Today I just got my statement from the insurance company about the gall bladder surgery and overnight stay. The bill was for $9014.35. Because I work for a university and have decent coverage, I only have to shell out $383.11 (there may be other statements to come, but this appears to be the bulk of the charges). On this particular form there is no identifiable line item listed for, say, a dose of the pain medication they gave me while I was in there, but I’m sure it was probably something outrageous, like $20/dose.
I’m thankful the bill is tolerable, but what if I had crappy insurance or none at all?
Our country is so in need of a single payer system (never going to see that in my lifetime), or at the very least a serious overhaul, and even minor attempts to rectify the myriad problems means having to deal with Big Pharma and insurance companies, who have nothing to gain with reform.
Even for those of us who are so fortunate to have health insurance, the fact that it is tied to your employer (significant particularly if you have pre-existing conditions, or kids) becomes a veritable ball-and-chain, limiting opportunities in order to preserve stability — a choice people shouldn’t have to make, but often do.
How many millions of people are in the same boat? What is the impact on the economy as employers pass on more and more of the cost onto employees, or offer reduced benefits in every open enrollment cycle?
Q of the day — do you have adequate coverage, sub-par coverage, or none at all?
If you do have health insurance and are gay, does your employer allow a same-sex partner benefit? In my case I work for a private university that extends the benefit to a same-sex spousal equivalent, my wife Kate works for the state (NC) and has insurance through her job, but there is no benefit extended to partners. So if I lost/left my job, I’d be SOL; if she lost her job, she could go on my policy.
Can you choose your own doctor, are you covered outside of your state (that’s one option offered, limiting in-network coverage to state boundaries to keep premium cost down for the employee)? Have you ever been declined a medical procedure that you would have expected to be covered?
It’s clear that even employers that provide decent coverage are struggling with costs, and which benefits to extend or reduce, but it often seems arbitrary to the layman.
193 Responses to “Q of the day - our health care system”
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do you have adequate coverage, sub-par coverage, or none at all?
I have excellent coverage. I live in the UK. It’s called the NHS. My co-pays are £6 on each prescription: sometimes less, but that’s the maximum.
If you do have health insurance and are gay, does your employer allow a same-sex partner benefit?
Yes: if my partner were for some reason not entitled to free coverage on the NHS, a civil partnership (or more than two years cohabitation) would mean she were entitled to the same coverage as I was under the NHS. Further, if I had private health insurance via my employer, my employer would be legally required to provide the same partner benefits to same-sex as to mixed-sex couples.
I thought my coverage was perfect for my needs: HSA to shelter $6500 a year of my income from my business activities from any taxes, partially-deductible premiums paying for a health policy from a well-respected local HMO that kicks in when 1) I’ve spent the $6500 or 2) I need emergency care.
Since I make chunks of money and only go to the doctor when I’ve stepped on a rusty nail, this seemed perfect–tax planning and medical coverage in one!
Then I had an accident.
The well-respected local HMO won’t pay the ER for the two mights and three days I spent there. They want me to buy a hospital night, because after the first 24 hours their contract with the only trauma center in my state says that I should have been transferred to one of the HMO’s hospitals. Since I didn’t make them put me in an ambulance and move me, they want me to pay.
Seriously.
HSAs are a tax shelter for healthy self-employed people who make a lot of money. They are not insurance.
I just recently took a step up employment-wise that moves me from sub-par to pretty good insurance. I can choose my own doctors, but that’s because I choose nationwide PPO plans whenever possible (not that there’s a huge difference between PPOs and HMOs, but I have a deep distrust of HMOs for whatever reason…even my dental is a PPO).
One thing that I was very pleased about re: where I now work is that they have a company-sponsored program to provide benefits for either opposite or same-sex domestic partners and their children. The thing that displeased me about that, though, was that it was only offered through one HMO company.
I have wretched coverage.
Most recent attempted denial (I’ll be appealing): fetal monitoring while I was admitted to a non-network hospital for preterm labor. Their reason: I should have driven to a network hospital for the monitoring. You know. While I was on hospital bed rest for preterm labor?
As of this year, I will be paying approximately 50% of my salary towards this shitty health plan. Why? Because I have too many risk factors to be able to buy an individual plan, and I can’t afford to have gaps in insurance while attempting to change jobs.
It really was an eye-opener when I got the bill/statements after the birth of my son. If I had not had insurance, I would have been on the hook for $15,000. That’s for a vaginal birth attended by a midwife in a hospital and released the next day, not a C-section with an OB and a four-day stay. Most of the fees were due the hospital just for the privilege of using their rooms, not to the people who actually attended me (you know, the ones who did the work.) With the insurance company’s rate, that got down to around $4,000, of which I paid $800. Not only did I have a $250 deductible for myself, I also had a $250 deductible for my son, who required no medical attention after the birth. The hospital billed $1,500 for “room and board” for a baby lying in a bassinet!! After that, I had to pay 10 percent of the remainder, which I think was the way they divided any big, expensive item, like surgeries or hospitalizations. And this was not cheap-o, catastrophic insurance, this was expensive, employer-based insurance considered to be good insurance for which I pay a high monthly premium, on top of whatever my employer makes. It’s frightening out there. And it’s especially upsetting to think that someone without insurance will be charged so much more, while the insurance company pays much less.
I’m thankful the bill is tolerable, but what if I had crappy insurance or none at all?
Don’t worry. According to the health care plans which have become the new liberal orthodoxy in certain quarters, you will be mandated by government to purchase insurance, whether you can afford it or not. Of course, if you make less than 2x the poverty line or so, you might get your insurance subsidized.
Of course, legislative sausage making will make it more complicated. Either subsidies in high cost of living areas will be extended to the working classes, in which case the GOP will complain about tax payer money going to those who don’t need it (c.f. S-CHIP and NY) or the working classes will end up having to pay for health care they can ill afford and the GOP will say “see, those evil liberals are making you pay for health insurance you can’t afford”.
And yet, on certain corners of the left blogosphere, unless you support mandates (which will be accompanied with subsidies), you are just not Politically Correct and not interested in real health care reform?
What’s up with that? Talk about perpetrating stereotypes of liberals. And why the middle-man? Why subsidize people to pay insurance companies for health insurance? Why not just frickin’ provide health care? Or at least pay the insurance companies to provide insurance? Adding another layer of bureacracy, and then having debates about means testing etc., just will re-enforce stereotypes of liberals (which is bad for any liberal agenda in the long run) and be, frankly, wasteful (which’ll play into the GOP agenda of labeling govnt. provided health care as “inefficient”).
Why are certain people so obsessed with shooting themselves and liberalism in general in the foot in the name of ideological purity?
I have pretty good coverage — but when I had a pretty major motor vehicle accident a few years ago, I found out what can happen if EMS takes you to a hospital that’s outside of your plan. The total bill for my out-of-plan (and unplanned, obviously) 5-day hospital stay was around $37,000, and my insurer tried to stick me with over HALF of that bill just because it was an out-of-plan hospital. I went through the appeals process and got my share dropped to around $6000. Argh.
Regarding health coverage:
If I get married (as I will be doing soon) and my spouse has coverage from her job (including family benefits), do I get covered even though I live and work in another state (until I can get a job in her area and move back in with her)?
I have really good healthcare coverage — I even get 50 mental-health visits a year, though it’s on a sliding scale of costs (ie visits 1-5 are free, 6-30 are $10, 31-50 are $30). But I work for a Very Large Corporation that is well-known in the industry for bargaining hard on behalf of its employees. If the health insurance company does try to screw me, I can go to human resources and get them to help me.
I’m not gay, but if I were, I would be able to have my registered domestic partner covered just as though they were a legal spouse.
No coverage. Currently wondering whether to bother going in to have a lump looked at, because I can’t pay for treatment.
Because I have too many risk factors to be able to buy an individual plan, and I can’t afford to have gaps in insurance while attempting to change jobs.
If I didn’t work for a large institution, and with it, a huge group plan, I would be in a similar situation. I have a chronic condition without insurance would cost about $800-$900 a month to treat. And forget getting an individual policy. That limits employment choices.
And people ask why I don’t blog full-time. I can’t afford to leave a FT job with health benefits, for goodness sake.
I’m thankful the bill is tolerable, but what if I had crappy insurance or none at all?
Been there. Not fun. Shit, I had to pay for a physical out of pocket because my student insurance wouldn’t cover one (and for several years included no ’script coverage).
I’ve got good coverage now, but who knows how long it’ll last.
I live in Massachusetts, so, not having other health insurance, the state hooked me up with it. I gotta say, it’s pretty good.
My monthly premium is $105. This is, however, taxing on my budget, and I wish it were less. It’s one major factor that makes continuing to live by myself after my current lease is up not terribly tenable. I’ll almost certainly be going back to sharing an apartment or house with other people, which will save me a couple hundred dollars a month.
I used my insurance for the first time yesterday (I got it in December, after a year of being uninsured). I went for a yearly physical, and the copay was $10. This included getting two shots — HPV #1 and tetanus booster — and having blood work done. Specialists are $20.
Getting prescriptions filled will be $10, $20, or $40, depending on what I get.
It includes vision care — a $20 eye exam and free glasses every two years.
Emergency room visits are, I think, $75. Trips in the ambulance are $0.
It partially covers abortions along with other day surgeries; my portion would only be $100.
I’m being sent to PT for some old athletic injuries; that’ll be $20.
If for some reason I land in the hospital, it won’t cost me more than $500 a year, for inpatient care and day surgery, with, as I said, each day surgery being $100, and each inpatient event being $250.
There’s other stuff, like mental health, allergy testing, medical equipment, etc., that I don’t need, so I’ve not gone into that.
Keep in mind, MA does this on a bit of a sliding scale. They make this inexpensive for me because I make less than $20k a year.
The choice of doctors is extensive, and I’m covered all over the state, which is better than some private health insurance. As long as I’m in MA, I’m “in network.” I’m not sure about when I’m out of state.
even get 50 mental-health visits a year
Some plans only allow 20 mental health visits a year. That’s it, no exceptions, no extensions. I think this kind of limitation/bias against mental health services may be common for other plans out there as they try to keep costs down.
I don’t know what someone does who is being treated for major depression or is suicidal. You simply have to pay out of pocket or be cut off from your mental health care provider. Or of course, have enough in a health care savings account to cover any visits after your 20 run out. That obviously hurts the working poor who need mental health services.
Some plans only allow 20 mental health visits a year. That’s it, no exceptions, no extensions…..
I don’t know what someone does who is being treated for major depression or is suicidal. You simply have to pay out of pocket or be cut off from your mental health care provider. Or of course, have enough in a health care savings account to cover any visits after your 20 run out. That obviously hurts the working poor who need mental health services.
Been there too. I just kept getting bills i couldn’t pay.
My health insurance sucks. Luckily I haven’t had to be hospitalized and have put off having any expensive tests or scans, but I have a very high deductible, and my insurance pays nothing until I meet said deductible. No co-pays. Which means that I have a $300 to $500 a month pharmacy bill. I am an extremely physically healthy 27-year-old, but because my brain chemistry is messed up I have to pay a quarter of my pay each month in medical bills (insurance premiums, doctor visits, and medications). Despite my excellent physical health, my mental illness will not allow me to be covered by any other insurance plans that have a lower deductible. The only way I am able to be insured is through my employer.
The only good thing about my insurance is that we do have a domestic partner benefit, which I was delighted to see despite currently being in a heterosexual relationship with a man who has way better insurance than I do.
They do seem pretty good with the network coverage, though, and I don’t need referrals to see a specialist, nor do I have to choose a specific PCP. It would just be nice if they, you know, actually paid some of my medical bills.
I have good coverage, because I work for a municipality. My wife recently had a hysterectomy, and our total out-of-pocket should end up being less than $1k.
It wasn’t always this way, though. Back when I was a student I had a bike accident on a friday evening at 6pm. Because all I had was student insurance, I couldn’t get looked at until the next monday at 10 am when the student clinic opened. At that point there was really nothing they could do about the torn rotator cuff I had, which bothers me to this day.
I have pretty good health coverage, for which I am extremely grateful. They have yet to try to screw me over a claim, their range of doctors is very good, they pick up some of the cost even if I don’t use one of their people, and they offer some benefits even for things that are now normally paid for under specialized plans, like dental and vision.
The prescription plan is adequate, but people who manage it are, by all accounts, complete dicks. We went through about a year where they were denying that employees were on their plans on average of once every two months and then stonewalling when HR tried to get on them about it.
If I were partnered with another woman, I would not be able to cover her on my plan. It’s being pushed for, but negotiations have stalled.
Given that my employer’s leave packages are also quite generous, it’s pretty much a given that, in spite of the crappy pay and no opportunities for advancement, they’re going to have to pry this job out of my cold, dead hands.
I have COBRA coverage since I quit my job and moved out of state. It’s really good coverage (Blue Cross) but I barely use it, and it’s expensive, but I have a couple of conditions requiring prescriptions and I’m afraid I’ll be turned down for an individual policy.
My partner’s company covers domestic partners, but coverage for both of us on his policy would cost more than twice as much as his policy plus mine.
“Our country is so in need of a single payer system (never going to see that in my lifetime)”
Great point, so maybe we should look instead for a program to provide coverage to those without insurance along with making it mandatory that all employees accept coverage if they are offered. Instead of a huge program to debate, it becomes a smaller step.
As for my coverage, we have it through the military. Our program is what the country could expect if there was a single payer system. I don’t mind it, though many would. For instance, pregnant women see whichever provider is available, be they a Certified Nurse Midwife or a OBGYN. CNMs are used because they are less expensive than docs and can be used for all but the complicated pregnancies. Also, it is not guaranteed that this provider will be available for the birth though.
Another area is ultrasounds. Patients have only one, unless there is a need for more. There are quite a few upset women who want one each visit, especially if the first did not catch the sex of the baby (”how will I know what color to decorate the room?!”).
Our system uses Primary Care Providers, whose approval is needed for specialties.
I don’t think Americans could ever agree on a single payer system - too many special interests involved (i.e., using nurse midwives, practicioners, and anesthetists for cases that don’t need docs). France seemed to do it right. They got the docs together and told them they wouldn’t make as much money, then they lowered the cost of medical education, and then they put limits on the tort system. Right there, you have three players who would need to be reined in for a doable single payer system - and I don’t think that can happen in the US.
Interesting topic. I had a lumpectomy at the end of October. I have coverage through a good HMO. I keep getting statements in the mail that read THIS IS NOT A BILL. Thank god. These are line items. As best as I can tell, the bottom line is around $17,000. So far, my share has been two $25.00 co-pays. I started radiation treatment the day after Christmas, and have yet to get a bill for that. I believe there is a $25 co-pay for each treatment, which will add up, but is still affordable.
I have what I call semi-crappy coverage. It costs $400 a month out of pocket just to cover myself and my daughter. I would add my husband but that would be $700 a month.
My husband has what I call craptastic coverage. He works for an employer with 75 employees and so it’s just “catastrophic” coverage. His deductible is two grand. Prescriptions aren’t covered at all. Doctor visits aren’t covered. Only things like surgery are covered, again after the two grand deductible.
I wish I could afford to put him on mine, but I can’t. He has had a hernia for three years that we can’t afford for him to get fixed. It’s not too bad, fortunately.
When my daughter got her appendix out, she was still on his craptastic coverage (I put her on mine shortly after this) so the deductible was two grand. Finance called me in her room to let me know that needed to be paid before they discharged her from the hospital. I got off the phone, stepped out in the hallway, cried, called my husband and told him we needed to come up with two thousand dollars before they’d discharge her. He borrowed it from a friend and we paid it back.
