Originally Posted by Justin '77

See, the thing is -- you're not! You're paying for the profit-margins of the health industry. The cost of actual care is so ridiculously small that 'free-riding' isn't a thing. $8400 is more than enough to pay for two months in a neonatal ICU, if we're talking abou tthe cost of care, rather than the total pricetag one dysfunctional system elects to put on it.

You should attempt to get out and learn stuff, rather than assuming that the system you know is a defining paradigm.

Are you kidding? Just the nursing care alone is more than that. A NICU unit is typically 8 incubators with 2 full-time staff (typically RNs) 24/7. So your two months of care requires 16 person-months of nursing time, which is acutally more like 17.5 months of nurse pay (yes, you have to cover vacations and personal days too) ... plus bnefits and overhead.

Let's assume that the standard transfer rate is used for nursing services at 2.5 times salary, and salary for a NICU nurse is $4,000 a month ... which is low-ball. At direct cost (no benefits or trasfers) two months costs 17.5 * $4,000 = $70,000. At transfer, that's $175,000 to provide nursing staff for one NICU ... and nothig else. Of course, the NICU is rarely full. They are sized to accommodate high demand, or the death rate would be attrocious. Assume your share would be in the $40,000+ range. Now, do the same calculations for the meds, air management system, neonatal laboratory and a hundred other unique things a NICU needs.

This kind of intensive medicine is incredibly expensive, so the only low cost choice is to let the expensive little buggers die. Or, we can agree that this is important, and pay for it together.

Originally Posted by Marx & Lennon

Are you kidding? Just the nursing care alone is more than that. A NICU unit is typically 8 incubators with 2 full-time staff (typically RNs) 24/7. So your two months of care requires 16 person-months of nursing time, which is acutally more like 17.5 months of nurse pay (yes, you have to cover vacations and personal days too) ... plus bnefits and overhead.

Let's assume that the standard transfer rate is used for nursing services at 2.5 times salary, and salary for a NICU nurse is $4,000 a month ... which is low-ball. At direct cost (no benefits or trasfers) two months costs 17.5 * $4,000 = $70,000. At transfer, that's $175,000 to provide nursing staff for one NICU ... and nothig else. Of course, the NICU is rarely full. They are sized to accommodate high demand, or the death rate would be attrocious. Assume your share would be in the $40,000+ range. Now, do the same calculations for the meds, air management system, neonatal laboratory and a hundred other unique things a NICU needs.

I call your napkinback assumptions and raise you real bills from a real incident in reality.

Originally Posted by Marx & Lennon

Are you kidding? Just the nursing care alone is more than that. A NICU unit is typically 8 incubators with 2 full-time staff (typically RNs) 24/7. So your two months of care requires 16 person-months of nursing time, which is acutally more like 17.5 months of nurse pay (yes, you have to cover vacations and personal days too) ... plus bnefits and overhead.

Divided by eight. (One patient occupies only one incubator, not the entire unit.) Which means only two person-months, not 16 (and then adjust for vacations, etc.).

Originally Posted by Justin '77

I call your napkinback assumptions and raise you real bills from a real incident in reality.

I had three grandkids in at once, so I have real world to draw on too. One had MRSA, in addition to everything else. They are all 7 and healthy now, but two were in trouble then, with the MRSA child needing constant attention. That's why I know they never have less than two RNs on staff.

My son paid the bills, or filed the insurance in their case. For the three of them, the bill was just shy of $400,000. Now that is overblown, but the insurance payment wasn't discounted all that much.

Originally Posted by Brian Rush

Divided by eight. (One patient occupies only one incubator, not the entire unit.) Which means only two person-months, not 16 (and then adjust for vacations, etc.).

Make it easy and skip the vacation. Use 2 person months as the absolute minimum (2.5 * 2 * $4,000 = $20,000), and 4 as typical (half the incubators are not in use, but the staff is still two RNs) to get to the $40,000.

Originally Posted by The Rani

Really.
When was the last time you earned 88K per year (before taxes, by today's standards allowing for inflation) and had to provide for a family of four on that income?

