Maybe in 2050.
2
Does any other industry obfuscate costs and choose only to announce the price of their services after the fact? I've faced much smaller but still disturbing bills after ED visits, both times because I was given oral medication which Medicare does not cover in that setting. One medication was only palliative and not necessary. The other could have been given by nebulizer. I was able to get the bills cancelled by pointing out the hospitals' own patients' bill of rights say that patients must be told they will be charged for these medications, but I'd bet most people don't question these bills.
3
For many families, the nightmare doesn't get resolved. What is so frustrating is that so many Americans are completely unaware that their health insurance could drive them to bankruptcy. They've never had an illness or procedure to test the limits of their plan. They live with a belief that they are covered and that their health insurance is a wonderful thing that they shouldn't have to give up. Yet, all of us are at risk of medical bankruptcy. No matter your plan, you can fall through these holes too, particularly if you live in a state with no legislation on surprise billing. American families need to wake up to our health care reality and politicians need to start informing people that a better option is out there - Medicare for all.
7
If you really understood how bad Obamacare is you would not have praised it. I suggest you dont understand it. I'm not a Republican and I am for a single payer health care but NOT Obamacare. It should never have been enacted. Its price structure is totally unfair to the middle class. In addition it forces you to buy coverage you may not want or need.
3
@Wonder Boy You are absolutely correct! Obamacare was a terrible compromise with the GOP whose alternative was nothing. We need to fix that pronto with Medicare for All.
7
The only people who don't need medical insurance are the very rich who could pay huge medical bills themselves or those who plan on refusing treatment should they become ill or be hurt in an accident. Even a young, healthy person could be hit by a car or fall down a flight of stairs.
Insurance plans--public or private--work because everyone in the group pays their share--including those who are at low risk. Some people will enjoy many years of good health and never get back all they paid in but will have the security of knowing they're covered. And those who do need care will pay less--often a lot less--than they would have without coverage. When you are in a public plan, you at least are not paying extra money so the private insurer can make a profit.
2
Man oh Man, am I ever glad to be Canadian at times when I read such stories. I suffered a near death ten years ago, spent three months in ICU, further six months in rehab, had two prosthetic legs made for me, attended physiotherapy until the day THEY declared me fit to return to work and life.
My bill for this life saving work? Nothing. Nada. I virtually left hospital and went home. I'm sure the final tally was well over half a million, but all I have to pay is $1000 deductible starting each January to to an insurer that covers my medications and any repairs to my prosthetics should I need them. How's that you say? I realize that in Canada we all pay more in taxes, but because you never know what life holds for your future, it's something that all Canadians are well prepared to pay. Sorry - you guys call this "Socialized Medicine". We call it our right to life.
13
I don't understand why so many Americans don't think they deserve nice things like universal healthcare. And I don't understand why so many Americans believe the lies Republican politicians love to throw out there concerning health insurance. I travel to Canada every year to the Festival Theater in Stratford, Ontario. We meet many Canadians at the theater and in hotels and restaurants. To a person, not one of them has express ever expressed unhappiness with the their healthcare. On the contrary, they wonder why Americans can't vote for a better health system for its citizens.
10
@maya
No no no. Most Americans think *they* deserve nice things. They just don't think that other people (poor, immoral, non-white) deserve nice things "at their expense."
8
Medicare for All really means universal coverage divorced from the need to have healthcare tied to employers, and taxes in lieu of premiums and deductibles. How that is accomplished remains to be seen. In Germany, there is a mix of employer participation but there is no reason to believe that once someone leaves that employment, healthcare is discontinued. What a relief that would be if such a system were applied in the US! Furthermore, taxes would be a far preferable way to face funding for healthcare rather than the endless increase of deductibles, coinsurance, copays, balance billing, and surprise bills, all of which seek to pass more and more of the cost of healthcare onto the backs of patients while the CEOs of for profit corporations get rich on our dollars. I’m for Medicare for All no matter what form it takes, as long as the insurance companies are well out of it.
4
40 years ago premiums were 25% of what they are today, maybe less. All of our health insurance companies were then nonprofits. It's time we make them so again. We should also make it that your doctor has to disclose to you what your costs will be before your procedure. Those two things will eliminate surprise bills. Socialized medicine has its benefits, but I can tell you about elders, on Medicare in top rated hospitals, who are forced out of their hospital bed after 3PM, even though they cannot walk. The way it's practiced in this country, it's far from a panacea.
3
"It would be nice just once if our insurance companies were filled with terror by the prospect of losing us."
They are. That is why the idea of Medicare for all, or even Medicare for anyone who wants it, is being resisted so vigorously. And why the insurance companies will have to be dragged (gradually) kicking and screaming away from using the health and lives of Americans to make money.
M4A (AKA single-payer coverage) is obviously the only long-term solution. What worries me is that Sanders and other progressives can't see that cutting out a multi-billion dollar industry will be a long, protracted battle, and cannot possibly be done overnight.
3
AS a health care practitioner, I have seen astoundingly often horrors brought to patients by insurance companies. Horrors. Bankruptcy, DEATH (yes DEATH) because of surprise insurance company actions. As they said often on the phone, "We are not saying they cannot have the treatment, only that we will not pay for it." OR "The person you talked to last month about your coverage was wrong; we will not pay." Half of bankruptcies, how many suicides, depressions, anxieties are caused by our INSANE system where insurance companies determine care, not caregivers on the front line. Crazy system that requires enormous amounts of information and data collection and demands that we employ thousands and thousands to "manage" payments and billing and insurance shenanigans. Medicare for ALL and let us stop feeling the shame of being laughed at by the rest of the world for our system. As for the Senate, the Senators that stand up for insurance company profits over a sane system need to be shown the door.
8
Surprise medical bills exist even within network providers. What may seem like (and actually be) a very simple procedure could cost over $1,000. according to the providers billing. The insurance company may pay a portion of it, but you may be billed for the balance. If you think that you might be able to convince your provider to reverse or reduce a particular charge for a procedure, claiming that it was a mistake, the Insurance Company might think that the provider was trying to defraud them. That's the answer I got from the insurance company when they refused to cover more of a particular charge that I was billed. A sad shell game.
2
A relative of mine in one of the Scandinavian countries has been fighting cancer for over a decade. After all the countless operations and procedures, and after all the doctor visits, her out of pocket costs now total zero.
6
As soon to be retiree, I am moving to France for the best national healthcare in the world. 12 long term illnesses are covered 100%. I will gladly pay my income tax to the French government for this peace of mind. People think that there are long waits for medical care. Not so! I find here that there is an average 6 week minimum wait for various medical field.
I want to see my GP asap? The last one in France had a two hour time frame every day for patients who did not have an appointment: he handled everything, no med assistant, no secretary. And he listened! It is a no brainer.
4
This from a Canadian on the national single payer system and now moving into my late 60s. Over my life and family (wife, children, parents) there have been two hip replacements, cancer surgeries and recovery (thankfully), severe stroke and long hospital recovery and therapy, and a host of life's normal medical events and surgeries from childbirth to death's passage. All was paid for as part of the system. Total cost overall was nominal (our family pays a higher income surcharge of about 8 to 9 hundred dollars a year, yes, a year), the procedures were done in a timely way and with no corners cut. One always felt in good solidly professional hands. All I can say is that what is going on south of our border on medical coverage is totally mystifying. It's like you all have a death wish or at least a desire to eject better organization for some illusory freedom of choice which usually beats you down anyway. I give up trying to see the plus side of a private insurance system.
7
Far too many of us cannot take the time to examine any idea that's larger than a bumper sticker, so they stop listening after "Socialism is evil" and don't consider "Medicare for all" on its merits.
And another slice of our population is happy with their company-provided health care, and don't worry about all the less fortunate who don't.
As a Medicare beneficiary, I can see things in it that I'd like to see improved, but until we get to universal coverage, I and those in my situation are in the minority and unlikely to attract much attention when we make suggestions.
But given how much the U.S. spends on health care, and the mediocre results we get, it's insane to continue to support and inefficient and unfair system that covers some but not all. We are the only 1st world (assuming we still qualify) country without some form of universal coverage.
It's too bad we're too lazy to take the time to think (and vote) for something better.
4
This is an insurance problem caused by a lack of understanding of insurance policies. Letters from insurers are worthless because they always use language that their decisions are subject to the individual policy and medical necessity. In other words, they are trying not to pay the bill. Health insurance is highly limited by networks and rules, none of which help the patient. Medicare for all only works if your doctor decides to accept what Medicare wants to pay. This works for the majority of the time, but not all situations. No one really seems to understand this concept. Healthcare, like every other economic good from food to shelter, is a commodity governed by market rules, even in socialized systems. There are always patients, physicians and institutions that do not want to deal with anything other than direct payment at retail levels. All of us need to know what an insurer defines as medically necessary.
1
As a physician who has worked independently, as part of a group and as a hospital employee, I have seen the storm from many angles and it's not pretty.
We have physicians not looking out for patients' best interests, hospitals competing instead of collaborating with doctors, all at the mercy of insurance companies that literally make out like bandits. It's the American version of illness management for profit; stop calling it health care. It's neither about health nor care.
12
Those of us fortunate to work for large employers who arrange and negotiate health insurance plans generally pay lower premiums than most folks who are self-employed or work for small businesses. Those who are sufficiently poor (intended oxymoron) can, so far, qualify for some version of Medicaid. Those systems are not, however, without excessive complexity and confusion about, among other things, billing.
The Affordable Care Act helped, but no one in Congress, who genuinely cared, believed that the ACA was more than a step; more than part of a process toward something better.
And where has the G.O.P. been in that process toward something better? A.W.O.L.
A constructive start would be to require all members of Congress to leave their governmental-sponsored health care plans and subject themselves to either the ACA or Medicaid. No, they should not get what a typical very large employer provides for its employees. Maybe then, Congress would begin to understand what their constituents deal with on a regular basis.
I know, "fat chance" of that ever happening.
4
As far as I can tell many if not most doctors are in the "gouge the suckers" business. After all it is not cheap supporting a life style of luxury, swimming pools, second homes and exotic travel.
2
Maybe you should vote for Medicare for all. Make sure people like me have to give up their weekend mansions. Oh wait, I don’t have one, though I do support Medicare for all.
3
"I went to bed that night not knowing whether we would have to declare bankruptcy in the morning."
If that's the worst that can happen, it's perfectly legal, and many have done it before you.
Read...
Deadly Spin- An insurance company insider speaks out
Wendell Potter (2010)
It just validated for me what I already knew
After a layoff I had to get an ACA plan for my family after many years of employee sponsored plans. It was like divorcing the emotionally abusive spouse and then marrying a physically abusive spouse.
Now I'm back with the sarcastic spouse who might say sometimes that I'm not very unpleasant, but at totally random times so I'm always anxious.
Insurance companies run a protection racket, simply said. It's your kidney, shame if something should happen to it.
4
The big lie we are told by politicians of both parties is that Americans love their insurance coverage. News flash: they don’t!
What Americans who have corporate coverage are worried about is what kind of commitment their is to replacing it with something better, and they are worried that politicians will use them as hostages in any healthcare reform.
Corporate coverage is better than having to buy Obamacare, and its better than being uninsured. However, it is still not what people want. The networks are restricted, the copays and deductibles are too high and the billing is a nightmare.
3
The American approach to the health of the American people, including insurance, is rightly considered savage by much of the developed world. When added to our horrendous gun-death rate, growing homelessness, addiction conundrums, incarceration (especially of minorities) rates, inadequate public education systems and growing inequality, the undeniable picture emerges of the U.S. as a failing democracy, which the current practice of politics chooses to do nothing about. Our new national motto should be, "Under Corporate-Dominated Authoritarianism We Suffer."
8
It is always astounding to me that most Americans absolutely refuse to believe the truth about the universal/single payer health care that works in other countries where it's unheard of to lose your home and/or go bankrupt due to medical bills.
13
As someone who has been paying for their own health insurance for twenty plus years, I sometimes feel that I am an expert. I've watch my premiums skyrocket, coverage decline, and played endless games insurance companies play.
Fortunately I live in a small community with a great little hospital far from an urban area. This fall I was diagnosed with a major health issue. My operation would have to be in the city far from home. Without a doubt though, the same hospital I visit in my hometown has a few hospitals in the metro area nearby. So easy, I could get care in both places, my records are easily shared.
Just after the start of my care, the doctors offices etc, were all confused because I suddenly became out of "network." It seemed that their contacts were all up in the air and not renewed (same hospital system) remember. One hospital is ok the other is not. Doctors pulled back and would not do anything until this problem was solved or I agreed to pick up the tab.
Two days of screaming at people on the phone finally solved my problem. Sure I'm embarrassed that I verbally assaulted people used horribly profane language. But I was scared and backed into a corner. People in far away countries read from cue sheets, I demanded to speak to american's people in our country were clueless without their talking points asking for codes I didn't have, and I finally reached someone a faceless nameless person who backed down and helped me.
Medical care in american.
4
Doctors need to be more knowledgeable and take greater responsibility for the information they give to patients. Most of them simply do not get involved or care about the $$ side of the equation, figuring their job is simply to provide the medical care and the patient will figure it out somehow. However, if doctors give careless info and the patient has a big bill, the doctor should be on the line for at least some of the payment.
Totally disagree. Doctors are not trained for this. Do you really want doctors spending half their time parsing out your plan, then making phone calls and writing appeal letters? Cause if that is what you want, they won’t have any time left for you. Understand that much of what you pay isn’t going to your doctor’s pocket. Say I prescribe a medicine that is exorbitantly priced, like maybe an epipen for allergies. I do not get a cent beyond whatever I get for the visit.
2
When I was a very young physician, the AMA violently opposed Medicare. That was it for me. I am now retired and never joined. Nuff said.
3
If non-Medicare recipients actually knew how Medicare works, and could understand why so many recipients are satisfied with it, it might help assuage the raw fear that people have of changing to something like Medicare for All. All the horror stories about patients dying because they can't get medical appointments simply does not occur with Medicare, so who is promulgating these horror fantasies. Looking at what the Insurance Industry has to lose, I think I know.
6
@William O, Beeman I'm more concerned with the doing away with private insurance for M4A, and having a future adminstration licking their chops to defund it for everyone. Once we get the whole country and the business community on board with such a plan, that will be a good time to try to make this change.
1
Had we instituted universal health care in the 1940s just after WWII, we would be in good shape with it today just like Europe, Canada etc. The problem with it today, is that is had become a political football that the GOP is constantly trying to dismantle...both with the ACA as well as Medicare and Medicaid now in existance. If we move on this too soon, while half the country is brainwashed into thinking this as the slippery slope to Venezuelan style socialism, it will never work. We should recognize the multiple attempts to repeal the ACA, the success in maiming it by removing the subsidies, not expanding in some states, destabilizing the insurance markets with the repeal attempts causing prices to rise, eliminating the mandate....all this will be that much more furious if Medicare for All is attempted to be passed before the country and Congress is ready for this change. Bernie Sanders can harp all he wants on how this is a "human right" (which it should be)...if the plug is pulled on employer coverage and private plans, M4A is passed by a partisan majority and the next WH is occupied by a Republican who reverses the whole thing...everyone, and I mean EVERYONE will find themselves with no coverage at all. Business will not pick up the tab again. Private insurers will be out of business and not likely to restart from scratch... M4A is a policy that will have to evolve slowly by making private plans obsolete gradually as funding is built up to make it a success.
1
What a lot of people aren't recognizing in the comments section is that the author is talking about an "elective surgery." Not a required surgery... an elective surgery.
That doesn't mean healthcare should be that expensive -- it also doesn't mean healthcare should be universalized because in that scenario there is no guarantee an "elective surgery" will be covered under universal care.
4
I have Medicare. I thought I could use it over seas to save money if I ever needed a procedure. Medical costs overseas are about 1/3 the cost. Prescriptions are 1/10 the cost,.. but I found out it doesn't apply.
I would have to buy insurance overseas.
I hope the 'medicare for all' covers 100% not 80%, and follows Americans even if they are living out of the country.
After all, we paid into it all our working lives and are entitled to it.
1
@Getreal There is no country in the world that covers medical care outside their own country, unless they have a reciprocal health care agreement in place. That will only get you emergency treatment. Imagine it the other way, if foreign governments were required to pay American medical bills because their citizens decided to get medical care in the US. They'd go bankrupt.
2
@Fenella Who is talking about the other way around? There is no reason that Americans, who have paid for their medicare insurance shouldn't be allowed to save medicare money by choosing a less expensive country to have a procedure done.
Bankrupt?? Get Real
I was recently billed $800 for a nasty cold. A bunch of unnecessary tests plus a 10-minute Dr visit coded at the highest level possible. No one could help, because each party blamed the other. And, yes, I have insurance.
2
@pm You need to get the doctor to re-bill with a code that the insurance company will take.
3
@pm
Foolish to go to any doctor for a cold. Pointless and unnecessary. Hope you learned about the mistake after the 800 dollar bill.
Stay away from doctors and hospitals. NPs are fine to use, but only go with REAL sickness.
2
@riley
It’s not the fact that he saw a doctor that is wrong:
It is the fact that he was charged an insane amount,.
1
the sad thing is so many Americans are so uninformed on how their medical insurance works. they don't know the difference co pay- deductible- annual out of pocket - in network out of network.
The first mistake is your doctor office doesn't have a clue how your insurance will bill. In network there is a maximum your doctor can charge going out of network means you can owe the sky.