Our country is so in need of a single payer system (never going to see that in my lifetime)
I don’t get why it seems like every mention of single-payer has to be accompanied by the above disclaimer. We all know what we need to do that would actually work and solve the problems we need to address… so let’s give up, and go along with a collection of variously terrible plans that don’t address the problems at hand and largely work to funnel more money to the insurance companies who are already the reason our current system is so broken? I mean, dang.
Oh just to add: when my husband was in the Army, I had our daughter at an Army hospital. The total cost was $19. That was for me staying in the hospital two nights at $9.50 a night. Husband gave them a twenty upon our checkout and got a single back. I still have the “receipt” in her baby book.
Good days, man, good days. That’s the only time I’ve ever had healthcare I didn’t worry about paying for.
I have crappy grad student insurance that I had to pay for upfront and which costs about %15 of my yearly income. But the deductible is still high enough to keep me waiting three or four days before I go in for a routine UTI because, well, it was summertime and I had no money coming in. One can get coverage for a spouse, but not a domestic partner, afaik. But it is prohibitively expensive. On the other hand, I can get alcoholism treatment. They must know grad students, man.
My college roomate was diagnosed with a rare form of (non-life threatening) cancer in her second year, and when she took some time off school to have it treated, her parents’ insurance company withdrew coverage because she wasn’t a full-time student. Her parents had to, I believe, take out a second mortgage and buy her a cobra plan. She had collection agencies calling her for years for radiation and MRI bills that she had no hope of paying. I hate to think what her credit rating is like right now.
” but what if I had crappy insurance or none at all?”
The answer is fairly straight forward. One die a boring and miserable agony with credit card debt.
Most of poor underclass who can’t afford insurance don’t vote anyway. So why bother.
PS. there is no such thing as itemization. The entire health care industry and pharmas are giant injustice. Try this: figure out how much Merck (or other top pharmas) sells their top 10 products annually and where it goes. itemization. It’s top secret. You’d be dead when you try to publish that number. (I challenge anybody to post those numbers.)
Privatization of mass health care system is one of the biggest scam invented by politicos after Iraq war reasoning.
I have good coverage at the Big Bank where I work. It is a PPO plan, and most of the time we can find a provider who is in the plan. Due to current and prior illnesses, my family would be uninsurable in the private insurance market.
My question about the system is this: When I get the insurance statement, they have paid a “Negotiated or Allowed” amount that is about 20% to 40% of the bill. If my bills were being shorted this amount, I would be out of business, or I would stop accepting that insurance plan. So, how do doctors, hospitals, labs, etc. remain in business? Do they double all of their fees, and accept the short pays, and vastly overcharge those without insurance?
Squashed, exactly. I think the whole thing is incredibly short-sighted.
A long time ago, we decided that free public education for all would benefit all of us. As a result, you never ever hear parents worrying over whether they are going to be able to send their five year old to school or are going to have to apprentice them to someone. It’s just not even a consideration. They get old enough, they get to go. Period.
Wouldn’t everyone having access to medical care benefit all of us? Doesn’t anyone see the connection between chronically untreated medical issues in children and absenteeism from school and lack of success in school, leading to a higher chance of being unemployed/underemployed? Leading to a higher chance of that adult needing public assistance? And using the county hospital, which our taxes support anyway? Why don’t we see that an ounce of prevention really IS worth a pound of cure? Actually it’s probably worth more.
But seriously? I despair of the HMOs and pharmas EVER letting go of their cash cow. Why would they? Record-breaking profits each year. They’re not going to let go of that voluntarily, no WAY.
Health insurance rules our lives. My partner and I are disabled. I am vision/hearing impaired with kidney disease. My partner is a C6 quadriplegic via SCI. Currently, I am on medicare and a BCBS medigap policy. He is on Medicare, TriCare, and Medicaid. Our two children each have their own BCBS policy paid for by me. Here is how all of this affects our lives:
1. We cannot get married. We are heterosexual male/female couple, btw. If we get married, his TriCare goes. This is through his father’s military service. If we married, we would lose that.
2. Neither of us can work. I cannot work more than a few hours a month or I lose my Medicare. I work part-time, making sure to keep within my limits so I don’t lose my medical insurance. I have so many pre-existings that even the six month/year grace period would put my health in jeopardy and would be financially unrecoverable. He cannot work at all, for he has to stay below poverty line to recieve medicaid. Without it, he would not only have catastrophic medical bills, but he would lose valuable services like home health care and attendant services. These services would be required for him to really work competitively, but would be 30K-80K a year of out of pocket expenses if he did not remain below poverty level. (Keep in mind, each of us CAN work with accommodations. He has a degree in engineering, I have a Masters in Ed. We are very willing to work, but not willing enough to risk our lives to do it.)
I pay over $500K in premiums a month for the two kids and I. I also have a $1000K deductable for the kids and then pay 20% of the bills. So, since they are healthy, I don’t really recieve any benefit for them from year to year. My medical bills are covered except for things like birth control, OB/GYN stuff, dental and vision, which are not covered by medicare/BCBS. Oh, and hearing aids or audiology. I pay 5K for hearing aid equipment every 7 years or so. Not covered at all. So except for my kidney stuff, my main needs–vision and hearing–are not covered.
Most of our adaptive equipment is not covered. His wheelchair stuff is covered on an extremely limited basis. He went for YEARS with a wheelchair that caused him all kinds of problems because insurance wouldn’t pay for a new one and was skimpy on repairs for the old one. He had pressure sore problems because of it, and could never go out very far because the battery would go dead with no warning.
Things like a conversion van, adaptive computer equipment, hearing aids, white canes, guide dog expenses, etc. are not covered. These are more things that could allow some of us to work.
He has suffered many, many injuries that required months long hospitalizations because medicare (and others) provides no preventative care. For example, a certain matress he needs (that costs several hundred dollars) that will prevent pressure sores is only provided for three months at a time as long as you have an open wound. When your wound closes, they take it away and then you are susceptable to another wound. Keep in mind, they are RENTING this equipment. The cost of which would be covered in six months if they would purchase it for him (besides the months of hospitalization and medical bills they pay for because of the lack of it.)
He has to be proclaimed “homebound” in order to recieve some of the essential nursing and attendant care services that he needs (some of which would make it possible for him to work). Therefore, he is not allowed to go out of his home AT ALL except for medical appointments. (Now, this is enforced–or not–to varying degrees depending on location and situation…so lets just say we are lucky here. However it is always a threat.)
We know for a fact that sometimes we do not recieve the same medical options as others due to the fact that we use medicaid/medicare. I needed a GYN surgery that was not available to me until I recieved employer provided insurance.
He is always in danger of being institutionalized in a nursing home should he be caught violating the homebound rule or if they just determine that they don’t want to provide homebound services anymore. There is a strong nursing home bias in medicare. We live in a “Medicare Waiver” state. Meaning, we have a state plan where the money follows the patient rather than the nursing home. In most states (and we are always in danger of legislation that may change this for us) Medicare money goes to nursing home beds, not the patient. Even though it is usually more expensive to care for someone in a nursing home. Therefore, many, many people with disabilities, young people, are falsely imprisoned in nursing homes for life.
The unemployment rate among the disabled is around 70% in the US. This is largely due to people in our situation who could work, are willing to work, but can’t due to health insurance issues. I recently read a statistic (and sorry, I don’t have a source) that in Canada, the unemployment rate among the disabled is 49%. I wonder how much this has to do with universal health care.
Sorry I wrote a whole post. But you asked! In short, this country’s lack of decent health coverage is one of the main issues that decide our lives. The cost of not insuring the disabled properly is great, and we marvel daily at the amount of unecessary expense the taxpayer pays because of the medical jujitsu of a system we are forced to live in. If we could work without fear of losing life saving health care, it would save millions for all.
Man, Leora, that’s awful. It seems like we’re really into cutting off our nose to spite our face in the US, doesn’t it?
What kills me about conservatives’ attitudes toward health care is that in their strident opposition to “socialized medicine,” they fail to see how the current situation places American businesses at a huge competitive disadvantage.
Case in point: the auto industry. They’re running enormous losses, in part because of their obligations to fund health care for retired workers and their spouses. This is great for the beneficiaries (full disclosure: my mother is one of them), but it means a constant financial drain for the car companies. A national health care system would relieve automakers of that obligation, putting them more on a par with overseas competitors.
Conservatives no doubt prefer the laissez-faire approach, otherwise known as letting employers pare away as many benefits as they can get away with. But those of us who think health care, at least on a minimal level, is a right instead of a privilege would like to see something other than profit motives and the oh-so-sacred “free market” determine health care policy.
I have adequate coverage, but the reason the pain killer costs $20 a dose is partly the cost of making sure all the t’s are crossed and i’s dotted, but also because they build in extra to cover the cost of uninsured patients that the hospital cannot refuse.
Universal single payer health care. It may not cure all of our health care ills, but it is a huge step in the right direction.
“I’m thankful the bill is tolerable, but what if I had crappy insurance or none at all?”
Silly! That’s no problem - that’s why we have Emergency Rooms at (some) hospitals.
(I heard George Bush explain it, using small words so we can all understand.)
If the ER won’t take you because they claim you need elective surgery to remove your gallbladder, well, you just wait until it damn-nearly kills you AND THEN you go to the ER. They HAVE to take you then…
You point out the case for big business, but the straits are equally dire for small businesses and entrepreneurs. Getting good employees is harder, because of the risks of working without a health plan. Starting a business is harder because of the risks without a health plan, or the expenses of covering yourself minimally.
I have health insurance through my dad’s insurer. As long as I’m a full-time university student under the age of 25 and living with my parents, I get to keep it. Once I graduate or turn 25, I won’t have health insurance. I work as a substitute teacher and whether you work full time or part time, they don’t offer health insurance. Not that a sub would ever go to the doctor anyway, because we don’t get sick days
It’s a pretty good plan, as far as plans go. I can’t pick my own doctor, but my most important doctor (ob/gyn) is covered by the plan. For dental and vision I’m constantly going to new doctors on the plan trying to find ones I like - it hasn’t happened yet.
His insurance company does provide insurance for same sex partners, which is very cool.
My insurance does cover out-of-state.
Have you ever been declined a medical procedure that you would have expected to be covered? Hahahaha. Ask me how my credit was ruined! I was raped (out of state, incidently) and went to the hospital. There was ambulance, an overnight stay, rape kit, etc. It was a nightmare trying to get my insurance to pay for the things they ought to have paid for. Because it was a sexual assault, the hospital refused to release my records to anyone, including my insurer. Okay…I signed apprx one billion release forms (actually: SIX. SIX DIFFERENT RELEASE FORMS) which just never seemed to make their way from my state to the hospital on the other side of the country. SIX DIFFERENT RELEASE FORMS were lost, misplaced, etc. Meanwhile the hospital is turning me over to collections agencies because I hadn’t paid my bills. Eventually everything got taken care of, but it’s a good thing my parents have good credit.
And I can honestly say that after that experience (with the hospital and the police), were I to be raped again, I would not go to the hospital unless I needed emergency medical attention.
At present I *think* I have pretty good coverage, but I have never had a catastrophic illness or had to spend any time in the hospital. I’m afraid that, like many people, I won’t know how bad it is until the shit really hits the fan.
My husband works for a town (for one of his two jobs) and gets good insurance from them. Kids are on state insurance because their mother doesn’t make much money–and amazingly enough, even though my husband said outright during our recent spate of court dates that he would be willing to put the kids on his insurance in exchange for not paying child support, the judge went ahead and kept them on the state insurance (as well as getting rid of the child support, which was appropriate since we provide most of the care anyway). We were really surprised but from what we saw from that judge, I suspect he’s the type who believes that the health care system is F’d up and people should be able to take advantage of what they can.
My agency does provide domestic partner benefits, and has since I’ve been here (1998), even before the state implemented civil unions (although an interesting wrinkle resulted from that–now DPs MUST have a civil union to qualify for partner insurance; I guess that’s fair, since they wouldn’t give insurance to an unmarried straight spouse either). Agency also subsidizes adoption and allows for leave time for adoption, including GLBT parents. At times, working in social services is a really good thing.
“the myriad problems means having to deal with Big Pharma and insurance companies”
You should really include Big Lawyer in your list. They demonstrably driven up the price of health care and in some areas eliminated it.
Do they double all of their fees, and accept the short pays, and vastly overcharge those without insurance?
Yes.
No, seriously, that’s how it works. Healthcare providers quote ridiculous prices to insurance companies, insurance companies negotiate a “discount,” and everyone still makes a profit.
This is why, ironically, you’re more likely to end up bankrupt if you started your illness with health insurance than not. If right up front you have no insurance, a lot of times the hospital will negotiate the price with you, because they’d rather get a little money than no money.
If you start off with insurance and lose it partway through, or if your insurance company refuses to pay things, you’re stuck paying that inflated list price, and hello bankruptcy court.
That’s for a vaginal birth attended by a midwife in a hospital and released the next day, not a C-section with an OB and a four-day stay.
Want to hear a real killer? My mom was a labor and delivery nurse for fifteen years and told me this. If someone opens up a C-section kit for you, EVEN IF YOU DON”T HAVE A C-SECTION, your insurance will be charged a couple grand for the cost of the kit. Just because someone thought maybe, maybe you might need a C-section and they wanted it read. $5k just for a maybe.
Yay for attentive doctors but, um, you didn’t use it!
My son’s burst appendix was billed at $60,000, but since I had insurance, that cost was “adjusted” down to around $10,000 billed to the insurance company. I probably paid $1000 of that out of my own pocket.
If I hadn’t had insurance, I’d still be $60,000 in debt.
Leora — Actually, I have good information on one of your points. The unemployment rate amongst disabled people in Canada is actually about 30%. I work with a coalition of people who do business-to-business outreach to make a business case for hiring people with disabilities, so I’m pretty up on it. I’m Canadian, by the way. Thirty percent is still way too high, as far as I’m concerned. People who want to work and can should be working.
I ♥ my OHIP. I get my regular medical care from a GP and a NP, with referrals to specialists when it’s medically necessary. Despite what the AMA likes to tell you about single-payer healthcare, you can choose your doctor; I’ve fired a couple myself, and you’re free to move to any practice that’s taking patients (whether or not you can find one depends on where you live, however). Regional doctor shortages have less to do with our healthcare system than they do with the previous provincial government’s deregulating medical school tuitions (sing it with me now: Deregulation is evil!) and with our population distribution. (Who wants to go be the local GP for Moose Factory, Ontario?)
I’m also pretty sure that if I had to survive in a US-like medical environment, I’d be long since dead by now. I’m disabled and have a bunch of chronic conditions, so I’d be uninsurable in a profit-minded system. I’ve also been pretty broke for most of my life…
Case in point: the auto industry. - Bitter Scribe
But Huckabee said that the reason Daimler-Chrysler chose to be in Germany vs. the US was due to Germany’s famously lower taxes!
“A long time ago, we decided that free public education for all would benefit all of us.”
…and there were some rich conservative assholes wearing top hats and long coats who started bitching immediately about having to pay for other people’s education…
“As a result, you never ever hear parents worrying over whether they are going to be able to send their five year old to school or are going to have to apprentice them to someone. It’s just not even a consideration. They get old enough, they get to go. Period.”
…and because it’s worked out so well, the “conservatives” have been trying to kill public education ever since.
When we can’t all agree on something that basic, that important, and that cost-effective, how will we ever get to a point when we all agree on national healthcare and do something about it?…
First off, Pam, glad you are mending reasonably well and that you have decent coverage for the operation and your chronic condition etc.
