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Only in America

16 Jan 2007 07:12 pm

A while back, it became clear that one or more squirrels had found a way to gain access to the walls of our house as a means of taking refuge from the cold. Obviously, we had a problem. So we called the management company who sent a guy over to seal up the relevant hole. Only problem: He left a squirrel trapped inside. Thus, it was only a matter of time until Catherine came home to find the squirrel in her room. She fled out of the room, down the stairs, screaming which prompted Wreck to bite her in the leg. The squirrel was dispatched, Catherine took some time to blog, and then she and Kriston went to the emergency room to get the leg checked out. And we all lived happily ever after.

Except! Right before leaving for the hospital Catherine recalled that she hadn't been working at her new job long enough to have health insurance. No problem, said Spencer, it's an emergency room, you don't need to pay. I said I thought that was wrong, you can get emergency service for free if you're indigent, the merely uninsured need to pay. But wait, says Catherine, she thinks the student insurance she had from when she was in the Northwestern Journalism School is still in effect. So she goes upstairs to get the insurance card while Kriston and I have a sidebar discussion about whether or not you need to worry about in-network/out-of-network distinctions when it comes to emergency care. We decide that would be too evil even for insurance companies, and he can probably just take her to whichever emergency room happens to be closest by.

I'm not sure how economists quantify it, but it's this stuff that's surely the craziest thing about the American health care system. I recall during my brief spell as a summer camp counselor standing in front of a counter at the emergency room of a hospital in Augusta, Maine. My head was bleeding and I needed some staples put in so it would stop bleeding. But before I could get that done, I needed to fill out some insurance forms. Unfortunately, I needed my left hand not only to hold the form in place, but also to hold the towel down onto my head so as to prevent blood from dripping into my eyes or onto the paper. Eventually, I settled upon on awkward posture where my left elbow held the paper in place while my left hand held the towel. Consequently, my writing was even less legible than usual, some blood got on the form, and the whole thing took a remarkably long time considering that the doctor wasn't actually busy treaty any other patients at the time.

I always wonder what happens if something really bad happens. What if Catherine's unconscious and not around to remember that her insurance card is somewhere in her bedroom? Would the Augusta people still have made me fill out the form if my whole left arm had been chopped off?

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Comments (63)

Re: The squirrel was dispatched, Catherine took some time to blog, and then she and Kriston went to the emergency room to get the leg checked out. And we all lived happily ever after.

Assuming she was not bleeding profusely, why go to an emergency room? This sounds like something that could be handled by a normal doctor's visit, or an urgent care clinic. In fact, if the bite was not serious, and you were certain that the dog (this was a dog bite?) was up to date on its shots, I don't think you even need medical attention as simple first aid (clean out the wound VERY thoroughly with alcohol or H2O2 and bandage) should suffice. The overuse of emergency rooms for non-emergency situations IS a problem with our healthcare system.

Assuming she was not bleeding profusely, why go to an emergency room? This sounds like something that could be handled by a normal doctor's visit, or an urgent care clinic.

"Urgent care clinic" rather than emergency room sounds like a good idea except I don't know what one is or where to find one. Our feeling was that the bite was pretty deep and she probably needs some stitches. The only place listed on Yahoo Local under "urgent care" in DC closes at 5PM.

Regardless, the situation MY describes is an objectively ridiculous way to run a railroad. It's a perfect that relatively trifling illustration of why health care is not, and will never be, a "market" worthy of the term.

Urgent care clinics tend not be open late hours nor do they often even open on Sundays. And since Catherine may have been without real insurance anyway, an emergency room is likely the best choice because you don't have to worry about out or in network and there tends to be just a flat fee per visit.

I know that when I seek medical care I find the whole insurance system, copays, deductibles, networks, etc. to be extraordinarily confusing... and I'm a doctor.

You guys really are young, and fortunate. You will probably always have insurance as long as you work for someone else.

