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Shopping for the best deal .....

I am a healthcare professional, a RN for 33 years working in acute care and the insurance industry. In the past my family has had their share of medical issues.

   1. 1995 my 13 yr old son was hit by a Chevy Blazer while riding his bike sustaining a closed head trauma and bumper fracture just below his right knee. I can see how I needed to stop the lifeflight to shop around for the cheapest trauma center. That bill was over 48K in 1995 dollars

   2. 1995 (fun year) my 72 yr old father falls down the John Day river bank and has a compound fracture of his hip. He has four ambulance transports and a fixed wing transport to the nearest trauma hospital. Yep, stop everything .... we need the lowest bidder.

   3. My 17 yr old son wakes me up at 4 am with a severe belly ache, I call our PCP and was told to meet us at the ER. He is in OR in an hour with a ruptured appendix. So I am to call around to find the LOWEST bidder while my son dies of peritonitis?

Then again.....

4. My youngest son is at a party with his friends celebrating his 21st birthday. The dumb kid was jumping off a 4 ft garden shed into the pool except he missed, landing on the pool deck (concrete) on both of his heals and right elbow which is dislocated. At midnight on a friday night, we are to shop around for the best deal?

Do you want healthcare from the lowest bidder like some government vendor?

Think of it..... The concept of choice in healthcare is a facility that has a record of low infections, safety, high rate of experience in your type of issue with good outcomes. NONE of that is considered by the "SHOPPING" for healthcare.

The front page story on Adm. Joe Sestak daughter's care at a Washington DC hospital is the heart of this issue. When your family is in need of healthcare, choices are made on experience in that specific disorder, their track record, is that facility a institute of excellence, not the lowest bidder in an low bid auction.

What if???

Your 55 yr old spouse is having chest pain, short of breath and clutching their chest. Just tell them to hold on while you find the yellow pages and do your SHOPPING!

Your Granny suddenly has right sided weakenss and slurred speech, tell her to hold on because Pops needs to go SHOPPING!

Your daughter is 8 months pregnant and has a sudden onset of labor with profuse bleeding. She was told she has placenta previa (really serious) and you tell her to stop bleeding to death so that your son-in-law can go SHOPPING!

Your two year old has a temp of 103.4 and has been screaming for the last hour, tugging their right ear. Then the child starts having seizures but you tell the child to just wait because YOU have to go SHOPPING!

You live in a small town on the coast of Oregon with a small 50 bed hospital and the next nearest facility is 60-90 minutes away on a winding road through the coastal range. So what are your choices? You only have one game in town, do you think that facility will negotiate a "deal"?

This is why Health Savings Account ARE NOT THE ANSWER to the healthcare crisis

Originally posted to katymine on Wed Apr 05, 2006 at 11:41 PM PDT.

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Comment Preferences

  •  HSA is a fine vehicle for the (0+ / 0-)

    wealthy who are healthy.  

    For the rest of us, not so much.  

    You have to have money available to participate in HSAs.  If you're struggling as it is to cover living expenses, and fortunate enough to at least worry about plain-old savings for emergencies, saving for college, saving for retirement, HSA sounds pie-in-the-sky. In these days of stagnant or declining wages, rising gas, energy and food prices, HSA?  Sure, if I was working-wealthy, I would.

    But, the current Bushco propaganda campaign on human beings-as-heath-care-consumers is right up there with the Iraqi case for war: a product meant to fool us our of our own blood and treasure.

    If you are hit by a bus, you are not a health-care consumer, you are a bloodied, unconscious soul relying on the mercy of both the healthcare "system" and the EMTs, nurses, doctors, etc. who see vulnerable consumers patients.

    Healthcare consumer?  Do us all a favor: laugh out loud every time you hear it, and give examples, as you did, of the real-life vagaries that human beings are subject to.  

  •  Whoops - forgot to include the props you're (0+ / 0-)

    due.  Good diary - this is exactly how we need to fight the "healthcare consumer" propaganda.  

    Recommened - I hope this is on the rec list tomorrow - because even here I see diaries on healthcare that really disturb me.

    If you smoke, why should I subsidize health care for your bad habit?  If you're obese - same thing - you sit around on your fat ass eating McDonald's and I gotta pay for it?  

    Fools, fools. Insurance is a risk pool. Life insurance, property insurance, disability insurance, home, theft, professional liability - it's sharing the risk.  And, guess what: if you smoke, or if you are overweight, you PAY MORE (40-50%) already for insurance if you're not employed.  You may not even be covered.  At all.  Ha!  Take that, you of poor habits that drive my insurance up!  

    It's not funny- we have people thinking we ought to raise insurance for riskier beings who may very well be priced out of the market.  