You always need in writing from the insurance company what they will allow if you go out of network.
If there is no one in network that provides that service then you can file for an override and get billed as if in network.
We are a capitalist country to the core. We value individuality above social cohesion.
At least since the 1940's, when our government was better funded and less dominated by the wealthy, repeated efforts at a national health plan were rejected. And now, as government is grossly underfunded (by Reagan's design) and less capable, we are even more wary of anything done by government. And, as this NYT piece points out, even when the capriciousness of private health insurance can lead to bankruptcy, we are still wary of government plans.
So why not revisit Warren's plan for a medicare for all who want it. Her plan is to take three years to make medicare so superior to private health plans that it will be the medical plan of choice. With adequate funding from her wealth tax, why not take her up on this trial of government vs private enterprise.
3
That’s exactly right. At the national level, there is little sense of solidarity nor social cohesion, and it got worse since the end of the draft. Some interesting research trace this partly to the sheer size of the country and its frontier history. But also to segregation and the legacy of slavery and Jim Crow. Basically, hidden racism from white america does not want anything seen to promote nor benefit black America. They love everything that will hurt black America, such as tough crime bills mostly applied to the letter of the law in black communities, Jim Crow laws, mass vote suppression, and so on.
What is also very concerning to me is that a large portion of the Democratic Party is so obviously pandering to this me-first approach by taking talking point against M4A from the insurance industry. The phrase « taking away private insurance from 146 millions Americans » is as deceptive as it gets when those Americans can lose it any day when they get fired, or seriously sick and lose their job. And when the insurance provides no protection against hidden bills, co-pays and deductibles.
2
It's hard not be have healthcare on your mind when you are reading daily corona virus updates. And with all the epidemic coverage, it's hard not to think about China and her government and how she compares to the US. And my question to my fellow Americans is this: Why can't we show the world that freedom and democracy is able to guarantee more than free thought/speech but also to provide for real needs like food, shelter, education, and healthcare? To show that our system works? To give me reassurance that we will be able to deal with the virus effectively. Right off the bat, if people don't think they could afford to take time off until they are literally too ill to work, if they fear that they can't afford a doctor's bill, we are going to be in for it.
1
Ordinarily I would be the last person to suggest that we need the federal government to fix this problem, but I think it is our only hope. The current system is broken - horribly complex and inefficient with no hope of a fix. I cannot think of another product or service I buy where I don't know, within reason, what the final cost will be. There is absolutely no pricing transparency.
Insurance customer service is more like a therapy session where you call to vent while the person on the other end of the phone commiserates with you, but can't offer you any help.
1
All I can say is thank goodness (not God) for Medicare. I'm in retirement and couldn't afford any of my medical care or medications without it.
Ronald Reagan was a joke. That's what you get for electing an actor. And thanks, Ronnie, for needlessly taxing my Social Security benefits. I paid taxes my entire 40+year career and now I have to pay more taxes for the benefits???
6
But you have to admit it is kind of strange that you clearly knew he was an out of network doctor, knew the possible ramifications of using an out of network doctor, had loads of time and instead of calling your insurance provider to find out the cost and coverage, you instead took the word of the out of network provider that your insurance would cover it and you throw in the doctors as well? Who thinks their Doctor knows the details about the myriad of policies that come through their office? With months of preparation, why would you choose an out of network Doctor anyway? There are plenty of these cases to be mad about, this isn't one of them.
3
I get the need to change the way health care is provided and paid for (my wife is a primary care doctor). But the meanspirited, cold-hearted part of me occasionally looks at my 400 pound (no hyperbole) friend who has excuse after excuse for not changing diet or exercise, or my chain-smoking sibling, and thinks "why am I supposed to pay more in taxes for your health care when your behavior causes a big chunk of those costs?" Maybe we cover all costs, but have some kind of cashback incentive for people who meet healthy living standards. BMI rates, test clean for nicotine and drugs, can run an 8 minute mile or whatever (prorated for age), etc.
1
@Matthew C why would you prorate for age? if you don't want to subsidize my healthcare if I'm fat, why should I subsidize yours for being old?
3
@Sara good point. Was just thinking a healthy 25 year old should be able to run a mile faster than an 80 year old, and getting old happens to us whether we choose it or not. But yeah, I can see where we should get to a point where people should have the absolute right to make irresponsible choices and ask others to pay for it. And I stated I would be willing to see all costs covered, but those who live healthy and generate fewer costs could be incentivized. I guess self-satisfaction and being healthy should be reward enough, eh? My bigger point is much of the talk out there is not about reforming health CARE, its about how to pay for health care. Do we want healthier Americans, or do we just want to spend the money?
I'm glad that Boylan's medical bill was wrong and fixed. However, the real disaster in American healthcare is that most of these bills are correct and can't be fixed. My mother experienced kidney failure and was on dialysis for eight years. By this time, she had no assets and her bill was covered by Medicare and Medical (California's version of Medicaid). However, these offices still sent the bills to her house just so she could catch any errant billings. Long story short, the bills were astronomical and they would add up to well over half a million per year. In those years where she had to undergo surgery for shunts and other complications, it would be over million a year. At her dialysis center, I witnessed some truly wealthy people go bankrupt, including a person who owned two car dealerships in the area. So much of the conversations at the center is about preserving financial assets so spouses of the patients don't end up on the street: fake divorces, setting up irrevocable trusts, sending money overseas. Indeed in America, it's hard to tell what's worst: the impact of a devastatingly bad medical diagnosis on your health or its financial impact on your life savings. It seems to me that the greatest blessing that anyone can have in America is not a happy life but an economical death that won't ruin it for you and your loved ones. We have to do better, and it seems that this election is our best opportunity.
4
Not one mention here that health care costs and mostly everything else fixable by Congress, will not get fixed as long as Congress is in the pocket of special interest money. Campaign finance reform should be the number one priority of more than just Elizabeth Warren. It is the embodiment of the general interest succeeding over the special (read: profiteer) interest. Why it is not on everyone's radar is beyond me.
3
" . . . the cure for American health care is the kind of universal coverage that virtually every other civilized nation has."
Delete "other."
7
I wonder what sort of elective, non-emergency, pre-approved medical treatment results in a bill for $145,000?
Perhaps health care financing wouldn't be such a disaster if neither providers nor patients didn't treat health care like an opportunity to bill a helpless 3rd party.
We need a national health service, modeled after Merry Olde England.
2
The conservative opposition to Medicare, Medicaid and even systems in other countries, like Britain's well-regarded National Health Service, is purely ideological. It is a core conservative belief that every American -- infants, the elderly, people with disabilities, someone who needs an organ transplant to live, you get the idea -- is responsible for their own lives from cradle to grave. This is the conservative concept of ultimate freedom, freedom from interference by the government on any level -- unless, of course, in the process you get a taste. And if they have to step over bodies in the street on the way to the bank, well, that's the choice those people made, right? They obviously chose to be poor and sick or old or newborn with a hole in their heart. Rep. Mo Brooks (R-AL) is quoted as saying " ... people who lead good lives don't get sick." He later tried to walk that back but he meant what he said, most conservatives feel the same but are smart enough to express their opinion more subtly.
5
Baloney. What 'fixed' the bill? That not disclosed, leaves me to believe it was for a reason that didn't help the sensational intent of the article.
3
Ms Boylan, I believe you work for Barnard College and therefore are covered by excellent health insurance. Why did you go out of network? I feel certain that there were doctors in your plan who would have been able to deal with your son's medical issue.
4
Just keep voting Republican. The Greed Over People crowd has a unique gift for doing absolutely nothing, usually after consulting with lobbyists from the medical-industrial complex
8
Within our deranged healthcare system reside so many pockets of no coverage, disparate coverage, and glaring self-interests that in the end only universal single-pay can end the abomination.
3
It ain't just the insurers, JFB. It's very much also the providers. Treating the latter as univocally wunnerful and the former as univocally wikkid is to mistake reality for the convenience of rhetorical pungency.
1
There's one thing we can say with just about 100% certainty. After government-run, tax-funded, universal health insurance is finally implemented in the United States (a version of Medicare For All), everyone will love it and wonder why we didn't do it sooner.
17
After trying to work with several doctors and receiving nothing but medical bills with zero attendant benefits, I no longer see any doctor at all for any reason. I have one nurse practitioner that I went to last summer so that I could get the one pill I take renewed. She took an hour to examine me and we discussed every detail. Her conclusion and was that I was in excellent health in every point.
I can take the one daily pill until July 2021. three months of pills cost a total of ten dollars, so 40 bucks a year.
I'll see the NP in July of 2021. My total cost for Medicare in the last year was 68 dollars for the vaccine shot.
1
Hope your feeling lucky, because you are. Let use know how you feel once something happens, like cancer. The odds are not in you favor as the years tick by.
3
@Philip
Just a kid at age 73. Yesterday spent 4 hours Nordic skiing on powder river pass At 5 degrees with wind on an ungroomed trail.
No question if you do not take care of your own health you are seeing lots of doctors for lots of mostly unnecessary tests.
This is right on the money. Our insurance coverage, for those who have it, is a disgrace. The whole system is a money pit in which a congeries of scams and ill-conceived ideas take away 20% of our gross domestic product, despite results at the bottom end of industrialized nations. Even those with health insurance are hit with major and unforeseen bills on a regular basis and entire days and weeks of precious work time are taken up trying to have the bills reduced or rescinded, even with preapproved treatment. My son was treated briefly last summer with preapproval and yet we just received a bill for hundreds for the several minutes of his treatment. This is a system only a health or health insurance CEO could like, bad for the doctors, nurses, patients, families, government, and society.
1
Four years ago I was diagnosed with chronic kidney failure. Recently my kidneys failed and I am on home dialysis waiting for a kidney transplant. I have received fantastic, let me repeat, FANTASTIC care through this entire journey—and I haven't paid one penny. It's all covered by our Canadian 'socialized' medical system. Many times my family and I have said "Thank goodness we don't live in the States. We'd be bankrupt." I have never met one person who looked south and said they wished we had a medical system like that. You're a great country but your abhorrence of universal health care is bewildering.
19
@Katie Rodgers...
I live in Denver, Colorado and I have been on Medicare and Medicaid since 1996.
The Republican party considers this to be Socialized Medicine.
I don't care what they call it... because it is simply the best Medical care that I have ever received in my life.
I can see any Doctor that I want.
I can't even remember the last time I was required to make a co-payment.
And for the life of me... I don't understand why the Republican party wants to take health care away from American citizens.
10
I am a retired lawyer and my husband is a retired military physician. We both have serious, chronic medical conditions which are readily manageable under our universal healthcare system and we live a comfortably well off lifestyle, not worrying a bit about access to or affordability of healthcare.
Yet not a day goes by when we don’t thank our lucky stars to be Canadian, as we listen to the horror stories of American families being driven into bankruptcy by medical costs or having to forgo needed medical procedures to stay solvent, as happened to our dear American friends, and which would be our terrible fate were we Americans. We simply don’t understand why so many Americans are afraid to embrace universal health care, when simple healthcare statistics from such countries as Canada, UK, Sweden, Norway, New Zealand, France, Germany etc., easily proves the superiority of access to and affordability of such systems for the vast majority of citizens of these countries.
I believe the American healthcare system is a gigantic con perpetrated upon Americans by your insurance companies.
30
Went to Italy last summer with my wife and two sons. While visiting the tomb of St. Michael’s, my wife tripped on a curb and shattered her ankle in three places. Taken by ambulance to the hospital, X-rays showed she needed surgery. She spent 4 days in the hospital, got great care and had the surgery. 5 pins were placed and a heavy cast put on that allowed her to travel home. When it came time to pay, my wife showed the hospital officials her Italian passport and they thanked us with a smile and we came back to the USA. Not once during her stay did anyone ask for insurance or payment. No Italians are dying in the streets! The medical care was good if not better than we get in Brooklyn, NY. Americans are brainwashed into thinking other industrialized countries people are dying in the streets while waiting for medical care. Although not perfect, I was impressed with the Italian system and barked about America’s horror system all the way home and since. Americans need to wake up. We pay more in taxes than Italians and get almost nothing in return. The have nots will never accept that fact as American propaganda halts any progress towards universal health care.
1361
@Unbelievable Unfortunately, a large portion of those taxes we pay ends up in the military industrial complex. Wouldn't it be nice if we could spend just a little bit of it making healthcare more affordable and universal?
237
@Unbelievable
A friend while in France needed emergency heart surgery which included a week in the hospital to recover. The bill, $600.00 Several years later at his home on the Island of Nantucket he had another heart emergency and was taken by helicopter ambulance to Mass General. The bill - not including Mass General, just the flight - $45,000. Something is very wrong.
367
@Unbelievable
Same with me in Holland four years ago. When I showed them my US health insurance card, they looked at me like I had two heads. Its the way it should be.
110
Although surprising and unexpected, this is not an example of a "surprise medical bill." It is a glitch with authorization and in- verus out-of-network care. It is distressing for the patient and a headache for the MD, but it ultimately gets worked out.
1
Due to a clerical error between our state government and Premera Blue Cross, we were billed about $3200 by Premera and threatened with loss of coverage. We paid it on good faith, assuming that since the mistake was so obvious they would quickly reimburse us when we showed them the paperwork. Many months, letters and phone calls later, after we had provided absolute proof of the error and appealed it to the top, they simply ruled against us and kept our money, blaming us for not providing a document it was impossible to procure.
We had contemplated getting a lawyer to help, but it was so obvious we didn’t imagine they would deny our appeal. And they probably calculated how much it would cost us for a lawyer and anticipated that our return on investment would be low if we hired one. They robbed us as surely as if they’d put a gun in our face.
For goodness sake, let’s get these parasites out of our health care system!
18
Can we just have single payer healthcare like the rest of the developed world?
18
"The bill in question was for a procedure that had been scheduled months before. We’d consulted with the provider, who, indeed, was out of network, but our doctors had assured us that the total cost would nevertheless require nothing but a modest co-payment." "But in this our doctors appeared to be wrong. Now we were looking at a bill for $145,000."
Going out of network on the say so of your doctor is extremely foolish. You got lucky, if you're really out of the woods. Sometimes it takes a year or more for the final billings to arrive. If it was the plan I ran, we'd have allpwed a maximum of 75% of the amount set out in the current year publication Medical Fees in the U.S., and paid 80% of that allowed abmount. That would certainly have been much less than the total amount billed, and you'd have been on the hook for the rest.
When you take the risk of going out of network, bad things happen and you have no one to blame but yourself.
3
A friend here in Canada, was prescribed an investigation for a possible health problem. His physician told him he is paid to keep him healthy. He will see a world-class specialist physician (who can provide high-tech health care in 3 languages). Under the Ontario Health Insurance Plan (available to all as a human right) he estimates 6 clinic visits will cost him $20- in parking fees plus $10 in gas. (And those are Canadian dollars).
Canada shares this beautiful North American Continent with America. Canada is a prosperous G7 country, and yes with inequities of her own and a past she is attempting to reconcile with her First Nations. But in your US News and World Report's estimate, Canada is the second most preferred place to live (not behind the US).
America’s corporations are not modern. They are modeled after your 19th Century robber barons’ ways of dominating your society, your economy and your people.
The world hopes for and would welcome the return of the America that is now fading away.
13
@Rob My best friend's mother complained of abdominal pain for a year in Ontario, requested a specialist and took 6 months to get in. By the time she was seen, inoperable pancreatic cancer and died in her 50's. The next year, his father's PCP watched him decompensate in heart failure whilst twiddling his thumbs--crossed the river into Detroit near death and got a pacemaker within a week--doing great now. Canada is not the Eden you've described.
2
How many seniors who like their Medicare coverage (e.g. me) realize that Sander's Medicare For All would abolish the current Medicare system?
All seniors currently on Medicare would be dumped into one giant national health pool with everyone else, including illegal aliens.
2
Nothing would be taken from you. In fact, you would actually have more extensive benefits and so would all other Americans. What’s wrong with that? Also, why did you feel the need to denigrate hardworking undocumented immigrants who deserve access to healthcare just like you do?
5
Yes, dumped into a system with all the young, healthy people who require far less medical treatment. That will lower the costs of Medicare for everyone. Get it?
5
@Zareen
"Nothing would be taken from you. In fact, you would actually have more extensive benefits and so would all other Americans."
And if you like your doctor you can keep your doctor, right?
We've all heard the promises before.
Have you noticed that all the politicians against health care HAVE healthcare?
Just sayin'.....
12
Reagan didn't hate Medicare. He was a hack B-grade actor hitting his spot and delivering his lines for a medical-industry-paid advertisement. To hate Medicare would have required coming to that conclusion through thoughtful analysis and discernment. Sorry. He didn't have the intellectual horsepower for that.
23
I am sitting in a rehab facility as I write this, where I have been approved to be for a minimum of 20 days after having a total knee replacement. I can’t go home, bec. they can’t find me adequate home health care. I was in the hospital for five days bec. there were no empty rehab beds. I have Medicare and premium supplemental care, and while a voluntary procedure, everything was preapproved. I was a health care lawyer before I retired. I can’t wait to get my bill and see what BC/BS decides to cover. I can tell you this, I am paying nothing beyond the copay!
3
Boylan "erects a straw man and then knocks it down".
She writes of a "surprise medical bill" which was a mistake and ultimately amounted to nothing.
The selection of Times Opinions that are published are repetitive and lacking in diversity of political thought.