You do realize that $88K is the lower income cut off for the top 20% households in the US, i.e. 80% of households make less than $88K.

It's a little silly to suggest that someone in the top 20% of incomes in America has to make a choice between food on the table and health insurance for the kids. That would translate to a vast majority of Americans living in abject poverty.

Your confusion might be a matter of your location. Not everyone lives in the Bay Area. Maybe instead of Napa Valley or Lake Tahoe this weekend, you should take in say, Bakersfield or Stockton - it could be a real eye opener for you.

Originally Posted by Justin '77

You're a wordsmith... what do you call a person who, confronted with the unfamiliar, aims to explain it, rather than to understand it? I'm thinking 'ideologue' is not a bad choice for that, but I'm sure there's better.

Perhaps, but that is not germaine to our discourse.

You're merely being confronted with a superior argument and this is a form of "calling uncle" on your part.

And that's okay with me; I'd rather have you focused anyway on the fact that the world is changing drastically in regard to health insurance and your reliance on free-riding is going bye-bye. Best of luck!

Originally Posted by The Rani

You've totally dodged the question.

Yep, that one as well as the one about still beating the wife.

But that's not going to take away from the silliness of defending someone in the top 20% of incomes not having health insurance on his kids.

Originally Posted by The Rani

Well, you're the one accusing* me of having stellar health insurance and spending my weekends in Tahoe, while being a self-proclaimed trust-fund baby yourself.
By the way, I've been to both Stockton and Bakersfield. Also Madera, Turlock, Modesto, Lodi, Eureka ... How about you?

* A strong but I think appropriate word for it.

I think your failing to see the fundamental difference.

We both have health insurance. I would like to see 10s of millions people get that same benefit; you don't because some very small group of people within the top 20% of incomes in the country decide to pay a relatively small penalty for not getting insurance for their own kids.

My lack of experience is possibly germane to the small minority of those top 20% not providing coverage for their kids. Your lack of experience is possibly germane to the vast number of people that would be getting insurance for the first time.

On a quantitative basis alone, your lack of experience is far far more of issue than my own limited experience.

On a qualitative basis, I would also say that an objective 3rd party would likely conclude that there is something wrong with the picture of a household in the top 20% incomes deciding to pay the penalty rather than buy health insurance for their kids. And that same objective 3rd party would likely conclude that there is something right about 10s of millions getting health coverage. Granted, there is the exception if said third party has freedom fries so far stuck up the wahzoo that they can't think straight.


I have a 4X-removed great grandma buried in Pioneer Cemetery near Coloma. She went out before the Gold Rush. She apparently met her demise in nearby Placerville which back then was called Hangtown; around the time of the Donner Party. There are family rumors. So yea, I've made my way a few times through the Big Valley - I laugh at what others call fog - nothing so blindingly scary than Tule Fog. I once followed tail lights thinking they would lead me safely on 99. Those red lights went off, next came the knock on my window by the driver asking why I parked behind him in his driveway somewhere south of the Queen of San Joaquin. He took pity and invited me in for a couple drinks of Gallo Red to calm the nerves.

Final note: trustee does not equal "trust baby." I can understand Glick getting that wrong.

Originally Posted by playwrite

I've been pretty consistent in addressing ACA issues from both the Left and the Right that I'm not too interested in dealing with hypothetical’s that, for at least our lifetimes, are never going to happen.

It's necessary that you address that one for clarification of your discussion with Justin. The question here is how much of the bill consists of profit for the health-care industry, and that's an important question entirely separate from whether we will ever carve profits entirely out of the picture. Simply put, if we had an effective way to drive health care costs down, cutting out all of the profit represents the limit of our ability to do that. We cannot possibly lower the costs more than that. So please answer the question and stop trying to look clever. Thank you.

Originally Posted by The Rani

Really.
When was the last time you earned 88K per year (before taxes, by today's standards allowing for inflation) and had to provide for a family of four on that income?

Out of curiosity, since the last time I was supporting a family of four was in 1989, I calculated that $88k today was about $45k then. I have to admit that my wife and I were between our incomes making more than that in that year. Probably about $60k all told, which would be a little over $100k today.

