Forums: Community: The Soap Box: Re: [Gmburns2000] What did we learn from this election?: Edit Log


Nov 10, 2012, 6:00 AM

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Registered: Feb 24, 2004
Posts: 1550

Re: [Gmburns2000] What did we learn from this election?
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Gmburns2000 wrote:
USnavy wrote:
The American system is pretty hilarious actually. Part of the reason why insurance is so expensive in the first place is because no one can afford it. So because no one can afford it, they get hurt and dont pay their medical bills. Then the hospitals have to raise their prices which in turn forces the insurance companies to raise theirs. That leads to an even greater increase in uninsured people, an increase in non-paid treatments, and the cycle goes on and on.

This is only partly the truth. You're partly correct in that some costs to the recipient payor (govt or uninsured patient) are high because there are people who use the incredibly expensive emergency option because they can't afford insurance. When they do this, either the person picks up the tab or the govt. When it's the govt, they pay a set rate (often at or below the hospital's costs). When it's the person, well, if they couldn't afford insurance then they don't pay the emergency room bill and, of course, costs rise. This is actually THE impetus behind the health care system in Massachusetts. Of course, other things are included in the overall system, but that's why it was created in the beginning.

But that's not really why hospital prices are high to the uninsured. In almost every single contract between insurance companies and hospitals is a clause that states that insurance companies will pay the lesser of either the hospital's charge (their price) or the contracted rate. In other words, if the insurance company agrees to pay $1000 for an emergency visit, and the hospital's charge is $900, then the insurance company pays $900. This causes the hospitals to increase their charges so that all charges are higher than all contracted payments are (from ALL the insurance companies contracted with that hospital).

Almost all hospital charges are high almost exclusively from this contract language.

I have a real question about hospital fees and it sounds like you might know something about this, so I thought I'd ask. I had hip surgery in Belgium (with one of the world's top hip surgeons) and in general costs (Doctor's fees, assistant's fees, implant cost, materials etc.) are all roughly the same as the US except for one HUGE difference: the hospital fee. My hospital fee in Belgium was a few thousand Euros but in the US hospital fees for the same surgery run as high as 40,000 dollars. This is the main reason hip surgery in Europe costs from 20 to 30 thousand dollars less than it does in the US. The hospital cost is apparently independent of whether or not the patient has insurance or not. I know of one top hip surgeon in the US (Thomas Gross) who has at least made an effort to lower his hospital costs, but for the most part doctors (and patients) don't worry about this, because insurance covers the fee. The whole thing smacks of some kind of Mafia-like arrangement between hospitals and insurers. WTF is going on there?

(This post was edited by yanqui on Nov 10, 2012, 7:15 AM)

Edit Log:
Post edited by yanqui () on Nov 10, 2012, 6:02 AM
Post edited by yanqui () on Nov 10, 2012, 7:15 AM

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