The result is propaganda-like.
3
If Boylan knew in advance that some of the procedure was going to be out of provider co-pay could she have asked prior to the procedure how much?
2
Sadly, no. Provides won't tell you how much ia procedure costs because they charge different rates to different insurance companies. Our "system" is so convoluted that you can't find out in advance.
2
Your bill was 'fixed'? Fixed how? It's kind of the only thing in your op I've zeroed in on. Everything else is just "blah-blah-blah we've heard it all before".
3
Three words:
Universal health Care.
The rest of the civilized world has it.
17
@LauraF Coverage is not the same as care
@John S
It absolutely is the same.
The USA also has a lower life expectancy than the countries with universal health care. Just look at the numbers. They are readily available on line.
In other words, better overall outcomes.
I've gone through serious health concerns with family members, and I can attest to the care they received. It's world-class.
Universal health care saves lives without bankrupting people.
The rest of the civilized world knows what the USA does not.
2
In geriatrics, we already functionally work in a 'socialist' single payer specialty. We are happy when someone has traditional Medicare--it is substantially less administratively burdensome than working with commercial plans, including the Medicare Advantage plans, which often have restrictive drug formularies and requirements for prior authorizations. But this is also much of the reason why geriatricians are among the lowest paid specialists--Medicare reimbursement is lower than commercial plans.
That being said, I'm amazed at the number of patients who want 'government to stay out of my health care' when they have been blithely using a government funded plan for years. They love their Medicare, so why not let others get in on that?
14
Republicans loathe the Affordable Care Act for one simple reason. It is associated with a Democratic gentleman who has a darker complexion than most GOPers.
17
I know that you have no interest in being President, but you have my vote.
1
Jennifer, you scheduled the procedure in advance, you communicated with the provider, you learned it was out of network, you relied on vague assurances by your doctor who was wrong.
The cost was amazingly high but not a surprise. What part of you brought this on yourself don't you understand?
4
@Mel What part of a verbal contract for a "modest co-pay" don't you get?
5
"It would be nice if the members of Congress — looking at you, Republican Senate — had this same devotion"
It's pretty funny when people like Ms. Boylan beat up on Senate Republicans for not accomplishing anything, after they exhorted Nancy Pelosi, Adam Schiff, and Jerry Nadler to waste the Senate's time with a 4-month impeachment process that they all knew was going no place, and had no basis in reality.
You can yell "resistance" all you want, but at the end of the day, Congress has accomplished nothing in the last year, and liberals need to look in the mirror to see why.
@G Mitch McConnell has boasted about more than 300 bills that have been sent from the House to the Senate that he has not released for debate or other consideration.
You were saying, G?
3
This is the reasonable reaction from a college professor and NYT contributor. Can you imagine the devastation for an average working American? We have a broken healthcare system among our many broken 'anti-citizen' systems and institutions. Vote 2020 before what is broken cannot be fixed.
6
Well said, Ms. Boylan. Well said.
1
Realize that if some hoodlum held up the local branch of your credit union and filched a tenth of the ransom these thieves tried to extort from you – two detectives would be assigned full-time till the perp was apprehended...
And once caught, our justice system would ring up a bill larger than your entire one, pondering – among other things – whether the video surveillance feeds from the branch's cameras were admissible or not...
As far as admissibility of out-of-network surveillance videos – deciding that would likely cost several-x more…
This whole article is abot a bill you didn`t have to pay?
Let`s hear from people who actually got stuck with a huge bill they had to pay.
5
“Of all the forms of inequality, injustice in health is the most shocking and inhumane.” — Dr. Martin Luther King, Jr.
6
Friends who have spent long hours dealing with health insurance companies told me that I should always consider the first bill they send as simply their opening bid.
4
America: where you are " free" to be bankrupted by the medical industry.
Pharmaceuticals and insurance companies run the US>
Plain and simple.
But for some inexplicable reason, Americans do not want healthcare because they keep voting for Republicans.
Try as I might, I cannot get my head around it. I lived in France where a doctor visit was $20. Here my internist annual check up costs$1100.
8
I tell people all the time about the availability of health coverage in western Europe, e.g., comprehensive coverage from 137 euros/month in Spain.
https://www.healthplanspain.com/sanitas/sanitas-health-plans/sanitas-mas-salud.html
I have no stake whatsoever in any insurance enterprise, just a hope the United States will someday have the political will to emulate our neighbors across the pond.
5
MEDICARE FOR ALL, NOW!
11
As winter residents of Georgia’s glorious Golden Isles, we have been on the receiving end of your health care “system” a few times.
For all this chatter about freedom, you haven’t a clue, America. This is not a free country.
25
Indeed it is not, a free country.
America is a very expensive country.
3
Yesterday we got a surprise bill for a routine MRI ordered by an in network doctor.....medicare and supplemental insurance denied coverage.....now trying to find a human to talk to about why has been impossible, so far....you can get a human when you want to sign up, but after the insurance companies only have electronic voices.
6
How can anyone in the US rationalize universal health care online for its country’s old people, not its youth?
How?
That is disgusting. The rest of the civilized world sees it. Shame on you for not.
15
I am appalled by how easily led people are. How they don't even question the lies they are being told, even as it affects their lives. I have been wondering when people will realize that they have no choice in their health care. I have listened to the myth of being able to keep your own doctor. When have most americans been able to choose their own doctor? As with the stock market indicators of the economy, choosing your own doctor is the domain of the wealthy and only applies to the privileged. We are on an employee health plan, which has changed vendors many times forcing us to find another doctor in system. This is not a choice. We have found a doctor we like only to be told they are retiring or no longer in system. We are told what our copays will be and have no recourse. Our bills are padded in the hospital. People are driving across borders, since it is cheaper to go to another country for medication. And still people are afraid of medicare for all! The role of governance is to do what is right for the people. This is apparently necessary as people are too stupid to protect their own interests and will follow the first shiny object put in front of them. I wish that George Carlin were still alive to eviscerate this particular brand of human stupidity.
14
Eleven years ago, I had a hysterectomy: not a laparoscopic, quickie, but a full-on, large-incision one. It was in network, as was my provider. A month or so later, I got a notice (you know, those pieces of paper labeled "This is not a bill") for $100,000. A month after that, I got another "This is not a bill" for the same procedure for $10,000, and in the end, had to pay $1000. I took both notices to my OBGYN, a wonderful woman, and asked what was going on, because a 5-hour surgery, plus a 4-day hospital stay, seemed to me to be worth something other than either of those two numbers. She shook her head and talked about how her fees had been cut and cut, along with the hospital's fees. And, she told me that if a poor woman without any insurance needed the same services, that she would be billed the full $100,000. And that was a Catholic hospital. We need a nationalized system. If the poor are expendable, in the end, we all go under.
15
A poor woman can then apply for assistance through the hospital and generally get the bill covered, which means we all pay the cost, which means its already socialized medicine. Medicare for all now please!
4
Just a few things to consider.
We need to duplicate the success of Medicare and make it available to everyone as a universal health insurance system.
We need to get employers out of the business of being health insurance brokers; we need to take the money paid by employers and employees for this benefit, use the negotiating power of the entire nation to secure the best prices possible for hospital and doctor services, prescription drugs, whatever else is needed for a positive patient outcome (casts, crutches, wheelchairs, medical devices, etc.); expand benefits to cover dental care, hearing aids, eyeglasses; we need to take the money that was once paid by employers and employees for health insurance premiums and collect it as we do every other payroll tax and use it to fund this expanded Medicare (call it something else if you have a problem with that.) McDonald's has successfully used duplication of a concept that works. Why not America? Scared of the government getting into your life? What makes you feel any better about a for-profit health insurance company refusing to pay your claims or a not-for-profit insurer telling you that its CEO can make millions but your non-covered expenses will cause you financial hardship or worse?
Just a few things to consider. Thank you.
5
These are all good ideas except for a payroll tax. it needs to be an income tax, not a payroll tax. Too many people get their income from non-payroll sources.
4
My business has had health insurance for employees since the mid-80's. We have had anywhere from 2 to 55 employees and the insurance cost goes up and down down for various reasons, the biggest being the size of the group. Imagine if the group were 340 million?
1
I don’t understand why more Americans don’t do what I recommend my patients do if they are ever hit with this kind of surprise medical bill: simply say, “I am not paying this.” Let them try to get it out of you! Let them try and convince a court that this absurd fee is somehow justified. Make them do all the work. And, meanwhile, get your local newspaper the write an article about it. Point out that in America, nonprofit - nonprofit! - hospital CEOs make an average of $3 million a year. Point out that physicians in America make 2 to 3 times what physicians make in other countries. Point out that pharmaceutical companies have profit margins five or six times higher than normal businesses. Put your foot down, make a lot of noise, refuse to pay, and maybe one day some sort of rationality will come to medical billing in the United States.
It is not your fault. It is the system’s.
15
I have good employer paid coverage. I went in for a thoracic surgery which had been cleared by insurance. The hospital told me to leave my phone and wallet at home. Good thing I kept it. Just 30 minutes before surgery a tech from an out of network service-camera aided surgical guidance -came in with a paper. " Your doctor has asked us to be present during your surgery so please sign this." I asked several questions. She kept repeating politely and sweetly that I needed to know they were out of network . I postponed signing and called my insurance company. At this point it was 4:15 in the afternoon. Thank goodness they answered. " Tell them right now that we have the ability to pay an out of network bill but they must submit it originally, and the first time as " pay at in network cost ." " Make it completely clear to them. Otherwise there will be serious problems and delays". So I made several more calls and all was well. The company never would tell me , despite questioning, what they were prepared to charge for their nuclear camera and 2 well trained techs. I'm glad that I never had to find out. And imagine if I had followed instructions to leave my phone and insurance cards at home. The situation is terrible. No billing transparency; no idea what it will cost up front and then surprises at the 11th hour or a month down the road. This must be fixed.
I'm glad it worked out for Jennifer Finney Boylan's family. Many people are bankrupted.
9
Really? They just trusted someone out of network who said “don’t worry about it?” What planet do they live on, after the hundreds and maybe thousands of horror stories over the years. Life requires you pay attention.
4
As long as our broken-for-consumer/patients Health "Care" system remains fully intact, individuals will get ripped off by that system. An international disgrace and embarassment.
It's all about GREED.
6
Agreed that we hate insurance companies more than colonoscopies. The actual procedure is almost always conducted under a very pleasant anesthesia, and then you get a muffin.
But I bet most people (or at least most people over 55, those younger having no idea what they're in for) hate the colonoscopy prep more than insurance companies, in fact, more than almost anything.
2
Just about everyone of a certain age in my life right now is either on Medicare or literally can't wait until they're old enough to get onto Medicare. They're making decisions like delaying retirement because they want to be on Medicare first.
These same people reject M4A as (scary voice) ~*Socialized Medicine*~ and argue against it, strenuously. They're also Trump supporters.
The mind boggles.
6
"Healthcare industry." Doesn't that phrase simply sum up what we have here?
How about starting with "health care service?" Or have we sunk so far to the bottom where anything with the word "service" in it is suspect. Read: socialism.
Shame!
4
Make the doctor (& hospital or surgical center) prove the bill is accurate. Is he double billing for expenses your own insurance pays the hospital or it’s employees? Were you drugged when you were informed of charges or asked to approve them? Where is this doctor “in network”? If he can’t document affiliations with reputable insurers, he may be misrepresenting himself. Medical Boards sometimes frown on that. As I vaguely recall, the Supreme Court has made rulings against professions who refuse to disclose their pricing prior to providing service. If he encountered “unexpected issues” during the surgery, is he deemed competent (board certified) to perform the work—and perhaps should have anticipated the unexpected. Did he use residents to perform the surgery? If so, how much did the hospital already pay for that supervisory service.
I know of no other licensed profession that can get away without disclosing prices in detail.
You may look up his professional standing on your state government licensing list. It will show, among other things, any Medical Board actions against him, status of his license & board certification. The more informed you are about a physician the better negotiating position you are in. Negotiate. If you are pressured to pay immediately, call the doctor’s billing service. Some kindly person may tell you when payment is due. PLT
3
Bernie Sanders, our next President?
Sheesh.
Give me stability and balance.
Bernie does not work well with others, and develops and projects unrealistic, over the top legislative proposals on a myriad of topics that get little support.
In 16 years as a House Representatives, and 13 years as a U.S. Senator, Bernie got 7 bills passed for which he was primary sponsor.
On what groundbreaking, over the top topics did Bernie get 7 bills passed for which he was primary sponsor?
1) renaming a post office in Vermont;
2) renaming another post office in Vermont;
3) OK’ng a Vermont-New Hampshire Water Supply deal;
4) a cost of living increase for vets;
5) changes to a VFW charter;
6) a bill that protects the Taconic Mountains; and
7) designating “Vermont Bicentennial Day”.
Contrast that with Amy Klobuchar’s record. Since she joined the Senate 12 years ago, 34 bills that she primarily sponsored became final, signed legislation. Examples?:
1) America's Water Infrastructure Act of 2018
2) Justice for Victims of Trafficking Act of 2015
3) Innovate America Act
4) Veterans to Paramedics Act
5) Comprehensive Addiction and Recovery Act
6) Congressional Accountability Act of 1995 Reform Act
7) Great Lakes Fish and Wildlife Restoration Act of 2016
Effective, studious, works well with others, focused, results-oriented.
That describes Senator Klobuchar to a T.
Senator Klobuchar can be trusted to get things done. That is exactly what we need.
1
But there is evidence that Trump is opposed to such surprise medical bills. Why don't you work with him rather than use your column to bash him?
From CNBC: "Putting an end to surprise medical billing is one of the White House’s top health-care priorities this spring."
But you ignore this in your column.
I would like to ask Democrats. Which is your priority? Is it to improve the lot of the sick? Or is it to use Trump bashing to (maybe) win in November?
2
@Ludwig
Trump has done what exactly to help Americans?
Cheaper, better healthcare .
Where is it?
1
The procedure was scheduled months in advance, so the complete consumer portion of the bill should likewise have been prepared and signed by hospital, physicians and patients months in Advance!
It is NOT healthy “ capitalism” when the costs for X service is not provided and contractually signed in advance. Rather, the insurance companies—and too often the hospital administrators— are engaging in a perverse form of bait and switch.
I hope the Democratic nominee will place Richard Cordray back a public position. Cordray was an outstanding as USA Director of the Consumer Financial Protection Bureau from 2012 to 2017. Before that, Cordray served as Ohio's Attorney General, Solicitor General, and Treasurer.
How about him for VP?
1
My son's cut finger cost (out of pocket) the same as it was to birth him only a couple years before. You may think stiches? Nope - ultimately a band-aid. A $4,000 band-aid.
7
I have nothing more to add to all the arguments for fixing our healthcare system and making sure that everyone is covered. However as a primary care physician I beg anyone who reads this to remember that only your insurance company can tell you what they will or wont cover, and even then you have to be cautious. The more you can stay within your provider network and verify your coverage for proposed treatments and procedures, the safer you will be. Ask about facility charges, anesthesia who else will be submitting bills and are they in network. Another caution, not even a participating specialists can refer you to another in network doctor if prior authorization is required by your insurance company, it has to come from your primary care provider.
Ms. Boylan's doctors were dedicated and willing to help, but many are not. What non participating doctors can charge when they are not restricted by insurance companies is, well there are no restrictions. So you know who is incentivised to do what.
2
Medical insurance is an industry dedicated to profit making and providing a healthy return for its share holders. Every dollar of that return comes at the expense of the patient. Corporate medical insurance increases medical anxiety as a function of their mission to be profitable. Capitalism eventually turns everything into an industry dedicated to parting people from their dollars. That profit motive enables modern society, but does everything have to become a consumer industry? Medical security should be considered the same as national security and be the Federal government's responsibility in the same way the military is. What could be more important to the security of a nation's citizens than those citizens feeling secure about their healthcare?
4
Our Mom was brought to the hospital by ambulance one December morning, in distress. She was evaluated in the ER and some diagnostic tests performed; she was admitted, and died about ten hours after she was first checked in. Because of a glitch with her Medicare coverage, we received a bill for more than $10,000 for her stay. After a lengthy process and much wrangling with the bureaucracy - all while still in shock from the sudden loss of our beloved mother - we worked it out to be a reasonable amount. Nonetheless, the initial shock of that bill remains, as does our sympathy for anyone trapped in the shocking mire of unforeseen expenses - especially when a recent study showed that the average American can’t cover $400 in “surprise” bills.
8
Our public schools are 'socialized'.
Our roads are 'socialized'.
Our police and firefighters are 'socialized'.
Our courts are 'socialized'.
Our EPA and FDA are 'socialized'.
Our Social Security is 'socialized'.
When its cheaper, fairer, more efficient to provide a service as a common good, it should be, as all of the above.
Can you imagine if your job determined what school your kid goes to? What police help you? Whether firemen come to your burning house?
Why would anyone want their job to dictate whether they can get medical care, or lose their life savings because they got sick?
Medical care should be 'socialized' - its cheaper and more effective. No more ads for hospitals (we pay for those ads_. No more $1000 1 mile ambulance rides. No more stuck in a job because starting your own business risks your kids health.
Every other modern country has it and they pay less for better care and no worries of bankruptcy.
How do we pay for it? We already do! One way or the other, we collectively pay for all the waste.