Originally Posted by playwrite

$150 dollars a month, even if true (I doubt it) is not going to buy the catheders for your hospital stay, freeloader.

And $700 a month, which is obviously an exaggeration, is $8400 in a year - that would be burned up in less than a week's stay in a hospital with any serious illness or accident.

I'm tired of paying for you free riders.

Stay off motorcycles, don't get sick and maybe quite eating so many freedom fries!

Wait, wait... now that I have bought health insurance, I'm a freeloader? LOL

And you don't believe the premiums? I guess you haven't been shopping for individual plans lately! $1800/year might not sound like a lot, but what exactly is the medical risk of being an active 30 year old with a healthy diet? Now that I have a standing desk I'm standing and moving around 12 hours a day, spinach and broccoli are on a short list of my favorite foods, and I don't touch fast food or anything excessively processed or saturated with refined sugars and oils. Rani probably has room to criticize my weekly steak dinner, but I'm not exactly living off bacon, sausage, and cold-cuts either. The biggest health risk in my life is probably related to driving, and car insurance has its own provision to pay for those accidents. How many 30 year-olds are really going to spend more than the $1800 in premiums + $7500 in OOP costs?

And no, this doesn't cover the fiancee or any hypothetical kids. A family plan with similar coverage would run close to $400 in premiums and leave the same OOP requirements in place. IOW, about $12,000 to deliver a healthy kid. I'm looking at some paperwork that might change my employment status, and they're offering some slightly better plans, but those will still end up costing me $180 every two weeks or $275 every two weeks for a family plan (close to 20% of income) while still leaving up to $2,000 in additional OOP costs. If I want to be able to go out of network, the premium shoots up to $650 and the OOP cap goes up to $3,000. If I go with the HMO family-plan, I can get the costs of having a kid down to about $9,000 - but I'd still be paying $7,000 a year if we don't have one or don't use any medical services at all.

Any way you shake it, having health insurance costs 7-20% of gross income and using health insurance costs about 30% of my annual income. That's the price of being covered and getting sick.

Why is my story relevant? My annual income is damn close to the median, but I'm also about 10 years younger and 20 pounds lighter than the median worker. So the median 30 year old is probably making a little bit less but paying a little bit more for their premium.

Do I have health insurance? Yes. Can I afford to get sick? No. This is why "idiot Americans" like me don't appreciate the deal lobbyists came up with and Congress forced us in to. It doesn't fix the incentive problems created by for-profit medicine, it doesn't address the resulting cost problems, and it doesn't really protect you when and if you do get sick and need some help.

I'm trying to figure out what the argument is here. Bear with me.

Is it about how much the uninsured pay for health care?

Is it how much the insured pay for the uninsured who need health care?

Is it how much self-employed individuals pay for health insurance vs those whose health insurance is paid through their employers?

Is is how much the mandate is going to cost uninsured versus how much those uninsured have to pay as a penalty under ACA?

Is it how much an ER visit costs for those who are insured vs those who aren't?

Is it the cost of ICU? (In late 2004, my 80-year old mother was in ICU for 40 days until she died. She had Medicare gap insurance. Her open-heart surgery, plus all that time in ICU cost about $200.00. )

Here's my 2 cents. Since 2006, the cost of benefits at my college has gone from $12 million to $36 million. Much of this increase is due to higher medical insurance rates. Will Obamacare, will this change? Will it affect my friend who already pays $650 a month with a $5000 deductible?

Originally Posted by The Rani

You obviously know nothing about my "experience," and you're not interested in learning either.

Your experience would have to be living below the 80% household income level with and without subsidized insurance coverage. It would have to relatively recent experience given the run up in helath cost. Moreover, some of the experience would not yet even be possible since the ACA providing the subsidiies has not yet been put in place. Also, given the diversity within 80% of households, what you experience at a certain age with/without family responsibilities would need to be considered. All that might put some limits on what we could learn of your personal experience with healthcare coverage that would make it relevant to deciding the value to people afforded coverage by te ACA but feel free to enlighten us.

Now if you wanted to suggest the value based on being a health care provider that would be a completely different thing.

