I have a recent health-care experience to share: In the beginning of April, I crushed my right hand trying to move a plasma TV that was no longer working from my bedroom to a storage area in my apartment; after the hand swelled up for several days I made an appointment at a clinic I am authorized to visit under this thing called the Healthy San Francisco Program, which I joined in 2010 and pay $150 quarterly. The doctors there told me it was something called a "compartment" injury, and I spent three days at San Francisco General Hospital receiving antibiotics intravenously. I paid a $10 co-payment at the clinic, and my only other out-of-pocket expense from the stay has been a $40 bill for an EKG that I didn't receive until July.

Maybe local governments can handle situations like this adequately?

Originally Posted by Justin '77

Except there's no possible way for that to have happened.

First, how would you know that? Do you work in the hospital’s billing department? The finances of running a hospital is clearly one of the most complicated business endeavors in the world; people running those rate policy and billing departments are constantly having to keep up with multiply and changing federal, state, local, industry requirements, the policies of multiply insurance providers and the demands of powerful labor unions of the people they employ as well as the unique situations of the unique communities that they serve. How in the world do you think you know why the hospital billed you the way they billed you?

Originally Posted by Justin '77

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.

Just makes the point that you were near instantaneously pigeon-holed into a particular category of payer as pre-determined by a myriad of regulations, policies and conditions by a multiply of players that you have not the faintest clue. And yet, you are certain that your billing was not subsidized. Amazing.

Originally Posted by Justin '77

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!

Wow, this is such an amazing discovery! Truly overlooked by so many! The ACA didn’t' fix everything and it didn't give us any magic ponies! Again, truly amazing!

Okay with feet back on the ground. Just a couple of the many things it did do: the federal program that reimburses hospitals for uncompensated care is going bye-bye; insurers cannot deny coverage due to pre-existing condition; it provides standardization of insurance coverage; a schedule of federal subsidies for coverage based on incomes; and a penalty for those who don't get insurance coverage.

Let me take that and translate to reality for you –

If Lucius' case took place post 2014, when you went downstairs to the cashier, you would get an itemized bill. If you did not pay attention to the itemization, in a week or two you would be pleasantly surprised to find a brochure in the mail from an insurer outlining your new health insurance coverage. Depending on your financial situation, the insurer would detail what premium payments you and the federal govt have already paid as a result of your visit to the hospital and what you and the feds will be paying for the rest of the year. The package would likely have a form and/or instructions on how to indicate on your tax form your new coverage so you are not subject to the penalty. You would have still been pigeon-holed by the hospital's predetermined policies; it's just the pigeon hole would mean different things. All is well including hopefully Lucius.

Now, on the other hand, let’s say you went downstairs to see the cashier and upon examining the bill's itemization you started throwing a fit and yelling "freedom fries, I want my freedom fries!!!" By its predetermined policies, the hospital would quickly make an assessment of whether you posed any danger to them or to yourself including alerting security if they are not already on the scene.

Let's say they determine that you are not a complete wacko or at least not a dangerous one, they will then pigeon-hole you into a different predetermined category. You will be told you are in an uninsured rate and they will hand you a new bill; I can guarantee you it will have a higher price tag than the previous bill you saw. For their own liability protection, they will likely have you sign a disclosure document that not only did they offer you the insured rate (with the insurance) but they reminded you that you will be paying a penalty on your federal taxes.

Now the above may not seem like much difference to you. Or, if you’re capable of lifting the ideological blinders enough to see that this is truly coming, you may not like it. However, I like it because when the hospital has to explain their rates to the various federal, state and local govts overseeing them, they will NOT be able to muddle the talk with their tears over uncompensated care. As such, the insatiable greed, that you want to spend your time jumping up-and-down about, will be much clearer and much more likely to be dealt with. I see that as progress; I see your jumping up-and-down on an Internet chat room as unproductive bullshit.

Originally Posted by Justin '77

-edit-
*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

It's called the Disproportionate Share Payments (DSH or "dish") program -

http://www.lbb.state.tx.us/Federal_F...SH_Program.pdf

- The Medicaid DSH program provides supplemental payments to hospitals that serve large numbers of Medicaid beneficiaries and low-income or uninsured patients.