We pay for ads and insurance companies that don't actually do anything, and for doctors who make more by doing things that are not needed, and for competing MRI machines.
13
If only...
If only Jennifer's situation were not a one-off. The bankruptcy courts are littered with cases that aren't. To add insult to injury, you still have to pay your bankruptcy attorney.
And then re-establish a viable credit rating.
If only the Republican Party had a heart even the size of Dr. Seuss's Grinch, before he met Cindy Lou Who. Even at that point Grinch's ticker was too big to fit in the average Republican rib cage.
Why not instead of "Medicare for All," require insurance providing employers to allow/offer employees the option to choose Medicare or the provided plan? Those who choose Medicare would have their paychecks increased by the amount the employer pays for their insurance (and the amount taken each payday for the employee's share of the premium) and then pay Medicare directly.
If only we had the choice.
2
What surprises me is that employed Americans are so ill-informed that they believe that if their employers discover that any government related medical insurance option is cheaper than what they [the employers] currently are paying for, that they can keep their private insurance. How misinformed must one be to believe such nonsense?
The next group of people who believe that Santa Claus or the Easter Bunny actually exists, somehow lose their minds over extending Medicaid or its equivalent in its states because of something called 'freedom'. Really? Those Bunny-Claus folks need to do some math, and add up what is the true cost of a lack of expansion of Medicaid within a state, what it means to its citizens and the fact freedom doesn't have anything to do with those real statistics.
True freedom means never having to worry that one may be wiped out financially because of a medical issue which will prevent you or your family members from procuring an education or various job opportunities. Opportunity is color blind. Opportunity is blind if you are a member of the 90% of the American population. I could go on and on, but I do not believe I will be persuasive to the Bunny-Santa believers, the religious right, and of course those who buy into the lies & half truths being currently promoted on Fox News and its true fake news cousins. Americans, please vote.
3
The reader would like to know, without intruding on privacy, what the procedure was. Perhaps without knowing who the patient was.
We received a $10,000 bill for an emergency room visit because of a nosebleed. The insurance company dealt with it. If you get a ridiculous bill, don't be frightened (it means nothing), and don't pay it.
Despite the author's name, he's actually a man.
1
Ohhh, I think our healthcare system is indeed in terror of losing us, and throws a lot of money around trying to prevent it from happening.
1
St. Ronnie was just the first right-winger to use scare tactics to convince the American public that, by not getting bankrupted by a voracious insurance industry, they were losing precious "freedom". Freedom is really handy. It's the last bastion of the hypocrite.
Canadians have single-payer health care and we love it. We would NEVER give it up, especially for the mess that the US has. No, it isn't perfect, but the worst billing surprise we ever get is for hospital parking. That's where they get you.
3
Want to learn something that will shock, amaze, anger, whatever. Go to your local pharmacy and listen to the interaction between consumers of drugs and drug pushers. I have Medicare and a good supplemental, am not taking anything exotic and pay very little for my scripts. Yesterday, the lady ahead of me in line paid $865 for 4 scripts for her mother. The parting words...”see you next week”. So, that’s $865 times 4. My old $98 tube of dermatology prescribed skin cancer “preemergent” is now $1400...I take my chances with Coppertone. Something OBVIOUSLY is very wrong.
3
Bernie is espousing policy that has worked in all the Nordic states for over 50 years. These governments are all true democracy's (unlike ours) and they are all capitalist market economies. They are also the most educated,healthiest, and happiest people in the world. That could be us if you just don't buy in to the red baiting propaganda...most people don't anymore that's why Bernie's winning ....
5
Very scary times for the author and family. So very sorry to learn that you had to go through those anxious first hours, days.
I was just summarily turned down by my Medicare-paired insurance company in an appeal by me to have the only drug I take (just prescribed and working well) lowered one tier after I meet my deductible because it would cost me less out of pocket.
This from someone who goes to the gym daily, maintains ideal weight, ideal bp, cooks for herself and uses 1,200 mg of sodium a day and does not smoke (friends sometimes call me 'the nun.")
But nuns would take umbrage because I imagine those swell ladies have more fun than I do some days. (Smile inserted here.)
The Rx which will cost me mightily out of pocket despite insurance is for something I am unable to prevent or control by my lifestyle. This is pretty damn outrageous. There is no reward in this system for another attribute some of us have: The absolute willingness and resolve to take care of ourselves healthwise.
Jennifer Bylan writes: "His understanding was that insurance companies often respond to preapproved claims with denial and delay, hoping that consumers will somehow just give up."
Thank you for this line. It nudges me to do what I planned to do anyway once I recovered from the exhaustion of dealing with the insurance company, phramacies, online coupons and doctors over the past few days, trying to cut my costs.
I will appeal the appeal. I won't give up.
7
Actually, pace Ms Boylan, I don't hate my insurance company (Anthem BC/BS if you must know). Sure they're bureaucratic and sometimes require all sorts of rigamarole for filing claims, where arbirtrary and capricious rules have led me to curse the day they were founded. But the rationale for a lot of the rigamarole is not all that unreasonable, and they paid hundreds of thousands of dollars for my wife's cancer treatments without a hitch. Admittedly I have one of those employer-based cadillac policies that some people love to hate until they get one, but it came at the cost of lower salary and reduced job mobility and much higher premiums than other insurance options provided by my employer.
Overall I've found their service staff (the people you call when you have questions or problems) to be enormously helpful and professional on the whole. Insofar as bureaucracies go they're pretty good -- I found them to be more helpful and easier to work with than some of the investment companies where my late father-in-law had his retirement accounts.
I'm all for universal coverage and I don't see medicare for All as some horrible prospect. And I certainly support strong oversight and regulation of medical insurer practices, including the types of legislation that Ms Boylan cites in her column. But in the search for corporate villains, I think there are dozens of industries and bad actors that I'd get after first before directing major attention at medical insurance providers.
"Later, another doctor in the practice told me that even when procedures are pre-authorized (as my child’s was) insurers often deny them anyway. His understanding was that insurance companies often respond to preapproved claims with denial and delay, hoping that consumers will somehow just give up."
This. This right here.
Several years ago my husband needed outpatient surgery. Everything - the procedure, the hospital where it would take place, the doctors - was pre-approved by our insurance company. I had the paperwork saying so. Yet when the time came to pay, they denied everything anyway and sent us the bill.
I was livid.
And then I had to take 2 days off of work and spend them on the phone with varying levels of insurance company flunkies explaining the situation, and faxing documents to them ad nauseum (the pre-approval documents which they claimed they didn't have, but which they had sent to us in the first place!) before they finally agreed that yes, indeed they had told us that we were pre-approved and didn't have to pay anything more than the original co-pay.
The American "healthcare" system and the insurance companies that control access to it are simply criminal.
16
For every doctor treating patients there are 30 administrators in the health care system. most of them are involved in selling policies, false billing, claims denial, bill negotiation, debt collection and sundry administration.
70% of health care costs add no value to patient care.
255 of all healthcare premiums end up as commissions to salespeople and profits to the company's shareholders. Why?
9
Losing my Mum early to a vicious cancer was devastating. Four months of a private hospital room, chemo, surgeries etc etc, added up to $300 out of pocket (thanks to Australia’s Medicare system, funded by a 1.75% tax on gross income). A broad spectrum of services was included (PT, occupational therapy, daily nursing when home, counseling etc). As her primary care giver, I was even entitled to one free massage a week!
My two bouts of cancer in the US have devastated us financially. I cannot overstate the stress this layers onto the physical suffering. Lots of insurance denials (inc regular scans etc), meaning almost everything feels like a nightmarish, bureaucratic fight. We pay all our taxes, luckily had saved diligently, bought the best insurance available... all seemingly for nought. I am at the point of not wanting to fight hard because I worry about draining the rest of our family’s finances and not surviving anyway. Sounds ridiculously dramatic but it’s true. #1 cause of bankruptcy in the US is medical debt.
No system is perfect but a chunk of this country seems so averse to, and terrified of, a proven, superior alternative. Cue the usual villainous suspects... Particularly vexing when the basic framework is already in place. I was healthy, until I wasn’t. I could be any one of you or your loved ones... (hopefully not)
18
I'd REALLY like to see NYT do an article explaining the GOP rationale for not having affordable health care for all Americans. There is no sense in having a sick country. Individuals can no more protect health than they individually stand up an army or navy to protect the nation.
There is no "Christian" reason for having lousy health care, there is no "capitalist advantage" to having lousy health care. There is no good political reason to have lousy health care.
Those of us who get "insurance" from our employers are still not fully covered and are paying tremendous costs due to a corrupt system between provider / insurance company / pharma company that keep blaming the other for increases.
8
@brian I think there's a certain subset that *prefers* the crowdfunding approach to survival. That's why Christians love those Christian health sharing plans- you don't consistently get reimbursement, you get it based on how worthy they judge you at that moment and you can always beg on social media if you need more. It means the most "worthy" get inspirational stories about how their coworkers came together to crowdfund their cancer treatment- and no one needs to talk about what happens to the less worthy
1
Today 18 percent of every dollar spent in this country involves healthcare. One problem is that rural areas increasingly rely on hospitals and other medical services (example elder care) for are employment as many jobs move to other countries or big cities.
Because of the disproportionate representation of small states in the Senate, people who think farming has an untouchable lobbying effort will be amazed to see how much worse the fight will be if Medicare for All is turned into actual legislation for Congress to vote on.
Healthcare workers (including insurance companies) have what Chairman Mao called an iron rice bowl.
Fixing global warming is a much simpler problem...
2
@John 1 in 18 may go to "health care" but at least 3 of those 18 are going to somebody's profits, and maybe a couple more, since the numbers are layered and vague.
If we saved just those profits, we'd fix half the problem between our costs and costs in Germany or Canada.
We could save the other half if we also saved the huge overhead of claims denials (insurance companies often respond to preapproved claims with denial and delay, hoping that consumers will somehow just give up). All that claim denial and confrontation costs money, because it is people paid to do it all (all completely unproductive of any actual health care).
6
@Mark Thomason It's not about cost. It's about how hard it is to take away a lot of jobs. Administrators and others, none of whom do much to improve healthcare, are prime examples of Chairman Mao's warning.
2
I pay for a silver plan but due to the high deductibles and history of getting screwed by the medical establishment, I refuse to see a doctor or go to the ER. The only reason I keep the plan is in case of dire emergency where I will either go to the ER or die. This is probably how republicans would like it to be; the medical insurers make a ton of money and never have to pay out a dime except to the politicians that keep this scam going. It's a lot like our so-called democracy in that you have a vote but it really doesn't amount to anything because the system is rigged. I'll always wonder about the IQ of the average american. It seems to me that we're a lot dumber than the most citizens of all other industrialized nations and we certainly have the least amount of common sense. I've traveled extensively abroad and have lived in many countries and this one is, by far, the most disturbing (with the exception of Israel).
9
I don't understand why we accept "out of network" anesthesiologist, or other specialist when having a procedure, operation, etc. I don't buy a can of peas at the grocery store without knowing the price beforehand, yet insurers and hospitals think we'll just automatically pay something we weren't aware of at the time of service. Granted, my body is not a can of peas, but just like BC/BS doctors have to accept the payment deemed by the insurance company, so should these out of network doctors, rather than bill the unsuspecting, unaware patient.
3
Hoboken University Medical Center advertises that labor and delivery is covered in-network "by state law". Our insurance did not agree and treated it out of network only paying part of the $150,000 bill. The hospital was hounding us for the rest.
Had we known in advance how much the bill would have been we would have picked another hospital, but they purposely make this system obscure to wring of you every penny you've got.
3
One of the more common arguments against universal healthcare is often "I get health insurance through my employer, and it's great!"
I just say, that's great, when you get cancer and can't work and so are no longer employed, how is that great health coverage going to work out for you?
It's not theoretical, a co-worker got cancer, couldn't work, the employer is nice but come on, you can't just keep giving benefits to an employee who isn't working. She's lucky to have coverage through her husband's work, but not everyone has decent secondary coverage available.
Stop using your work-provided insurance as some excuse, it won't help you if you lose your job!
8
In September I had a bicycle accident. I was in so much pain the next morning that my partner, a surgeon, insisted on taking me to the ER. Our local hospital, and the one in the town next door were purchased by Stanford Hospital, and so now are quite pricey. So I asked him to take me to a hospital about 15 miles away--it was in network. I was there for 4 hours and had two CT scans. My bill totaled $29,000. One CT scan was $8,000 and the other $11,000. (I can walk into a local digital imaging facility and without insurance pay $350 for a CT scan.) Even though the hospital was in network, the Emergency Room doctors were not. My insurance company finally agreed to pay the ER docs as if in network and my total bill was just over $1,000. But the stress was horibble for months. I went on Medicare recently and I am so relieved.
15
Maybe this has been already dressed but Medicare only covers 80% of costs. Who or what is going to cover the other 20%? Surgery is not cheap in this country nor is a hospital stay so 20% or son could be very catastrophic.
2
I think I can speak to those who wonder why people fear Medicare for all. No, we don't love insurance companies. But we also don't know the details of what Medicare for all will cover, or what it will look like when the cost is spread across everyone's paychecks. Foreign health systems sound enviable when your problem is a broken limb or a standard drug, but what about cutting edge drugs? For example, the new CF drugs took time to get into foreign markets-- when ivacaftor was first approved, it wasn't covered due to the expense. Will Medicare cover every FDA approved drug when it is suddenly covering everyone? Can we afford it? Does one size fits all healthcare mean too bad for some of you, but hey, it works for most of us?
Having nearly been trapped by a surprise medical bill a few years ago, I called my insurance company to find out if a needed procedure was covered. After telling me to the dollar how much my co-pay would be, the nice man on the phone said: "The rest of the medical bill may or may not be covered." He went on to ask - with no evident irony - "Does this answer your question?"
4
Surprise medical bills are indeed shameful. In fact, I just received one myself for an in-office visit that involved an electrocardiogram. Before the visit, I had discussed the billing in detail with the provider, who was in-network, and had been told that everything was covered and that there should be no co-pay. But a few weeks later I received a bill for a co-pay of $31. Obviously, this amount will not bankrupt me and I won't even bother calling the provider, much less my insurance company. On the other hand, this is, of course, exactly what they want and expect me to do - just forget about the whole thing because trying to straighten things out would take a disproportionate amount of time and energy. It makes me wonder how many millions (billions?) of dollars the medical insurance industry generates this way. One thing is for sure - the system is set up that way by design. These are not honest billing mistakes, but rather involve systematic exploitation.
Nonetheless, I am not convinced that Medicare for All is necessarily the best alternative. Having grown up in Germany, I can tell you from experience that public healthcare comes with its own set of problems, especially long wait times and denial of coverage. Because the government has such a dominant market position - there are also private healthcare insurance carriers, but they cover only about 11% of the German population - most people are in no position to complain or switch providers.
2
USA pays twice as much per person as any other country. And every other country includes coverage for everybody.
The only freedom I see here is the freedom to fleece the population in the coldest way possible.
Reagan was working for unbridled capitalism, which has become a runaway horse (or freight train maybe).
8
I have Medicare and a BC/BS as secondary. It's been really, really good. I hope everyone can have Medicare and a choice of secondary.
But I would like to see lower drug prices that people can afford. Big Pharma needs a wake-up call.
5
My son spent 6 hours in a hospital after feeling pain in his lung. They found a "bleb" which resolved on its own over the next few days (the pain disappeared within a few hours). The bill? Over $35,000. One page of the bill identified ME as the patient, and listed all the bogus services I received. It also contained things like a $12 charge for a single aspirin, which my son did not request or receive. After reading "An American Sickness" by Elizabeth Rosenthal, I now know to ask - if a friendly doctor happens to appear in the hospital room to "see how the patient is doing" in a jovial manner - whether that doctor is "In-network." If they are NOT, kick them out. You may be charged $10,000 (as we were) for that brief and cheerful conversation. Sickening.
16
Moral of the story: double-check with your insurer before going out of network; do not rely on what your Doctors say about your insurance coverage.
On the macro level: vote in line with your economic interests re: health care (and everything else). If everyone did this, Obamacare would not be under serious threat and progressive alternatives to Obamacare would be welcomed instead of derided by many who would benefit from them.
4
This opinion piece gives us another reason to take care of ourselves and avoid doctors and hospitals when possible.
Americans need to do more self-preventative care and stop begging the medical establishment to take care of them. How long will it take for us to wake up and realize we need to change our lifestyles: sleep, diet, exercise, human relationships instead of screens?
There will always be a need for the medical establishment but I believe Americans who want Medicare for All also need to take some responsibility for their own health. Look to the countries that have health care for all. Are they as lazy and ignorant as the US when it comes to taking care of themselves?
Lastly, before some of you (or loved ones) with conditions that require regular medical attention feel targeted by this comment, I am not talking about you. I want the system to be functional and affordable for you; those of us who can improve our health by changing lifestyle need to do so NOW.
1
What an absurd comment.
We never know what life has in store for us. I was in great health in my mid-40s: slim, a regular runner, healthy eater, non-smoker. After some pain in my breast — that I initially dismissed as peri-menopause — it turned out I had six malignant tumors in my right breast and cancerous cells in my lymph nodes. Even with good healthcare provided through my spouse’s employment we were out of pocket tens of thousands of dollars each calendar year that I received treatment. (If you’re going to get really sick try to do it in January, each calendar year you’re out of pocket expenses start over.)