Originally Posted by Brian Rush

It's necessary that you address that one for clarification of your discussion with Justin. The question here is how much of the bill consists of profit for the health-care industry, and that's an important question entirely separate from whether we will ever carve profits entirely out of the picture. Simply put, if we had an effective way to drive health care costs down, cutting out all of the profit represents the limit of our ability to do that. We cannot possibly lower the costs more than that. So please answer the question and stop trying to look clever. Thank you.

I am not a neo-natal expert nor am I a hospital administrator to ascertain their costs which I'm sure varies considerably by doctor, hospital, community or what the hospital administrator had for lunch that day. As a profit endeavor, what I can say is that they will charge what the market will bear or what the govt dictates as limits.

I can also say (and, both Justin and I did) whatever they charge will show up differently on the billing to an insured person where the payment is coming from a combination of that person and his insurance (which in today's market has probable been pre-negotiated with the care providers) versus the billing to an uninsured person where the payment is being subsidized directly by a government program to reimburse providers for uncompensated care and indirectly by the providers’ attempts to spread any difference between the insured/uninsured rates by raising their prices for all customers.

My point in bringing this up was to address Justin's assumption that the "better deal" is to go without insurance and pay non-insured rate. I'm pointing out that not only is the federal program for paying hospitals for uncompensated care going away, but the hospitals are going to be required to be much more clear about the degree that they are spreading the costs of uncompensated care to all other customers. The combination of those two things is going to put a laser light on those trying to get an uninsured rate from providers. Coupled with broader knowledge of the availability of subsided insurance for everyone but the top 20% incomes, there is going to be considerable pressure put on the continued availability of special uninsured rates from health providers. Moreover, with the inability to preclude pre-existing conditions, I’m sure the standard operating practice for those uninsured showing up at the emergency room will be to first sign them up and bill them for new insurance coverage (with a tax form provided so they don't pay the ACA mandate penalty that year) and then proceed from there; if they insist on their freedom fries to go it alone, I can guarantee you their final bill is going to be really really “special” and a whole hell of a lot higher than the billing to an insured person (and, icing on the cake, the freedom fryer will also pay the mandate penalty on his taxes that year).

What I was pointing out was the "free riding" is going to get a whole lot more expensive after 2014. It still may make financial sense for limited health care situations and the freedom fryer is going to have to make some financial calculations and trade-offs - just like the rest of us.

All of above (and previous posts) is regardless of whether hospitals are profit or non-profit or how much it actually costs for neo-natal ICU or any other care. Those are different questions. The ACA has some provisions to make those things more transparent and competitive and allows for states to experiment with possible cost-control measures. Here's one example being discussed -

http://www.angrybearblog.com/2010/02...ost-curve.html

Breaking The Healthcare Cost Curve

I think its fine to discuss options for lowering health care costs and even to be very disappointed that the ACA didn't sufficiently address let alone resolve it beyond just a modicum of degree. However, given all that has happened, including the Right not giving up after even probable the biggest SCOTUS decision since Roe v. Wade, I think its living in magic ponyland to suggest that the ACA could of, should of, or would of.
And again, that's not worth my time .... even if it afforded another chance to look clever.

Originally Posted by The Rani

You called me a chicken.
As Bugs Bunny said ... "He don't know me very well, do he?"

Well, of course. You knew me to be Pig, I had assumed you would know my first name is "Porky"

http://www.youtube.com/watch?v=gBzJGckMYO4

Originally Posted by JohnMc82

Wait, wait... now that I have bought health insurance, I'm a free loaders? LOL

And you don't believe the premiums? I guess you haven't been shopping for individual plans lately! $1800/year might not sound like a lot, but what exactly is the medical risk of being an active 30 year old with a healthy diet? Now that I have a standing desk I'm standing and moving around 12 hours a day, spinach and broccoli are on a short list of my favorite foods, and I don't touch fast food or anything excessively processed or saturated with refined sugars and oils. Rani probably has room to criticize my weekly steak dinner, but I'm not exactly living off bacon, sausage, and cold-cuts either. The biggest health risk in my life is probably related to driving, and car insurance has its own provision to pay for those accidents. How many 30 year-olds are really going to spend more than the $1800 in premiums + $7500 in OOP costs?