Pam says,
I am also in this position. I had good PPO coverage through the major university I worked for for 5 years (any Dr. I chose, domestic partner coverage regardless of sex, good dental and vision, etc.). Then I had to stop working due to my chronic illnesses. The COBRA payments were steep, but still only 30% of what my out-of-pocket would have been. I stayed on COBRA while I got my Master’s degree, but it has recently run out (18 month limit).
Thanks to HIPAA, my insurer has to offer me a conversion plan so I will not be entirely uninsured. However, this conversion plan does not cover prescription drugs, vision, dental, partners, etc. Since the bulk of my costs are due to one of my medications, I am stuck paying most of my medical costs and a monthly premium. Most of my specialist visits and regular bloodwork are covered, though.
The pharma that makes my expensive drug (Roche) just raised the cost of my drug again. The drug (CellCept) goes off-patent in May 2009. My Dr. and I think it’s no coincidence that they’re raising prices again now, to squeeze the last drops of blood out of patients who need CellCept. To their credit, Roche does offer an assistance plan to patients whose net worth is less than $4000. So people who have been completely bankrupted by greedy drug and insurance companies can get their life-saving drugs free!
You should really include Big Lawyer in your list. They demonstrably driven up the price of health care and in some areas eliminated it.
Actually, the states that put caps on awards for damages in malpractice lawsuits have seen their healthcare costs rise at the same rate as states that don’t have those caps.
Almost makes you think something else is going on other than out-of-control malpractice suits.
I have no insurance being a grad student not on stipend and not quite making enough to pay for a student plan. My wife just dropped hers because she couldn’t actually take enough time off work to see the doctors anyway. Next summer we’ll both be insured again when I start working full-time after graduation.
One thing that I noticed while interviewing this year: one of the employers specifically informed me that if my wife had the option of getting insurance at her own job, my insurance would refuse to cover her whether or not she enrolled in her own. They called this something like a “mutual destruction (something?) clause” and claimed that it is normal in the industry. Is this normal? I’ve never heard of it, and we’ve both been insured together before through a PPO.
Almost makes you think something else is going on other than out-of-control malpractice suits.
You wouldn’t be implying that insurance companies are blood-sucking leeches, now would you?
Even if you aren’t, I’ll say it. The reason costs have gone up is because of the blood-suckers in the insurance industry.
I have pretty darn good insurance here at my new job. My partner and I are registed as domestic partners with the county, but that literally only gives us a nice piece of paper to display.
Even though the non-discrimination policy here very clearly states that sexual orientation is protected, since I cannot get legally married, I am being treated “equally” by the company by not being able to cover my partner on my insurance. He has good health insurance at his job, but no dental (and lousy teeth because of a doctor’s screw-up when he was a child and put him on a drug that ruined his teeth for life).
His employer doesn’t cover me - (again, we aren’t “married”) so while I was out of work, I had to pay for Blue Cross out of pocket, and they pretty much declared everything I needed the coverage for to be a pre-existing condition, so it all came out of pocket. We only carried it in case of some catastrophic issue or hospital stay. Even so, while his salary was enough to cover our daily life, I had to eat into my 401(k) to afford the insurance, which ended up not covering anything, between the deductible and the pre-existing clause.
None of those expenses would have hit us if we had been able to get married (same county office, same forms, same fee, same people involved) the day we registered as domestic partners.
Just over $9000? El wifo had a cyst removed about 2 years ago and the total bill was somewhere over $11k - all the more galling seeing as the cyst was just under the skin, the whole procedure took about 15 minutes, and was outpatient.
Insurance wound up paying nothing because the hospital’s billing department was a big ball of fail. And due to our agreement with the insurance company, the hospital couldn’t go after us for the money either. Because they were so doofy, the hospital had to eat that bill.
I’m an american living in Germany. My husband (also american) and I are required by law (as is everyone) to have health insurance. We pay 50 Euros ($75) per month for the two of us to a state insurance company. I’m covered in the entire EU.
Before this I worked at a state hospital in Seattle. I paid $24 per month and received benefits that seemed to cover all of my preventative medical/dental visits. There were same sex partner benefits available.
In college I had no insurance and was lucky enough not to get sick and paid for BC (and the required annual pap smears) with my credit card. My brother, on the other hand, now has almost $30,000 in debt from an emergency operation for a gangrenous gallbladder. He was switching health plans and had a week during which he was uninsured. Guess which week he had to be rushed to the hospital?
You wouldn’t be implying that insurance companies are blood-sucking leeches, now would you?
Now, now, I can’t have you insulting leeches — they’re actually useful in medicine, unlike insurance companies.
Just to continue on to what Mnemosyne said, if you think about it, here’s how it works. They run up hundreds of thousands of dollars worth of bills. Then when you can’t pay that fast enough, it goes to a collection agency who buys that debt for a fraction of its actual worth. The amount the hospital is selling it for is actually more in-line with their costs..then the collection group or even the hospital group themselves, can claim all that debt as money owed to them, making their bottom line look a bit better, which raises stock prices, making all the top management, who are paid in stock options..rather rich.
America simply can’t compete with such an anchor holding it down. No ifs ands or buts. Each level is demanding their additional 10% year after year…and that’s all compound.
Profit (more accurately stock value increases) is the root of inflation. Health Care is an industry that feels it more than most because of all the middle-men.
BTW. The reason why single payer is a no-go is because of “anti-communist” paranoia. The Democratic plans are all pretty good, in that it would wipe out the insurance industries ability to..well…operate as they do, and probably force the issue to where government run health care is the only option left.
“The reason costs have gone up is because of the blood-suckers in the insurance industry.”
Jeff, you can’t seriously believe that good, God-fearing American Capitalists would act in an unethical and immoral way, taking advantage of a situation that hasn’t been properly addressed by the government to reap obscene profits while often leaving patients dead or in dire straights, could you?
Don’t you love America?…
A. They will drop your coverage when fit hits the shan.
B. Poor still won’t be able to pay for it.
C. Same problems getting initial coverage as now.
I have some kind of coverage, but I get the feeling it might as well be none. Thankfully I haven’t needed to find out. I know I have to pay for it ($22/wk, and you can imagine the luxurious comforts THAT’LL buy you).
I have decent coverage through my university. This was the year of living dangerously, so I ended up in the ER twice, once for a broken bone, and once for an allergic reaction that confined me to the hospital for 4 days (I got really lucky on that one: total cost to me $1500, most of which my parents handled for me). I shudder to think what would have happened if I were still only covered by my parents’ insurance, because it doesn’t extend to the state I live in. As it is, I’ve been covered for the majority of the costs I’ve incurred through rugby and bad luck, all for $1000 per year.
My coverage is actually pretty amazing. It only costs me about $80 a month, because my employer pays 2/3. Every hospital (that’s open, anyway - I’m in NOLA) is in network. I’m on a HMO but it was actually a better option than the PPO, because most physicians are in-network, and I don’t ever leave! Also, chiropractic care is covered, and that’s important since I prefer to treat illnesses holistically.
I’m actually afraid to go back to grad school because I don’t want to lose this coverage. I did get screwed around by a private hospital when I got sick a few months ago, but that wasn’t my insurers’ fault.
Leora, thanks for your detailed outline of some of the ways U.S. insurance and (lack of) decent health care impacts the lives of disabled people. Most healthy people don’t understand about institutionalization and the “homebound” limitations of Medicare… a disgusting and oppressive system that is one of the major violations of human and civil rights in this country.
We are demonized for not working, and for being dependent. But the whole system is set up to deny us any shred of empowerment or ability to work and be productive citizens. We get the choice of no support, or complete dependence and the removal of many of our human rights.
I actually had someone tell me yesterday that she is categorically opposed to changing our current system because she “wants access to GOOD doctors.” I asked her why she thinks national health care = crappy doctors. She couldn’t answer. She’s just bought the line.
She also said she doesn’t want to “pay for other people’s medical stuff.” I said you pay for other people’s kids to go to school (she doesn’t have kids). What’s the diff?
Couldn’t answer, again. Just adamantly shaking her head, no, no, no, no, NO.
While I’m sitting here wondering how I’m going to pay the 20% coinsurance on my daughter’s ER visit last July (my total is $1500), she is on her husband’s “good” health insurance, and so doesn’t care how other people are faring.
I just finally watched Sicko, so this thread is timely. I keep thinking about how that former PM in the UK said that most people there think of health care for all like they think of votes for women. No one bats an eye. It just is how it is. It is how it should be. They wouldn’t roll back the clock now for anything.
And here we are, still in the 19th century, I guess. I need to buy some stock in Merck, huh?
Jeff, you can’t seriously believe that good, God-fearing American Capitalists would act in an unethical and immoral way, taking advantage of a situation that hasn’t been properly addressed by the government to reap obscene profits while often leaving patients dead or in dire straights, could you?
Isn’t that all the definition of an American capitalist?
I hate to be the second person to sound the smug-Brit horn, but when I read these comments I really am glad of the NHS. It has its problems - please don’t take Michael Moore’s view as authoritative - but throughout my v.recent pregnancy and the birth of my daughter, not once did I have to even think about cost.
Having said that, there really are problems with the NHS, many of which are indeed to do with over-zealous and badly thought out managerialist government meddling, together with even more badly thought out pseudo-privatisation models. If you want a good system to look at, take a gander at the French.
Kathy said:
“She also said she doesn’t want to “pay for other people’s medical stuff.” I said you pay for other people’s kids to go to school (she doesn’t have kids). What’s the diff?”
Not only that but she is paying for other people’s health care stuff. Not only people like me (medicare) but also all of the uninsured who wrack up the costs in ERs and by not having preventative care. I can’t believe people still buy that line.
If you want a good system to look at, take a gander at the French.
Well, that guarantees “we” won’t be taking a look. Can’t learn from the Freedomites, after all.
Good coverage, through my wife’s employer. Because I am covered on my wife’s plan, I don’t take my company’s health insurance, so the company gives me a $2,400 a year kickback for not taking that benefit.
We had to choose our physicians from the list, but it was a pretty big list. The biggest drawback is that all prescriptions have to be obtained at the hospital pharmacy to be covered.
I don’t like to support the single-payer plan, but have (very regrettably) concluded that that is what we have to do. I’d note here that none of the three “main” Democratic presidential candidates supports single-payer, as do none of the Republicans.
I have no coverage and I work in the healthcare industry.
I know, Leora. Part of our property taxes in this county goes to support the county hospital, where people without insurance get treated. I did point that out to her, too.
I’ve never seen someone so incredibly cut off to hearing anything different that what she feels. She literally just kept shaking her head and saying no over and over while I was (really politely) trying to speak.
In the end, I rather impolitely told her she better hope she and her husband always have that great health coverage.
I have an HSA and I hate it. As many horror stories as I’ve heard about them, I had virtually no negative experiences while in an HMO, whereas the HSA is hella confusing and expensive. I’m paying much more out of pocket than I did with an HSA, and I feel like the quality of my coverage has decreased. I had cancer 2 years ago. Last year (my first with the HSA), I had to have a CT scan. I’m *still* paying out of pocket for it, over 12 months later, and was almost sent to a collections agency b/c of the lack of communication coming from my HSA/PPO provider. No former-cancer patient should ever have to ask themselves, “Do I really need that CT scan?”
Kerlyssa, if it’s a breast lump, you should be able to be screened and treated through your state’s Breast and Cervical Cancer Screening and Treatment program (run through Medicaid, but usually without the means test if you’re uninsured). CDC has a list of screening centers.
My health coverage is good, but not great. My wife gets insurance through me as her employer is a small non-profit that could never hope to afford health insurance for its two staff members. The company does offer dom. partner coverage. My boss is lesbian with a partner who has multiple health problems (and as far as I can tell doesn’t work).
Last year our son was born on my old plan. Despite a difficult birth, we didn’t have to pay more than a very small copay (I think it came to $40).
Then in the middle of the year, my company switched health plans. When we wanted to get minor surgery for our son, we had to shell out over $1000 bucks in deductible exepenses. As a result, we’re holding off until we can switch plans again this summer (It’s to get a birthmark removed, needs to be done but not urgently).
Care for my wife, son, and I has otherwise been fairly good, though I did have to change a doctor because the one I had been using was out-of-network. Still I loathe having to check to find “approved” physicians or specialists. Living in a big city it’s more of a hassle than a problem, but still it’s a pain.
She also said she doesn’t want to “pay for other people’s medical stuff.”
But she is with her insurance too. Sometimes I think people don’t understand how insurance works. Your money doesn’t go into a little account where it’s set aside for you when you get sick, it all goes into a pool, and that pool gets paid out to people as they need it. So if you don’t have any big medical bills, your insurance payments are paying for other people’s medical stuff - and/or lining the pockets of insurance companies. You don’t get it back if you dont’ use it, anymore than you do under socialised medicine.
rowmyboat wrote:
Which begs the question: just how much do you think you ought to pay? Since health insurance premia are normally much higher than the $1,260 you are paying a year (including both the employer and employee portions), who is picking up the tab for the rest of your health insurance? The answer, of course, is that the taxpayers of Massachusetts are subsidizing your health insurance.
If we go to single payer, as Pam (and I) support, we need to be honest about one thing: our taxes will go up, way up, because it has to be paid for in some fashion. We’d lose the costs of paying insurance, as would our employers, but the odds are pretty good that most people would wind up paying more in new taxes than they’d save on their current insurance payments.
I have the Federal Employees Health Benefits plan, actually, a whole big book full of plans, from which I get to choose. In action, it’s a lot like Tri-Care, the military plan. Some years ago, I did the figures, and proved to my own satisfaction that this plan could be extended to everyone in the country for no more, or very little more, than various local, state and federal agencies are now paying for what is often inferior care. It’s a good plan, as plans in the US go.
As an example, Mr Nice Guy recently had brain surgery, and we are now looking at the bills. The bill from the hospital was over $24K. This does not include the surgeon’s bill, the anesthesiologist’s bill, precare and postcare. So far, our share of all of this is under $1000, and I don’t think it will go over.
On the other hand, this wonderful plan has a few flaws. Dental coverage has just been added, but unlike medical coverage, dental pays less the more serious your problems are.
And we have a son who is mentally ill. Because no doctor would actually issue a formal diagnosis, he can’t be covered on my insurance after he ages out. Because the medication which works for him costs about $30 a day, he can’t afford it without the insurance. He’s found a work-around, but it’s so bizarre that it really points up the failings of this “system.” As a crazy person, he of course comes into frequent contact with the legal system. Spends time in jail. The jail doctors now know him, know what he needs, and prescribe it for him while he’s in jail. Lately, they’ve been giving him some to take home with him when he leaves. Is this not an outrage? It works, more or less, but this is a smart kid. He wanted to be an engineer. Now, of course, he’ll probably never work at all.
Mrs Nice Guy
Be prepared - you will likely also get statements from the nursing contractor, the anesthesiologist, the private practice group with which each of the physicians is affiliated, the radiology group and any drugs
I have no insurance. My partner is a full-time student, so he has pay-through-the-nose coverage from his university. He has a chronic condition that makes it impossible for him to get private insurance (we’ve tried), and his current insurance won’t pay for the treatment because it’s…guess what…pre-existing. We keep him on the insurance because eventually he’s going to finish school, and at that point the only way to get him covered will be to have the record of continuous insurance. We’re married, and to put me on his insurance would cost 8000 per year. No thank you–that’s a ridiculously high proportion of my income, and at this point I prefer housing and food to insurance. I guess I’m one of those lazy, greedy folks Romney keeps talking about who simply can’t be bothered to get insurance.
