Why the health care problem will never be solved

[ouch]

This is not an invitation for debate as to how we should handle this confounding problem, nor am I looking for opinions regarding root causes or who to blame. It's just a simple story that reflects just how deep the problems go. So if you can't restrain yourself from enlightening us with a detailed explanation as to how this is all George Bush's fault, or how the Democratics are a bunch of commie pinkos, nota bene: you better make it a good one, worthy of it being your last post on the barber shop.

At the end of January, I was involved in a car accident and was taken to Beekman Downtown Hospital in Manhattan. My wife and daughter came to collect me, and when my then 11 year took one look at me, she fainted (I know- this isn't the first time I've had to contend with such behavior from the ladies).

My wife screamed for someone to help her. A few nurses lifted her onto a stretcher that was outside my room, and she was in full view for the entire time. They said that they had to admit her before they could treat her. They took her blood pressure and temperature, and pricked her finger for a blood sugar test while simultaneously filling out the paperwork. They handed her a glass of orange juice, and I shouted to her, "You better sip that drink slowly, sweetheart, because it's going to cost around 100 bucks." Everyone laughed.

My company provides me with pretty good medical benefits, so I wasn't worried. Here is what happened, and you can't make this stuff up. The hospital rendered a bill for roughly $350 for treating her. Who cares? I was only responsible for a $50 copay, so it doesn't matter to me what the charges were. Then my wife noticed that my insurance paid the hospital $850. For those still paying attention, that's $500 more than they asked for. My very detail oriented wife contacted the insurance provider to advise them of the overpayment, because even though it wasn't coming out of my pocket (directly), the very thought of it was anathema to us. We were told-- get this-- that according to their policy, they were contractually obligated to pay a minimum of $850 to the hosptial irrespective of the details of the admission. I told them they had a lot of damned nerve charging me a $50 copay when they were so perfectly willing to throw away half a grand.

This health care mess is so deep, I don't see how we will ever dig our way out of it.

Again, tolerance level for political diatribes for this thread is zero.

 

[philipfromga]

Another anecdote along the same lines. My wife has to take a specific medicine that our insurance will only pay for 30 pills every 28 days. Well her doctor wants her to take 2 pills a day so we have been paying about $150 bucks a month out of pocket for the difference. We appealled the decision and were told she could have the other similar medicine as much as she needed. 30 pills of the similar medicine cost $358 bucks. We argued and argue but to no avail. The doctor disagrees with the insurance company on the compatibility of the medicine by the way. How can the insurance company justify offering to pay $358 bucks more a month instead of paying for $150 for 30 pills of the current medicine. Its just comical how stupid the health care industry can be.

 

[jkh]

I have had similar experiences. It boggles the mind, really.

 

[strat1117]

Absolutely mind-boggling.

This story sounds like something out of the movie "Brazil."

 

[rabidpotatochip]

Ah, I'll risk it...

When I was in the hospital the running joke was that it was the most expensive hotel I'd ever stayed in; the cost was ~$1,000 per day and that was just for the room. From what I remember (n.b. I was heavily drugged at the time and this is the Canadian healthcare system I'm mentioning), there's a ridiculous amount of paperwork involved in admitting, treating and discharging a patient, moreso when you involve an insurance company. I agree that a minimum $850 charge is insane, though it makes me think I picked the wrong profession, but it's probably meant to offset the cost of handling small claims.

 

[richmondesi]

So my wife was pregnant and had a UTI. Knowing that this could lead to premature labor, and because she had Bracks and Hicks contractions, we took her to the emergency room. We get there at around 9, and they monitored her until mid afternoon. After giving her some medicine for the UTI and taking one vial of blood, they sent us home. Then a couple of months later, I get a call from a collection agency because I hadn't paid the $6k bill that I NEVER received. When I contacted the hospital, they refused attempts to settle for a reasonable amount (I was thinking even $1k would be something I would pay). Instead, they are never tried to itemize the charges in any way, they just stopped communication concerning the matter.

It was crazy

 

[Austin]

Ouch, unfortunately, that's how the system works. The insurance company pays according to DRG's (geekspeak for coding) and/or CPT's. The amount is negotiated between the hospital and the insurance company. The hospital makes money on some claims and they lose money on others. Go figure.

 

[bigmo]

My wife just recently had some medical issue, so given her past the doctors ran several thousand dollars worth of test, after all the test were done, they should nothing she was perfectly healthy. Which didn't help explain why she was having issues. So after some trail and error on her part she figured the problem out on herself. So when she went back to the doctor to see if he could help her pin point the specific food alergy she was informed, you'll just have to figure that out by trial and error, we don't have a test for that. None the less several thousand dollars worth of medical bills and they can still only tell her that she is healthy, which is good, but not exactly what the problem is.

The medical system ten years ago put my wife though a real ride that lasted more then two years and included only doom and gloom for her and after several doctors and medical bills that I know entered into the hundreds of thousands of dollars, she was told there was nothing wrong she was healthy.

 

[Brodirt]

I have vasovagal syncope, its a nerve disorder that causes fainting...my trigger is, combined with my already very low natural blood pressure, having my blood drawn.

I have to advise all of my doctors of the situation whenever I am going to have any injection.

A few years back I tore up my thumb ligaments while skiing and was having a diagnosis at a hand specialist. The office was like an airport hub with the reception and nurses station in the middle and offices around the outside.

I signed in and was shortly dispatched to one of the exam rooms where I was administered a local anesthetic directly into my thumb with the very smallest of needles you could imagine. I had advised the Doc of my propensity to pass out so he gave me an OJ and sat with me for 5 or 6 minutes to see. Nothing happened.