And no, this doesn't cover the fiancee or any hypothetical kids. A family plan with similar coverage would run close to $400 in premiums and leave the same OOP requirements in place. IOW, about $12,000 to deliver a healthy kid. I'm looking at some paperwork that might change my employment status, and they're offering some slightly better plans, but those will still end up costing me $180 every two weeks or $275 every two weeks for a family plan (close to 20% of income) while still leaving up to $2,000 in additional OOP costs. If I want to be able to go out of network, the premium shoots up to $650 and the OOP cap goes up to $3,000. If I go with the HMO family-plan, I can get the costs of having a kid down to about $9,000 - but I'd still be paying $7,000 a year if we don't have one or don't use any medical services at all.

Any way you shake it, having health insurance costs 7-20% of gross income and using health insurance costs about 30% of my annual income. That's the price of being covered and getting sick.

Why is my story relevant? My annual income is damn close to the median, but I'm also about 10 years younger and 20 pounds lighter than the median worker. So the median 30 year old is probably making a little bit less but paying a little bit more for their premium.

Do I have health insurance? Yes. Can I afford to get sick? No. This is why "idiot Americans" like me don't appreciate the deal lobbyists came up with and Congress forced us in to. It doesn't fix the incentive problems created by for-profit medicine, it doesn't address the resulting cost problems, and it doesn't really protect you when and if you do get sick and need some help.

I thought what you meant by the $150 was the penalty that free riders will have to pay. Sorry.

The question is in comparison to what? You're already paying insurance so the ACA is not going to impact you anywhere near what it will do to the uninsured (mostly for good, but yep, some penalty for the free riders). At best, there is the counterfactual of the broader pool lowering everyones' rates (once everyone is in as designed) but that certainly doesn't mean anyone's premiums are going to go down or even level off from here.

If you were expecting more and very disappointed, hey, join the club! It's free and you get to whine with people from the Left and the Right, kumbaya!

But as I have said to friends on both the Left and the Right (yes, I have some; we try not to kill each other), if you really think that more was possible at the time, right now or for the foreseeable future, you are living the magic pony. My hope is that the Right stays there for a long time or at least long enough for those on the Left to wake up and put in place a whole host of very progressive things such as a public option, if not single payer, in some of the state/regional exchanges and gettng the Medicaid expansion in every state.

So please go back to sleep and dream of magic ponies; the ones that poop gold nuggets are really cool.

Originally Posted by annla899

I'm trying to figure out what the argument is here. Bear with me.

Is it about how much the uninsured pay for health care?

Is it how much the insured pay for the uninsured who need health care?

Is it how much self-employed individuals pay for health insurance vs those whose health insurance is paid through their employers?

Is is how much the mandate is going to cost uninsured versus how much those uninsured have to pay as a penalty under ACA?

Is it how much an ER visit costs for those who are insured vs those who aren't?

Is it the cost of ICU? (In late 2004, my 80-year old mother was in ICU for 40 days until she died. She had Medicare gap insurance. Her open-heart surgery, plus all that time in ICU cost about $200.00. )

Here's my 2 cents. Since 2006, the cost of benefits at my college has gone from $12 million to $36 million. Much of this increase is due to higher medical insurance rates. Will Obamacare, will this change? Will it affect my friend who already pays $650 a month with a $5000 deductible?

The argument is about everything. Very few people know a lot about the healthcare delivery system. Even fewer, the healthcare financing system. Lying is guaranteed ... intentional or not. Sadly, there are few qualified fact-checkers, and no one willing as far as I can tell.

There is a GOP narrative and Dem narrative. Today, the GOP narrative is the more coherent. Simplistic and mostly wrong, but coherrent.

Originally Posted by annla899

I'm trying to figure out what the argument is here. Bear with me.

Is it about how much the uninsured pay for health care?

Is it how much the insured pay for the uninsured who need health care?

Is it how much self-employed individuals pay for health insurance vs those whose health insurance is paid through their employers?