I received wonderful medical care and am thankfully doing well a few years on, but I can’t imagine having to face all I did, along with the threat of colossal financial ruin.
Yes, we should all try to take care of ourselves, but when accidents and sickness befall us, why shouldn’t we expect to receive quality care without bankrupting our families and our futures? Why should the wealthiest country in the world not take care of its citizens?
8
Some people compared the U.S. system of care with foreign systems, notably Canada's. I experienced the Canadian healthcare system and noticed significant differences that helps to explain their ability to offer universal healthcare.
In the U.S., hospitals compete with each other for customers with good insurance plans. For ex., they design gorgeous facilities with lobbies worthy of a Fortune 500 company. The hospital in Canada was plain: no lobby, small waiting rooms with a few chairs, a rather crowded intake area, some scuffs on the wall. But the whole ER was kitted out with all the necessary technology.
Second, U.S. hospitals compete by coddling patients. There is always a nurse ready with a warm blanket, offering ginger ale and crackers. Not in Canada. When my stomach was churning, I had to ask for some food, but it was brought to me quickly.
Third, there seems to be less staff. In the U.S., an orderly will guide you or cart you down the hall in a wheelchair, even a short distance. In Canada, the nurse pointed, and I walked down a long hall by myself, pushing the IV holder.
Fourth, in the U.S., hospitals spend a great deal of money asking for donations, then they turn around and give those donations to other non-profits in order to advertise. They also advertise on TV like a commodity I saw no ads by hospitals in Canada.
However, my care was better than I've received here. Canadian hospitals save millions by not having to compete.
14
@Locavore Exactly- and I'd rather have a hospital without giant mansion-like lobbies or fancy statues if I can avoid being charged half my paycheck if I fall down the stairs.
7
I love the people who whine my companies insurance plan is better. Some are until the day you lose your job, then they aren't.
9
Every civilised country has some form of public health system paid out of income tax receipts. In Australia, where I live, I had 2 artificial knee joints inserted at no cost to me, except for the x rays. I could have taken out additional health insurance which would have put me in a private room rather than a shared room and given me priority for the operation. Most people here don't know much about your health system but they know you don't have a universal public health system and they have heard about the horrific amounts charged for medical procedures. I may be wrong about this (no doubt I'll hear if I am) but I seem to recall a story about Sarah Palin crossing the border into Canada to get subsidised medical treatment.
4
The reason that universal healthcare coverage cannot get into law here, is the belief by most Americans, that anything the government does must be bad and all efforts by private businesses must be better. They believe that the more you pay, the better the service must be.
Couple this this with bought-and-paid-for politicians of both parties - but mostly Republicans - and you have a situation that won't change anytime soon.
And just look at the money being made! Drive down any commercial street in American and there they are. Every flavor of "healthcare provider" you could wish to buy services from. Entire city blocks given over to "healthcare providers" and their "Health Campuses." Some have valet parking and the buildings look like something out of a Hollywood movie. They are making out like bandits! Drive down that same street anywhere else in the developed world and this nonsense doesn't exist - at all! They have primary doctors and then they have hospitals, with a sprinkling of specialists here and there, out in the community. Their healthcare outcomes dwarf ours in quality, but no matter, we pay more, so that must be fake news, or jealousy
It really is all about the money. If you're part of the healthcare troika of insurance companies, drug companies and hospital companies, you will get wealthy, ever if you're pretty low down in the food chain. there's just so much money to be made, out there doing the "health care" thing.
6
You know, what you say also seems to apply to a lot of colleges and universities. Super fancy campuses and amenities to attract students and money and constant skimping on salaries and full time professors - more and more under paid adjuncts (and under paid and staffed nursing depts).
1
"It would be nice just once if our insurance companies were filled with terror by the prospect of losing us."
Trust me, they are. They wouldn't spend so much money on political donations, lobbying and advertising against Medicare for All if they weren't.
11
Congress has the best insurance money can buy and they get to decide what we have. Lets see if the bills get passed.
4
"I admit I have never quite understood the hatred Reagan had for Medicare, nor the hatred today’s Republicans have for Obamacare (itself modeled on Romneycare, a Republican idea)."
We don't have "health care" system in the United States but a system of pick pockets who take and take from Americans and we are still not healthy. Republicans enjoy the cruelty.
6
I work with a woman who is considering not doing colonoscopies after getting a bill because they found something that needed further investigation.
Americans are simply not going to go to the doctor anymore. I know I'm not.
5
Many people have never had a major medical expense. They see their doctor once a year for a routine check up, or not at all, or for an occasional bout of the flu or sprained ankle, and their insurance seems fine. For them Medicare is an unknown. People fear the unknown. They don't trust the government. Can you think of any reason why? They fear that their taxes will go up to pay for the healthcare of the lazy undeserving poor who don't know how to behave in the workplace and need to learn the dignity of work. They fear losing what they think they have. And politicians like Joe Biden give speeches saying that Medicare for all would amount to taking health insurance away from 150 million people.
4
I recently visited some friends in Quebec. They're middle class, with four daughters, one of whom has a challenging mental illness. During my stay, they made me repeat, over and over, that yes, yes! I actually had to pay for my daughter's birth, for my trips to the dermatologist for skin cancer, and thousands in co-pays when I broke my back. They are not proficient in English, and my French is even worse, so they thought they were hearing incorrectly, or translating wrongly. Could you say that again? You mean, you have to pay for this? You? Mon Dieu! You?
They simply could not believe I was responsible for nearly $20,000 a year in insurance costs, given their outstanding and free medical care. Their daughter might have bankrupted them. Instead, they live in lovely house, and the mother is able to stay home and raise her children.
What we accept as normal is a shocking revelation to others; a nightmare scenario that must be repeated again and again to be believed.
17
It is time to take the word "healthcare" back. Insurance companies are not in the healthcare business, they are in the financial services industry. Just like payday lenders...
1650
@Glen
The problem is the underlying cost of care driven by a profits-over-all business, not that we need insurance to subsidize it. These surprise bills arise from providers doing an end run around reasonable reimbursement limits set by insurers.
We might as why a medical bill is $145K or a hospitals bill $5K / day for a bed in an otherwise empty room.
The sole focus on medical insurance is why Medicare for All in an unserious effort to enact healthcare reform. The assumption that savings from eliminating the overhead of insurance will offset the cost of medical care, or that raising taxes to pay for it (a tautology) is the central challenge standing in the way of enactment is is either disingenuous or naive.
The real issue is controlling cost. That means having the government step in to levy price controls on service and provider compensation. Otherwise taxpayers simply chase medical cost inflation into oblivion.
23
@RD
Medicare deals with price controls in a simple and elegant way: a medical professional or institution agrees in writing to accepting Medicare’s levels of reimbursement in return for treating and billing for patients enrolled in traditional Medicare. They cannot pick and choose among Medicare patients as to which ones will pay at the Medicare levels or at higher rates. Since those enrolled in Medicare make up a large proportion of patients in many locations, there’s a powerful incentive to accept these prices, which are de facto controlled.
Interestingly, there are medical specialties such as psychiatry and plastic surgery in which many practitioners operate outside the world of insurance, (treating paying patients only) and locations, including the Washington metro area, where practices are able to operate profitably while restricting their patients to those with private insurance.
11
@Kate I've been referring to them as "medical bill brokerage houses" for a long time.
12
My memories of private, top-flight, $800/mo. health insurance in 2010 are not fond. Again and again, until it was clear this was standard practice, the first response to a claim was, “patient not covered at time of service.” Second, “patient is covered, but you sent bill to wrong address.” Third, “the first address was correct, please resubmit.” Then, coverage.
No wonder costs were so high, with multiple submissions required because the first answer is always DENIED.
Single payer, Medicare for All—call it what you will, it is time to eliminate the costly added layers of infinite private plans, and the anxiety produced by Suprise Medical Bills. And a better name than “suprise” would be appropriate for this predation on people already in distress from illness. How about Fraudulent Medical Bills” to describe making the same mistake every single time?
6
This American in London will be forever grateful to the NHS (National Health Service) for medical care for a condition that would have been fatal if untreated. This required a series of interventions over 18 months. The care was excellent, and I am fine.
The NHS is funded out of general taxation, to which we contribute of course, but I did not pay a penny directly. Not once during this rather harrowing time did I have to worry whether I could afford not to die.
The NHS isn't perfect, a lot of its problems stem from under-funding by the recent conservative governments, but it is a beautiful thing and the very dedicated staff are not in it for the money.
990
@KB I too have the NHS to thank for being alive - I had an appendix attack during a weekend and it was not a good experience . The NHS is underfunded-mostly because of your comment above -greed is not only in the USA.. and coming in on a weekend is not a good experience. However NHS is top notch for Preventive care -which is the best and I have had very good care and free meds as a senior now for 8 years. We gladly pay taxes to support it. The American public was sold a bag of goods.. by very wealthy people like Reagan and it is time they woke up. Nobody in the UK or in Canada would trade our health care for the travesty that is the "best medical care" not...
201
@KB
As a teenager flying out of the slums of Santiago de Chile to live with my grandparents in Southampton, England, I too praise the NHS for saving my life, without charging anything to me or my grandparents. I became visibly jaundiced days after arrival, and was diagnosed with hepatitis due to living in unsanitary conditions. The doctors were superb and very kind. Had they refused care because I was a foreigner or because I was indigent at the time, I would have died.
I became convinced back then that medical care is a human right. I cannot complacently listen to Trumpers in waiting rooms in Florida,(often Evangelicals discussing God's Will as opposed to Human Will) denigrating those whom they consider illegals receiving medical help in the emergency rooms at our hospitals.
They lack compassion and empathy because they lack the imagination to envisage that as a poor teenager abroad, or indigent, their lives too might have been saved by a system that recognizes the essential divinity in every person.
213
@KB the NHS saved my life as well. I was rushed by ambulance to the local hospital in the middle of the night with a pulmonary embolism (blood clots in the lung). The ambulance ride, 3 weeks stay in hospital and months of follow up checks were all free. To quote an old politician “the NHS is the closest thing the English have to a religion”.
76
Ms Boylan
You and your wife stumbled into one of the medical insurance industries "dirty little secrets", and it's really not a "surprise" to them.
They know when they send out a bill (outrageous or not) for a preapproved procedure, some people will give up and pay it. They only need a very small percentage of these bills to be paid to up their profits enormously.
Having had two children who needed hospitalizations and surgeries (my daughter needed two) that were pre-approved, performed by in network doctors, we were still sent a bill of over $100,000, each time.
Several phone calls to the insurer, with the pre-approval number, finally yielded a letter stating that the charges "were in error".
If we hadn't followed the insurance companies procedures exactly, including their very precise timeline for reporting the information to the company, it would have been denied.
(BTW: I really miss George Carlin...why is it "pre-approved" instead of simply being "approved"?)
I am now covered by Medicare...and love it!
4
The red flags should have been raised immediately with the, "...our doctors had assured us.." statement. Unless it is out of the mouths of the actual insurance company, in writing or recorded those in need of medical care don't have a fighting chance.
This is one of America's largest swindles right up there with sub prime and college loans. The Hippocratic Oath is a sham and doctors and insurance companies will continue to swindle until regulated and held accountable. We are witnessing the effects of unbridled capitalism, monopolies and deregulation; it has proven itself to be predatory. Wake up America and vote in 2020.
1
Ms. Boylan,
You act surprised that the Republicans hate Medicare and the ACA. The GOP hates to see government doing anything to better the lives of the average person. To make sure it doesn’t accomplish such a horror, they are trying to destroy government in any way possible, whether it’s a dramatic tearing down or a slow chipping away. We can’t let this happen. Remember in November VOTE BLUE NO MATTER WHO.
2
The two bills are directing their ire towards the wrong people. Hospitals and physicians already spend massive quantities of time and money following the labyrinthine challenges of billing insurance. The surprise costs come from the insurance companies' decisions about how much they agree to pay and to whom. Force the insurance companies to notify their clients when they won't pay for something, and force them to pay usual costs to out-of-network providers. Patients shouldn't be caught in the middle, but neither should increasingly-time-and-money-strapped providers!
Simple solution. When I work with a contractor to do a job the cost is stated up front. Hospitals should be required to state the cost up front.
546
@W.A. Spitzer Yes, of course, but this is a case in which the insurance company, in effect, said "Go ahead. We've got this," and then attempted to renege after the fact. It may be true that if the hospital and other providers included on that bill had asked for pre-authorization of a $145,000 procedure the company would have said "No," but we can't know that. What we can know is that pre-authorization is not the end of the struggle to get insurance companies to fulfill their commitments -- a struggle that thousands of Americans engage in every day.
59
@W.A. Spitzer Medicare has been trying this approach with elective knee and hip replacements. The result has been a very small decrease in cost, while all but the most ideal patients are turned down for the procedure. From the hospital's perspective, a high risk patient with a bad outcome could result in the kind of catastrophic losses that could close a small hospital.
12
@W.A. Spitzer Oh good-then you go without the procedure. Fantastic.
16
A for profit medical insurance system is immoral. Period.
8
Let's all understand how many millionaires this insurance looting has created....and how many of the upper management of insurance companies have accumulated multi-generational wealth.....
Are they going to give up this "legitimatized looting" of the American public? Hardly. They are going to use it to continue to buy influence -- now also legitimatized -- of Congress and the President.
Trying to change this situation is a titanic David vs. Goliath challenge. The way to start is by throwing out every -- Dem and Republican -- incumbent this fall.
Sadly, that is the only way because they all, in one way or the other, are on the healthcare and pharma payroll.
3
I don't love my insurance company. What I love is my employer which does all of the business of negotiating with insurance companies so that I don't have to. My employer, a big university, also employs very competent people to explain policies and co-pays and all that to me should I have a question. Frankly, I think it is time to ditch the current system if only because there are now innumerable outstretched hands between me and the services I receive and my employer who oversees the logistics, each of which has their hand outstretched to capture their share of the healthcare dollar. If we had the interaction down to one or two steps, the costs would go way down and it would be far easier to understand what we're paying for.
479
@Susan . I think you have it backward. The insurance company represents your employer. If your employer wanted everything to be covered, the insurance company would administer that plan. Your university might even be "self-insured." The insurance company might be administering the plan, not accepting the risk. Yes, the insurance company is a convenient scapegoat for your employer to "blame," but the employer drives coverage. Insurance companies negotiate with providers. I too work for a university and teach this topic--it is very complicated and difficult to fully understand.
49
@Sisyphus
We own a small business in NJ, we offer healthcare for all our employees and their families as well as pay the $2500.00 deductible. Sadly, we pay more each and every year but for LESS coverage. This is the sin of American "healthcare".
113
@Carol And what happens when people lose their jobs? Connecting health insurance to employment is insane.
98
Elizabeth developed a plan that will end such bills for everyone. But what happened? The pundits, pollsters, and moderate Dem candidates (incl Wall Street Pete and Any and Biden) piled on her. The ignorance and cowardice of these moderates and media are at the root of our problem. Scare tactics benefit no one but the big insurers. I’ll never support Pete, Joe or Amy. They are part of the problem.
5
State insurers here in Utah are paying patients $500 and buying them plane tickets to San Diego so they can cross into Mexico to buy their prescriptions. Do you need to know any more to know how completely the profit motive has destroyed health care in the U.S.? Rescue inhalers used to cost about $7. Regulations caused manufacturers to change to propellants that don't damage the ozone layer, Pharma used that change to re-patent the inhalers and now they can cost over $200 depending on your insurance, or lack of insurance. People dependent on insulin for life itself are now forced to shop the gray and black market for their life sustaining medicine, which is over a century old and costs no more to make than before vulture capital got hold of supply and distribution. This is madness.
13
I’m an American who lives in Canada. A stay at home Mom with a disabled husband. If we lived in the US I don’t know what we’d do for Insurance. But here I was treated for breast cancer with no outlay of cash. Not for surgery, chemo or radiation. And no forms. I’m 7 years out! Thank you “socialized” medicine. Oh and a week in the hospital post c-section? Same thing. Bless you Canada!
1305
@ST Wow! I was kicked out of the hospital 2 days after a C-section...and after a total hysterctomy years later, spent just one night there. My cousins in the UK and Ireland were appalled.
80
@weary1 The federal government's rule governing the length-of-stay requirements for a vaginal or cesarean delivery of beneficiaries covered in a group or individual health plan was made final in 2008.
The rule implemented changes to the Employee Retirement Income Security Act of 1974 (ERISA) and the Public Health Service Act (PHS Act) made by the Newborns' and Mothers' Health Protection Act of 1996 (the Newborns' Act). The Newborns' Act prohibits the restriction of mothers' and newborns' benefits for hospitals length-of-stay in connection with childbirth to less than 48 hours for a vaginal delivery or 96 hours for a cesarean section. The final regulations were effective Dec. 9, 2008, and apply to group and individual market plans with coverage that began on or after Jan. 1, 2009.
6
@Matthew C
It is only my guess but it is an educated guess. The rules (legislation) were made by men.
9
Brilliantly written, thank you. I have zero hopes that the GOP will let anything pass in Congress or by this vile President which will actually make life (and health) easier for the hundreds of millions of Americans who are not part of the 0.1%.
2
Privatized insurance companies, privatized corporate assisted living, privatized prison systems...seems like all our taxes go for war and military and we get nothing for ourselves. Privatization is another word for letting some GOP's buddy make billions. Why would we prefer that over our taxes working for us, keeping us in our homes with affordable health care and not afraid to go out walking if we're black...??
