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?

Well, I have looked into about 100 different health insurance plans, so yea, I did a little bit of research. I am aware of the $60 a month plans you are referencing (actually more like $85 a month) and they are complete utter shit. In Hawaii, $85 a month will get me a plan with a $10,000 deductible, maybe $5,000 if I am lucky. Then, it will include another $10,000 in copayments with only 30% coverage before I hit the copayment limit roof, and on top of that it will have coverage limitations (PPO, HPO, ect) which means if I have an emergency and there are not any in-network hospitals in my area, I get 0% coverage or even larger deductibles.

Furthermore, with a plan like that I have practically 0% coverage for any type of standard treatment outside of basic office visits. If I go into the doctor and need an xray, MRI, or something of the like, it will count towards my annual deductible which means I have no coverage. Basically, aside from medication, wellness office visits, STD testing, and other very basic amnesties, I have no coverage until I reach my deductible cap.

In Hawaii, a plan that has a $500 deductible and no copayments would cost me about $300-400 a month. For a $1,500 maximum out of pocket, it would cost me about $200 a month. Oh, and did I mention I am 25, a non-smoker,in perfect health and I have no dependents? Fortunately my affiliation with the military has made this all irrelevant as I have coverage through them. So, thank you but no thank you. If a serious trip to the ER is going to cost me $20,000, it mind as well cost $200,000, it is all the same; thus, there is no functional point for me to have a “health insurance” plan like that.

The military health insurance program, TriCare, should be the de facto standard on how health insurance should work. Do you know what happens when a service member needs medical care? It’s easy. I walk into a clinic and show my DoD ID card. I get the treatment I need: office visits, xray, lab testing, medication, whatever. Then I walk out the door and drive home. I don’t get any paperwork in the mail, no bills, no coverage limitations, no networks (for ER care), no questions, no bullshit, I get the coverage I need and that is the end of it.

Healthcare in America is disgraceful and we very much need the healthcare reform act. I just dont understand what the functional point of fining people without insurance is. Supposedly it is to help force people to buy insurance, but if the insurance costs too much, it costs too much, end of story. We need to focus on making insurance affordable, not fining those who cannot afford it or have realized that there is no functional point to having a plan with a out of pocket cap that is roughly equivalent to the cost of a brand new sedan.

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.

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?

Not an expert, but I would guess that 'regulation', negotiation by insurers with providers, and everybody paying their part (insurers and people) brings the costs down.

Example: The merchandice we buy at stores includes the cost of money lost by the merchant through theft... It gets passed on to us... Along with 'what the market will bear. In a similar manner, if everybody paid their hospital bills (i.e., had insurance) the providers wouldn't have to charge extra to those that do pay to recoup costs of those that don't... AND, instead of providers charging "what the market will bear", some sort of regulation or negotiation (between insurers and providers) would bring the prices down to what is "fair", instead of just what people (or insurance companies) would pay... On that last not, what is paid to providers (by both me and my insurance combined) is less than what someone paying cash would pay , as what is paid is the "negotiated rate" if I use a provider in my "network", which is almost any provider... I see this on my bill sumaries (i.e., the amount billed, negotiated rate, and what is paid).

If hospital costs in Europe are generally as low as you say they are, then I'm not sure why that is. If I had to suspect a reason, it'd be that hospitals get some sort of funding from the govt.

Hospitals aren't cheap to operate. Costs and revenues are actually pretty difficult to forecast in relation to each other. And MRI machines, for example, aren't cheap. Someone in Europe is paying for that. It may not be the direct consumer or insurance company, but someone is. And it doesn't matter if a person has insurance or not, why is it that the hospital shouldn't be paid? After all, they have the greatest financial risk in the game.

Payors (insurance companies) and hospitals are definitely NOT in bed with each other. That would be illegal and constitute as price setting. The problem is that during negotiations you have this language I noted above and the hospital's inability to know, considering all contracts and shifts in population, where revenues will fall in relation to costs. Hospitals charge what they can to ensure they get the best deal possible. There is a strong belief that if providers had to deal directly (financially) with patients then prices would be different.

Having said that, there is a strong initiative amongst everyone (payors, doctors, hospitals) to lower costs overall these days. Govt involvement has essentially mandated this. Also, there are many, many hospitals in the US that are hurting financially in spite of the current climate.

Also, never trust a doctor who says he's trying to get his hospital's costs lowered. All that means is he's trying to get a bigger slice of the pie (i.e. - control of where the money goes). Are there some egalitarian doctors out there? Yes, but most are looking at the bottom line, too.

In short, someone is paying for that hospital. My bet is that in Europe, the govt is and you're not being charged because you're not european. In the US, you see the charge because the govt doesn't pick up that tab.

I think this is an interesting point and I don't see it talked about much at all in the US, so I'm going to push this some. My information came from investigating costs for hip surgery, but I suspect it is generalized.

First off the hip surgery I was interested in costs about 12,500 Euros in Belgium or England and the main reason for the cheaper fee is that hospital costs are so much lower (less than 5000 Euros for this surgery). You suggest this has to do with government support, and perhaps some support could make a small difference in cost, but I don't see how it can account for the huge difference that exists. For example, in a hip surgery site I recently saw this:

"I should say at the outset - I am paying my yearly deductible of $8200 and then insurance pays 100% of the balance of the medical bills. I just received the bill from the hospital for my 48 hour stay. $81,046.86!!!"

Like I said, I paid less than 5,000 Euros for the same thing.

As another piece of evidence, Dr. Thomas Gross (a US surgeon I contacted) has actively managed to get the cost of his surgery down around $25,000 by aggressively going after hospital costs, but this is mainly because he is passionate about what he does (he is booked up many months in advance and almost all patients pay from insurance). Other doctors continue to charge $50,000 or more for the surgery when the extra money is all going to hospital costs. Who cares, right, if insurances covers the difference?