It lays out over $11B a year to hospitals for uncompensated care including for the uninsured. And according to this -

http://www.shadac.org/files/DSH%20summary.pdf

- Oregon hospitals get over $45 million of that. I’m pretty sure your differential is in there.

That is going bye-bye.
- but yea, no big deal and I'm sure the hospitals are going to continue to be real interested in giving special lower rates to folks deciding not to get insurance after 2014.

I may not give out magic ponies but in the long run, the reality I provide will have you thanking me.
You're welcome.

Originally Posted by Justin '77

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!

The key point is that Lucius was born in Russia, not the United States. Bear that in mind, folks, when you respond to Justin's posts.

Originally Posted by playwrite

...It's called the Disproportionate Share Payments (DSH or "dish") program ...

Well, there we have it. PW confirms what I had long suspected -- when he talks out his ass, it doesn't know any better than the rest of him.

Rest assured, not one red cent from the DSH program goes to the hospital where Lucius was born, or to the one where he stayed in the NICU. And as for pigeonholing, if anything, we were looked at as cash cows there (as would naturally be viewed anyone else in our circumstances).

So. Yeah.

The costs were the costs; and absent the need to gouge most effectively, the mechanism for transferring those costs to the users is able to be pretty damn transparent. It's theft that needs to be hidden under layers of arcane concealment.

-----
-edit-
and to Jenny's point, the services we received -- successful health care -- is exactly the same one sought from and provided by any medical provider.

Originally Posted by Justin '77

Rest assured, not one red cent from the DSH program goes to the hospital where Lucius was born, or to the one where he stayed in the NICU. And as for pigeonholing, if anything, we were looked at as cash cows there (as would naturally be viewed anyone else in our circumstances).

The hospital was paid in Rubles, yes?

Originally Posted by Justin '77

Well, there we have it. PW confirms what I had long suspected -- when he talks out his ass, it doesn't know any better than the rest of him.

Rest assured, not one red cent from the DSH program goes to the hospital where Lucius was born, or to the one where he stayed in the NICU. And as for pigeonholing, if anything, we were looked at as cash cows there (as would naturally be viewed anyone else in our circumstances).

So. Yeah.

The costs were the costs; and absent the need to gouge most effectively, the mechanism for transferring those costs to the users is able to be pretty damn transparent. It's theft that needs to be hidden under layers of arcane concealment.

-----
-edit-
and to Jenny's point, the services we received -- successful health care -- is exactly the same one sought from and provided by any medical provider.

Cute.

I'll just let the idiocy of what you've been posting stand for itself.

If people can't figure out the subterfuge, then there really is no hope for them.

One way or another, what passes for the Right these days, lies about everything all the time.

For profit hospitals.

Comment: Nobody expected the for-profit HCA hospital chain to change its
fundamental practices. It hasn't. It is an investor-owned corporation
designed to make money, which it does very effectively. The PNHP model of
single payer reform calls for an end to for-profit, investor-owned
corporations in health care. You need only to read this fairly long article
to understand why.

The New York Times
August 14, 2012
A Giant Hospital Chain Is Blazing a Profit Trail
By Julie Creswell and Reed Abelson

During the Great Recession, when many hospitals across the country were
nearly brought to their knees by growing numbers of uninsured patients, one
hospital system not only survived ? it thrived.

In fact, profits at the health care industry giant HCA, which controls 163
hospitals from New Hampshire to California, have soared, far outpacing
those of most of its competitors.

The big winners have been three private equity firms ? including Bain
Capital, co-founded by Mitt Romney, the Republican presidential candidate ?
that bought HCA in late 2006.

The financial performance has been so impressive that HCA has become a
model for the industry. Its success inspired 35 buyouts of hospitals or
chains of facilities in the last two and a half years by private equity
firms eager to repeat that windfall.

HCA?s emergence as a powerful leader in the hospital industry is all the
more remarkable because only a decade ago the company was badly shaken by a
wide-ranging Medicare fraud investigation that it eventually settled for
more than $1.7 billion.

Among the secrets to HCA?s success: It figured out how to get more revenue
from private insurance companies, patients and Medicare by billing much
more aggressively for its services than ever before; it found ways to
reduce emergency room overcrowding and expenses; and it experimented with
new ways to reduce the cost of its medical staff, a move that sometimes led
to conflicts with doctors and nurses over concerns about patient care.