4
The healthcare system should not be a profit-making industry, period. Keep in mind that its current motivation is to maximize profits by denying claims
5
We should all welcome Medicare for All, which should more accurately be called Comprehensive Care for All Americans.
5
The obfuscation of rules, processes, terms and underlying structures was part of what created the run-up and then meltdown of the housing market over a decade ago.
Seems like a lot of that is going on in healthcare.
2
!. Doctors do not have a clue what your costs will be with your health plan and your benefit plan.
2. I am sure her health plan would have had qualified physicians in plan she could have utilized.
1
Funding a national medical plan would be as simple as instituting an national VAT at a suitable level to sustain the plan. The rub is to convince people (meaning those who think they don't need it or don't want "those" people to have it.)
Let the medical insurance companies offer supplemental plans, but sorry, there's no gravy now.
1
A few thoughts:
1. My heartfelt sympathy to the author and her family for her shocking, terrible, and all-too-common event.
1.5 Shame on anyone who reads this article, understands that it replicates itself hundreds of thousands of times each year in America, and thinks that the system is optimal as is.
2. Recently, I had a simple and common procedure. I was told that there would be some out-of-pocket cost for me. I inquired how much and was told it would be about $1000. The actual number was closer to $1500, without any reason other than estimation error. This is a less extreme example of the same problem. In any other industry, including mine, a provider is responsible for bad guesses outside of a specified range. How many Americans' budgets are broken by bad guesses?
3. A single-payer system such as medicare-for-all is a good and workable system. But so was the Affordable Care Act. I do not believe that medicare-for-all is achievable in the United States today. But strengthening the ACA, and adding a public option, is a workable way to get to medicare-for-all over a longer period of time, while still covering everybody now.
4. Historians will argue bitterly over the area or issue on which Trump caused the most damage to America. I believe that Trump's outright duplicity on health care issues, while simultaneously trying to gut protections, will be a contender.
2
As it has been with mass shootings, our politicians are not moved by these stories to any extent that something gets done. The money from the medical insurance and drug industries turns our representatives heads and the problem is swept under a rug, that is already full with issues that have been swept there previously. The only thing that will change this, as Bernie Sanders says, is a mass movement of people standing up and demanding change. Otherwise very little if anything will be done.
4
Private health insurance is great, as long as you never get sick. It gives you peace of mind, at the low, low cost of $10,000/yr. or more for a married couple lucky enough to have employer-subsidized insurance.
But woe to him or her who gets sick. Then, instead of peace of mind, you get to wrestle with a company that charges you ten grand a year for peace of mind, but would much prefer that you not trouble them with a pesky claim. Even then, if my experience getting treated for a heart attack is any thing to go by, you're not wrestling with your insurer, but with a bunch of doctors you never heard of who played some unknown role in your treatment. I mean, I know who put in the stents and I know the doc I see for follow-ups, but as to the other billers, it's a mystery. Some have practices with words like "heart" or "cardiology" in the name, but others disclose only the fact that they're "Professional Associations." I'm sure they are.
The good news is that my wife goes on Medicare this year and I join the lucky crowd next. The "Okay Boomer" taunts will have a a little less sting. But, I do wish the young 'uns to know that we're Boomers who do not wish the pull the ladder up behind us, but instead will vote will vote for a candidate who promises to bring the US in line with other civilized (and uncivilized) countries. Fingers crossed.
9
Having spent collectively over 100 stressful hours on the phone with Blue Shield over claims they denied, faxes that mysteriously got lost, sudden rule and policy changes that negated the last phone call, reps that promised to follow up and never did I really appreciated this article. We just yesterday finally received a check for all but one i
of the many claims we've been working through over the last six months. We've been experiencing routine delays, denials and broken promises since a family member became ill in 2013. Bureaucratic incompetence and poor training cannot explain the repeated denial of valid claims. Blue Shield clearly hopes that its members will just give up on using the benefits we pay for. We'd switch to a different insurer if we had any reason to think they'd be an improvement.
3
Meanwhile, I read yesterday that our president, in his new proposed budget, wants to eliminate military medical care and outsource that to private institutions. Another gift to the extortionist private sector. Except that hardly anyone will accept Tricare because it pays so little. So our military will be unable to get care or have to go a long way to find it as the facilities in bases and posts will be gone. Another Brilliant Trumpian Idea!
3
“I went to bed that night not knowing whether we would have to declare bankruptcy in the morning.”
Nothing but hyperbole for the sake of drama.
Medical bills can always be negotiated down.
1
@Passion for Peaches
When a person has had a serious medical issue. They are trying to regain their health.
They do not have the time or energy to "out clever" a giant insurance company that they have paid to insure them.
12
@Passion for Peaches
"Medical bills can always be negotiated down"...
So can your credit score.
5
@Richard Fried, did you even read this piece? The medical bill was for a daughter, not an adult.
1
I am glad it worked out in the end but a caveat here about Medicare, and Medicare for all! Medicare does not cover all! Medicare is not free, it is means tested. One still needs to purchase prescription drug coverage, again means tested (the higher your income, the more you pay) and filled with limitations if you are on a higher tier (newer, non-generic) drug. Then comes the supplement insurance (Part B), which surprise, is provided by the same insurance companies you are thinking you will be free from. And, all of this assumes you will find doctors who accept Medicare, and further doctors in your supplement insurance plan. Oh, and there is no dental insurance, and what they do offer makes no sense because the limit of what they will pay in any year is less than the cost you pay for the insurance. Hmmm, not so simple after all. But yes, no one should receive surprise bills!
3
Senator Sanders’ single-payer universal healthcare plan is much more generous than traditional Medicare because it would fully cover all prescriptions, plus vision, dental, and long-term care. Also, it would not require the payment of any premiums, deductibles or co-pays. It should be called Comprehensive Care for All because that’s really what it is.
Bernie 2020
3
In response to this: "Later, another doctor in the practice told me that even when procedures are pre-authorized (as my child’s was) insurers often deny them anyway. His understanding was that insurance companies often respond to preapproved claims with denial and delay, hoping that consumers will somehow just give up."
Insurance companies that knowingly do that should be fined $1000.00 each time they do it. They would quickly stop this practice.
The problem is that government has shown little ability or competence to deliver quality health care. Look at the Veterans Administration, which is plagued by long delays in treating former military members. Look at Medicare, which is rife with fraud and waste. Look at Medicaid, which is also poorly administered, and provides coverage to wealthy non-Americans who show up at emergency rooms across the country. If the U.S. government showed any ability whatsoever to administration of health care, then I would be on board. The government does very few things very well, and there is no evidence that we are capable of a government-run health care system.
1
Sir, just to be clear, no one is talking about government run health care.
Current Medicare recipients use private healthcare providers who are reimbursed via the Medicare insurance system.
The insurance is government run, not the healthcare providers.
5
@David Ricardo
The problems with the Veterans Administration are, for the most part, local issues. Both retired vet friends of mine are completely happy with the VA (as are most vets incidentally).
Medicare fraud is investigated and one reads of arrests and convictions regularly. Those folks will go to jail (assuming Trump doesn't pardon them). Ironically, the most recent case involved millions stolen from private insurers.
The US government only has control of certain aspects of healthcare. The remainder is a run-away train or political football.
The antigovernment rhetoric is tiresome. The government actually does many things well. Look at the myriad of services provided to you each day including the ones, at first glance, that may not be so obvious.
4
The government subsidizes 72% of the healthcare bills of the members of congress and they have other means to reduce their healthcare bill. if If the Affordable Care Act is repealed, members of Congress have a fallback plan. They would be able to return to the FEHBP. Twenty million other Americans won’t.....
2
I was recently ill in London on a business trip and felt I really needed to go to a clinic. My London-based colleague called up the closest NHS clinic and I was able to see a doctor that afternoon. I met with a doctor for 30 minutes where she took my vital signs, asked me a series of questions about the pain in question, and concluded that it was a nasty stomach virus. Despite being a non-resident, the cost was 80 GBP with my anti-nausea drug costing 9 GBP at the local Boots. Compare that to the US where you need to make sure that the clinic, hospital or lab is in network before you even make an appointment. I've taken to taking a screenshot of the United Healthcare site indicating that an entity is in network the same day as the appointment. And people wonder why our health statistics aren't great.
4
When I read in the article "Before Medicare, only 54 percent of Americans 65 and over had hospital coverage; three years after its passage, 96 percent of older Americans did. Eighty percent to 90 percent of recipients really like Medicare — and these older Americans are the most conservative voters in the country." I could not understand why, the, so many Americans continue to oppose some form of socialized medicine for all. As a Canadian, I understand that the cost of providing socialized medical care is much much much less than what is provided in the United States. I also understand that a sick person's and their family's anxiety should be about that person receiving good treatment, and becoming well - not anxiety about cost.
5
Until everybody in the government has the same health insurance the rest of us do, it will not change.
6
There just was a bipartisan bill in congress to curb surprise medical billing. Senator Chuck Schumer, who had received over a million dollars from New York hospital groups, worked behind the scenes to kill the bill. Nancy Pelosi also played a role in killing the bill. This illustrates the difference between the corporate democrats and the progressives democratic policies they dislike. Follow the money. We need politicians who represent the needs of the people and are not subject to legal bribery.
3
@Dan https://thehill.com/policy/healthcare/481287-pelosi-enters-fight-over-surprise-medical-bills
Not quite accurate: there were two bills and both Pelosi and Schumer were fighting to curb surprise medical billing. I imagine I know where you got your information but it is false.
8
Some problems are big and obvious persist in this country because our political leaders do not have the will to take on large monied interests. This surprise billing is one such issue. Prescription drug prices are another. Assault weapons are another. Hedge fund managers being taxed at a lower rate than their secretaries. Climate change.
Really, rich monied interests only need to buy off one political party - generally the Republicans - and they can effectively block the government from ever fixing these problems. Unfortunately, although Republicans are a minority in this country, our political system - Senate representation of small rural states, the electoral college, etc, and large donations from large monied interests - keep them in office. We need to change the political system to fix these obvious problems.
1
@Michael Smith The hallowed "founding fathers" electoral college and two senators from every state no matter how unpopulated or small is the gift that keeps on giving.
Understand that one reason Medicare works is that it is subsidized by private health care insurance. Hospitals could not survive financially if paid at Medicare rates for every patient. Doctors' Hospital in Pinole, CA, went bankrupt and closed for this reason. Medicare premiums would have to rise if there was Medicare for all. A health care system is only as good as its funding. Britain's NHS bounced close to bankruptcy several times during the Tony Blair years, and hospital conditions suffered. Don't be surprised if you have to wait six months for knee surgery, or two years for cataract surgery. In fact, Medicare has just made major cuts in reimbursement to physicians. For example, cataract surgeons were just cut 15%, and now make less in actual dollars for doing the surgery than what was paid in 1980.
3
@R. Edelman
This sounds about right. I think for the US to try to move to a British NHS or Canadian HC system we'd have to have a significant tax increase to cover it. Either a VAT (value added tax) or payroll increase. What's frustrating to hear from Warren and Sanders is that they promise all the good but do not follow up realistically with the bad: Cost. It's not sustainable to simply "tax the uber wealthy." For one, there's not a giant pool of them and another they'll restructure their wealth because they can afford to do that. You might cover expenses for year 1 and 2 but what about year 3 or 10? You'd have to have EVERYONE buy into the new system and not just a fine like the ACA. The question is how much will everyone be expected to chip in and how will you capture it? 30% increase? VAT?
No candidate or current occupant is discussing that. Which is why we'll still have this discussion in years to come.
@R. Edelman I'll take all that, which I think is exaggerated and shaped to create fear, rather than a bill that will destroy me financially for the rest of my life. For every example you can dredge up, I suspect there are 10 cases like the one Jennifer Finney Boylan describes.
2
Well, yes, a lot of people know someone with a story like this. Is it not time to rally behind Sanders, and, unified, defeat Donald Trump? Then we can be like the rest of the civilized world. (I say Sanders because Warren's campaign at this point would need a miracle for her to become the nominee, and she was the only other candidate to--apparently--support Medicare for All).
I say, grow some backbone America. It works quite well elsewhere.
What? You're asking me to give up my free choice and my private plan? Don't threaten my right to be billed $145K for nothing.
3
Our insurance companies have been intensely scared if not terrified for a long time by the prospect of losing the profits they make from health care. Their response has been to lobby intensely and mount advertising campaigns claiming that non-profit systems would be a disaster. The response from corporate health-care providers has in many cases been similar - they are not really interested in providing value to customers, just maximizing profits and the compensation of those at the top of the system, and they do this by means which are not truly competitive.
This is why the for-profit system of healthcare must be curtailed - it is not working. Consumers simply do not have the knowledge or opportunity to shop on price. Other countries have various systems, but in all prices are directly controlled by government, not the "free market". Government essentially bargains on behalf of consumers.
1
The biggest issue with "Medicare for All" is that it's now designed for healthcare treatment of people over 50. What happens when women/girls of childbearing age (young as 10 or 11 and old as ...55+) need to be covered for infertility, contraception, and abortion under a national Medicare plan? Will that plan simply not cover any of those issues? I note that men's prostate and ID issues are covered, interestingly enough.
1
@Katrin Public money for infertility? I can think of *hundreds* of other medical needs that come before that that aren't covered!
I hear people saying we can't afford Social Security Benefits for the elderly and can't afford all the kinds of medical care needs they have and people are worried about covering infertility with public funds?
Time to sit down and discuss our priorities!
2
Our insurance companies have been intensely scared if not terrified for a long time by the prospect of losing the profits they make from health care. Their response has been to lobby intensely and mount advertising campaigns claiming that non-profit systems would be a disaster. The response from corporate health-care providers has in many cases been similar - they are not really interested in providing value to customers, just maximizing profits and the compensation of those at the top of the system, and they do this by means which are not truly competitive.
This is why the for-profit system of healthcare must be curtailed - it is not working. Consumers simply do not have the knowledge or opportunity to shop on price. Other countries have various systems, but in all prices are directly controlled by government, not the "free market". Government essentially bargains on behalf of consumers.
2
I do not understand why the debate over health care doesn't address the fact that Kaiser Permanente has a longstanding and successful business model that provides medical coverage without any surprise billings. I've been a Kaiser member for over 30 years, including the past three years when I went on Medicare and now have my supplemental coverage with Kaiser. Kaiser certainly isn't perfect, but if Kaiser can make its business model work why can't other health care providers do what Kaiser is doing?
3
Solutions like Mr. Doggett's bill and a public option are like playing whack-a-mole with the healthcare system. No matter which problem you attack, many more will continue to pop out just because our whole healthcare system is based on people being able to make a lot of money out of it and not a desire to keep people healthy.
We've had Democratic presidential candidates cynically lie to the American people about what Medicare for All actually means to frighten them.
And it's amazing how any column that seems to support Medicare for All could fail to mention Bernie Sanders.
11
Arguing that "the rest of the world" has some form of universal healthcare coverage is unconvincing and I wish proponents of M4A would stop shopping it around as if it's a winning argument. What works in Sweden, Denmark, Canada or the U.K. will not, necessarily, work in the U.S. Americans are skeptical of government. It's in our DNA, put their intentionally by our founders and reinforced by government inefficiencies and failures over generations.
The idea that the U.S. government could build and maintain a national healthcare program covering all Americans and do it better and more efficiently than the free market is hard to believe. The scale alone is beyond anything previously accomplished by our government, and that includes navigating the Great Depression when there were far fewer people and much less complexity to the economy.
If die-hard M4Aers are so sure of it's success, why not endorse M4A-Who-Want-It and give the government the chance to PROVE it can do it better. If successful, people will opt in. Said another way, give people a choice rather than taking one away.
1
@John You obviously haven't looked at the statistics. America spends FAR more than any other country to get poorer health outcomes. If we don't trust government we trust insurance companies even less. The argument you make, that it won't work here, never has any details. I suspect what you mean is that Americans don't trust or love each other enough to "pay for so-and-so's" healthcare. So just say it, you hate your fellow Americans and don't want to help them, even if they would help you.
27
@John We have seen what has happened to the Affordable Care Act in states that did not want it to exist. If a plan is partial and its funding can be directed or redirected by the states, it becomes unfair and less functional, often for those most in need. To say that if a partial solution is acceptable, people will opt in, is to jeopardize, or at least hinder, the whole project from the start.
4
@John
I disagree. The free market is both unwilling and incapable of providing coverage to all Americans. And they certainly have no incentive to do so affordably or efficiently. The free market loves denying people coverage, withholding treatment, and keeping premiums for bonuses.
Medicare is the standard against which all other insurers are compared in HEDIS measures. Most private insurers fail to compete with Medicare, and Medicaid managed care plans perform better than private insurers. Health care is just not appropriate for commodification.
Medicare for All Who Want It is yet another do-nothing policy that doesn't address structural inequalities. We can be better; it is possible.
4
"About 20 percent of Americans receiving elective surgery are now on the receiving end of these bombshells."
Key words here: ELECTIVE SURGERY. As in, optional.
Using something you don't need as an excuse to take my insurance away and put us on a government system is very deceptive and disingenuous.
4
@Randy L. I had three ruptured disks and the repair was called ‘elective surgery’ by insurance company, my fathers bypass was elective. Most procedures are elective.
51
@Randy L.
