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View Diary: Justin Amash (R) gets Town Hall question: "Why would we want to trust insurance companies...?" (170 comments)

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  •  Thanks, webranding. (19+ / 0-)

    Sorry it was a setup. But you are right, that is the time to go and you can't ask "how much."

    What I described could have been appendicitis. And that can turn deadly in the time that it takes to check prices.

    This better be good. Because it is not going away.

    by DerAmi on Sat Aug 31, 2013 at 10:56:15 AM PDT

    [ Parent ]

    •  How would you check prices? (27+ / 0-)

      Even in the best of times, how would the average health care consumer know how to go about doing this.

      If you called a hospital, say, would they really tell you in advance how much care for a heart attack would set you back?

      Just because the government keeps a record of real property transfers, it doesn't mean that the government wants to confiscate your home.

      by NCJan on Sat Aug 31, 2013 at 12:55:51 PM PDT

      [ Parent ]

      •  Of course, the answer is, "They can't" (30+ / 0-)

        The have no way of knowing, a priori, what kind of care you're going to need.

        Do you need a quadruple bypass, or just a dose of nitroglycerin to calm your angina and some follow-up health management?

        Is that outrageous pain in your knee the result of breaking the bone, tearing a tendon, destroying the cartilage, or just a nasty bruise? What do you mean, you can't tell?

        How would they be able to assess any medical situation over the phone?

        It's like they all belong to the "Dr. Frist School of Remote Diagnostic Quackery," and want us all to join them there.

      •  Yeah, the doctors CAN'T give you a quote. (19+ / 0-)

        You can't even get a quote from the doctor at a practice who is recommending a test, directly, himself.

        Much less get a quote from an emergency room and then competing quotes from other emergency rooms around the area to decide where you want the ambulance to take you.

        After, of course, you called around a half dozen ambulance companies to get competitive quotes and bids from them.

        I work in a business that does things this way, bids, quotes, scope of work documents, and so forth.

        This is NOT how the health care business operates.

        I don't mean it's not how the health care business should operate.

        I mean it flat out does not operate like this.  There is no one you can talk to that can give you a bid or quote on the emergency room care you will need for those chest pains you are feeling.

        Even if you have a very specific issue, say, an obviously broken arm, where that is all you need fixed and nothing more, they STILL aren't going to be able to give you a quote or a bid!

        I wish that every one of these jackasses who think that health care should a) operate like a business and b) think it should operate on a competitive free-market basis, would have a heart attack, without any insurance, and have the ambulance refuse to pick them up until they manage to get 4 competitive quotes for emergency room services from local hospitals.

        Do I wish harm on these people?  

        Yes, actually, I do.  They are killing me.  They are killing a lot of people.  

        My children will lose their dad, years early, because of Max Baucus, because of Joseph Leiberman, and because of asshats like this Rep.

        Let them gasp for breath, clutching their chest, looking up phone numbers to ambulance companies and collect competitive bids before making an informed decision as informed consumers, I say.

        Let them suffer agony and stress while the ambulance asks them which hospitals to call for competitive emergency room bids.

        The funniest part is as I said at the top: no one there could give you those bids even if you were insane enough to actually try to treat your health care like you would treat reshingling your house or repairing the fence from that storm damage.

        Doctors, hospitals, MRI locations, none of these people are set up for this sort of dealing, they just aren't.

        "It puts the lotion on its skin, or it gets the GOP again." - The Democratic Party (quip courtesy of Nada Lemming and lotlizard)

        by Rick Aucoin on Sat Aug 31, 2013 at 07:17:36 PM PDT

        [ Parent ]

        •  Isn't part of the problem (7+ / 0-)

          with getting quotes for such things also that often, the amount hospitals decide to charge ends up being somewhat arbitrary, and not related to the actual cost of the treatment?

          •  That's part of the problem. (13+ / 0-)

            Probably only one of a hundred different things that are parts of the problem.

            The pricing of medical services is by roulette, there's just no discernible rhyme or reason behind it.

            If you go to the pharmacy and hand them a prescription it's $100.  If you tell them some magic combination of words and numbers, it's suddenly $35.  A different combination of words and numbers and they'll charge you $65.