I’ve looked into private insurance for myself (healthy, no pre-existing conditions, no serious illnesses ever..thank Whatever You Thank), and not only is the cost prohibitive, I have yet to find a plan that will cover the things I’m likely to need: dental, vision, any kind of gyn care including pregnancy. Plans available to me have explicitly stated that any care related to pregnancy (or pregnancy prevention) will not be covered. Way to look out for the next generation!
As long that second shoe doesn’t drop for either of us, or his chronic condition doesn’t worsen, we’re fine. But we are kinda holding our breath.
Well, I thought I was covered until I had a kidney cancer diagnosis. Talked to my rep about the treatment plan (partial or total removal of the left kidney to start with, follow-up plan contigent on tissue biopsy). It turns out that it was a look-alike and sound-alike boogie of a cyst with no malignant potential.
Anyway, I was nickle and dimed to death on the insurance. The surgeon and anesthesiologist was fully covered, but the surgical assistant was not. The primary kidney surgery was covered, but the insertion of a stent through the urethra and into the ureter which is recommended practice was deemed a second procedure and not covered. Radiology coverage topped out before followup x-rays.
“If we go to single payer, as Pam (and I) support, we need to be honest about one thing: our taxes will go up, way up, because it has to be paid for in some fashion”
Dana, if a single payer system is designed correctly, our taxes will not have to “go up, way up”.
The fact is we already pay more than enough for healthcare in this country to cover everybody. We just spend in the least cost-effective way.
More preventive care, fewer trips to the ER, and cutting out the Insurance Co.s (and their obscene profits) from the process will go a long way toward getting healthcare costs under control, and ensure delivery to all who need care…
My health insurance (thru spouse’s job) has been pretty okay so far. Premium is something like $2500/year, and is good on prescriptions–I pay $2.51 per month for BCP, which is the only Rx we pay for regularly. We’ve been able to see any doctor we want, without a problem, and co-pays are $25. Fortunately, spouse and I haven’t really had the opportunity to try out all the provisions except for a tonsillectomy that cost $1500 out-of-pocket… We’ll be embarking on baby-making soon and are planning on saving up $2000 to offset the out-of-pocket hospital bill at the end.
I don’t mind having to plan ahead for big expenses, and we’re fortunate in that we’ve had the luxury of being able to plan ahead; but it kills my soul a bit to know that we approach these things as finance-based “health decisions” rather than having a reasonable expectation that we have a right to health whether or not we can spend several months saving up for it.
Dana, to answer your question —
To qualify for my health insurance, I need to make between about $15k and $20k a year (150%-200% of the poverty level). I am making about $16k this year; if I was makings, say, $19k, paying $105 would not tax my budget. At $16k, said budget is a little strained. I am more looking for a better scaling, because, I’ll tell you, there’s a BIG difference between making $15k and making $20k a year.
I’m totally ok with, in a few years, when I’ve finished my MLS, and get a real job, paying taxes and all that. I support higher taxes so that everyone gets what they need. Tax payers support me now, and when I no longer need that support, I’ll happily pay it forward and support others.
Okay, Squashed, I think you need a reality check. Progressives don’t do ourselves any favors when we engage in hyperbole about corporations — the truth is quite sufficient.
Merch publishes the revenue of their top dozen products in their annual report to the SEC (the 10-K). All you have to know is where to look. This table appears at p. 49 of their 2007 Form 10-K:
$ (in millions) 2006 2005 2004
Singulair $ 3,579.0 $ 2,975.6 $ 2,622.0
Cozaar/Hyzaar 3,163.1 3,037.2 2,823.7
Fosamax 3,134.4 3,191.2 3,159.7
Zocor 2,802.7 4,381.7 5,196.5
Primaxin 704.8 739.6 640.6
Cosopt/Trusopt 697.1 617.2 558.8
Proscar 618.5 741.4 733.1
Vasotec/Vaseretic 547.2 623.1 719.2
Cancidas 529.8 570.0 430.0
Maxalt 406.4 348.4 309.9
Propecia 351.8 291.9 270.2
Vioxx - - 1,489.3
Vaccines/Biologicals (2) 1,859.4 1,103.3 1,070.3
Other 4,241.8 3,391.3 2,949.5
$ 22,636.0 $ 22,011.9 $ 22,972.8
Note that the table includes three years of data — the backward comparables allow investors to determine trends and estimate the life-cycle of their drugs.
As to “where it goes,” it’s revenue. It goes to settle the Vioxx cases, pay excessive executive compensation, lobby our legislators, market off-label uses, and other “legitimate corporate purposes. (I kid! What’s a joke between some guy and an excessively powerful, greedy corporation? C’mon, have a sense of humor. I’m sure all that off-label marketing just happens on its own! More to the point, I have no specific, nonpublic information; I only know what anybody can read who knows where to look.)
I work for a public university and have the usual PPO coverage ($300+/mo). It’s above-par, but not excellent. My husband has similar PPO coverage which is both cheaper ($200/mo) and better for regular care. My coverage is better for surgeries and major stuff. Since we rarely have major stuff and lots of regular stuff what with two kids and all, we switched from my coverage to his, but kept the Flexible Medical Spending Account my job offers and into which I put $150/mo.
Then I had surgery. After the $750 deductible, the $30 a pop co-pays for the specialist, the Rx, the surgery center and the anesthesiologist, I am flat out of funds in my FMSA for the year. That won’t re-up until Sept 1. So, for the next 9 months there will be no doctor, dentist, eye doctor or other visits. Can’t afford it.
And I still owe the Surgery Center $400.
I seem to have pretty good insurance. It’s not as good as the state insurance (university employee) we had before, but it’s covered everything no questions asked, so far. This includes an ER visit and MRI, as well as an unrelated full round of testing for recurrent pregnancy loss (14 blood tests, saline ultrasound). Who knows what’d it’d be like if I had something truly disastrous.
Squashed, progressives don’t do ourselves any favors by overstating the facts about corporate behavior and secrecy. The truth is bad enough.
Merck publishes the revenue of its top products annually, for the last three years, in its Form 10-K annual report to the SEC. For example, at p.49 of its 10-K for 2007, Merck has a table. You can view it here. They give total sales for thirteen drugs or drug families for 2004, 2005, and 2006.
Squashed, progressives don’t do ourselves any favors by overstating the facts about corporate behavior and secrecy. The truth is bad enough.
Merck publishes the revenue of its top products annually, for the last three years, in its Form 10-K annual report to the SEC. For example, at p.49 of its 10-K for 2007, Merck has a table. You can view it here. They give total sales for thirteen drugs or drug families for 2004, 2005, and 2006.
Squashed, progressives don’t do ourselves any favors by overstating the facts about corporate behavior and secrecy. The truth is bad enough.
Merck publishes the revenue of its top products annually, for the last three years, in its Form 10-K annual report to the SEC. For example, at p.49 of its 10-K for 2007, Merck has a table. You can view it here. They give total sales for thirteen drugs or drug families for 2004, 2005, and 2006.
Also, Dana, don’t mistake my desire for a less stressed budget, of which paying my health insurance premium in part, for not being grateful and happy about my health insurance. I’m fully aware of what a good deal I’ve got here.
If I had my whole family on my work insurance, I would be paying $400 a month. I have a very hard time believing I would pay more than that in higher taxes if we had a single payer system, given that I pay $212 a month for my share of the ENTIRE FEDERAL BUDGET (minus social security). We could double the federal budget - and double our taxes - and many of us still would be paying less. I’m sure someone will come along and tell me my calculation is wrong, but this just seems messed up.
I have no insurance coverage because I work freelance and can’t afford to buy a policy for myself. When I was working for a company, I had terrible coverage anyway. The insurance company refused to cover routine tests (like Pap smears) and I had to pay out of pocket anyway, despite having paid my premiums (my employer only paid 45%) and deductible.
My boyfriend (we’ve been living together for 5.5 years) has insurance through his employer but it is not available to me because we aren’t married. If we were gay domestic partners, however, I would be able to be on his plan.
I understand the risks I am taking very well in not having insurance but I cannot afford it now. I was $40,000 in debt when I was in college due to lack of health insurance. I was covered under my father’s plan, but it turned out that he’s such a deadbeat that he wasn’t actually turning in the enrollment verification forms I was dutifully bringing to him each semester. I was dropped from his insurance with no notification and ended up in the hospital twice in the next month despite never having been sick previously in my life except one cold when I was 16 and chicken pox when I was 11. I owed $40,000 as a result and had to drop out of college and work 2 jobs to pay it off. I was not able to return to college and graduate until I was 29. Now, employers discriminate against me because I have a huge gap in my education.
The insurance companies are criminal. We need our own NHS.
I work for the same university that you do Pam, but I doubt I have coverage as good as yours, and what coverage I do have is not usable/effective since I can’t make same day or same week appointments with my primary care provider and must use Urgent Care for everything other than yearly physicals and follow-ups. My recent emergency room visit had a $200 co-pay. WTF? And the only reason I had to go to the emergency room was because I can’t make same day appointments at the primary care facility that I’m mandated by my insurance to use (and I was in incapacitating pain).
I should add that I’d still have $750 of out-of-pocket expenses before a penny of insurance kicked in, even with the $400 a month. And several other people here have posted that they pay more a month than that for their insurance through their employers.
Item of questions:
1. Why is it we can buy fancy motorized lawnmower for $600 but motorized wheelchair cost $500-800
2. Why is it we can go to star buck buying exotic imported coffee bean for $4 bucks a cup or a bag of complicated chocolate for $10-20 bucks a small bag but 3 weeks dose of flu medication can easily cost $30-50.
3. Why is it Intel can sell entire computer chip for $80 with a fab costing anywhere near $0.8-1B a pop while pharmaceutical charging relatively low tech cancer pills for $120 a bottle?
4. And finally why is it antibiotic for animal growth feed cost 1/10th - 1/100th compare to exact same compound for medicine purpose?
5. India pharma companies with no patent protection where the industry has to compete on thin margin or die can push aids drug 1/100th the price.
All these are strictly production cost that can be compared right? for anybody who is in big university, go ask around different department (mechanical engineering, veterinarian, med school, business school, etc)
What hold the cost up? certainly not technology or manufacturing capacity.
It’s a legalized ripoff. that’s what.
My family (I’m a student on my mom’s insurance) switched over from a smaller insurance company to one of the huge ones at the beginning of this year because our insurance is through my mom’s work. She is a high level employee at a hospital and the hospital pays her premium.
I’m leaving next week for a four-month trip to West Africa. I called my insurance company yesterday to let them know that I will need a vacation override, so that I can get four months’ supply of medicine (HBC, Zoloft, and Lariam to prevent/assuage malaria). When we switched insurance companies, I was looking forward to how much better! easier! this one would be because it is a larger company, more doctors in network, blah blah. Wrong! I had no problem getting a five month supply of medicine with our other insurance company when I went to France. This company (Aetna) will only allow me to get a three month supply and I can only get it five days or less before I leave. So, if you are going on vacation for more than three months (ahem, moi), then what are you supposed? Just hope that your vacation is super fun and you won’t need your medicine? You can’t just stop anti-depressants randomly WHEN YOU ARE IN A FOREIGN COUNTRY AND THE REASON YOU TAKE THEM IS BECAUSE YOU HAVE ANXIETY ABOUT THINGS THAT ARE NEW/DIFFERENT. And really, it would be a lot better for them to give me a whole supply of malaria pills instead of having to pay for it when I get freaking malaria. I just don’t understand how this can be the policy- people do, indeed, travel for extended periods of time- and what I am supposed to do. Have my mom refill all of my prescriptions and then hope the package gets through the West African mail system in time for me to take them?
Support Dennis Kucinich in the primaries, since he’s the only Dem calling for TRUE not for profit universal healthcare!
Chingona, I wonder about that, too. In order to cover my family, my employer would take nearly $700 a month out of my paycheck. As it is now, I’m paying $400 for myself and my daughter (the higher figure would be just to add my husband).
I work for a very large employer, btw. The largest in my city. They recently changed HMOs and bragged about it saving millions. But apparently those savings weren’t passed on to the employees at all, because our monthly premiums went up. And the coverage is suckier than the old HMO.
I absolutely do not see how, if we had national healthcare, I’d be paying an extra $700 in taxes. No way.
So yeah, it’d be less. And my husband could finally get that hernia fixed.
I’m a grad student, and my particular (very very rich) university gives me mostly very good health insurance - great for everything covered on-site, which includes physical therapy, x-rays, mental health, etc. Also very good maternity coverage, from what my pregnant friend tells me. I don’t know about other hospital stays, since I haven’t had to have one. However, they don’t cover vision or dental at all, which is galling, since they have a gajillion dollar endowment and could afford to subsidize an annual teeth cleaning. But I know I’m lucky - I’m a frequent user - seeing a fabulous therapist, getting physical therapy for back problems, etc, and it’s all free. Cheap prescriptions too.
Lillet: serious question–why is Kucinich the only one supporting that?
Even with what I would call “decent” coverage over the last few decade, all the co-pays, co-insurance and deductibles can be a financial killer anyway.
Mrs. Sam had 3 high risk pregnancies. 2 out of 3 of our children had birth complications that required a day or two in the NICU. Our son was born with a lateral cleft that had to be repaired and was also later diagnosed with Asperger’s. Mrs. Sam had cardiac and plumonary problems after her last pregnancy and I had my appendix removed. All this in 5 years.
Long story short, all of this added up to such a list of doctor’s, specialists, labs and hospitals that I literally needed an Excel spreadsheet to track them all. As a bean counter, I always thought of myself as a diligent bill payer, even as much of a struggle as that load of medical bills was. In the end, however, it didn’t matter. One of the hospitals sued because we couldn’t pay them the $300+ per month they demanded for service (on top of the already $500+ per month we were paying on back balances).
We’re now a year past our Chapter 7 bankruptcy. Can’t buy a car, can’t buy a house like we’d planned but, hey, at least I don’t have a 4-page spreadsheet of medical bills to worry about.
Somehow I’m not sure our “free market” system worked well for us. Not sure at all…
Betsy,
Lucky you on the good on-campus services. I won’t set foot inside Health Services or Counseling Services where I’m a grad student.
Some plans only allow 20 mental health visits a year. That’s it, no exceptions, no extensions. I think this kind of limitation/bias against mental health services may be common for other plans out there as they try to keep costs down.
Some plans don’t allow them at all — you’re just SOL if you have psychological problems. But, as I said, I’m lucky that I’m working for the Very Large Corporation that aggressively pursues lower healthcare costs for its employees (which not incidentally means the company pays less, too).
Interestingly, the mental health portion of our plan is covered by a completely different company than the ones who do our “regular” health care, but it’s included with all of the plans except Kaiser (which has its own mental health care).
Also, and I know this doesn’t apply to everyone, but — I consume very little health care. Unless I have a catastrophic injury or illness, even my $105 a month would probably cover it. So really, I’m not gonna cost the tax payers of MA all that much.
Another smug brit checking in here. Point of minor detail, prescriptions without discounts weigh in at £6.35 per item, and the prescribing regulations say one item is, for the most part, a month’s supply at the dose prescribed. So as the dosage of the stuff I’m on long term has gone up and down in response to my condition, I’ve paid £6.35 a month for it. From one to three to two pills per day, I handed over the same sum each month at the pharmacy.
I wouldn’t go for any kind of privatisation. I want a good doctor, not the guarantee of the cheapest junior sawbones my insurance company could find.