The Belgian healthcare system is one of the best in Europe. It is divided into state and private sectors, with fees payable in both. The state system is funded by mandatory health insurance which allows residents to access subsidized services such as doctors, hospital care, dental care, maternity costs, and prescriptions.
6
“Elective surgery” is a term insurance companies often use to avoid paying claims.
Many so-called elective procedures are vital to one’s quality of life.
18
If the medical industry doesn't end up with all of your hard-earned retirement savings, some law firm will.
511
@George
Hyperbolic nonsense. If you want to have a real debate about healthcare, stop the useless morality commentary and deal in reality. You can't turn an aircraft carrier on a dime, nor can you change the US healthcare system in a single Presidential cycle. M4A-Who-Want-It is the only rational approach that brokers a real peace between the public and private spaces. Let the US government prove they can design, implement and sustain a healthcare program that is more efficient and more effective than private healthcare and people will opt in. It's that simple.
9
@John there are templates from all other countries in the civilized world on how to do it. Cheaper, better outcomes are the result. . What could be wrong with that. Other than entrenched highly profitable interests in the medical network.
32
@John Watch John Olivers report on healthcare from last Sunday to see why M4A-Who-Want-It may not be a good idea
15
I feel for the author's plight, medical care in this country is inflated to the point of ridiculousness. However, I would never take my doctor's word that a procedure would be covered. When my husband required an endoscopy, I asked the doctor's office for the coding for the procedure, then called my insurance company to confirm that everything was in network and would be covered before he went in.
Actually, I kind of like jellyfish, unless there are too many of them. But whatever, I love this article. While the matter of "surprise" medical bills is a matter of major concern, another almost equal problem is the concept of "in-network" itself. Where I live, access to quality medical care is limited to the few doctors and medical establishments that are available. Not all of these medical practitioners are great. In fact, some are pretty bad. Finding a good doctor, especially specialists, who will accept my insurance is tough, unless I can and want to travel hours to the closest big city, and even then my insurance may not be acceptable. My partner has a brain tumor, and virtually no neurologist in my state is qualified to help with that particular problem. Insurance providers should be required to provide, and providers should be required to accept, coverage for all patients, regardless of the source of coverage. Practitioners should not be allowed to deny service to patients because of their insurance provider, including Medicare or Medicaid, or to engage in this "surprise billing" nonsense. Practitioners and insurance providers need to work out the financial mess, not off-load it onto the patient's back, who already has problems. Or we could just have a national health care plan, like most civilized countries do, and take care of the whole rotten to the core mess.
3
In the United States 49% of the population gets it's insurance through an employer, 6% through non group plans, 20% through Medicaid, 14% through Medicare, 1% through the military for a total of 90%. For the sake of discussion consider only 10% are uninsured. Therefor the vast majority of the population is anxious about the risk of a total change in healthcare coverage and is not capable of even beginning to understand the positives and negatives of each plan. This is why a government offered Exchange that offers income based coverage for the uninsured is always the best first step. It allows the government to actually test the concept on a small population and engage in a true cost benefit analysis.
1
@Shirley Eis
These folks had insurance. The article is about healthcare billing, insurance payment, and copay policies.
1
That's the price we must pay to have the world's best medical system.
Pay any bill you receive ans be glad you don't live in one of those countries where you get the same quality of care for little or no payment.
Remember: it's not Medicare we need for everyone, but Medicaid. Depending on how the regulations are written, Medicare can bankrupt you as quickly as our stellar private insurance industry.
@KD Unfortunately there are no data to show that we have the "world's best medical system". The U.S. pays 50-100% more of their GDP than almost all other industrialized countries and our outcomes are mediocre at best.
It would be wonderful if you could pay any bill you receive-how about $145.000? Actually the over-all quality of care in "one of those countries" is in most cases as good or better than we receive. Of course the wealthy always have access to better care.
I suppose Medicare could bankrupt someone but I have been on Medicare for almost 20 years and have never known anyone to experience such. I do personally know several people that are severely hurt by having $8000 deductible plans and surprise bills.
The stellar private insurance industry is taking 20% of the cost of healthcare and putting it in their pockets.
2
@Dan I thought my irony was more obvious.
Medicare began well enough, but most people on Medicare need also purchase private insurance to fill the gaps in the program. Plus, it does not cover things like hearing aids. How many older folks do you know who need hearing aids?
We can do better.
1
My grandson was born six weeks premature and spent one full month in the NICU. There was a team of more than ten professionals at his birth. I am told that the expense would have been around $100,000.00. In reality, the total outlay was a few dollars for parking near the hospital. No insurance companies, no co-pays, no forms or anxiety of any kind. I cannot understand why many people believe that universal health care is a dreaded thing. The US has socialized army, navy, air force and marines. People deserve a better quality of life than they are getting.
1487
@Neil
So I'm always confused about your healthcare: How do hospitals and doctors and time and surgical materials and medications get footed? Did the government pick up $100,000 for you? I'm not quarreling, just trying to understand. Somewhere that cost exists. Who paid?
13
Canada’s healthcare system is financed through taxes.
It’s that simple.
134
@Jerry Engelbach
I'm asking the Canadian for a more detailed reply than "taxes." I pay plenty of taxes in the US.
13
While in Madrid a few years ago I sprained my ankle pretty badly. Seeing me on the sidewalk in obvious pain, a Good Samaritan in his car stopped, offered me a ride to the hospital, drove me there, waited until I was situated, then left, refusing any money offered in appreciation. I had x-rays done which showed a severe sprain. The ER treated me, wrapped my ankle as warranted, gave me some pain killers, had me sign a few papers and released me. They gave a voucher to bring to a pharmacy for a pair of crutches. I got the crutches $3.00 (usd) and proceeded to enjoy the rest of my visit. Total cost? A few hours of time, $3.00, and total appreciation for a health care system that truly cares.
1317
@Western Slope A similar event happened with my family in Europe. I am curious what the corresponding experience would be like for visitors to the good old U.S.of A.
37
@Ron C A while back I read that Canadians who visit the US make sure they have enough travel insurance to cover the unexpected. I assume most travelers from other countries do like wise.
36
@Western Slope But god forbid if poor people of color get health care for free.
32
Many younger people believe that Medicare is free and covers everything. Nothing could be farther from the truth. My wife and I are both on Medicare but must spend over $8000/ yearly on health insurance to cover what Medicare does not cover, and there are still deductibles to be paid.
4
We finally got poor enough to qualify for New York state Medicaid for the kids. Turns out my daughter had a rare brain tumor. She’s all better now, but will need certain medications daily for her entire life.
When I first received the bills for some of her care I almost fainted: easily 50k for just the radiation and accompanying MRIs!! Not mention the surgeries and ICU stays. I was not responsible for the bill. Thank heavens!
Thank you NYS for saving my daughter's life.
848
@Pam I am so happy that your daughter has done so well.
Try not to think of moving to another state that isn't as generous. Their cost of living is much lower, but they will have no problem not covering her meds. Even if they are preventing seizures or recurrence.
They may have sunshine, but they don't have compassionate politicians that would prevent this.
34
@Bathsheba Robie That a stupid thing to say to a mother who almost lost her child. What's wrong with you?
28
@Bathsheba Robie People do get less or no treatment from a lack of money. They don't take prescription medications or ration them out.
Presumably, most people, when faced with a life or death situation, would go into as much debt as possible to get the care they need and likely have to declare bankruptcy later, which will impact their finances for decades if not a lifetime. That's not a much better solution than NYS paying.
5
In addition to the surprise aspect, there's the question of why are these bills so outrageously high. How can they justify them?
To give one example, I got a bill for newborn "nursery care" that was something like $5000 a day. Can someone explain why it costs so much? Is it the real estate? Nope, each newborn takes only a few square feet (there were maybe a dozen in that room). Is it the staff? Nope, there are several newborns per nurse, but since it's 24/7 let's say it's one-to-one on average. Even so, nurses are not paid anywhere close to thousands of dollars a day. Is it the equipment? What equipment, the reusable plastic crib the put the baby in? The diapers and formula? OK, sometimes they put the newborns under a special lamp to treat jaundice, and being medical equipment I'm sure it's ridiculously overpriced, but still, it is capital equipment so the cost is amortized.
In fact after the insurance company gets involved, the bill gets "negotiated" down by 90% or more, to what starts to be a somewhat reasonable price. But what if you don't have insurance? Then you have to fight or pay. There's a word for that: extortion. I suppose they use the ones who pay to subsidize the ones who don't, but why should the few who are foolish enough or rich enough to pay for that? Why not send a sensible bill in the first place? This is a complete failure of the government, since health care is not a functioning free market.
1119
@Bob: The insured are the ones who pay for it, that's who, through higher co-pays and deductibles. When someone can't afford to pay a medical bill - the hospital, doctor's office, outpatient clinic, whomever - they push their rates higher to compensate for the financial losses. Insurance companies then push their rates higher in response, and the cycle continues. We are the ones who get raked over the coals while the insurance companies laugh all the way to the bank, hospitals close, doctors go out of business or consolidate and downsize, etc.
43
@Bob That's one of the elephants in the room in this whole debate. Sure insurance cos. make lots of money, but for medical costs to come down, the provider side will take a major hit as well. This isn't talked about much. Pay will come down, especially for specialists. It's the right direction, but you will see MAJOR battles, many behind the scenes, before any big changes are enacted.
40
@Bob
Excellent point ! Any other transaction like that would be criminal.
10
Americans who worry about single payer health care eliminating their "choices" and creating waiting times need to take a close look at what is going on now.
Our "choices" are limited to what your insurance will pay: in network, 3rd party companies reviewing a doctor's treatment to see if it meets their "approval" for payment, long waits for specialists, not matter how serious the need, etc.
American health care is a disgrace. Every patient pays a different out of pocket amount depending upon their insurer. Many are denied treatment because they can't pay out of pocket and insurance denies coverage.
I still can't get over how an insurance clerk with a high school diploma (I know her!) can deny M.D.'s recommendations for treatment. A doctor goes to school for 8+ years and has to get approval from someone with limited education and no medical background. This system makes no sense!!
11
While I’m sympathetic to truly surprise billing, I’m not sure this qualifies.
The provider was out of network, but you asked the provider how much it would cost?
Try asking your insurance company next time. The difference is that the provider may guess, while the insurance company will know.
None of that changes the unfairness or provider networks, with which we all must deal until we collectively come to our senses.
This, however, isn’t quite what you’re saying it is.
2
@Barry
Please read Cathy just below. I am a physician and if you think that the insurance company can tell you if something is covered or not ahead of time you are sadly mistaken. The head of billing in my office knows that the only way to see if something is covered is to do the procedure or test and submit the bill and see what happens and then appeal.
2
I work in a medical office. We try to tell people up front how much they are responsible for paying by looking up their benefits and getting authorizations ahead of time.
I think translating the Rosetta Stone was easier.
In our practice, we routinely deal with about 10 different companies, and less routinely with another half dozen or so. Each has dozens of plans. All the plans have different copays, deductibles. Some have both in network and out of network plans.
Only one or two plans makes it easy to see what they will cover - statements like "Outpatient surgical and provider fees covered in full" are rare. Instead we see a screen that shows that a plan has a deductible, and you need to find the secret wording that indicates when and where it applies, because it applies differently depending on the place of the visit, the type of service, and who performs it.
Calling to find out benefits takes anywhere from 20-30 minutes per transaction - for a simple MRI authorizations I once went through 7 levels of of people - 7 transfers - only to be told a doctor had to review it.
All of this is to insure that surprise billing is the norm.
1607
@Cathy
Exactly correct. The opacity, impenetrability, mysterious codes and descriptions, etc. are not bugs but features of a system designed to extract as much money as possible from people at their most vulnerable.
263
@Cathy
Thank you for that inside account. I was in the healthcare industry for over thirty years and never had to deal with the money angle - until I retired.
79
@Cathy
It is that kind of bureaucracy that makes our health care so expensive. There should be one price no matter who is actually paying.
131
People on the political right talk about rationing if one has "government medical insurance."
Medicare does not turn a profit (because it does not charge the money that would represent a profit to be sent to shareholders), does not pay million dollar salaries and bonuses to CEOs and other bigshots, and spends a relative pittance on advertising because there is no other competitor in the public sector.
People on the political right never consider that private medical insurance companies do turn a profit (which is paid to private shareholders), does pay enormous salaries and bonuses to CEOs and other bigshots, and spend a ton of money on advertising to try to win business away from other private insurance company competitors. Competition is not used to hold down costs, but to maximize revenues.
Oh, and then those private, profit-making insurance companies RATION healthcare, because every dollar they spend on YOU is a dollar less in profit for them. They are in business to MAKE MONEY. They deny as much coverage as they can, because paying for that covered expense costs them money.
The private insurance companies do not actually PROVIDE any healthcare. Do you go to their office for examinations, tests, treatment, surgery or the like? The private insurance companies only HANDLE MONEY, and take a slice of that pie for the privilege.
What do you think comes first for those insurance companies, paying for your health care or turning a profit? You have three guesses ...
42
@Joe From Boston
Even the Non-Profits have millions in cash on hand, Money they use to buy up hospitals. Eliminating competition and creating heath fiefdoms, if not outright monopolies.
3
@Joe From Boston
Insurance companies, like parasites, fool their hosts into accepting them as a necessary part of their existence while exploiting the host.
2
You gave your consent to use the out of plan provider. My insurance is very clear about what they’ll pay for out of plan or out of network services. The last person who knows what your payment responsibilities are is the service provider. They are not the insurer. Very few details provided by the writer. What was the procedure that caused you to not use your plan? I like to hear from an insurer.
2
@mark
Please see Cathy above. I’m a physician and her experience happens multiple times daily.
1
When my eldest daughter was 14, she needed a very serious dental operation. When I tried to find out exactly what was covered, our rep told me unofficially that they would only pay for laughing gas in any dental procedure. When I told this to the surgeon, he said there was no way he would use anything as unreliable as laughing gas on a 14 year girl for this operation. If I insisted on laughing gas, I would have to find another surgeon. So I told him I would pay him and see if I could get the money back from my insurer.
The operation went fine and when I submitted the bill, the insurance company refused to pay for the anesthetic, $800. After yelling, I finally got the name and address of someone with authority in the insurance company.
I wrote a letter to her and received no reply, but a week later I got a check for $200. So I sent her a longer letter, and I got the surgeon to write a letter, a copy of which I also sent. Again, no reply, but I got a check for $200. I began to see a pattern. So I sent her the same letter with another copy of the surgeon's letter. A week later, I got another check for $200.
The next time I sent the letter that referred to the surgeon's letter, I omitted the surgeon's letter to see if anyone would notice. A week later I got a check for $200. Now I had the entire $800 they owed me, but purely as a matter of scientific curiosity, I sent them the letter again. A week later I got another check for $200.
29
@Len Charlap You should have kept going (but not deposit the checks)...just to see when they'd finally tweak to their own ridiculousness.
1
Until the health insurance debacle is fixed, Congress should be forced to get and pay for their own insurance. Experience is the best teacher.
24
@Lene Our congress critters do have to buy their health insurance on the open market. I think it was Chuck Grassley who made that happen.
2
Nowhere in the Hippocratic Oath does it state that "I will use treatment to help the sick according to my ability and judgment" while extracting the maximum cost the market will bear.
We don't have a health care system in America. We have a health care business that monetizes misery at the expense of care.
31
Surprise medical bills are a major problem. The writer should have explained what the surprise bills were for as well as how and why they were resolved. This is an important issue and clarity is much better than vagueness.
The usual reason for surprise medical bills is that non-participating doctors charge much more than other doctors. Was the bill resolved because her doctors agreed to charge a lower fee? The other likely possibility is that the doctors pre-approved one set of procedures and then they billed for another set. Was that the issue?
6
Elizabeth Warren lost ground because she decided to postpone Medicare for All until her third year and pass lots of complex fixes like a "public option" in the meantime. Sanders is doing just fine with a simple understandable program.
5
@Chris Martin Except that his surrogates have also acknowledged that if they can get M4A passed, they're still looking at a 3-4 year transition period. There's absolutely no basis for preferring Bernie to Warren on this point.
8
@Chris Martin We will see In New Hampshire together warren and Sanders bot a smaller percentage of the votes than the other two candidates in the center. Show me a state where Sanders captures 40-5O% of the vote then I will listen. There is a vocal Sanders movement but so far we haven't seen a truly popular movement, have we.
Thank you for this clear assessment of our problematic healthcare system, you never said exactly how you got this bill to disappear or what it was reduced to or what it was for exactly. All I know is my med's are 75% less in Switzerland than they cost in NYC, which is really something considering everything else paid for in in CHF seems to be 50% more expensive there.
15
@Jt They did not roll over and pay the bill- advocacy by the doctor's office and insistence that the company cover something they approved worked. Insurance companies are very good at accepting premiums, its the paying bills they often need to be forced into.
7
@Jt, A friend of mine found that she had stage 4 breast cancer. Her oncologist prescribed a set protocol that included follow up every few months with a CT scan. The insurance company denied the scans. She got our school principal, our senator, her doctors, and our local politicians to pepper the insurance company with letters. Strangely enough the insurance company covered it and said they had never denied it in the first place! After more than ten years she is still alive. Something we had never expected to happen.
3
I've been a strong supporter of Medicare for All, and I still favor universal health care.
But.
I turned 65 last year and went on Medicare. I was delighted at first -- lower premiums, fewer denials.
I thought.