Is is how much the mandate is going to cost uninsured versus how much those uninsured have to pay as a penalty under ACA?

Is it how much an ER visit costs for those who are insured vs those who aren't?

Is it the cost of ICU? (In late 2004, my 80-year old mother was in ICU for 40 days until she died. She had Medicare gap insurance. Her open-heart surgery, plus all that time in ICU cost about $200.00. )

Here's my 2 cents. Since 2006, the cost of benefits at my college has gone from $12 million to $36 million. Much of this increase is due to higher medical insurance rates. Will Obamacare, will this change? Will it affect my friend who already pays $650 a month with a $5000 deductible?

First and foremost it is about the disappointment that Obamacare did not result in every one of us getting magic ponies that poop gold nuggets and as long as we are in their mere presence, we will never get sick and we will never die. Take a moment, and let the grief of that knowledge wash over you. If you can move on from there, you will have accomplished something that many many people cannot.

Okay, since you made it this far, the next thing to grapple with is that somewhere, someone is going to maybe have to pay a small penalty (relative to their income since generally they'll be in the top 20% of incomes) for not getting health insurance. This is like being made to eat French Fries when all you ever wanted is Freedom Fries! Like, OMG, next thing you know they'll tell us we need a govt-issued license to drive a car! Oh, wait, ah, well, just never mind, where the heck is my freedom fries?!

Make it through those two things and it gets a little boring, at least from a national level perspective. Get down to the state level and it gets more interesting.

At the state level, you'll learn all about certain Red State governors deciding that their state can't afford to give health insurance (Medicaid), which really does mean in most cases not giving them health care. They can't afford it even though the feds pick up 100% of the tab for the first three years and 90% thereafter. But, you know, its the old camel's nose under the tent thingee and pretty soon those poor people will take over the world and worst shrink the gap a tiny bit between themselves and the 1% who will feel less rich because, well, rich is a relative thing.

You will also learn about the ability of states to set up their own or join a regional insurance exchange that has lots of possibilities including possibly the "public option" emerging. This can get pretty wonky but it can be fun if you're that kind of person.

Then there's the personal level that you are bringing up. Health insurance is going to change drastically in this country over the next couple of years. What worked before or what you thought worked before is not likely even an option in the future. Time to put on the thinking cap and look out for number one - your country wants you to. Good luck with it, but if you made it this far, you are likely far ahead of a lot of others and I’m pretty sure you’ll figure it out in a beneficial way for you and yours.

Originally Posted by playwrite

First and foremost it is about the disappointment that Obamacare did not result in every one of us getting magic ponies that poop gold nuggets and as long as we are in their mere presence, we will never get sick and we will never die. Take a moment, and let the grief of that knowledge wash over you. If you can move on from there, you will have accomplished something that many many people cannot.

Okay, since you made it this far, the next thing to grapple with is that somewhere, someone is going to maybe have to pay a small penalty (relative to their income since generally they'll be in the top 20% of incomes) for not getting health insurance. This is like being made to eat French Fries when all you ever wanted is Freedom Fries! Like, OMG, next thing you know they'll tell us we need a govt-issued license to drive a car! Oh, wait, ah, well, just never mind, where the heck is my freedom fries?!

Make it through those two things and it gets a little boring, at least from a national level perspective. Get down to the state level and it gets more interesting.

At the state level, you'll learn all about certain Red State governors deciding that their state can't afford to give health insurance (Medicaid), which really does mean in most cases not giving them health care. They can't afford it even though the feds pick up 100% of the tab for the first three years and 90% thereafter. But, you know, its the old camel's nose under the tent thingee and pretty soon those poor people will take over the world and worst shrink the gap a tiny bit between themselves and the 1% who will feel less rich because, well, rich is a relative thing.

You will also learn about the ability of states to set up their own or join a regional insurance exchange that has lots of possibilities including possibly the "public option" emerging. This can get pretty wonky but it can be fun if you're that kind of person.