    Beware what you wish for.  Got diabetes?  Got a family history of diabetes, cancer?  BIG RISK.  BIG BUCKS to cover you.  I don't want to pay your premiums!  

    •  Why insurance premims are so high... (2+ / 0-)
      Recommended by:
      2lucky, exNYinTX

      Insurance premiums are calculated using the risk of the group that is under review. The additional factor is Medicare & Medicaid do not pay 100% of the cost of hospitalization. The overage costs are shifted to the commercial insured which is called cost shifting.

      The first paradym of insurance risk is to have a large enough risk pool. If the whole US population is in the pool then the risk is spread across all health status.

      The next is that ALL Universal healthcare policies cover prevenative care. When the population is covered to STAY well, then costs go down across the whole population.

      If the Government is responsible for wellness, then wellness issues would be a federal issue. Cleaning up the food industry, making sure that drugs are safe, and when the population is well, all the costs of healthcare should go down.

      •  Premiums calculated using the risk of the group (0+ / 0-)

        under review is incentive for private insurers to exclude risk.  That's what they're doing via either doubled risk premiums, or non-coverage.  

        I wasn't aware of the cost-shifting on M&M.  Worth some thought.

        Private insurance premiums are also high due to administrative costs.  

        It's a mess.  

        While preventative care is key, most people worry about the catasrophic event or illness that could leave them without adequate care and bankrupt them.
        Which, in addition to the large risk pool of the population, is why I tend towards federal relief.  

        Because if it gets down to Kaiser, the medical monopoly, vs the feds,I'd feel safer with the feds.

      •  Insurance premiums are high because (0+ / 0-)

        we will pay anything to live.

        It is a sellers market by the simple laws of supply and demand. The rot of market based medicine runs in a circular pattern around supply and demand:

        • we will pay anything to live - huge demand
        • There are fewer and fewer providers - low supply
        • brand prejudice - reduces supply
        • no money no service - greater demand

        Not to mention the slow erosion of  subsidization by employers and the state.

        Premiums rise because we will pay anything to live. It never was a legitimate market. It is, literally, a captive, hostile, market and they are writing the rules.

        Lovely.

        Ignore the base, hide our values, and chase the swing voter and we not only lose, but we fall farther behind.

        by k9disc on Thu Apr 06, 2006 at 01:50:57 AM PDT

        [ Parent ]

  •  You Destroyed The HSA Myth That Shopping... (0+ / 0-)

    around by consumers will somehow lead to lower health costs. One other HSA sales myth is that somehow people are "overusing" health care. I could see a diary like this one where, for example, you could have told your 17 year old son to wait a few hours to see if his stomach pain persisted. We are in a world where early detection seems to be the best way to ensure that one survives cancer. We want to send the message that health care is "overused"?

  •  Market Based Medicine: Shopping for Life (0+ / 0-)

    Nice piece here.

    It really makes a statement as to just how stupid we all were when our elected officials started talking about shopping for providers. How could we have thought that a good idea?

    Do you really ever get a fair price when you shop? What's the markup in retail these days? The only time you get a break when shopping is when you buy something that nobody else wants or needs.

    Blunt Trauma the the head? There's a Bluelight Special going on in aisle five; if you hurry, you might make it.

    Market Based Medicine: Shopping for Life.

    Ignore the base, hide our values, and chase the swing voter and we not only lose, but we fall farther behind.

    by k9disc on Thu Apr 06, 2006 at 01:33:54 AM PDT

    •  Wait, wait... (1+ / 0-)
      Recommended by:
      exNYinTX

      You mean Mr. Bush is proposing that I can actually use my own money to pay for my medical costs? Wow! That is, like, so cool! And he'll even give me a little bitty tax break, too! I am so, so grateful!

      The man's a genius! Who would have ever come up with the idea of letting people pay for their own healthcare costs?

  •  Sick people don't want to shop! (0+ / 0-)

    They want to stay alive.

    Sick Americans are not consumers, they are people in need of help to live.

    How much different can those two concepts be?

    Shopping is a frivolous thing, buying things you don't need. If you can't afford something when shopping it's no big deal. You put away something in your SAVINGS ACCOUNT so you can buy it later. When you can't afford medical care you die.

    Can they be any different?

    Isn't it time we start to think about human beings instead of dollars?

    Ignore the base, hide our values, and chase the swing voter and we not only lose, but we fall farther behind.

    by k9disc on Thu Apr 06, 2006 at 01:42:06 AM PDT

  •  Claw backs and penalties are where they get you (0+ / 0-)

    Are these still the accounts where you lose the money at the end of the yaer if you don't get sick?

    I have never understood this because it seems like a total scam.