My mechanic for 20 years worked full time at KMart's Penske auto shop and full time for himself after hours and on weekends. Hardest working guy I ever met. His KMart folded so he went to work for WalMart, which of course wouldn't give him insurance right away.

In the interim he was diagnosed with metastatic cancer of the small intestine. He lost his job which was fortunate since that allowed him briefly to qualify for SSI, and hence Medicaid. So, his surgery was paid for. But then his RSDI disability checks started to come in so that disqualified him for SSI. So no Medicaid for the rest of his chemo which had just started. But the RSDI disability did start his two year wait for Medicare... not that he would live that long.

The last time I talked to him he was filling out paperwork trying to qualify for local and pharmaceutical charity plans to cover the rest of his chemo.

When talking about our healthcare system it is not nearly so simple as insurance or not.

And insurance companies/too evil... that is just rich.

The real American story only begins with litigation against the management company for the medical costs of treating Wreck's bite.

It seems to me there are four components in the economic value of lost time:

(1) The amount of time spent by patients thinking about this stuff & filling out paperwork T
(2) The amount of time & money spent by hospitals & insurers processing & analyzing this paperwork A
(3) The amount of money saved on health care expenditures by using information gleaned from paperwork S
(4) The economic value of applying the proper procedure using information gleaned from paperwork P

Then, the cost is T+A-S-P, which might be negative (and hence mean all of this stuff is a net win). The liberal argument is that T and A are the dominant terms in this equationl; that S is clost to zero because insurers are mostly just cost shifting, and that P isn't that big because other than at the VA we're not taking evidence-based medicine seriously, and that you could get just as much (or more) EBM benifits at lower cost (lower A values) by eliminating the multiplicity of insurers or otherwise using monopsony power.

Ladies and gentlemen: the Ivy league.

Would the Augusta people still have made me fill out the form if my whole left arm had been chopped off?

Depends. Are you left-handed?

Matry,

See what you do is miss the point . What ok. You are a neocon so I will esplane it to you. The problem is not with the inshurance company or with you're nonambidexterity. What the problem is is that hillary clinton is not president. I will repeat for the rest of the neocon's. What the problem is is that hillary clinton is not president. If you rememburr that what hillary Clinton promise is health care for all. That's rite. Every man, woman, and child is cover under hillary for president weater they have indigestion or not.

Merci for reeding my word's and Merci for you're voat for hillary clinton for president.

"Your husband only had a bad case of indigestion. For ambulance and emergency room services, please hand over the money your family has struggled 5 years to save."

The real American story only begins with litigation against the management company for the medical costs of treating Wreck's bite.

I too thought this post was going to be about the sweet, sweet settlement you garnered from the management company and negligent worker. Joint and several liability, baby.

Um, yes you do have to pay for an emergency room visit if you don't have insurance. They will treat regardless of whether you are insured. And there are not many "Urgent Care facilities" left (it seems it was a short-lived trend), so for most it is not an option.

And why scream about a squirrel? They're sort of cute and fuzzy and won't much hurt you. I know you don't want it in the room, but did the screaming really help?

hillary for president: "See what you do is miss the point . What ok. You are a neocon so I will esplane it to you."

I blame me for this post. Hillary was obviously emboldened by my vote for her; if I had not voted for her, she would not be running for President today, and we would not have this post.

Nice town you've got there. There are 24 hour urgent care places in this town, and it's not very large as cities go. (Has a Major League Baseball team and an NBA team, but no teams in the NFL or the NHL.)

And if you're not going to include a photo of Wreck with this post, I guess matthewyglesias.com has given up the eye-candy for good.

Interesting; my girlfriend has been having a similar squirrel problem. She returned home one day to find a squirrel in her kitchen, but with assistance managed to chase it back outside. Since then, she borrowed my cats, but as neither Starbuck nor Nelson is much of a match for a determined squirrel, contacted an exterminator to deal with the problem. At last count the exterminator had captured four squirrels and uncovered the existence of a racoon in the chimney. The racoon has not yet been apprehended...