I can confirm NHS bureacracy as being bruising stuff: my sister’s a doctor, and despite being smart enough to research and teach oncology at the tender age of 26 (if you’ve got cancer in Bradford look out for the short brunette with the bedside manner of someone whose big brother bought her a complete set of House DVDs last year…) she finds the paperwork utterly baffling.
Wow, I am so insanely grateful for my health coverage after reading your stories.
I work at a small-medium sized software company in Cambridge, MA. Our health care is a Blue Cross Blue Shield PPO and it costs me $40 a month to cover both myself and my husband and that’s for medical, dental, and vision combined. If I were gay, I could cover my partner. We have no co-insurance payments on in network care and it is capped at $1000 for out of network care. A primary care visit is $10, a specialist, $20, and ER $50. We get reimbursed $150 per year each for our gym memberships, making our total out of pocket costs about $7.50 a month each. Our plan has a vision component that covers contacts or glasses each year and a tiered prescription component that starts at $10 for a 3 month supply.
You know, I’m not a John Edwards supporter, but he’s right about there being two Americas. I try not to talk to my parents about our insurance because I know my mother struggles with hers. She’s self employed, and unlike Massachusetts, where I live, Tennessee, her home state, does not offer universal care plans. Her costs are in the $400 a month range just for basic coverage. It’s just not right.
Okay, so I did the math.
As of this year, I will be paying between 70 and 85% of my total (pretax) income to pay my insurance PREMIUMS. I’m not even talking about the copays, prescription costs, etc.
I shit you not.
My husband’s job pays better, but offers even WORSE health insurance (if you can imagine), so this is what we get.
If we had national health care, I could quit my job and find a better one. If we had national health care, I could go back to school and be a more productive member of society, with all the bells and whistles and contributing more taxes and all that fancy shit.
That would be good, right?
Anyhoo, to all the people who say “ZOMG, national health care would raise taxes!”, I have a couple of questions.
Would it make my tax rate higher than 70%? I’m guessing not.
Why can every other industrialized nation figure out how to provide affordable health care and we can’t? Do Republicans really think America is that dumb?
If national health care is such a travesty, why does America routinely score so low on issues of maternal mortality, infant mortality, and preventable death?
My PPO coverage is through my spouse’s insurance. His company covers 100% of his insurance (which we’ve taken to calling the Cadillac of health insurance because of how much it actually covers), but we have to pay 40% of my coverage as his spouse, which amounts to over $8k per year. Our copays are low, and our deductibles are low, which is really nice, but we can only afford this coverage because we have investment income to balance out cost.
When we first married, I had just finished law school and didn’t yet have a job. We looked at a number of health insurance options for me, but not a single one covered pregnancy within the first 10 months to a year of paying the premiums. Not even insurance specifically for pregnancy.
My mother, as a nurse, has the worst health insurance of nearly any professional I know. I don’t know why, but health providers get stuck with awful insurance with high premiums, high deductibles, and low coverage. Where’s the fairness in that?
Kathy,
I think he’s the only one supporting true single-payer because he’s the only one who hasn’t accepted any money from insurance companies or Big Pharma, which Clinton, Edwards, and Obama have all done. It’s also quite likely that this refusal to be beholden to corporate interests is the reason why, despite qualifying, NBC is refusing to let Kucinich participate in the debate tonight.
Dennis Kucinich’s website is www.dennis4president.com — there’s a comprehensive treatment of his healthcare proposals there. Also, by not including him in the debates, the rest of the candidates get to scoot by as if their calls for healthcare reform are more reformatory than they actually are.
True universal healthcare is an issue that could really unite this country, and it is tragic that all the candidates save one are too timid/ beholden to corporate power to wholly support it.
Lillet
“Do Republicans really think America is that dumb?”
Yes.
And within the context they mean it (referring to the people who gave GWB four more years), they may be correct…
Mr Ess wrote:
Certainly they will, because much of our health care coverage is not being paid by taxation now. There’s some offset through the loss of having to pay insurance premia, but not everyone is currently paying them, so they’ll see the biggest net outflow.
The obvious answer is that “we’ll just tax employers, and the employers who weren’t providing health insurance will see the biggest net cost increases,” but that isn’t realistic, either: if all of a sudden WalMart sees a $10 billion tax increase, because it wasn’t providing all of its employees with subsidized insurance, then WalMart will have to raise its prices sufficiently to cover that additional $10 billion. Since most of WalMart’s competitors (from other big box stores to small shops) were also not providing much subsidized health insurance, they’ll have the same types of net cost increases, and have to pass them along to their customers.
Nor is there any particular reason to believe that spending for health care will somehow be more efficient if it is run by the government; very little other government spending is terribly efficient!
I have for years listened to people extol the American system over the Canadian and yeah, the Canadian system has plenty of suck in it. However, I know for a fact that I am not paying over 20% of my monthly budget in basic health insurance costs, what is not covered by the government basic plan is covered by my husband’s work plan (dentist, private physio etc…) and if my son falls down, I rush him to hospital without checking my wallet.
I go see the doctor more regularly than my American friends, I worry less and we aren’t held captive by our insurance plan. It really is time for the American political class to come to the conclusion that health care is not a commodity, they are marketing the lives of their own people and they are losing out on the benefits of a healthy population.
I dunno, if we’re just talking pure efficiency of the socialized governmental systems we have now, the postal system is amazingly cheap and efficient for the end users. The public education system is something some people love to bitch about and is far from perfect, but if you really think about what gets accomplished on a day to day, year to year basis, it’s pretty amazing.
The fire and police departments in my city are top-notch, as are the libraries. The roads are great. The county hospital serves SO many people without health insurance. I know I’m not talking about national systems, but when we’re talking about programs that are found nationally and funded in a few different ways, they really are quite efficient.
I can’t make same day or same week appointments with my primary care provider
No difference for me, really. ER visits are $150 co-pay. I think maybe once I saw a PCP on the same day, otherwise I can wait months to see other doctors, or pay to go to urgent care. To see my endo, I have to schedule 3 months out or more.
A good example — for the surgeon who did my gall bladder surgery, I had to wait about a month to get the consult and surgery date. I was left in that limbo for a month in a good deal of misery, but not enough to justify going to the ER.
I can’t make same day or same week appointments with my primary care provider
I gave up on getting in to see a therapist because it was a 2-3 month wait. Scheduling a physical required a 5-month window.
I had no coverage at all from March of last year until this January 1, and I hurt my foot in September. New York City has a system wherein you can get temporary insurance and pay on a sliding scale if you go to a public hospital — which are crowded and mostly in rough neighborhoods — so I went to a public ER and spent 8 hours there to get a measly X-ray, but in the end, I’m okay and the ER visit will only cost $40. (It would have cost more if I’d opted to get the prescription for pain meds filled, but I didn’t bother.) The ER shared a waiting room with the low-income clinic, so I saw some really sad cases.
Now that I’m covered, my boss asked a bunch of us worker bees last week if we’d be willing to let our co-pays go up to $25 in exchange for a slightly lower monthly premium, which we agreed to because otherwise the monthly premium would have gone up, and I work in a fairly low-paying industry, so it’s not money any of us are wanting to part with.
But, yeah, I had a panic attack before remembered that I could get low-cost health care at a public ER, which I learned via an article in New York magazine about uninsured New Yorkers. All because I got laid off last year and my new employer made me wait 6 months before insuring me. So, yeah, single-payer all the way.
And Dana, the US pays more per capita than any other country on our wasteful and ineffectual health care system, so I think we can scrounge around for the money to fund single-payer. Hell, I’d be willing to pay a little more tax money to ensure I never have to go through the public ER experience again.
For those who think a government-run health care system would be so inefficient (which on this thread is just Dana, but I welcome Dana’s feedback), I don’t hear lots of old folks - most of them members of the politcally powerful AARP - bitching about their Medicare. I hear doctors complaining abou the low payments, but not so many that they are actually refusing to see Medicare patients or leaving medicine.
We are lucky. My employer covers 100% of my insurance, and my husband only has to pay $100 a month for his. Both plans are pretty good, PPOs, although we’ve never had a major claim. My plan does not cover domestic partners, his plan does. In any single payer, tax-supported system, we’d most certainly end up paying more. I still support it though. Insurance being connected with employment is STUPID. It truly makes no sense. If I had a serious illness, chances are I could not work. Would I lose my insurance? What if I lose my job and therefore cannot afford COBRA, and then get sick? The extra money is worth the peace of mind. We know how insecure our jobs are in the new world order. We are one quarterly earnings report from disaster.
I have a pre-existing condition so the individual health care market is pretty much a joke for me. After I graduated college and was working temporary jobs with no benefits, my parents bought me an individual policy. It cost almost $200 a month, had a $2000 deductible, covered NOTHING that I had had in the past, and would not cover a pregnancy. (culture of life, my ass). The company never paid one dime for my healthcare, the only benefit was I could filter the bill through them and that would lower the amount the doctors could charge me. Without the insurance I would have been on the hook for the full amount.
I think something will be done as less and less americans are insured. The problem is most of these plans keep the leeches at the table. We need to kick them off.
they found a birth defect in my right kidney when i was 13. ive had 15 surgeries since then. when i was younger i was on my moms insurance via her job with the state, and then she kept me on cobra til it ran out.
now, im 26, went back to school full time this year to start my undergrad degree, so im not working. i was just rejected for medicaid, i dont have the money for my states high risk insurance which starts at $241 a month with a $5,000 deductable, and my school doesnt offer student health insurance.
my mom and i are looking into charity hospital programs, teaching hospitals, kidney foundations, etc. if none of that works out, my choice is drop out of school and try to find a job with good insurance, or die. im currently almost 4 years overdue for a surgery.
luckily for basic care like colds and everything theres a low income clinic i can go to, and they also have a fantastic dental clinic. whenever i go for any sort of medical care i bring a print out of the Target $4 generic drug list and ask for meds off of it.
Besides the savings of paying higher taxes vs. paying grossly high premiums, think of what would happen to all other insurance premiums when liability for medical care is removed. When your home, car, business liability, workers’ comp, etc. coverage only has to cover material damage and lost wages, but doesn’t have to cover accident victims’ health care, premiums across the entire insurance spectrum would have to come down.
Oh, but we don’t want to pay higher taxes because that would cost too much.
I’m a 40 year old returning undergrad student. I have no insurance because I can’t afford even the student subsidized plan. Oh, and tuition is going up this year.
Mnemosyne: “states that put caps on awards for damages in malpractice lawsuits have seen their healthcare costs rise at the same rate as states that don’t have those caps”
The caps were not low enough. If we don’t want the insurance companies feeding off us, neither should we tolerate the lawyers doing the same.
like JimB gives a shit about people. That’s funny.
Oh! I did find out recently that if you pay cash (don’t even use your insurance) at Wal-Mart you can get cheapo antibiotics. We hate Wal-Mart, but with husband’s crappy no-coverage insurance, he now gets any antibiotics at Wal-Mart for three bucks. Instead of about eighty-five bucks. It was his doctor who told him about this.
I work in health care so i have excellent coverage. I work for a county institution which serves a lot of uninsured people, but accepts patients regardless of ability to pay. Still, many of them cannot afford to fill their perscriptions.
I’ve got good coverage, but Val says she pays about $1500/month for it.
Damn overfed doctors.
I’m willing to concede that something needs to change in the malpractice system, but whatever tort reform looks like, there needs to be a way for victims of gross malpractice or their families to be compensated for what may be lifelong pain, suffering, lost income and additional medical costs that will have to born out of pocket, given that the victim of the malpractice now is uninsurable (which gets back to RobW’s point). If there is a way to do that and protect the interests of patients and cut out the lawyers, I’m for it.
But it’s important to remember that real people get really hurt by malpractice. (Like my great-aunt, who lived for 10 years with severe brain damage after being given the wrong blood type, but retained enough awareness to try to kill herself 5 years into her new life, and who needed live-in attendant care to remain at home. They didn’t sue because it happened at a state hospital, and they figured they wouldn’t get anything. Instead my uncle kept working to 75 to be able to afford her care.)
I’ve got good insurance, including dental and vision.
I work for the labor union that represents state employees in Ohio, so I guess I should expect nothing less.
Same sex partner benefits are available under our plan.
I was trying to figure out the best way to say the same thing. A lot of hidden costs for insurance could be eliminated if we had universal healthcare. All of those lawsuits that JimB is so desperate to get rid of? We can do it with universal healthcare, because people will no longer have to sue to get coverage for their injuries.
Dana’s kind of missing the point that in the US you already pay twice as much for your healthcare as anyone else in the world. (And get so much less for your money.)
Thomas, TSID:
Progressives don’t do ourselves any favors when we engage in quadruple postings about corporations — the truth is quite sufficient the first time.
I kid!
Depressing thread. My insurance is free through the school, but they’re typical dickheads. I have a thyroid condition that doesn’t require medication YET, and for the year I spent without insurance, I didn’t have it monitored. Couldn’t afford it. Now, being a responsible person, I went through the insurance once I had it and got an appt with an endo. I brought in my old (greater than a year) labs and explained that I needed periodic bloodwork. They are refusing to pay, claiming it is pre-existing. I guess I was supposed to live in suspense of my thyroid tanking and possibly gain 70 pounds in 12 months before my pre-existing coverage kicked in and I tried to see a doctor.
It is immensely frustrating to be screwed for trying to take care of yourself in the way that insurance is supposed to allow you to do. And this is a low-level condition at this point, a couple hundred bucks for a consultation and preventative testing. It makes me not want to leave the house, b/c if I have an accident, who knows what they won’t pay for. Anecdotally, my gf has the same insurance, and she’s been jerked around for a chronic condition too. She’s worried about getting coverage with a job after graduation, b/c then her condition will be pre-existing, and I told her “Welcome to America.” (she is a foreign national).
Pam,
Almost certainly that was only the bill for the hospital stay. You should still expect a bill from your surgeon and anesthesiologist for their services. That was the case when I got my tonsils out (at 29!). Plus there might be extras for other services, for example, if you got a blood transfusion.
(Been there, done that…)
If we go to single payer, as Pam (and I) support, we need to be honest about one thing: our taxes will go up, way up, because it has to be paid for in some fashion.
Would you care to prove this by, say, showing the budgets and GDP percentages paid for healthcare by socialised systems of medicine compared to the USA?
Em - check the law in your state. In most places, if you have not received treatment for a condition in the last six months, it cannot be considered a pre-existing condition for insurance purposes. (Though they will try to screw you. A friend who has a chronic joint problem that has required several surgeries going back to childhood had a similar situation to yours and was able to eventually get them to pay up by making a huge pain of herself.)
But, but, if we replace the insurance companies with Universal Healthcare, where will all those insurance co. executives get work? Who will pay for all those expensive perks? What about the stock options? The revenue sharing? How will they be able to get those huge golden parachutes when they leave in disgrace?
Won’t anybody think of the CEO’s?…
Em- do you require synthroid? It’s pretty cheap even without insurance paying it; about $15-20 for a month’s supply.
That was the case when I got my tonsils out (at 29!).
I just got an email from a student who had that done this break. Mine were done when I was four–thankfully I was still covered under my parents’ insurance at the time (dad was in the AF).
Won’t anybody think of the CEO’s?…
Well, they’ll be good for making kitty toothpaste
Chingona–I had no treatment for over twelve months and that is what they require, as far as I can make out. I’ve sent them the documentation and am waiting on the results. I may have to be a more a pain, but I think I can get them on this. Thanks for the info; I am now more hopeful that I can get them to pay.
pablo–not yet. I have Hashimoto’s, but my gland hasn’t gone kaput yet. They measure my goiter and check my antibodies and TSH every six months and I monitor how I’m feeling. Or, they should.