In late 2008, for instance, HCA changed the billing codes it assigned to
sick and injured patients who came into the emergency rooms. Almost
overnight, the numbers of patients who HCA said needed more care, which
would be paid for at significantly higher levels by Medicare, surged.

As HCA?s profits and influence grew, strains arose with doctors and nurses
over whether the chain?s pursuit of profit may have, at times, come at the
expense of patient care.

http://www.nytimes.com/2012/08/15/bu...pagewanted=all

Originally Posted by The Wonkette

The hospital was paid in Rubles, yes?

Of course. The billing rates are all very much out in the open, and legally that's the only thing businesses over there are allowed to charge in. If we'd tried to pay in tenge or pula, we'd have likely gotten nothing but funny looks.

----
-edit to avoid double-posting-
Got caught up in your own unjustified self-confidence, eh, pw? It's embarrassing, to be sure (I know from much unfortunate person experience). But you'll get over it

Originally Posted by The Rani

Which of course was the point of my post about drug company fraud.
Apparently it's so well concealed that most people can't even comprehend it.

And the way to begin to get at that is start stripping away the layers. The ACA does that by unveiling and greatly diminishing the uncompensated care excuse. That is progress. Jumping up and down about greed, politically impossible change, and disguising your experience in another country as being relevant to our own are all sheer useless bullshit.

Originally Posted by playwrite

And the way to begin to get at that is start stripping away the layers. The ACA does that by unveiling and greatly diminishing the uncompensated care excuse.

The ACA moves the exact wrong way -- by enshrining as core fundamental to the system the players and process that generate those layers. More of the same, and harder, is all ACA does.

Ah yes, and the experience outside the broken American paradigm does no less than illuminate the fact that, if nothing else, the prices associated with the broken American system are orders of magnitude removed from the actual costs of providing actual care.
I mean, maybe 150 thousand dollars is an appropriate figure to put on supporting a system of leeches and thieves feeding off an infant intensive-care patient. But it's sure not the cost to just take care of a newborn in intensive care. The real question for you is, which of those is the purposes you feel best for a medical care system to aim for?

Originally Posted by The Wonkette

The key point is that Lucius was born in Russia, not the United States. Bear that in mind, folks, when you respond to Justin's posts.

Now why would you go and spoil a perfectly good game of chess like that? I was really enjoying the setting of the trap too.

Originally Posted by Copperfield

Now why would you go and spoil a perfectly good game of chess like that? I was really enjoying the setting of the trap too.

Meh. Wasn't really a trap. After all, the only way to get an objective look at the real costs of a system as intentionally convoluted as health care/insurance in the USA is by comparison to some sort of outside yardstick.

Otherwise, we'd just be comparing imaginary numbers to other imaginary numbers. And, short of defending the status quo from reform, what would be the point of that?

Originally Posted by Justin '77

The ACA moves the exact wrong way -- by enshrining as core fundamental to the system the players and process that generate those layers. More of the same, and harder, is all ACA does.

Ah yes, and the experience outside the broken American paradigm does no less than illuminate the fact that, if nothing else, the prices associated with the broken American system are orders of magnitude removed from the actual costs of providing actual care.
I mean, maybe 150 thousand dollars is an appropriate figure to put on supporting a system of leeches and thieves feeding off an infant intensive-care patient. But it's sure not the cost to just take care of a newborn in intensive care. The real question for you is, which of those is the purposes you feel best for a medical care system to aim for?

I think I've been pretty clear from the start - I'm not interested in magic ponies and that includes the US becoming Russia. It's slowly changing there, but the medical field as a place of employment has a long sullied history as a "Pink Ghetto;" there is no way in hell US medical providers would accept the pay and conditions of what Russia has to offer. Why not tell Rani what her counterpart makes in Russia and how she lives?

And don't try to BS it; I've not only lived there but I have a Russian wife and all the Russian network that comes with that AND that spends most of its time in conversation on how the medical system in both places suck.

Originally Posted by Copperfield

Now why would you go and spoil a perfectly good game of chess like that? I was really enjoying the setting of the trap too.

If you want to join Justin in magic pony land, why not get a room. I'm sure the magic pony can do what ever the two of you want to dream up.