Then there's the personal level that you are bringing up. Health insurance is going to change drastically in this country over the next couple of years. What worked before or what you thought worked before is not likely even an option in the future. Time to put on the thinking cap and look out for number one - your country wants you to. Good luck with it, but if you made it this far, you are likely far ahead of a lot of others and I’m pretty sure you’ll figure it out in a beneficial way for you and yours.

I have what is now considered excellent health care through my job. It used to be even better, of course. Now it's Cigna- GreatWest administered through another company. I don't quite get the point because it seems like it just adds administrative expense. So, when I go to my claims handlers website and log on with one password, I then have to go to Cigna's site and enter a whole other UID and password. In addition, even the Cigna rep had trouble figuring out my 9-digit member number.

I think ACA is a good beginning. It's not optimal nor what I'd prefer, but given the current political climate, it's a miracle that any health insurance (note: not health care) reform came about This could have and should have happened back during the Nixon administration at the latest. Health care reform would involve a reevaluation of the whole fee-for-service concept and for-profit hospitals.

The discussion on this thread seems to be all over the map.

Originally Posted by Marx & Lennon

I had three grandkids in at once, so I have real world to draw on too. One had MRSA, in addition to everything else. They are all 7 and healthy now, but two were in trouble then, with the MRSA child needing constant attention. That's why I know they never have less than two RNs on staff.

My son paid the bills, or filed the insurance in their case. For the three of them, the bill was just shy of $400,000. Now that is overblown, but the insurance payment wasn't discounted all that much.

And all you've established is that the system under which your son operated was able to squeeze out a hell of a lot of money. The bill, that is. At issue, however, is not the size of bills, but the size of costs.

Granted, all I've got is a bill (or rather, a pile of them, well-itemized), too. From a different place, granted -- one most assuredly not burdened by a history of capacity to leech off the resources of those unfortunate enough to have to frequent it -- but still roughly, from the sake of outcomes and outcome-related inputs, the same service.

The disparity in our bills can be explained in exactly two ways -- either mine reflected more-or-less 'cost' and yours was ridiculously overinflated; or yours reflected more-or-less 'cost' and mine was ridiculously discounted. Of course, the rationale for a leech-system to suck out as much as it can get away with hardly needs explanation -- why, and that, such a system would behave in that way is axiomatic. On the other hand, there's very little to indicate either why a non leech-system would deny itself even so much as recompense of its own costs (in particular, from a willing-to-pay/able-to-pay party) or in what possible way a system that so operated would be able to sustain for any length of time. The reasonable conclusion, it strikes me then, is that the qualitative difference in what your son was billed and what I was billed is more likely due to the first of those two explanations.

Originally Posted by Justin '77

And all you've established is that the system under which your son operated was able to squeeze out a hell of a lot of money. The bill, that is. At issue, however, is not the size of bills, but the size of costs.

Granted, all I've got is a bill (or rather, a pile of them, well-itemized), too. From a different place, granted -- one most assuredly not burdened by a history of capacity to leech off the resources of those unfortunate enough to have to frequent it -- but still roughly, from the sake of outcomes and outcome-related inputs, the same service.

The disparity in our bills can be explained in exactly two ways -- either mine reflected more-or-less 'cost' and yours was ridiculously overinflated; or yours reflected more-or-less 'cost' and mine was ridiculously discounted. Of course, the rationale for a leech-system to suck out as much as it can get away with hardly needs explanation -- why, and that, such a system would behave in that way is axiomatic. On the other hand, there's very little to indicate either why a non leech-system would deny itself even so much as recompense of its own costs (in particular, from a willing-to-pay/able-to-pay party) or in what possible way a system that so operated would be able to sustain for any length of time. The reasonable conclusion, it strikes me then, is that the qualitative difference in what your son was billed and what I was billed is more likely due to the first of those two explanations.

RE: your bills and my son and daughter's, more than half of the bill was due to the child with MRSA. She was also the one who was in for roughly two months. The other two were in for a lot less time, and needed a lot less care. I don't have access to the bill, so this is based on memory from the time.