I’ll start brushing my cat’s teeth when he brushes MINE. Same with the dog. Feh.
Married to my insurance agent! Staying right OUT of THIS conversation…
Just for a data point: no coverage whatsoever.
Hey, thanks Dana!
“Well, they’ll be good for making kitty toothpaste”
Cat’s aren’t stupid.
Once they taste the corrupt and over-privileged essence of CIO-flavored toothpaste, it would all be over.
After that, the cat wouldn’t let you come near with a toothbrush in hand…
I have health insurance through the grad school, but benefits do not extend to my husband. So he has no insurance, because we are poor. I’m perfectly wiling to pay higher taxes if it means every single person can just go get the care they need when they need it.
Yes, I’m Canadian.
Went from excellent coverage to expensive coverage without changing jobs due to a merger. My deductible more than doubled, and my out of pocket maximum - the only number I really care about - almost tripled. And I work for a company that was $9B in the black 3rd quarter - profit, not revenue. I am trying to put off getting care until at least March when I’ll have cash on hand to cover our new $1100 deductible, after which 90% is paid by the plan.
We have the option to buy down the out of pocket max through higher premiums, but the dollar return isn’t worth it. Otherwise it’s HMO and managed care - and none of the specialists I use are on the only HMO option made available to us.
chingona: “But it’s important to remember that real people get really hurt by malpractice”
I absolutely agree. Lawyers should be removed from the process of medical malpractice. We should accept there is risk inherent in administering health care and go from there. An aggressive process should be in place to quickly weed out incompetent doctors from doctors who will make inevitable mistakes simply because medicine is not an exact science. Set up an independent board appointed by state governments to determine causes, access damages and make fair awards. Monitor the board for corruption and enact severe laws against it.
“An aggressive process should be in place to quickly weed out incompetent doctors from doctors who will make inevitable mistakes simply because medicine is not an exact science. Set up an independent board appointed by state governments to determine causes, access damages and make fair awards. Monitor the board for corruption and enact severe laws against it.”
…and because a lot of laws and legal mumbo-jumbo that is unintelligible to regular people will be involved, they will need some kind of representative or something to help them get through the process and make sure their grievances are fairly addressed.
Some kind of, oh I don’t know, a “legal” expert, somebody who would be specially trained to understand laws, regulations, and consumer rights.
Somebody who’s been to some kind of special school in order to learn to be somebody’s “legal representative”.
I wonder what we would call that kind of person, with that very specialized knowledge?
A legalist?…
JimB, regulation by administration alone inevitably results in regulatory capture. Regulators who deal with doctors all the time and whose decisions are of importance primarily to doctors will be lobbied by doctors and come to see themselves as acting for the doctors, not overseeing them. That is what has happened to almost every attempt at regulation, from the FDA to the SEC to private endeavors like the MPAA and the credit rating agencies.
Look, Jim, you’re just full of shit, peddling the “tort reform” line which, its proponents admit in private, is really aimed at strangling the lawyers who represent ordiary Americans, who are disproportionately liberal and funnel money to Democrats and left-of-center orgs. In other words, “Tort Reform” is just a crass Republican partisan project that has scared a few doctors into supporting it.
Caps on damages are the worst policy idea out there. Caps only affect the good cases. Pleading requirements at least affect the bad cases more than the good ones. The real answer is for hospitals to pull the privileges of docs who keep acting negligently. But they don’t.
Regulators who deal with doctors all the time and whose decisions are of importance primarily to doctors will be lobbied by doctors and come to see themselves as acting for the doctors, not overseeing them.
That’s not a bug, Thomas, that’s a feature! JimB wants the same accountability for doctors that we have for CEOs, i.e. none. If the doctor injures you, go piss up a rope. Shouldn’t have gotten sick or injured.
As a grad student I have pretty decent basic coverage - though I have to pay for it ($1800/year, which is a lot when you’re barely scraping by). The crazy thing, though, is that they require you to go to the campus health center for any non-emergency visits, otherwise you have to pay something like 80%. But as I’m only registered part-time (dissertation), I don’t pay all the student fees, so I’d have to pay $40/visit in order to be able to use the campus health center! That’s on top of my $25 copay to see a doctor, plus having to pay for any labs. Grrr!
Anyway, I can’t complain too much, as I did internships for ~4 years and had no coverage at all during that time. Thankfully the worst health problems I had then were a couple ear infections and severe poison ivy reactions requiring steroids. An ex-boyfriend once cut himself badly enough to need stitches while out of work (and with no insurance) and just went without care, as he couldn’t afford the emergency room expenses.
We desperately need universal health care here!
No coverage at all since 2002.
Current employer is a temp agency; they have an arrangement with a local insurance salesperson who does individual policies, but the employer doesn’t subsidize the premium so I’d be looking at $500-600 a month for high-deductable, high co-pay insurance that doesn’t include ob/gyn, vision, dental, prescription, or anything else that can be pared off and which would be subject to going away if I stop working through this agency.
Last employer was a small business (under 25 employees) that didn’t offer health insurance of any kind.
Previous employer was a different temp agency that didn’t say anything about insurance; I assume they didn’t have any arrangements.
Before that, I worked for yet another temp agency that offered a plan, but you didn’t get to find out the details until you’d worked for them 1250 hours in a calendar year, which I didn’t.
Before that, I was unemployed for over two years, but since I’m not destitute, was told I didn’t qualify for my then-state-of-residence’s medicaid plan (even though I had, technically, no income after I exhausted my UI benefits.)
Before that, I had insurance through an employer, but wasn’t able to get COBRA coverage when I was laid off, because my separation packet had someone else’s insurance paperwork in it, and they couldn’t get me the correct paperwork because the office it came out of was shut down due to the layoff and the out-of-region office to which the functions had been transferred wouldn’t be able to help me, because the records were still *here* only there wasn’t anybody still on payroll to do the work, and it wasn’t going to happen within the 30-days-from-separation enrollment deadline anyway, and even if it had, it would have cost two weeks’ UI benefit per month to pay for it - and my rent already cost 3 weeks UI. (Do the math, there aren’t that many weeks in most months.)
My partner has decent insurance through his job, but it won’t pick me up unless we’re married (which we aren’t, for various reasons.)
So, uh, yeah, I’m for single payer. I’ll pay more, but I might actually get something for my money.
And I could get new glasses. It’s been seven years and the duct tape is giving out.
My husband is a PhD and works as an instructor at a community college. Health insurance is not offered to him by his employer- only full preofessors (and secretaries and janitors) get health insurance. Not instructos. (Nothing against Janitors and secretaries! I only mean to point out how arbitrary it is).
I have had at least two simultaneous jobs my whole life, NONE of which even OFFERED health insurance. Because, you know, employers DO NOT HAVE TO offer it.
Consequently, we purchase insurance through the NATIONAL Association of Self-Employed People. It costs @ $400 a month, has a three thousand dollar deductible PER PROBLEM (not yearly), and covers almost nothing. FOr instance, I had a cyst that required an outpatient operation. The insurance covered $1500. I got a bill for $9000.00
I believe MOST self-employed people have this policy. FOr the self employed, this is the only game in town other than Blue Cross/Blue shield, which will not cover anything resembling a pre-existing condition. Like if you had a kidney stone in college, you will never be covered for that again.
As I understand it, Blue Cross varied by county nationally in how good it is. I think there are Blue Cross areas where the coverage is great. Just not here!
I have also heard that health insurance costs in Texas are far far higher than elsewhere. I know that hospital and dostor costs here are very high. My husbands kidney stone operation (lithotripsy, if you can CALL that an operation..there’s no cutting) cost $15,000.00 (a two hour outpatient procedure). His brother, is West Virginia, had his kidney stone treated for $2500.00
Big difference.
I personally demand a single payer system in the next four years.
WHO IS WITH ME !?!??!?!
I used to have great coverage…then I lost my job (the company closed down). Now not only am I making about 1/4 what I used to make, I can’t afford the insurance they offer when my 90 days is up. I can barely pay my rent with my current salary, so buying insurance is not an option.
I am currently working through the paperwork to obtain my medications for free (suddenly, I fit into the program guidelines of the “working poor”), so at least I don’t have to shell out $700 per month on my credit cards for pharms. I am just going to hope I don’t get any kind of major illness or anything else.
And since I have those ever-popular “pre-existing conditions”, I can’t get individual insurance even if I could afford it (asthma, by the way, is considered one…even if it is minor, only bothers you maybe twice a year, and can be controlled with an inhaler),
The United States’ health care system is broken. We trust the government to take care of our police protection, our fire protection, our military, schools, etc. But for some reason (I wonder what that could be), we reject government health care.
[sarcasm]I’m sure it’s much better that hundreds of thousands are uninsured than to have government health care. I’m sure the Canadians, British, and French despise their health care systems and die early due to their poor health care. [/sarcasm]
Mnemosyne, exactly. Political capture is part of the program of corporate America to return us to the McKinley administration. And the Roberts court, 5-3, helped them today, with a decision that lets the bad actors off the hook in Enron. (The case before them involved Charter Communications, but the implication is that all the banks in Enron can get the case dismissed.)
In other words, WalMart and other employers who refuse to provide health insurance benefits to their minimum-wage employees are receiving a tax subsidy because when their minimum-wage employees are injured or become sick, they do not have insurance or money to pay for their health care. Therefore, they are the recipients of Medicaid or are forced to declare bankruptcy because they cannot pay their medical bills.
That’s sweet for somebody.
“I’m sure it’s much better that hundreds of thousands are uninsured than to have government health care.”
They’re just trying to prevent Americans from being infected by Socialism Cooties. You give ‘em healthcare, and the next thing they’ll want is a living wage, better schools, consumer protections, reduced pollution levels, a reduced defense budget, freedom of speech, privacy, and government accountability.
The Terrists would then sweep through the country and make us all slaves to the IslamoFascistoCommunist Manifesto.
Our leaders will spend every life in America rather than give in to the Red Menace…
I have also heard that health insurance costs in Texas are far far higher than elsewhere. I know that hospital and dostor costs here are very high.
Oh, that can’t be possible, because JimB tells us that caps on damages bring down medical costs, and Texas has one of the tightest caps in the country.
Please, JimB, explain to us how Texas can have both the strictest caps and the highest costs? It almost seems like something’s not working.
Oops. I was wrong. According to census data in 2007, http://www.cbpp.org/4-5-07health.htm, more than 44 million Americans do not have health insurance.
I have decent health coverage, but, then, I haven’t had any major ailments. I have a copay on my psychotherapy sessions for clinical depression, and I do not take any prescriptions. I believe my therapist is required to give monthly reports regarding her analysis of me to my insurance company (which is Cigna, btw).
And yeah, I’m damn lucky, but I’m pretty sure I will not be on this plan at the end of next year, so I will have to see what kind of plan I can get when I start teaching.
My husband is a PhD and works as an instructor at a community college. Health insurance is not offered to him by his employer- only full preofessors (and secretaries and janitors) get health insurance. Not instructos. (Nothing against Janitors and secretaries! I only mean to point out how arbitrary it is).
I’ve worked at my current university for 5 years. This is the first year I’m eligible for benefits, and it’s only because of teaching load (summer courses don’t count). I’ll probably lose it next year if I stay.
Really, the system, at every level, is fucked up. The political actors we have in place won’t address it because the corporate class is too interested in fucking over workers to notice that universal health care will help them out, too, and because of decades of conservatard complaining that “government is the problem.”
We’re governed by idiots, but it doesn’t help that much of the populace buys their idiocy.
A newspaper in Arizona did an analysis of people on Medicaid here (called AHCCCS - “access” ha!) who have jobs, and found Wal-Mart had more employees on Medicaid than any other employer in Arizona. And you have to be poor poor poor poor to get on Medicaid here. We’re stingier than many states, I’ve been told. I forget exactly how many Wal-Mart employees were on AHCCCS, but it was thousands, if not tens of thousands. So yes, they are getting a taxpayer subsidy.
I just got a statement from my clinic for the last time I was seen there, during a strange spell of numbness and violent vomiting (after a round of MRIs and neurology visits they decided it was just an atypical mirgaine and gave me anti-depressants for prevention).
On this itemized statement it shows that the shot they gave me to stop the vomiting and relieve the headache is listed as 3 different items and cost a total of 180$!! 25 for the nausea med, 90 for the pain med, and 75 for the nurse to inject it in my butt! Now, after the insurance discount and what the insurance paid, I only had to shell out $1.02 for it on top of the $20 co-pay for the appointment, so I am glad I got it.
What I wonder is whether, if I didn’t have insurance, the doctor would have told me the cost before giving me the shot. I mean, it was a huge relief to get it, but if I had to pay 180 bucks for it i would have just rode the thing out. Or maybe the doctor would not have even seen me without presenting an insurance card first.
Thank goodness I have never been seriously ill during the times when I have been without insurance.
Costs are rediculous here. I don’t have any experience with the European system, but I have been sick in Africa. I was in Nairobi, Kenya when I had a bruch with some food/waterborne bacteria that gave me some mean diarrhea, vomiting and fainting from dehydration. I spent a whole day in Nairobi Hospital ICU, which is one of the best in Africa and pretty much on par with most smallish american hospitals. I got all sorts of labs and tests and IV fluids and staff attention for 12 full hours and the whole thing cost me like 400 bucks, which was reinbursed under a basic travel medical insurance policy. 400 bucks TOTAL COST for the same care I would have had in any American ER and paid probably 5 figures without insurance. You would expect certain operating costs to be a lot lower because of the lower cost of living over there, but the difference is grotesque.
There is something very wrong when an American falls ill and can reflect on how much BETTER OFF they would be (at least financially) if only they had access to an AFRICAN emergency room. It definietly gives me pause.
FashionablyEvil: Thank you, but it’s not the appointment that would be impossible. That would only take a week’s pay. It’s after the diagnosis that the fun starts. It would be the costs of a biopsy, then removal/chemo that would be impossible. I’m not eligible for medicaid since I work, and I don’t have any support system if I don’t work. I can’t even run up treatment costs on a credit card like dear leader suggests since I have no credit history and therefore cannot get a credit card no matter how many times I apply. Last time I tried, with a new bank, they suggested I save 5k and then borrow against it, and they’d look at my application a year or two after I did this.
There’s at least one way we’re getting more like health care in developing countries - clinics in pharmacies (and Wal-Mart). All over Latin America people go straight to the pharmacist for anything short of a broken bone or cancer. While it may be better than nothing and cheaper than the ER for those without insurance, I hate that it’s being touted as the solution. And if you have something weird that has similar symptoms to something common, you’re screwed.
Yes, I’m Canadian.
We will note the inadequacy of the Canadian health care system which allows smugness to fester and spread throughout a patient.
I have kick-ass terrific coverage. The co-pays have been going up and up the last few years, but I have major and preventative medical, I have almost unlimited mental visits, I have dental, I have vision, I have prescription, I can visit any specialist in-network without referral. How? I work for the state. In a union. Basically, the closest thing we can get to single-payer, since it’s a godawful huge number of employees in a government run system.
Interesting how that works, isn’t it?
RE: getting better care in Africa
It is becoming common for Texans to drive to Mexico ffor health care and dental care, because the care IS BETTER and costs A TENTH of what it does here.
Texas is Big, so Mexico isn’t really CLOSE for most Texans. But at least it is an option.
Polls say the War in Iraq is the Big Issue this cycle; if Americans had any IDEA how fucked we are in the Health Care Dept, it would be THE ONLY issue that mattered. I don’t think most Americans realize how close they are to losing their lives and/or homes to health care costs.