            Does that make sense at all?  And if you don't happen to know the magic combination of words, letters, and numbers that gets you the cheaper price, you pay the $100, whether you can afford it or not, and no one there is going to tell you that you COULD have gotten the medication for $35, if only you had said:

            Member ID

            Seriously, if you just say those words and numbers and letters to them, suddenly instead of $100 it's $25.


            Because.  Just because.

            And that's just with pharmacies and prescriptions.  The rest of the system is easily as inscrutable.

            "It puts the lotion on its skin, or it gets the GOP again." - The Democratic Party (quip courtesy of Nada Lemming and lotlizard)

            by Rick Aucoin on Sat Aug 31, 2013 at 10:33:19 PM PDT

            [ Parent ]

          •  The New York Times has been running (10+ / 0-)

            a series of articles on the high costs of health care.

            Then, too, there was Steven Brill's article in Time magazine on how health care costs are calculated.  

            The system is insane because the market will never be free as the consumer* is without knowledge not only of pricing decisions but the basic medical expertise on which to evaluate their own needs.

            *I hate using that word because the proper word is always "patient".

            "There's something wrong with a system where a handful of people have more than they'd ever need and the mass of the people have less than they always need." -- Rev. Joseph Lowery

            by caul on Sun Sep 01, 2013 at 12:30:21 AM PDT

            [ Parent ]

            •  We are called patients because (1+ / 0-)
              Recommended by:

              our medical system taxes our patience to the nth degree.

              It's difficult to be happy knowing so many suffer. We must unite.

              by War on Error on Sun Sep 01, 2013 at 07:24:26 AM PDT

              [ Parent ]

            •  I remember hearing recently (2+ / 0-)
              Recommended by:
              Rick Aucoin, caul

              about some guy who went to Belgium for a hip replacement.  He was told that here in the US the procedure and everything related to it would be about 130,000 dollars.  In Belgium, the whole thing, including the flight, was something like 13,000.

              He asked them to break down the costs for him.  Asked about how much the surgery cost, and I think they said it was like 10,000 or so.  Then he asked how much the operating room cost, and they were baffled.  After all, how can you have a surgery without an operating room?  Why would they charge for that?

          •  They can't give you quotes because... (0+ / 0-)

            ...they don't know how your specific medical issue will's not that they really don't care its because they really don't know.

            Our nations quality of life is based on the rightousness of its people.

            by kalihikane on Sun Sep 01, 2013 at 09:15:50 AM PDT

            [ Parent ]

        •  True Story (2+ / 0-)
          Recommended by:
          Kevskos, Rick Aucoin

          Something really heavy fell on my foot.  It looked like a balloon almost instantly.

          Being uninsured, I called the nearest hospital to see what it would cost if I came in through the ER.

          The quote:

          $1,200 JUST to be admitted PLUS the cost of X-ray.

          I said I would be paying cash, any discounts?


          I then asked if there was another way to reduce costs.

          YES, go to your Doctor and get him to prescribe a visit to the hospital's X-ray department.

          How much, I asked

          $250 for ER visit and the X-ray

          I asked if I could get a discount for paying cash.

          YES, 50%

          So the visit to the ER Plus the X-ray ended up costing me $125, plus the $45 for the 5 minute Doctors visit to get the note from him to the ER.

          BUT WAIT.  About 30 days later I got a bill from an X-ray company in Indiania for $25.

          I called the hospital to ask What is this bill for?

          Answer:  Oh, we don't have a radiologist to read the X-rays so we outsource to the Indiana company.

          So, in the end the ER visit and X-ray, if I hadn't called and asked a bunch of questions would have cost me

          $1,200 ER + $250 X-ray + $25 for Radiologist read

          Total $1,475

          Actual out-of-pocket equaled

          $45 + $125 + $25 = $195


          And, I wonder that if, even with the Doctor's note, what would the hospital bill an insurance company.

          This one example of the disparity of charges speaks volumes of what is wrong with the cost of health care, imo.

          Competition my ars.  The present system is more like

          Get as much money as you can!

          It's difficult to be happy knowing so many suffer. We must unite.

          by War on Error on Sun Sep 01, 2013 at 07:23:27 AM PDT

          [ Parent ]

        •  Another true story (3+ / 0-)

          I finally qualified for that "Welcome to Medicare" checkup.

          I called the Doctor to see what that might cost me.  I know, I'm either dimwitted or cynical.