    Now all that you need is a real IRA (like the original IRA before that developed all the rules) which can also be spent on medical care. Contributions would be mandatory and there would be some incentive like this would escape the estate tax. The average person would have no trouble accumulating $50,000 for that inevitable big operation

  •  Let's be real (1+ / 0-)
    Recommended by:
    exNYinTX

    The median household income in America is about $45,000.  That means half the households in this country are below that figure.

    How much extra cash does a family making less than $45,000, perhaps much less, have to sock away each year for anything more expensive than a few co-pays?

    I can't imagine HSAs are even a relevant solution for the majority of Americans.  In fact, the campaign against them virtually writes itself because I just can't imagine most people being interested.

  •  HSA's are ludicrous (1+ / 0-)
    Recommended by:
    exNYinTX

    HSAs would be good for health care providers because that's who would be receiving more funds.  I'm not saying they don't deserve more funds.  And health insurers would no doubt immediately rate out the sickest and oldest of their insureds, citing the fact that those individuals could always start an HSA.  But HSAs are NOT the answer for the middle class.

    Check your Explanation of Benefits (if you have health insurance).  Example:  My office visit was $65.  I paid a $15 co pay.  My insurance paid $0.  My doctor "ate" $50.  My husband had outpatient surgery.  The bill was $1,150.  The insurance paid $372.  

    If we hadn't had insurance, we would have been responsible for the entire $65 and $1,150.  How can providers justify accepting such low reimbursements from insurers?  I just happen to work for a state insurance department, so I asked the actuary in charge of approving rates.  She said that providers accept less from insurers because they "know they will be paid".

    So why don't uninsured persons with good credit get the 67% discount?  Because they have no voice.  They don't make huge donations to politicians.

    HSAs would be disasters for the middle class.  How much is a simple appendectomy?  $6000?  $10000?  How long would it take to accrue that kind of money in an HSA?  Too long, my friend.

    What's that?  You want us to buy large deductible policies in case of a big loss?  Okay, so I must come up with funds to put in my HSA, and funds to purchase high deductible health insurance, and still have enough in the HSA to cover the deductible in case of a serious illness or accident.  Not going to happen.

    Then there's the tendency of poor people to put off health care they feel they can't afford, with the effect of making the health care more expensive when they are so sick they must seek care.

    HSAs would increase the payout from individuals exponentially, with a corresponding decrease in overall health from postponing needed care.

    On the other hand, the people that would eventually approve this plan are covered by an excellent plan in which they have almost no out of pocket expense.  So why not pass it?  It's not their skin in the game.

    Separation of Church and State...the FIRST amendment

    by dazed in pa on Thu Apr 06, 2006 at 06:05:47 AM PDT

  •  thank you for this diary (1+ / 0-)
    Recommended by:
    exNYinTX

    when my daughter was in a car accident, it was 2 hours before the hospital called.  apparently the emergency medical personnell were more concerned with cutting her out of the car and saving her life than finding her purse, so that i could google medical providers, and sort by cost.  needless to say, any savings i had as a working single mom was gone before i was even notified.  the auto policy was split between my child and another who died in the accident.

    blessings to your entire family.  i hope your son's closed head trauma wasnt too traumatic.  my daughter's head trauma was closed, but she needed a craniectomy anyway.  

    •  My son is fine (1+ / 0-)
      Recommended by:
      exNYinTX

      The 13 yr old car vs Blazer is also the pool jumper, he is in college now and other than being a "boy" he did survive. Sure scared the sh*t out of me, he had a flat affect, wanted to be in the dark and would not talk for weeks after the accident. Then one day.... I hear him laughing... at something on TV.... it was an old episode of I love Lucy.... knew that I was getting my kid back and did....

  •  HSA (1+ / 0-)
    Recommended by:
    exNYinTX

       is BushSpeak for "pay for it your own damn self".

    "Fascism should more appropriately be called Corporatism because it is a merger of state and corporate power" -Benito Mussolini

    by happy camper on Thu Apr 06, 2006 at 06:58:16 AM PDT

  •  Reasonable and Customary (0+ / 0-)

    You probably never heard of these words outside the healthcare field.

    They stem from the English common law.

    Medicine is unique in the fact that you can't let your injured child bleed to death.

    The urgent medical care provider should only be owed the lesser amount of either his actual charge or reasonable and customary amount.

    If emergency room doctors handling difficult cases are typically paid $350 an hour, that would be the reasonable and customary amount.

    If a day in intensive care is typically compensated at $4,200, that would be the reasonable and customary amount.

    It would be absurd to require a desperate parent with an unconditional duty to their child to have to pay an amount that is not reasonable.

    Physicians have filed suit against Blue Cross for not paying reasonable amounts:
    http://www.dmhc.ca.gov/...

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