Next I had to go around the hub to the X-ray room. On my way a nurse stopped me at reception to fill out some form I had missed. Well...apparently I was upright for too long because my blood pressure crashed and I fell out right there in front of about 15 people waiting to be seen.

The funniest thing is that whenever this happens I come to laughing because I find it so ridiculously funny. Every time this happens it makes the Docs think I am out of it and they try to treat me.

Same thing happened this time, but I stopped them. I told them I was fine. They escorted me to the X-ray room and within 30 minutes I was done and on my way.

I got no bill...just a statement from the insurance co. for some charge for the treatment given to me in the reception area for passing out. It was uncalled for but not as bad as the OP. I called my insurer to discuss and I was told that since it happened at reception it was an additional incident and that I was not covered under the referal given for my hand injury. If it had happened in either of the exam rooms I would have been covered!

I explained to them my disorder and that the passing out was a direct result of having been given the injection in the exam room and not some isolated incident. They said they would investigate. I found out later that they called my primary care Doc for my records and then forwarded them to a neurologist for confirmation and then onto their coverage/claims dept. to analyze whether or not vasovagal syncope is a covered condition and if it was or was not a pre-existing exception. After deciding that I was covered they then did an incident investigation at the hand specialists office to determine if I told them the truth of what went on.

My primary care Doc told me when it was over and they decided to cover that the total cost of the claim investigation was probably 3-5x the cost of the care provided to me! He also claimed that this was part of the system as to how the insurers pad their costs.

 

[Abagadro]

Ouch, unfortunately, that's how the system works. The insurance company pays according to DRG's (geekspeak for coding) and/or CPT's. The amount is negotiated between the hospital and the insurance company. The hospital makes money on some claims and they lose money on others. Go figure.

It's an application of the central limit theorem to avoid having to code for each individual case. Over a normal distribution of cases they have likely determined that $850 to be the average and just pay that on all cases.

 

[Austin]

It's an application of the central limit theorem to avoid having to code for each individual case. Over a normal distribution of cases they have likely determined that $850 to be the average and just pay that on all cases.

I don't know what you said but it sounds cool!

 

[Basset]

Is it so impossible? Every country in Europe has national health care, as does Canada. It's only a matter of political will, I'd think.

Harry Truman had proposed national health care, but the idea ran aground when Southern Democrats, who ran the involved Congressional committees, opposed the idea out of concern that it would ultimately lead to racially integrated hospitals.

 

[rabidpotatochip]

I don't know what you said but it sounds cool!

+1. I nominate him for the title of "He who knows stuff"!

 

[Trench]

My boss's mother was fighting a losing battle with cancer a couple of years ago. She was on a regiment of different drugs. At one point either the hospital or the insurance company made a clerical error and my boss received a bill for one of the drugs instead of the insurance company. The cost for a one month supply of that particular drug was $12,000!

I can't imagine any drug, even with R&D costs figured in, could cost anywhere near $12,000 to produce for a one month supply. That is beyond insane and I'm sure is only one of myriad reasons why the cost of health care is so ridiculously high.

 

[Doc4]

... My wife and daughter came to collect me, and when my then 11 year took one look at me, she fainted (I know- this isn't the first time I've had to contend with such behavior from the ladies).

...

Ah yes, Ouch has a long an Pied-piper-of-hamelin-esque history of making children faint, cry, run away &c. wherever he goes.

 

[Scotto]

I'd like to get to a state where people appreciate what everything costs so they can make rational decisions about healthcare like they do about other decisions in their life. How come I can get on the web and in about 2 seconds find out what a car costs with the particular options I want, who the most reputable dealer in the area is, and various options for purchase? Ever try to find out what something costs in healthcare, like having a child or getting a test done? Nigh impossible. As long as we keep pretending like we aren't paying for things, we'll never get anywhere. I don't know what the right solution is, but transparency goes a long way in at least starting the dialogue.

 

[Obsessed]

I have not read this entire thread, but I want to offer one completely serious piece of advice based on personal experience:

If you are ill or injured in downtown Manhattan, and you or anyone with you has any choice in the matter, DO NOT UNDER ANY CIRCUMSTANCES GO TO NEW YORK DOWNTOWN (F/K/A BEEKMAN) HOSPITAL.

Seriously. Don't.

 

[mmack66]

I have not read this entire thread, but I want to offer one completely serious piece of advice based on personal experience:

If you are ill or injured in downtown Manhattan, and you or anyone with you has any choice in the matter, DO NOT UNDER ANY CIRCUMSTANCES GO TO NEW YORK DOWNTOWN (F/K/A BEEKMAN) HOSPITAL.

Seriously. Don't.

 

[ouch]

I have vasovagal syncope, its a nerve disorder that causes fainting....

That's exactly what I was diagnosed with as the cause of the accident. I think it's the scientific term for "we really don't know what it is". I hope you have better luck with it than I did on that day.

 

[pablo_h]

The health industry needs an attitude adjustment. Right now it's up there with the banking industry.
For some reason, certian industries don't care what they get charged or charged out, because someone else out there will pay the bill. They're in La La land because everything seems to be working out as it is.

For example, I run my own business, my business account gets charged if I drive past a bank, fees and charges for everything. They don't care, and they know that I don't care TOO much, as it's a business account, it's all tax deductable. But that's the only reason why they are getting away with it. But in the end, someone has to foot the bill, so they are stealing money from someone.
It's similar in my industry, and other trade type industries where most people add a bit if a job is an insurance claim and they get away with it. Victimless crime right? Well someone has to pay for it. Normally the tax payer or the people paying the premiums.

But make too big a deal of it, and premiums and/or fees will go up before payouts go down, it's al a club and they all love the money being thrown about too much.