          The Doctors office said "We don't do the billing, call this number"

          I called "this number" and they told me they couldn't quote me either.

          So I went for the appoint.

          I was told I had to pay $147 deductible, $99 due on the spot the rest to be billed.

          I got the bill for the balance and paid it knowing that not do so could result in hours of phone calls trying to UNDO being turned over to a hateful collection company.  

          Medicare is very organized when it comes to having specific numbers for specific services.

          There was an ID number for the service.  I finally had something I could research.  This is what I found.

          TRUE STORY.  The Doctors office billed Medicare for "Out Patient, follow up visit" as if I had been released from the hospital.  I had not ever been in the hospital.  In addition, Medicare was billed for two blood tests taken BY BOTH THE DOCTOR ($8) AND THE HOSPITAL ($45) BILLED AS, and I paraphrase: "TAKING THE BLOOD SAMPLE"

          Out right fraud and I am out-of-pocket for $147 which I have no idea how to recoup.

          I reported them to Medicare, found another Doctor and will have my FREE "Welcome to Medicare" check up next week which, btw, includes a FREE Electrocardiogram.  I will bring proof, a Medicare printout,  of this to the Doctors office so I get this service.

          Here's the kicker.  I didn't get any kind of real check up.  The fraudulent Doctor's office didn't have me dawn a hospital gown and THE DOCTOR DIDN'T EVEN TOUCH ME.  I had to ask him to listen to my heart before he bolted out the door after a 20 minute chat.

          Two weeks after I reported Doctor to Medicare, I got a phone call inviting me in for my Welcome to Medicare.  The shear gall!  

          And the "Welcome to Medicare" visit.  I found out from the New Doctor's office that this will be a half hour Doctors visit.  I haven't had a real check up in about 10 years as I am fortunately healthy but I am curious about a few nagging seemingly chronic symptoms.  I wonder what it will cost me to get a true health report after spending $100 a month for MedPartB, $147 deductible, and 20% co-pays?  Heck, an MRI costs over $1,500 in my area.  If I have one, will I also have to pay another $300+ co-pay?  Will anyone at the hospital be able to tell me what I will owe?

          Another example of what is wrong with Health Care in America.

          It's difficult to be happy knowing so many suffer. We must unite.

          by War on Error on Sun Sep 01, 2013 at 07:42:33 AM PDT

          [ Parent ]

        •  i think this misrepresents the argument (0+ / 0-)

          The competition is not intended to come from patients directly. It would instead come from insurance companies. The insurers would negotiate with providers. End consumers would choose insurers using price as a guide. So insurers most successful at negotiating prices would be able to offer the lowest prices.

          •  So how in the world (1+ / 0-)
            Recommended by:
            Rick Aucoin

            does Obamacare threaten this system?

            It seems that by regulating how much insurance companies can profit, and by providing exchanges, Obamacare is actually making it easier for consumers to make intelligent and informed choices in picking insurance providers.

            If  a Republican wants to make the argument that it's insurance companies he wants the competition from, then he is not arguing against Obamacare--he is arguing for Obamacare.

            That's why I'm saying--they've got nothing.

            Just because the government keeps a record of real property transfers, it doesn't mean that the government wants to confiscate your home.

            by NCJan on Sun Sep 01, 2013 at 08:13:42 AM PDT

            [ Parent ]

            •  im not sure what the response would be (0+ / 0-)

              I find it difficult to entirely understand the republican opposition to a republican designed plan.

              We better be careful with that regulated profit thing. It gives incentives for insurers to increase their costs.

            •  on second thought (0+ / 0-)

              A hole in the aca is that it does not create system-wide competition. The system still encourages employer provided insurance. The bulk of end consumers will still not be adding competitveness to the insurance market unless it is indirect via their employer.

              •  Employer provided insurance (0+ / 0-)

                I imagine that having employer provided insurance increases competition and lowers prices.

                People getting together and buying things as groups always does this.

                For example, I never had to worry about having a pre-existing condition as long as I was covered by an employer.

                It may not be that the employee him or herself chooses the insurance company, but frankly I was always happy to trust that my employer would come up with a better deal than I could.

                Just because the government keeps a record of real property transfers, it doesn't mean that the government wants to confiscate your home.

                by NCJan on Sun Sep 01, 2013 at 01:35:14 PM PDT

                [ Parent ]

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