I always wonder what happens if something really bad happens. What if Catherine's unconscious and not around to remember that her insurance card is somewhere in her bedroom?

They treat her and sort payment/insurance out afterwards, because letting someone die has different and much worse (malpractice) insurance implications.

BTW, as a D.C. resident dog, Wreck doesn't even get his "one free bite."

Not that you all are a litigious household or anything...

Having said that, I bet pre-emergency room blogging might mitigate any claim.

Twenty- and thirty-somethings need to be a little bit less casual about their insurance coverage. A couple of years ago, I was bitten one morning by my cat(not the cat's fault- just a misunderstanding much like Catherine and Wreck). The bite became seriously infected by the end of the workday. I went to the emergency room, had a three-day stay in the hospital with hand surgery. $10,000, but fortunately I was insured. Had I not been insured, they would have charged the un-negotiated rate of about $20,000. And this was for a one-time incident that didn't label me with a pre-existing condition that bars all future coverage. Any medical situtation has the potential to seriously damage your finances.

Milwaukee doesn't really deserve the baseball team...
Why does everything cost twice as much for uninsured people? I know that insurance companies can negotiate using their large customer base (give us a discount or we don't send people to your hospital / cover your drug), but doesn't the fact that uninsured people have high rates of nonpayment mean that they don't get anywhere near what they charge at full price?

Re: "Urgent care clinic" rather than emergency room sounds like a good idea except I don't know what one is or where to find one.

OK, I did note that the severity of the bite was (and should be) the deciding factor. Your post did not make it explicit how bad it was. I've had minor dog bites and cat scratches myself that I simply cleaned out (very well--they are dangerous) and then bandaged. The only times I've been to an ER (for myself) was when I had pneumonia with a 104 fever (and was almost not breathing) and when I woke up screaming at 4am with two badly abraided corneas after a mishap whose severity I did not realize. (On the latter occasion I wasn't even hassled with paperwork upfront or asked to wait; the triage nurse sent me right back to a cubicle and a doctor attended me within minutes, bringing a local anesthetic for my eyes which gave me the greatest and most blessed relief I have ever known.)

On the issue of costs though I disagree with posters suggesting the ER is best for uninsured patients. By no means! A doctor's office (assuming no diagnostic tests or outpatient surgeries) will charge under $100 for a simple visit, while an ER visit, even for the simplest matters, will easily run into the hundreds of dollars. And yes, you do have to pay-- or else you will have collection agencies on your tail. The idea that the uninsured get "free" treatment at ERs is nonsense, and nonsense on stilts. Bankruptcy court awaits those who think they can go uninsured and just duck into the ER when they need a doctor. (Note: this is NOT a jibe at Matt!)

Re: And there are not many "Urgent Care facilities" left (it seems it was a short-lived trend), so for most it is not an option.

Huh? They are quite common in most places I have lived, and have been since the early 90s at least. Usually they are subsidiaries of either large hospitals or even of HMOs themselves.

Re: And this was for a one-time incident that didn't label me with a pre-existing condition that bars all future coverage.

Pre-existing conditions do not bar future coverage (as long as you have not been uncovered for more than 62 days). They may result in exorbitant premiums but you cannot be turned down outright. (And if you are getting coverage through an employer you will pay group rates anyway and your previous health history will not matter, at least not as far as your out of pocket goes).

innumerable blood tests: $650

IV drip: $500

charging your drug overdose to your student insurance who also happen to be the biggest a-holes in the business: priceless

You most certainly can be barred outright for preexisting conditions -- I have been -- unless you mean "as long as the gap hasn't been 62 days," in which case I'm just not reading right.

Previous health history also does matter: I qualify for my fiance's insurance once we marry, but with a one year exclusion period due to my preexisting condition. They don't deny me outright (for once), but we do pay my premium while at the same time receiving no coverage for me.

"Evil" is too generous a word for these companies, imho.