You might argue that use of hospital facilities and a two night stay over (in the US hospital fees often include the implant cost as well) is somehow really "worth", say 81,000 dollars, but I suspect if people had to pay for this surgery out of their pockets (as I did) that a reasonable lower cost alternative would have evolved. I find it very difficult to believe that European governments subsidize each hip surgery to the tune of 30,000 or 40,000 dollars and find it much easier to believe that insurance companies in the US have not looked after their clients interests in allowing this cost to balloon. Exactly why that lack of interest exists is an interesting question, but I am convinced it is one of the main reasons premiums are now so expensive

Well, I have looked into about 100 different health insurance plans, so yea, I did a little bit of research. I am aware of the $60 a month plans you are referencing (actually more like $85 a month) and they are complete utter shit. In Hawaii, $85 a month will get me a plan with a $10,000 deductible, maybe $5,000 if I am lucky. Then, it will include another $10,000 in copayments with only 30% coverage before I hit the copayment limit roof, and on top of that it will have coverage limitations (PPO, HPO, ect) which means if I have an emergency and there are not any in-network hospitals in my area, I get 0% coverage or even larger deductibles.

Furthermore, with a plan like that I have practically 0% coverage for any type of standard treatment outside of basic office visits. If I go into the doctor and need an xray, MRI, or something of the like, it will count towards my annual deductible which means I have no coverage. Basically, aside from medication, wellness office visits, STD testing, and other very basic amnesties, I have no coverage until I reach my deductible cap.

In Hawaii, a plan that has a $500 deductible and no copayments would cost me about $300-400 a month. For a $1,500 maximum out of pocket, it would cost me about $200 a month. Oh, and did I mention I am 25, a non-smoker,in perfect health and I have no dependents? Fortunately my affiliation with the military has made this all irrelevant as I have coverage through them. So, thank you but no thank you. If a serious trip to the ER is going to cost me $20,000, it mind as well cost $200,000, it is all the same; thus, there is no functional point for me to have a “health insurance” plan like that.

The military health insurance program, TriCare, should be the de facto standard on how health insurance should work. Do you know what happens when a service member needs medical care? It’s easy. I walk into a clinic and show my DoD ID card. I get the treatment I need: office visits, xray, lab testing, medication, whatever. Then I walk out the door and drive home. I don’t get any paperwork in the mail, no bills, no coverage limitations, no networks (for ER care), no questions, no bullshit, I get the coverage I need and that is the end of it.

Healthcare in America is disgraceful and we very much need the healthcare reform act. I just dont understand what the functional point of fining people without insurance is. Supposedly it is to help force people to buy insurance, but if the insurance costs too much, it costs too much, end of story. We need to focus on making insurance affordable, not fining those who cannot afford it or have realized that there is no functional point to having a plan with a out of pocket cap that is roughly equivalent to the cost of a brand new sedan.

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.

it's sadly really that your healthcare reform was not real healthcare reform.

Payors (insurance companies) and hospitals are definitely NOT in bed with each other. That would be illegal and constitute as price setting.

Once one of my friends set her purse on the top of her car in a parking lot while she was looking through her trunk. When she stuck her head back up, the purse was gone. She took her eyes off it for less than 20 seconds. She claimed it on her renters insurance policy but the claim was denied off the basis that the property was "abandon" because she left it unattended. Now both her and the insurance company knew the abandon property clause of her policy refereed to indefinitely leaving an item unattended on unspecified property with no intention of returning to reclaim it. Clearly the insurance company broke the law, but with a $500 claim, do you think she is going to sue? I tried to get her to, but she chose not as it was not worth the risk of loosing out on $10,000 in attorney fees.

In this case, I have to agree with the insurance company. She should take better care of her stuff. If every-time someone had their unattended purse stolen, an insurance company had to pay for it, the insurance situation in America would be even worse.

Also, not sure how this is an example of insurance companies in bed with the hospitals.

IS2. So what, DP used to be a cross between what is now IT and CT right?

I can give you a perfect example. Once one of my friends set her purse on the top of her car in a parking lot while she was looking through her trunk. When she stuck her head back up, the purse was gone. She took her eyes off it for less than 20 seconds. She claimed it on her renters insurance policy but the claim was denied off the basis that the property was "abandon" because she left it unattended. Now both her and the insurance company knew the abandon property clause of her policy refereed to indefinitely leaving an item unattended on unspecified property with no intention of returning to reclaim it. Clearly the insurance company broke the law, but with a $500 claim, do you think she is going to sue? I tried to get her to, but she chose not as it was not worth the risk of loosing out on $10,000 in attorney fees.

For $500 she could have sued in small claims court with zero attorney's fees.

Curt

For $500 she could have sued in small claims court with zero attorney's fees.

Curt

Sure, she could have. But the defendant would still have their Harvard grad lawyers by their side. Companies keep them on retainer specifically for stuff like this. So how exactly is a layman without an attorney supposed to win a suit against a defendant with a team of high price attorneys? I think if she were to win the suit, she would need help. Plus, many small claims courts now say that if the plaintiff looses, s/he has to pay for the defendant's attorney fees.

Basically, he argues that the Republican party has moved from being conservative to being radical, and lost its problem-solving ability.

GO

No... You are missing a very important point... The insurance companies are in the business of making $$$, and weigh cost vs payout. It would COST much more to defend against your friend with "Harvard Lawyers" and court costs than it would to pay out a relatively small claim... IF she had filed. (i.e., $100K paid to the lawyers to defend, or $1,000 to settle... Do the math)