Originally Posted by Justin '77

Meh. Wasn't really a trap. After all, the only way to get an objective look at the real costs of a system as intentionally convoluted as health care/insurance in the USA is by comparison to some sort of outside yardstick.

Otherwise, we'd just be comparing imaginary numbers to other imaginary numbers. And, short of defending the status quo from reform, what would be the point of that?

Whhheeeeee!!!!!!!!!

Originally Posted by Justin '77

Meh. Wasn't really a trap. After all, the only way to get an objective look at the real costs of a system as intentionally convoluted as health care/insurance in the USA is by comparison to some sort of outside yardstick.

Otherwise, we'd just be comparing imaginary numbers to other imaginary numbers. And, short of defending the status quo from reform, what would be the point of that?

Could not agree more.

As for trap setting, I offer my apologies for my misunderstanding. "Trap" may not have been the best word to use.

Originally Posted by playwrite

If you want to join Justin in magic pony land, why not get a room. I'm sure the magic pony can do what ever the two of you want to dream up.

Now, now, don't be so upset. Justin has a live son to show for his experiences. You... Haven't provided nearly that much yet.

Originally Posted by playwrite

I think I've been pretty clear from the start - I'm not interested in magic ponies and that includes the US becoming Russia. It's slowly changing there, but the medical field as a place of employment has a long sullied history as a "Pink Ghetto;" there is no way in hell US medical providers would accept the pay and conditions of what Russia has to offer...

Why should I (or, indeed, anyone) give a shit what fat, pampered Americans want to get paid? Who doesn't want to get paid their weight in diamonds for every little thing they do?

But that's again not even remotely related to what we're talking about here. We're talking about costs. Not just what one party wants to get. Now granted, the ridiculously-high price for medical care is not only directly a consequence of thieves and skimmers -- there's also the very significant fact of cartelization and in general restriction of supply.

Still, none of that changes the fundamental point -- that medical care quite simply does not cost even remotely close to the prices Americans are taught to think of as appropriate. Apples to apples here, let's not forget we're talking about medical care. That is, the facilities, personnel, and expertise necessary to save the life or health of an ailing person. That's what Lucius got -- it wasn't as visually attractive as you'd find in the States, but that's already wandering off the matter of medical care. And in the matter of medical care (which is what people need), the system we engaged is closely comparable to the one whose pricetag you are frantically trying to defend.

..
Oh, and as for 'pink ghetto'? Naturally, without the cartel strangling the supply of medical training, that field is not particularly more highly rewarded than any other field with specialized knowledge and high personal responsibility. Engineers and lawyers (for example) don't shit gold bricks in Russia unless they have some other quality that puts them above the field, either. There's no fundamental reason why someone who trained to be a doctor all-other-things-being-equal is worth an order of magnitude more. That they are led to expect otherwise is another feature of a nonfunctioning (at least, from the standpoint of society at large) system.

Heh. Not all MDs are in private practice.

I recall hearing that GPs in the UK actually make more on average than specialists because they manage, or oversee, the patients' care. Perhaps a better word would be they coordinate the patient care.

I had to visit the doctor while in Italy. Right downtown Florence, I went up a set of steep narrow stairs and waited. An attractive middle aged woman came out, asked me to wait and, after she finished with the last patient, saw me in her small office. To be fair, she also worked at a larger clinic with more facilities, as well. The place, with its old beams and rough plaster walls, had nice art and a great view. She diagnosed me quickly and then we had a nice conversation about architecture, bug bites and art for about 10-15 minutes as I sat by her large desk. She gave me great anecdotes. She wrote me a scrip, explained how it worked, and why. I paid her 40 Euros (about $50 USD) because that's what a visit cost for those without Italian insurance.

Much as I like my GP, he would have been able to spend about 5 minutes with me, and without insurance it would have cost me about 3X that much.

Originally Posted by annla899

She diagnosed me quickly and then we had a nice conversation about architecture, bug bites and art for about 10-15 minutes as I sat by her large desk. She gave me great anecdotes. She wrote me a scrip, explained how it worked, and why. I paid her 40 Euros (about $50 USD) because that's what a visit cost for those without Italian insurance.

Much as I like my GP, he would have been able to spend about 5 minutes with me, and without insurance it would have cost me about 3X that much.