If insurance company care was second rate, Medicare is tthird rate. Quite simply, it won't pay for the therapy that my doctor says I need. No way to appeal. It just won't pay. And there is no way even to get a partial payment and make up the difference yourself.
Medicare has become so rigid and skinflint that doctors are dropping out -- only 60% now accept it, down from 80%.
The specialist dentist who makes my sleep apnea appliance is an example. Medicare now want to classify her as a durable goods supplier. That means that not only will they not pay for a followup visit, they won't allow her to charge for one. And since sleep apnea appliances can cause problems with teeth and the jaw, she considers that unethical. So she's thinking of dropping out.
It's pretty crazy, too. I had to get a $5000 sleep study to qualify for a $750 CPAP -- even thought I've had sleep studies in the past. Talk about waste.
This is all making me uncomfortable about Medicare for all. I understand that we need universal health care, but I'm no longer convinced that Medicare is the way to do it.
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Actually sounds not so bad, compare to insurance that will cover nothing until you spend 4K of your money on the top of 6k in premium.
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@Josh Hill Did you purchase an Advantage Plan to go along with basic Medicare? In both the states of New York and Massachusetts, it has been my personal experience with sleep specialists and orthopedic surgeons that Medicare + Advantage paid well more than 95% of the costs with no denials involved. Though I am just one data point, for me Medicare is a success.
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@Josh Hill Medicare for All would cover more than basic Medicare does now. It's important to have a Medicare supplement plan in order to pick up the things that the basic Medicare plan does not currently cover. If you don't have that, you should consider getting it and make sure it is one which covers pretty much everything. Conversely, if you have a Medicare Advantage plan, which is theoretically a partner plan between traditional Medicare and a private health insurer, you may be required to pick up all kinds of deductibles, out of network cares, copays, etc. It looks good on the surface due to upfront premiums often being lower than traditional Medicare, but the devil is in the details. I have seen many people who took Medicare Advantage plans recently and found that even the neighborhood hospital they have used for decades was no longer "in network" and they either had to pay a large percentage of co pays or travel 25+ miles to a hospital "in network". Medicare Advantage is a prime example of how profit making in health care corrupts the availability and expense of health care.
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Insurance companies are terrified at the prospect of losing us. That’s why they, along with the pharmaceutical industry, will pour unlimited amounts of money into fighting against Medicare For All.
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@Trader Dick
Instead of the combatting alternatives of reducing costs and providing better service and transparency? Instead of millions spent lobbying and advertising against MFA why not just make it unnecessary?
It also makes one wonder if doctors intentionally remain out-of-network because they expect further negotiation to occur with the insurance provider. If they are in-network, they would have to accept a lower contracted fee, but they can charge the going rate if they are out-of-network, and it may end up being substantially higher even if negotiated . And given that an in-network doctor may not be available all the time, so insurance companies allow for such "flexibility"?
It is an intentionally grey area, and maybe an unspoken method of operation---but I don't know for sure.
Is it at all possible that they know that the bill can be negotiated down the line, therefore easing the patient's mind about the cost? Is it also possible that if some patients are not resourceful, or just don't put up a fuss, eventually paying their bill, but the resourceful ones get it "excused"? Is there a double standard?
This system only encourages non-clarity, and if there is non-clarity, suspicions become a part of the equation.
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I've never understood why politicians think people want to be free to choose their health insurer. They want to choose their doctor and their hospital. People will be happy with any insurance, including Medicare, with affordable premiums, copays, and deductibles (if any, depending on the details).
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@Jack I really wish that sort of thing existed. The only times I've been happy about my insurer is when I could afford the premiums and they actually covered things.
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Excellent piece (and great writing). I remember watching a TV program on healthcare in the world. The journalist was interviewing a man (govt official, maybe?) from Switzerland and the journalist asked him: How many people in your country go bankrupt each year due to medical bills?
The Swiss looked so puzzled; he could not even comprehend the question. "None," he finally replied, still confused that any sane, knowledgeable person would think to ask this question.
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The big issue with health care that needs to be addressed and solved is transparency.
Transparency of medical billing, upfront before care is given if possible.
Transparency of medical coverage, with information presented in easy to understand terms.
Transparency of procedure and medication authorization, with reasonable and evidence-based methods of determination.
If private insurance and healthcare groups can accomplish this, then by all means let them continue to exist.
If not, then it is time for government to step in and provide for the common good.
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@padgman1 agreed this is what is needed, but Medicare billing is not transparent either. So having the government "step in" is not necessarily the solution. Not that we shouldn't try, but the problem doesn't lend itself to one-liner solutions.
@KdG
I agree there is no one-liner solutions.
Enjoyed your story, thank you.
I lived in England for awhile with my family. The first time my young son got sick I took him to the doctor and on the way out I felt so odd as no one was looking for some sort of co-pay....It felt unnatural... we went to Boots to get his prescription filled and I was told to just walk out... I felt like a shoplifter.... Then by the time I got home I felt a lovely sense of calm and security ....
All my friends and family look forward to Medicare for all and the feeling of security and calm it will bring....I think what Americans are afraid of is the unknown....They just haven't experienced that feeling of calm....
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My wife was prescribed a procedure and I called to find out the cost. They told me $550.00, but I could reduce it to $510.00 if I pay in advance. They asked if they could help with anything else.
I asked "is this everything? Are there any other costs?" They said that the doctor fee is not included and that I need to call another phone number to get that fee.
I called the number and reached an automated system with no access to a person. The system said the give contact information and a procedure code and the cost information would be sent to me. They sent the same numbers that the person on the phone gave and did not give me the doctor fee.
The hospital fee just hit my insurance yesterday, and I still don't know what the doctor will charge. It's radiology and in the past the doctor fee is about $400.00. We'll see.
You can't get the cost information even if you try.
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There's an easy way to fix the surprise hospital bill problem through Medicare reimbursement policy - and it wouldn't require expanding enrollment.
Medicare pays each hospital a pre-set amount for each case based on the patient's admitting diagnosis. If the case turns out to be particularly expensive, Medicare may pay an additional amount through a formula that includes a ratio of the hospital's cost and charges. Congress could pass a law that limits, or eliminates, that payment if the hospital's charges are, let's say, more than twice the cost. Hospitals would immediately reduce their charges to reasonable levels to avoid the loss of reimbursement.
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@PWR Surprise bills are primarily a problem with private insurance not Medicare. I suppose you could face a problem with a medical provider that did not accept Medicare, but in my almost 20 years this has not happened to my knowledge.
@Dan
You are correct in that surprise bills are not a Medicare problem. However, few hospitals will risk losing an important part of their Medicare reimbursement just so they can attempt to collect exorbitant charges from out-of-network insured patients. It isn't necessary to put everyone on Medicare to fix the problem through Medicare policy.
It would be nice to see the CEOs of insurance companies denied coverage - then they would change their tunes.
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@E : That CEOs of insurance companies are not denied coverage is just more evidence that we live in a world where there are multiple levels of service for everything, depending upon how wealthy and influential you are. The privileged classes take their privileges for granted and rarely notice the lack of them. The further down the social ladder you are, the more you are reminded of your total insignificance to the system.
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@E Or not because they earn so much that gigantic bills wouldn't matter to them. What's $145K when that's less than you monthly pay?
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Years ago I had some "routine" surgeries, contacting the hospital and surgeon's office and asking "how much is this going to cost", after giving them my insurance information, neither could give me even a "ballpark" amount.
Maybe the courts should consider those "open ended" financial statements you are forced to sign as "invalid", as the providers have not specified their prices.
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It is quite odd indeed to discuss the vital necessity of Medicare For All without mentioning that the Democratic frontrunner and most popular politician in the country, Bernie Sanders, has made Medicare For All the most central message of his campaign.
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@LLW It might be odd, if the author had specified "Medicare for All" as the specific public option she recommended. She did not. So it is your reply that is odd... but these days, mind-numbingly predictable.
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Haven't members of the U.S. Congress granted themselves (and their families) comprehensive health insurance, subsidized heavily by taxpayers - the same kind of coverage that is enjoyed by all citizens of other advanced nations such as U.K. and Canada through universal coverage?
Isn't it interesting that U.S. Senators and House members become extremely alarmed about the cost of taxpayer funded health insurance only when there is talk of extending coverage to those pesky taxpayers themselves?
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Actually, members of Congress are under the same ACA provisions as all federal employees.
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@Riley2 Congress members are subject to the ACA provisions. Civilian Fed workers have options to select coverage through the Federal Employees Health Benefits Plan which offers choices based on locale of established plans by major insurance companies not through the ACA exchange.
@Shailendra Jha Chuck Grassley threw in the proviso that all members of Congress should have to buy their health insurance in the open market. He thought it was the poison pill that would sink the ACA, but it didn't.
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I once asked a doctor what it would cost to see him. He said, "Ask the nurse." The nurse said, "What's the matter? Don't you have insurance?" And so forth. Never got a price so I canceled the appointment. Now on Medicare, it seems that my many visits are covered and my co-pays are only about $700 a month. Medicare Advantage plan, naturally!!!
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@George Be careful with Advantage plans. There are many different plans and often you are required to see only network doctors. Trump is giving extra money to insurance companies to switch people to Advantage-much money for advertising paid for by whom? His intent is to privatize Medicare and get oodles of money from the insurance companies.
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Oh, but you have "choice" in your health plans! And we are all about choice even though it is not the kind of choice that matters. The choice we want as citizens is to select a doctor of our choice and then work with that doctors for your health needs.
What you don't want is a health insurance plan riddled with hidden copays, deductibles with varying payment levels for tier one, tier two or tier three levels of providers all with different costs to you. Including the same thing for prescriptions.
The reason current health benefits are so screwy? They represent 40 years of tinkering with benefits to slowly, but surely shift as much cost to the consumer as possible. This, in addition to ever higher premium contributions, is why health care costs so much for consumers these days.
Meanwhile back at the ranch, health plan and health system managers get multi-million pay and exit packages, some docs make $5 million a year, and conflicts of interest are rampant. It is the most corrupt industry in the US.
This is no way to run a health care system.
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@Mike
Yes, choice....Gun or knife?
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I'm not sure what people think they'll lose if we are all forced onto Medicare for All. People are worried about losing choice, but the fact is we are already limited depending on our insurer's network. People worry about having to wait for doctor visits and procedures. But I have had top-line health insurance plans throughout my life, and I've ALWAYS had to wait from one to three months both for procedures and for some specialist visits. Even my primary care doc often has one-month wait now because she's so busy. People worry about "death committees" - people deciding who gets life-saving treatment and who doesn't. Uhh...we already have that - see all the people who are denied health coverage and subsequently can't get surgeries, fancy cancer drugs, etc.
All the arguments against M4A are red herrings. People are just scared of change.
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I have lived in rural areas in four states. To see any specialist, eye, ear, dermatology, etc., has a three to six month wait unless it is a dire emergency. We make the next appointment during the current visit in order to ensure it. And the long Canadian waits that are quoted are an average of a short wait in the cities and suburbs and long, long waits in rural and remote areas. The same as here. I looked up the studies on which the recent article going around Facebook is based. Another red herring.
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@Kas
"Even my primary care doc..."
I am a recently retired PCP. That's the area with one of the biggest shortages. No medical student with half a brain wants the gig because the job is hellish. Info on this is all over the internet.
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@Kas
“People worry about "death committees" - people deciding who gets life-saving treatment and who doesn't.”
We already have that. It’s the Republicans who keep trying to take ACA away so people have NO care. If that isn’t a death committee I don’t know what is.
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Nonsense on so many levels
1. It is absurd to claim Medicare for All is Warren's proposal. Bernie was proposing single payer health insurance back when Warren was taking advantage of asbestos victims
2. "Medicare as we know it" is not single payer and is nothing like what Sanders proposed all those years ago (and Conyers before him). By law there are two payers in "Medicare as we know it" and in real life -- unless you choose Part C (which almost 40% of us now do) -- there are four or more
3. People don't like basic Original LBJ Medicare as the author claims. It is terrible insurance with high co-pays, lifetime limits, crazy rules and no coverage of many needed services... including no coverage of an annual physical exam. What they like is the ability to choose among an array of supplemental options (especially the Part C option mentioned above that has grown from zero to almost 25,000,000 beneficiaries in just a generation and is now the most popular option choice 2:1 over all the other choices for those fully signing up for Medicare for the first time)
4. Before Medicare, only about 54% of people UNDER 65 had insurance too. Many felt they didn't need it. With Medicare, the government drove up the cost of health care by large percentages so that now people need it
5. It would be interesting to hear the real story on the $145,000 surprise bill. I think it would surprise the readers
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The problem is people over 65 do need the insurance, and although Medicare is not perfect, majority do take it, and even those who takes part C that restricts your doctor's choices benefit from Medicare because that what keeps part C affordable. If the healthcare was affordable in the first place there would be no need for Medicare or for health insurance at all. Greed of the doctors drove the health care cost up, that required the health insurance that added more cost, that required the Government intervention on behave of most vulnerable part of population.
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Great piece. I love the tongue in cheek humor-if we stop laughing we've lost.
The author does a brilliant job bringing up the obvious absurdity of our current system. The idea that every time you have an issue you have to find 'in network' providers is totally insane. What happens when you go on vacation? What about folks who live in more than 1 location? What about folks who need to move across state lines in pursuit of new opportunities that don't include employer provided insurance? We're hamstringing our economy by sticking with employer provided insurance and employers are spending time and resources dealing with insurance that would be better spent focusing on their actual businesses.
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@Dan
It's not just a question of finding in network providers; it's about identifying the out of network providers, who surround you like ghosts--just standing there doing nothing but fantasizing about the easy money they're accruing by showing up to your bedside. Ask who they are and kick them out immediately. I do this every time I end up in hospital.
I discovered this the hard way when I was taken by ambulance to the ER for a suspected heart attack and several people who entered my room and just stood there later billed me as out of network providers. They couldn't even answer any of my questions. They just stood there like zombies waiting for an easy paycheck. One was a nutritionist!
Hospital personnel are also suspect. The doctor who checked me out of my in network hospital was an out of network doctor, who charged me separately. Hospitals shouldn't affiliate with out of network personnel.
When taken to the ER out of state, in California, my entire hospital bill and doctors were out of network according to my insurance company, Humana---a financial catastrophe. Managed to pay all back except for nearly $3000 ambulance, because unreasonable amount, and couldn't believe they wouldn't reduce.
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I just reviewed the Statement of Benefits from my insurance company for my outpatient double hernia surgery on New Years Eve. Less than 6 hours from admission to discharge cost about $35,000. I have (had) great employer provided insurance (I left that job on January 2), and fortunately the roughly $5K for the anesthesiologist and radiologist were covered in-network.
As of February 1, I am in the wonderful world of COBRA. Even though the “C” stands for Continuation, the transition has been far from seamless. There are apparently 3rd-party companies that “administer” COBRA, so my COBRA premium goes to them, rather than the insurance company. Always an opportunity for someone to skim a couple of percent in our ever-growing rent-seeking economy. And when my wife went to her primary care doc last week, she was told at check-in that our insurance had lapsed, so I spent a couple of hours on the phone to learn that our Continuation coverage had to be activated!!!
So those who say that Americans love their current health insurance are simply lying.
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@Kevin Brock
The world of COBRA wasn't always that wonderful. When my employment as an adjunct professor ended in 1986, so did my medical benefits just two and a half months later, apparently, and I had to fight hard to get COBRA to kick in--to cooperate. As a result of all the stress and worry, became hospitalized for toxemia, with child born prematurely through C-section.
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I’ve taught or helped team teach a couple of courses in a Masters program at a local school. Adjuncts these days get a cash payment, and that’s it. Medical benefits? LOL.
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@Kevin Brock "Always an opportunity for someone to skim a couple of percent in our ever-growing rent-seeking economy". You summed up the rot at the heart of the system perfectly.
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I am now experiencing the nightmare that is American health insurance through what is happening to my adult son. Self-employed, he was kicked off his insurance with no warning while trying to see a doctor because of a supposedly late payment, when he had thought he had paid for six months in advance. Many of these companies are predators - they spend their time looking for any and all mistakes their customers might make trying to follow a deliberately confusing system so that they have an excuse to deny them care.
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For a number of years, here in the United States, my wife had a work colleague from Canada.
The colleague was frustrated and dismayed that, whenever she had contact with the American medical system, she would ask "How much will this cost me out-of-pocket?" and the answer would invariably be, "Oh, we have no idea."
So she was frustrated because the American system (if anyone can call anything with so many institutional players and legislative influence-peddlers a "system") could not answer, in advance, the most simple question. And, understandably, dismayed because she couldn't think of a single other area of her life where she was expected to "buy" a "product" whose price was a secret.
We asked: How does it work when you see a doctor in Canada? She answered: "I just go to the doctor. The end."
But, of course, Canada is generally a more civilized and compassionate nation than ours.
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@TimesChat
We have friends from Canada who winter in FL. Their first year there the woman needed to see a doctor. Called whoever in Canada. They said we’ll check and find a doctor who takes Canadian healthcare near you. Called back with name of doctor, she got appointment, no charge.
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The introduction of the network concept in the 90's along with managed care and HMO's ruined insurance. This concept has no place in American life, It is one of the biggest reasons why Medicare for All must be passed.
Bernie 2020 and the Senate.
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These sorts of stories seem to never end, and time and again our legislators do nothing about it. Unfortunately, this is the real American Exceptionalism.
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