The fact is, NICUs are modern miracles of healthcare, but they are expensive as hell do in large part to several social decisions we have made. First, we've decided that it's A-OK to have multiple births ... even for mothers who are less than fit. This guarantees a huge influx of preemies - many near the lower edge of viablity. The NICU I'm familiar with is located a block away from the first invitro fertilizatoin clinic in the country. They're alwasy busy. Second, and probably even more important, religous or personal reasons are convincing parents to continue pregnancies that would have miscarried in the past. Today, we have the capacity to keep them going, so some NICU patients are not only preemie, but have serious maladies as well. A 2-pound spina-bifida baby requires maximal services, so they have to be there waiting to be used. Another issue is the variability of demand. NICUs have to be ready to handle the maximum potential load, which is not often the case.

... and no, I have no idea how to alter this model ... other than altering the activities that generate the demand. Something tells me that this is unlikely.

Originally Posted by The Rani

Here's where the money goes:

GlaxoSmithKline to Plead Guilty and Pay $3 Billion to Resolve Fraud Allegations and Failure to Report Safety Data

Are you arguing that Big Pharma gouges to cover the cost to settle law suits when it's caught gouging? Did I miss something?

Originally Posted by Justin '77

And all you've established is that the system under which your son operated was able to squeeze out a hell of a lot of money. The bill, that is. At issue, however, is not the size of bills, but the size of costs.

Granted, all I've got is a bill (or rather, a pile of them, well-itemized), too. From a different place, granted -- one most assuredly not burdened by a history of capacity to leech off the resources of those unfortunate enough to have to frequent it -- but still roughly, from the sake of outcomes and outcome-related inputs, the same service.

The disparity in our bills can be explained in exactly two ways -- either mine reflected more-or-less 'cost' and yours was ridiculously overinflated; or yours reflected more-or-less 'cost' and mine was ridiculously discounted. Of course, the rationale for a leech-system to suck out as much as it can get away with hardly needs explanation -- why, and that, such a system would behave in that way is axiomatic. On the other hand, there's very little to indicate either why a non leech-system would deny itself even so much as recompense of its own costs (in particular, from a willing-to-pay/able-to-pay party) or in what possible way a system that so operated would be able to sustain for any length of time. The reasonable conclusion, it strikes me then, is that the qualitative difference in what your son was billed and what I was billed is more likely due to the first of those two explanations.

The third choice of course, and previously mentioned, is that your billing was heavily subsidized by a federal program specifically established for that purpose and further indirectly subsidized by the providers adding any loss from their otherwise less-than-stellar profit off of you to the costs to all other patients.

However, I can now see from your incredible logical argument that is an utterly ridiculous option to even consider when you are in the picture with the combination of incredible negotiating skills coupled with your fortunate but likely planned (hey, if you’re gonna be superman…) going to the most benevolent health providers in the nation!

Silly us!

Live the dream, bro, live the dream…. It’s going bye-bye in less than 30 months.

I'm not arguing against the health provider industry literally getting their blood money. What I'm pointing out is that is going to be made much more clear by the ACA doing away with the muddle of another unfair cost to most of us of indirectly paying for your care.

You can walk and chew gum at the same time, right? One would assume any superman could.

Originally Posted by playwrite

The third choice of course, and previously mentioned, is that your billing was heavily subsidized by a federal program specifically established for that purpose and further indirectly subsidized by the providers adding any loss from their otherwise less-than-stellar profit off of you to the costs to all other patients.

Except there's no possible way for that to have happened. But whatever; invent whatever context makes you feel better, eh?*

Oh, and I didn't negotiate a damned thing in Lucius' case. The docs told me what needed to be done; I got it written up; took the papers downstairs to the cashier's desk; paid the bill.

The gouging that you treat as a necessary part of health care is in fact a necessary consequence purely of subsidized or mandated health insurance (remember hw those are the exact same thing? how weird that I keep acting like they're not...) As has been stated by many more than just me, ACA enshrines the broken elements of the American system and pretends like anything has actually been fixed. In fact, all that's been fixed is a few more protected groups' meal-tickets. On the backs of the people at-large, naturally. The system works!

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*or, if you feel so confident that you have the answers, hazard a guess as to the name of that program, or the federal department under which it might be administered. It'll make shooting down your explainifying that much easier