Oh wow. So it's not just in the dank dungeons of the Soviet "medical" system where one encounters prices far less than the American one would have you believe are necessary. How do those poor wop doctors survive on such starvation-wages??

Originally Posted by The Rani

Same thing is true in India.
It's funny how docs from over there come to the U.S. to make more $$$, because my cousin is a surgeon in India and he seems to do just fine.

Not sure about India, but I know that whatever US medical licensing board is completely uninterested in even looking into reciprocity for central and eastern-european doctors. "20 years as the head of cardiology in... Wroclaw?... I'm sure we can find a place for you on our hospital's cafeteria staff. Welcome to America!"

Originally Posted by Justin '77

...But that's again not even remotely related to what we're talking about here.

No, that is your misunderstanding.

I'm talking about the reality that confronts us here in the US. You are talking about things that have no bearing on that now and will not have any bearing on it for far into the future if at all. No one is going to touch any healthcare reform for decades now. There's a slim chance that a GOP sweep would lead to a repeal of the ACA or slightly more likely its de-funding, but there will be NO mythical "replace." Anyone who thinks otherwise is living in magic pony land. What we got is what we got – deal with it.

You and your ilk here are why I find it so extremely hilarious when people claim the pragmatism of Xers, the putting of their heads down and moving forward come what may. You all are a bunch of whinny babies – “oh, heavens me, look what mommy and daddy did to us now! Oh, I’ll show them, I’ll get another big tattoo or impale another body part. Yea, bro, I’m a tough Xer machine!”

You're like the snarly teenager brought along to the family's outing to the community pool. The adults are trying to find ways to entertain the kids - a game of Marco Polo, a race to the other side, who can hold their breath underwater the longest, whatever. The adults are trying to make it work with what they have. For whatever reason, the family wasn't able to go to the beach. You, on the other hand, the snarly adolescent sit on the edge of the deck, removed from the action and offering no help. Every once in awhile you pipe in with the insightful, "Hey, this is not the beach! Hey, this sucks!" Then you sit for a couple minutes before more insight, "Hey, this is not the beach and we can't ride the waves. Hey, this sucks."

Now the adults (that would be me) are patience, and we come by and say, "Come on little Justy, you can have some fun here, come in the pool and play, help us with the little ones."

But no, little Justy, sits stoic, arms crossed and explains, "This is not the beach. And besides, they have magic ponies at the beach and there are no magic ponies here at the pool. This sucks!"

And so it goes. Maybe if we're lucky, little Justy folds his arms, puts on the Justy pouty face on, studies his impaled navel, and just stays quiet for just a few extra minutes before his next oh-so-insightful "Hey, this is not the beach! This sucks"

Originally Posted by Copperfield

Now, now, don't be so upset. Justin has a live son to show for his experiences. You... Haven't provided nearly that much yet.

I have a few kids, maybe a grandkid on the way. My experiences, now and in the future, are about what happens here in the US.

Perhaps you, Justin and Rani could start a new thread and talk about what happens overseas or in mythical lands. You all could even exchange magic pony playing cards!




wheeeeeeeeee!!!!

Originally Posted by playwrite

I'm talking about the reality that confronts us here in the US.

Indeed. And the main part of the reality that confronts us in the US is a system that priorities Big Cash Prizes to whatever special interest groups over the actual provision of medical care to people needing it. We use outside, independent yardsticks to help get a clearer view ... a sense of scale, if you will ... of what permeates the environment in which we live.

ACA, as has been repeatedly pointed out to you in what I think have been pretty clear terms, not only fails to address this fundamental problem in the way the system in America is broken -- it enshrines it as a major protected part of the thing. You seem to recognize that point yourself when you write that, thanks to the ACA, the American medical care industry will be completely safe from reform for the decades that it takes to guarantee the safe, cushy retirement of institutional investors. No need for them to worry -- the Big Cash Prizes are now guaranteed them. People will even go to jail if they won't contribute to them.

ACA is a major victory, to be sure. Just not for the consumers of health care.

Originally Posted by The Rani

If you want to get a medical license as an immigrant from any country, no matter what your credentials, you must complete a residency program in the U.S.
And those programs are reluctant to accept FMGs (foreign medical graduates.)

OMG, one of the magic pony riders is injecting some reality! What will little Justy do?

Maybe a comparison to how Martians don't require no stinking badges or residency?