I am *so* fed up with people claiming that the “tort system” is what is keeping malpractice insurance high.
What is keeping malpractice insurance high is that
-(a) the insurance companies are greedy and will use any pretext to raise the rates on a provider, and
- (b) the insurance companies are greedy because they don’t want to take a hit in the profits *from their investments* if the stock market tanks.
The vast bulk of income growth in the insurance industry is *not* from general premiums. It is from *investments.* (several studies I’ve seen show a correlation between market downturns and increases n malpractice premiums, without a concomitant rise in malpractice awards)
And the insurance industry is also in a very lucrative position — AFAIK, they are one of only two industries in this country that are exempt, by law, from anti-trust legislation (the other is Major League Baseball).
And they spend big bucks to keep that exemption, and to lobby for favorable treatment from the various federal and state legislatures.
They also pay a tootload of cash to PR firms to keep people scared of the “Big Bad Tort” system — playing up big jury awards (or even just playing up cases that *ask* for big awards before they even go to trial), and neglecting to show the actual award amount after reduced by judges or arbitration, or cases that don’t even go to trial.
You want to se real accountability for medical malpractice? Make the tort system have *more* teeth. But good luck in getting that — especially in light of the current U.S. Supreme Court decision that has held that, essentially, investors cannot sue certain corporate entities even if they colluded to defraud.
Excuse me, I have to go have a drink…..
I’m in Germany, which does not have a single-payer system, but strong regulations on the insurance companies. Not sure if I can compete with Jesurgislac’s quality of coverage. I feel that Germany has the second most complicated system of health insurance in the world, and it’s changing every year as the regulations change.
I know that a legally married spouse as well as all my hypothetical children would be covered by my health insurance, but I’m not up to date on a partner I’m not married to, or on this year’s laws on SSM.
I’m paying about 7.5 per cent of my pre-tax income for standard health insurance, plus about one per cent for nursing home insurance. (The latter would be less if I had children.) My employer more-or-less matches that - the law used to be that the cost was shared 50/50 between employer and employee, but recently it has been shifted to the benefit of the employers.
If you earn less than 800 Euro, you pay as if you earned 800, because, as you could not live on 800 Euro in the minds of the lawmakers, you’re hiding a wealthy spouse somewhere and should get insured through them.
My mother, who used to be a state employee, has a private insurance and pays about twice what I do for 40% coverage. Her employer matches that, plus pays fully for the other 60% coverage. Private insurance means the doctors bill you whatever they feel like, and you try to get it back from the insurance company. It works less badly than one would expect, but you need to be able to part with 10K Euro or something for a few weeks or months until you get reimbursed. None of that hassle with standard insurance, you never pay directly, except for the co-pays. To be allowed to switch to private insurance, you need a yearly income around 48K Euros, or be a state employee, or self-employed.
A friend switched to private insurance when he was 29 and single, because it saved him money. Seven years later he fell in love with a disabled woman. They cannot marry because she would lose her standard insurance and he couldn’t afford the private insurance rates for her. So he tries to trick his way back into standard insurance, where she will be covered at no extra cost.
Private insurance it popular among the young, healthy and male, because for them it is cheaper, and you are said to get treated more friendly by the doctors and nurses. (It’s true.)
I can go to any doctor or hospital I want. Co-pay is 10 Euros per quarter and doctor (unless I get referred by a doctor I already paid that fee for in the quarter), 10 Euros per night in a hospital, and IIRC 5 to 10 Euro for medication. Medication is only covered if it is prescription-only.
I have actually once been denied care, because I lacked proof of insurance, and the doctor would not take cash, nor promises. The next doctor down the street took “I’ll have it next week” as sufficient proof of insurance.
AFAIK I’m covered within the EU, but I do have travellers’ insurance for 6 Euro a year, which covers me everywhere as long as I haven’t been away from home for more than 6 weeks.
Tooth replacement is not covered. You can get a tooth extracted for free, but replacement is about 1K Euro. Glasses or contacts are also not covered. You can get add-on insurance for those, but for teeth it’s only worth it if you plan to have big trouble in ten years or so, and for glasses it’s not worth it at all.
Current expressed will of the politicians and the makers (and unmakers) of regulations is to make the system more like the US one, without the employer-based health insurance part, though. It seems they can not bear that the lazy used-to-Bismarckian-principles populance just runs to the next doctor when they are sick, instead of self-diagnosing and spending several days wasting the doctors’ secretaries’ time to haggle for the best price for their self-prescribed treatment. Or something.
So I wish you in the US the best of luck in getting single-payer health insurance ASAP, so that our fanboys will get confused!
Matt —
The “usual and customary” fees are what the insurance industry has determined, for its own profit margin, what the services “should” cost.
Providers agree to accept that payment - some can charge the remainder of the “real bill” back to the patient, other’s cannot (usually those who are “in network” accept the payment as-is, after the scheduled patient co-pay. Those who are “out of network” can back bill the patient for the balance, if they want)
As for the “short billing,” if you are uninsured, you are charged that enormous rate — the uninsured are, in essence, subsidizing the insured.
And that’s another tidbit the conservatives and libertarians really don’t want you to dwell on.
Dana: If we go to single payer, as Pam (and I) support, we need to be honest about one thing: our taxes will go up, way up,
Not necessarily. Cutting out the middle men can save metric shitloads of money here.
I am somewhat familiar with the cost of health services in Germany (as I said, my mother is on private insurance and sees the actual bills she gets), and the prices are between 50% and 10% of those quoted here and in other sources from the US.
Recently I did some research on the cost of having a baby in three different EU countries, and it was around 1K Euro (about 1500 USD at the moment) in all three (Germany, Belgium and Austria). Having a mole removed costs 30 Euros. Getting a tooth implant is 1500 Euros. (These things are “cosmetic” and not covered.)
My husband had the same surgery Pam did this summer, but his was an emergency instead of planned. (He developed acute pancreatitis from a gallstone and spend ten days in the hospital.)
He has Blue Cross HealthSelect everything was covered. The total bill was $72,000.00 but our part was only $2,500.00 Still, look at that total bill figure again, and try to think of one person in your acquaintance who could come up with 72 grand for that kind of a bill. Heck, our first HOUSE cost only $72,000.00 and we had a 30 year mortgage for that amount.
Yeah, our health care system is insane.
There are so many factors in the cost of healthcare.
For a hospital, there is new and heavy competition for money from treating patients. The largest threat (aside from the Emergency room) is the trend of specialty services to form their own standalone ‘clinics’ where they have their own staff and their own building and pretty much rule their own turf. Their costs have gone down from using the hospital building and their staff and they have more control over that staff. Who stays, who goes and how they are hired now is the domain of a smaller and more focused group of people.
The chinks in that plan are showing up now when you find these ’surgical centers’ that, being excised from the hospital system then does not have the support of that hospital system (the emergency room) and patients are dying due to unintended complications that sometimes occur over night, when there is ‘reduced staffing’.
The story of the wife having to call 911 to get medical attention for her husband, who eventually died from a complication that would not have killed him if he were in the traditional hospital system (the emergency room and critical care unit).
Like was noted earlier, an HSA is not insurance and a ‘XXX Center’ is NOT a hospital but a money making fish bowl where specialty physicians are able to micromanage a facility to maximize their profit and power rather than the level of healthcare. They exist to make the most money possible.
Well, that leaves the traditional hospital, saddled with the massive expenses of the emergency room, creaking from the weight. The ‘XXX Center’s’ often cherry pick a certain class of patient too. Those that have ‘good insurance’. Those that do not have the right insurance (MediCare/MediCaid) don’t usually see the foyer of these facilities because they aren’t admitted.
How can the ‘XXX Center’ do that? Because they aren’t a ‘hospital’. They don’t have staff 24x7x365 and don’t have emergency rooms and critical care units. They CAN cherry pick. Those that don’t meet the criteria end up in the ‘traditional hospital’ saddling it with even more debt, liability and the extremely slow payment for services rendered.
Some hospitals are reacting to this situation by closing their emergency rooms. Others are converting their emergency rooms to lower level care ‘doc in a box’ units that don’t offer what a traditional emergency room offers. Some are increasing their services and competing to become ‘level one trauma centers’ that have specialty service physicians and teams on staff 24x7x365.
The result is that the costs of and to the hospital have increased dramatically and the days of ‘milk and honey’ are gone. The hospital system is once again being squeezed from another angle. Something has to give at sometime.
Our healthcare system is on life support and failing us. IF you have good healthcare you are lucky. If you have great healthcare you should be grateful and if you have fantastic healthcare, be aware that it will end if things don’t change for the better.
My coverage is decent, for about $100 a month, through my company. I had the same surgery as Pam in January last year, and after everything was said and done, it ended up costing me about $2000 out of pocket. Fortunately, I did have the money to pay it, but I ended up paying over 4 months, so it didn’t hit all at once, which would have been do-able, but definitely pinchy.
What bugs me about my insurance company and employers agreement though is that changes are made, and are in effect immediately, but aren’t communicated to us for a couple of months. Last year, we got a newletter in April about a change made in January. And this was a potential biggie. It seems that it’s up to me to make a choise if I need the ER or an urgent care center. If I make the wrong choice, and go to the ER instead of the urgent care center, I get to pay the WHOLE ER bill. Guess who makes the decision if it really was an ER or urgent care needs? The insurance company.
Fortunately, I live in an area where there are plenty of urgent care centers, including one where my PCP practices, but one of my co-workers lives in the middle of nowhere, and the nearest urgent care center is further than the nearest ER. Guess where he went, and then ended up fighting with the insurance company about?
No former-cancer patient should ever have to ask themselves, “Do I really need that CT scan?”
Nor should you have to feel grateful that you can get that crappy HSA coverage at all. But in the 14th year of marriage to a cancer survivor who can’t be insured at all in our state…I’m going to suggest that you take a moment to reflect on that idea.
In something like 23 states, there is no requirement that the for-profit insurance companies that sell ‘health policies’ offer insurance to anyone who has certain adverse items in his health history. My state has a high-risk pool which is subsidized by state funds and offers lousy coverage that excludes a bunch of stuff including mental health (’cause everyone knows that being a cancer survivor makes you feel happy as a jaybird, ‘cause you lived!).
The premium for this wonderful service would be half of our mortgage, should we choose to participate in the racket known as small group or individual health insurance.
I’m getting out of the HSA and just insuring my kid next year. I couldn’t have gotten more careless, reckless treatment at the trauma center ER had I staggered in uninsured, and my so-called policy fights every damn claim on the injury for which they are clearly liable. It’s cheaper to save the money and negotiate with the hospital using the equity in our home as a bargaining chip, which is what we did when said cancer-survivor wife had a lump.
As to the objection, Our taxes will have to go way up to pay for universal care!
Let’s learn about the term ‘cost-shifting’ before we start howling about our taxes.
Right now, uninsured kids are taken to the ER for ear infections. Do you think that their parents pay $667 in hundreds on the spot? They do not. The appropriate state agency is billed and the family is referred to Medicaid or SCHIP according to income. The state then sucks up the $667. This amount has now been billed to Medicaid.
Now, if you have ever taken your child to a primary care ped with an ear infection, you know that the insurance company paid the doctor about $50-80 and you paid between $10-50 in the form of your co-pay. If we take the upper end of both of those ranges, we’re at $130.
Clearly getting everyone access to primary care would save approximately a boatload of money per patient, in addition to the health and welfare of everyone involved.
I work in a kitchen in Seattle, a job that I really don’t like, but has great health coverage. Which is good, because in September I also had my gall bladder out, leaving a giant scar since it was inflamed to the size of a cantaloupe (according to one of the surgeons) and spent 5 days in the hospital. My bill was for over $21,000, but my copay is $300, which I’m paying over 6 months, cos my crappy job doesn’t give me that much money.
The hospital I went to (Virginia Mason, in First Hill, Seattle) was a really good one though, and when I first went there, my coverage hadn’t gone through, and had to be started up retroactively. They were prepared to have at least some portion of my bills paid through a charity, I’m not sure how much I would have had to pay in that case.
Still the state of healthcare in this country is goddamn ridiculous.
Inge wrote: “Recently I did some research on the cost of having a baby in three different EU countries, and it was around 1K Euro (about 1500 USD at the moment) in all three (Germany, Belgium and Austria). Having a mole removed costs 30 Euros. Getting a tooth implant is 1500 Euros. (These things are “cosmetic” and not covered.)”
Are you sure about the 1,000 Euro cost? Does that include the hospital, or is it just the doctor’s fee?
We live in Germany (and love it by the way, I don’t ant to move), and have experience with the German med system because my wife sends patients off base when there is no room. We also have German friends who are involved with the medical system is various ways.
One problem in comparing the costs is that Germany does not have the lawsuit situation that we have in the states. Also, the docs don’t make as much. And, an additional factor are med school tuition. If I understand this right from our German friends, university is free, and in Germany, they start learning to be a doc at 18, this skipping undergrad, as opposed to the states where med school is at graduate level, and docs to be have to pay under grad and med school tuition. And, taxes are enormously high in Germany (you’re even taxed on the number of radios and TVs in the household).
Beyond that though, Americans compare other systems and think that we should copy those systems. Yet, they do not take into account cultural differences that can allow such systems. Here, people do things for the community and accept government regulations, whereas Americans tend to act for themselves and question authority. Here, docs here take their 4 weeks vacation from their private practice (losing patient time and fees for that period) - Americans barely take a week holiday. People clean their sidewalks on Saturdays. Parents accept that they can only name their child from the government provided list of names. Germans split their garbage into 4 different containers. They teach religion in public schools. Religious holidays are taken off nationally. Stores are closed for the most part on Sundays so families can spend time together. Europeans have a national ID card, which would never fly in the states due to criticisms from the left and right. It cost @$2,000 to get a driver’s license, including rigorous training - that wouldn’t fly in the states because it could exclude poor people. When drivers see a car put its blinkers on, they actually slow up and let the other driver into their lane. My kids can ride their bike to school and not lock it (they go to the local German public school). Cigarette machines are located in residential neighborhoods. Kids still play board games. The beer is the best. Dogs are allowed in restaurants and ski slopes (which don’t have ski patrols up and down the slopes).
In sum, when we, as Americans, look at other economic systems, we need to consider the cultural divide. There are cultural influences that allow certain practices. In the states, we need to work for a system that works within our cultural constraints. We can have health care for everyone, but we need to work for a system that all sides of the political spectrum can accept. For our health care program to work, we have to worry about the lobbying of docs, carriers, trial lawyers, med schools, etc. To me, our best option lies more in developing a transportable insurance program not tied to employers, with a government program for those who can’t afford the premiums, as opposed to a national single payer health care program. I don’t think we’re going to get docs to take less money, med schools to lower tuition, trial lawyers to accept constraints, etc. as is done in other countries. For an effective program, we need all parties to accept constraints. My worry is that no politician is including all affected parties in their discussion of med care - because they each don’t want to upset one special interest group or another that provides lots of money to their campaign (or future hedge fund or lobbying job).
I live in Spain, and my co-pays are so extremely low that I once payed 2 euros for a prescription that actually costed 200+ euros.
And if I were retired, it would’ve cost me nothing.
How much does it cost to our government? About 1300$ per capita. Which is nothing compared to the 2500$ per capita that the US health system costs to your government.
My family has a member who fell out of insurable status (neither minor nor student) right as she also developed major depression that requires ongoing medication and treatment. We are hundreds of thousands of dollars in debt.
tintinintibet: The Belgian figure comes from a flyer addressed at immigrant women (without papers? not sure) , telling them to apply for monetary help as soon as they know that they are pregnant, otherwise they might end up having to pay the full cost of about 1K Euro out of pocket. The Austrian is the services of a midwife during pregnancy, including delivery and aftercare. (Not quite clear if delivery at home or in a hospital). The German one is from a health insurance calculation about additional costs created by pregnancy. So, except for Austria, where it’s possible that there might be some additional costs in case of complication, it’s the full cost.
One problem in comparing the costs is that Germany does not have the lawsuit situation that we have in the states.
Lawsuits are rarely necessary, because health care for the victims of some mess-up is already paid for. Also, there are fixed rates for a lot of things. A friends’ parents had the financially worst kind of car accident (both 100% disabled, father was sole earner for a family of four, with two minor childen), and the one thing that wasn’t a problem for them was money.
Less despair and more regulations seem to make for fewer lawsuits.
If I understand this right from our German friends, university is free, and in Germany, they start learning to be a doc at 18, this skipping undergrad,
You finish school at 19 or 20, men have to spend a year at the military. If your grades are not good, you’ll spend some time (a year or two) waiting for an opening. You graduate after 6.5 years. Post-grad is not necessary anymore, and if you do it you can start it before graduation. Fees are about 1000 Euro a year lately, cost of living is maybe 8000 a year. And unless you specialize in some well-paying field, you are unlikely to get rich, especially as a junior hospital doctor.
And, taxes are enormously high in Germany (you’re even taxed on the number of radios and TVs in the household).
Radio/TV: Not a tax, however, but a payment to the broadcast companies for services. 64 Euro a year to the broadcasters if you have one or more radio, and 200 if you have one or more TVs. Considering the crap that’s on TV and on the radio, that’s vastly overpriced.
Tax on petrol is OMGWTFBBQ. OTOH, building roads is expensive, and petrol tax collects money from the people most using the roads.
Don’t know how the rest compares to US tax rates: Lowest income tax range is 15 percent on every Euro after 7664, highest is 45 on every Euro after 250K. Average is 18 per cent. Church tax is 9 per cent, but only if you’re Catholic, Lutheran, Jewish or Unitarian. Tax on income from capital is around 20, on average. Sales tax is 7 per cent on food and books, 19 on other stuff. Social security insurance, health insurance and nursery home insurance are not part of tax, but cost about the same.
And really, I wouldn’t recommend the German health insurance system to anyone. It’s insanely complicated, rather expensive, and leaves poor people without teeth or glasses. It might actually be the second most ineffective in the world because of its insistence on giving market forces a chance.
Wow, the same day this was posted I got an email from the AFL-CIO’s Working Families, asking me to participate in the 2008 Health Care for America Survey.
The survey asks for folks to share info and their stories about the joys of healthcare in America.
Is the great leftwing conspiracy working?
For those who are interested: All individual survey responses are kept completely confidential. And “Survey responses will be given to the presidential candidates, every U.S. senator and representative, every candidate for Congress and state and local officials in every state in our country.”
http://www.aflcio.org/issues/healthcare/survey/
Wow, this is just like the AFL CIO’s Working Families 2008 HealthCare Survey.
http://www.aflcio.org/issues/healthcare/survey/?source=hc_survey_wfn
Very interesting post Inge. Thanks for elaborating. Isn’t there also an annual car tax, beyond an initial sales tax when the car is purchased?
About the German health care system, we do smile when my children’s classmates are in the hospital for 2 weeks due to their tonsils being removed. With my daughter, she was in and out in 1 day, then a few days rest. But I do wish we could be prescribed a stay at what seems like a spa for the “cure”.
Regarding the lawsuits, I was thinking more of when a doc or hospital messes up. One difference appears that in the states there are awards for injured parties that pay for future costs, but then there are “pain and suffering” awards and “punitive damage” awards that go beyond lifetime medical care costs. I believe Germany also has a system where if one sues, and loses, they must pay for the legal fees of the party they sued. That isn’t the case in the states where defendants must pony up their defense costs even if they are found not at fault (in most cases).
Time for a Weizen!
Let’s see, my insurance history:
Had crappy insurance through Aetna for awhile, but luckily never had to use it. The only other health insurance I’ve had since 1998 was the $1000/year my grad school gave me as part of my assistantship, but it was taxed as income and I had to submit to the insurance company for reimbursement if I used it. I never did, never actually got the money in income, and still had to pay the taxes. Wee!
When I was 25, I had emergency surgery to remove a hemorrhagic ovarian cyst and an ovary. Since this was at a public hospital, they reduced the hospital stay from $12,000 to $3,000 out-of-pocket, but I got a $500 bill from the emergency room, a $500 bill from the Urgent Care, and several thousand dollars worth of bills from the anesthesiologist, radiologist, surgeon, etc. Ah, good times.
When my husband had his car accident 5 months later, it wasn’t his fault and eighteen months later the other person’s auto insurance company paid his $30,000 bills.
When a stray kitten bit me, I got the pleasure of paying a $200 co-pay to be seen in the ER (the only thing open). Then they charged me $300 for triage and the doctor charged me almost $300 for his ten minutes. The only reasonable cost was the radiology bill for $25 for x-rays.
Two years ago, I got another ovarian cyst. I had to pay $100 to get an ultrasound, then $200 for a GYN to confirm that a cyst was there, another $100 for a second ultrasound six weeks later, and a final $200 to the GYN to confirm it had gone away on its own.
Two months later I was pregnant and we paid for the pregnancy and delivery out-of-pocket. The OB and the hospital weren’t too bad: $2400 and $1800 respectively. It was all the friggin’ tests that racked up an additional $6000. We’re still paying for it. Funny thing is, before I got pregnant I looked for single-payer insurance and to get maternity coverage would have cost me $600-$1000/month, with a $5000 deductible and the maternity benefits would not kick in for 12 months. It saved us money not having insurance.
When I had to start weekly therapy for PPD, that was $100 per visit. Luckily, the therapist took pity on our uninsured state and only charged me every other session after the first five months.
For my son’s 2,4,6, 12, & 15 month well-visits we have paid an average of $103, then there are additional vaccine costs and two sick visits of $50 each.
When my son got sick in the middle of the night we had to take him to the ER at a private hospital. For ten minutes of time and a dose of anti-nausea medicine (cost: $120 for 5ml) to stop the projectile vomiting, we still owe them $600, after the $75 we paid just to be seen. And the doctor sent us his bill for $300.
Last week, I got bronchitis and had to go to Urgent Care. We paid a $70 co-pay and I am awaiting the final bill. The prescription wasn’t too bad– $35. If a script is less than $100 I count myself lucky.
So Dana, are you really suggesting that I would have paid over $25,000 in taxes in the last seven years with a universal health care plan? If not, then whatever taxes I would pay would still have saved me money.
Every single time I read a thread with Americans describing their health insurance situations I end up with my jaw on the floor. Even WITH insurance, it seems, you have to play a constant game with the insurance companies, battling to make them pay, and still having to pay an excess (which I think is what “co-pay” means in UK speak).
Worrying about what your insurance company will or will not pay for is hardly conducive to recovery. Nor is wondering about the bill afterwards. I cannot see how this can possibly be an efficient way for an advanced industrial country to conduct its affairs.
Sorry to just state my astonishment - I know it is not helpful. I just wanted to restate me astonishment, so you’ll keep on fighting the idiots who think that “socialised” medicine is eeeevil. They are mad. As in barking. Insane. Loopy. Homer Simpson.
In the past year, I’ve needed about 40-50 doctors visits, 6 emergency room visits(one in an ambulance), about 4 x-rays, two casts fitted(I’m clumsy as hell), at least 15 different prescriptions(many of them repeat prescriptions) two lots of dental work, a dental stint, two barium swallows and myopia, for which I‘ve been given two pairs of subsidised glasses, of very high quality. So far this year I’ve been diagnosed with severe bronchitis, asthma, fibrocystic breast disease, gastritis, a chest infection, a jaw disorder, two lipomas and severe anxiety, so it’s not been a good year healthwise, but for all that, I haven’t paid a penny. Everything I received was free on the NHS, and although I’d normally have to pay a small prescription charge, as well as pay for my own glasses and dental treatment when I turn 19(university/college students get free care til that age) everything else would stay free. Fortunately, with my asthma, I’ll be given an exemption certificate so I don’t have to pay any costs towards my healthcare, and neither do my parents, who suffer from incurable ailments themselves. And for this, in taxes, we pay a very small amount. While formulating something like this in the US may mean higher taxes, it would certainly work out cheaper than the huge co-pay amounts I’ve seen on this thread.
In the past year, I’ve needed about 40-50 doctors visits, 6 emergency room visits(one in an ambulance), about 4 x-rays, two casts fitted(I’m clumsy as hell), at least 15 different prescriptions(many of them repeat prescriptions) two lots of dental work, a dental stint, two barium swallows and myopia, for which I‘ve been given two pairs of subsidised glasses, of very high quality. So far this year I’ve been diagnosed with severe bronchitis, asthma, fibrocystic breast disease, gastritis, GERD, a chest infection, a jaw disorder, post nasal drip, two lipomas and severe anxiety, so it’s not been a good year healthwise, but for all that, I haven’t paid a penny. Everything I received was free on the NHS, and although I’d normally have to pay a small prescription charge, as well as pay for my own glasses and dental treatment when I turn 19(university/college students get free care til that age) everything else would stay free. Fortunately, with my asthma, I’ll be given an exemption certificate so I don’t have to pay any costs towards my healthcare, and neither do my parents, who suffer from incurable ailments themselves. And for this, in taxes, we pay a very small amount. While formulating something like this in the US may mean higher taxes, it would certainly work out cheaper than the huge co-pay amounts I’ve seen on this thread, and I have no doubt that it’d save lives, just like it saved my life when I fell seriously ill at 13 and needed round the clock hospital care that, without the NHS, I simply couldn’t have gotten.
I’m actually really bowled over by the level of fluency the Americans on this thread have with their health care coverage. Here in Australia, I have no idea what’s going on really. All I know is, I get sick, I go to a doctor who bulk bills under medicare (ie it costs me nothing), and then I pay about $17 australian for whatever medicine they prescribe. The only thing it doesn’t cover is teeth, which I know because I went to the dentist and it bloody cost me $100 to get a tooth fixed.
Actually, as an aside, that’s one of the things that really pissed me off about that show LOST. Parts of it were meant to be set in Australia and in one episode a significant plot point revolved around Claire being unable to pay her mother’s medical bills and thus discovering that the costs were being taken care of by a mysterious dude who then turned out to be her father. Except of course for the fact that in Australia our hospitals are free, so there goes that entire plot thread, fools. There were all sorts of other badly-done Australian-based plot points in that show too, including Sawyer’s presumptive father working in a shrimp van (we call them prawns, and I’ve never ever heard of a “prawn van”) and also every scene in Australia showed the sydney opera house in the background from impossible angles, indicating that the various hotel rooms etc in which the view was featured were all located in the middle of the water.
Stupid LOST writers.
I’m actually really bowled over by the level of fluency the Americans on this thread have with their health care coverage. Here in Australia, I have no idea what’s going on really. All I know is, I get sick, I go to a doctor who bulk bills under medicare (ie it costs me nothing), and then I pay about $17 australian for whatever medicine they prescribe. The only thing it doesn’t cover is teeth, which I know because I went to the dentist and it bloody cost me $100 to get a tooth fixed.
Actually, as an aside, that’s one of the things that really pissed me off about that show LOST. Parts of it were meant to be set in Australia and in one episode a significant plot point revolved around Claire being unable to pay her mother’s medical bills and thus discovering that the costs were being taken care of by a mysterious dude who then turned out to be her father. Except of course for the fact that in Australia our hospitals are free, so there goes that entire plot thread, fools. There were all sorts of other badly-done Australian-based plot points in that show too, including Sawyer’s presumptive father working in a shrimp van (we call them prawns, and I’ve never ever heard of a “prawn van”) and also every scene in Australia showed the sydney opera house in the background from impossible angles, indicating that the various hotel rooms etc in which the view was featured were all located in the middle of the water.
Stupid LOST writers.
Haven’t read all the comments.
I just got Sicko and watched it. Unbelievable.
Of course, it’s all propaganda, right? Health care isn’t that good in the countries with universal health care, the people in the movie were lying. Right? At least that’s what the MSM talking heads were saying about it.
Why wouldn’t it work here? All anyone keeps saying is it can’t work here. Why not?
Those people seemed stunned at question Michael Moore asked: “Why should YOU pay for someone else’s care?” They stammered, looked confused, said, “Well…they’d do the same for us…if I have more and some have nothing, SOMEONE has to look after them…what do you mean, why?”
Is that why it won’t work here?
I cannot see how this can possibly be an efficient way for an advanced industrial country to conduct its affairs.
Sorry to just state my astonishment - I know it is not helpful. I just wanted to restate me astonishment, so you’ll keep on fighting the idiots who think that “socialised” medicine is eeeevil. They are mad. As in barking. Insane. Loopy. Homer Simpson.
Thank you, Katherine. This makes me feel better.
Say, what are the immigration laws like in the UK?
“Why wouldn’t it work here? All anyone keeps saying is it can’t work here. Why not?”
While Americans as a whole are as smart and capable as anyone else, and therefore we should be able to design a Universal Healthcare system that works well, the problem is our political system and how it (doesn’t) function.
Since the medical insurance companies are directly in the sights of any reasonable plan, they will fight tooth-and-nail to prevent their cash cow from being eliminated.
They can buy an awful lot of “flexible” politicians with the kind of money they have…
To all those worrying their heads about the horrible cost via taxation of ’socialized’ healthcare: you already are being taxed. Certainly you all seem to shell out far more money in the course of an average year for your medical care and insurances - without the guarantee of actual decent or appropriate treatment as well, than I pay in total income tax here.
I live in the UK and currently make under 15,000 pounds a year. I pay 22% income tax on my earnings, excepting the first 5500 or so, which is tax-free, and the next 1500 or so, which is taxed at 10%. I pay around 140 pounds a month in income tax - 1680 a year, more or less. Of course, only a portion of my income tax actually goes to pay for the NHS - the rest goes to the usual places - schools, police, emergency services, the welfare state etc.
What would the sum total of my yearly income tax contributions - 1680 pounds - buy me ONLY in terms of healthcare in the USA? Not much at all, it seems, reading this thread and talking to stateside friends.
I cannot understand why some Americans are so anti the idea of better access and fairer prices for healthcare when they already pay way more it seems, than any nation with ’socialized’ medicine extorts from its citizens in taxes throughout the average year, often for less service. Why fear the taxman when you have a rapacious, revolting insurance industry willing and able to both divest you of your earnings AND fail to provide proper treatment options should they consider it unprofitable?
Cara: “Why wouldn’t it work here? All anyone keeps saying is it can’t work here. Why not?’
There seem to be two responses, one is “We don’t need not stinkin’ health care”, and the other “The corparations won’t allow it.”
There were all sorts of other badly-done Australian-based plot points in that show too, including Sawyer’s presumptive father working in a shrimp van (we call them prawns, and I’ve never ever heard of a “prawn van”) and also every scene in Australia showed the sydney opera house in the background from impossible angles, indicating that the various hotel rooms etc in which the view was featured were all located in the middle of the water.
Look on the bright side - if anyone wanted to reference New Zealand in a TV series these days, they’d have to film fucking Elijah Woods with hairy feet.
I’ve got good insurance, including dental and vision.
I work for the labor union that represents state employees in Ohio, so I guess I should expect nothing less.