Back in your old stride Matt. Well done.
--ml

I don't know about amputations, but I had to fill out a shitload of paperwork when right-handed me broke my right arm.

Oh, and it took eight hours to get someone in that @#$%ing emergency room to x-ray my @#$%-ing arm.

I broke my right arm very badly as a youth. They do not expect pre-teens with bones jutting out of their arms to fill out paperwork. But they then proceed to provide you with relatively crumy treatment. They decided my bone was sufficiently well set at 50% alignment. If not for a later surgery (paid for from insurance), I would be crippled today.

America is so efficient!

What's up with the expectation that NO ONE should ever go to an emergency ward unless the have a gunshot wound? Ok, yeah, ER is expensive. But really, everybody acts like it's irresponsible or wasteful to actually get care when you need it.

Well, Chris, my last trip to the ER was when I walked into a tree while reading Thucydides. I had seven stitches and a concussion, so I guess I belonged there. But I have to say the place seemed to be overrun by people who there shopping around for a doctor with a personality they liked for pretty routine stuff.

The real outrage we currently face is the so-called urgent care unit. Abandonate ogni speranza....

Yes, as mentioned previously, an ER will treat you, but they will also bill you. If you're uninsured and can't pay, it gets turned over to a collection agency. There may be some means by which the truly destitute can prove their destituteness and get the debt forgiven, I'm not sure. But most people are going to have their credit ruined.

As to out of network, my parents had an HMO, and my mom had a problem with a nosebleed that wouldn't stop, and she was losing a lot more blood than from a normal nosebleed. My dad called the HMO contact to see if he could take her to the nearby out-of-network ER instead of the in-network one an hour away, and they told him they couldn't tell him definitively if it would be covered. Basically, the contact said they would review the case. If they determined it was truly a medical emergency, they'd pay the bill. If they felt that it wasn't serious enough to warrant rushing to an out-of-network ER, then they'd deny the claim. There was no way my parents could know if they were covered when they had to make the decision. They decided to drive the extra 30 minutes to the in-network ER. (Thankfully, they got it stopped and later operated to correct a problem with her nasal passage.)

These are rather ridiculous decisions for people in emergency situations to have to make.

It's the fucking clipboards that, from my expat perspective, symbolise everything that's rotten about American healthcare. No matter where you go, you'll get thrust the fucking clipboard and pen to fill out the relevant details. I can't think about health insurance without getting angry at its inefficiency and inequality and its veneered plywood approach to care.

Insurance companies are scum, and I honestly believe that there'd be popular support for their being put out of business. I would laugh at the fate of those overpaid CEOs, and I frankly wouldn't cry to see thousands of billing pen-pushers and data entry types lose their jobs. Stuff the medical workers' mouths with gold to do it.

On Christmas day, my mom slipped and hit her head on the floor. She wasn't bleeding, nor did she pass out, but she was screaming in pain, so we figured we should take her to the ER, just in case. She didn't even argue, which indicated how bad she felt.

When we got to the ER, I explained her symptoms to the person at the front desk, gave her information, signed a release for her to be treated, and then she was taken back. It took about an hour to get a CT scan, and another hour before a doctor came by with the results (negative, thankfully), and by then she just had a very bad headache and they sent her home.

What was weird was that they didn't ask her to fill out any forms, didn't ask for insurance, nothing like that. I specifically asked if they needed anything more, and they said no. I'm sure she'll let me know if she gets a bill.

No problem, said Spencer, it's an emergency room, you don't need to pay. I said I thought that was wrong, you can get emergency service for free if you're indigent, the merely uninsured need to pay.
Haven't both of you written articles about healthcare in America? Yes, you have to pay for emergency room visits. The COBRA laws force any emergency room to accept and treat anyone who walks through the door. Since more than a few of the patients can not pay, the hospital raises prices for all procedures to cover the cost shortfall, which means that more people can not pay. This is a large escalator for hospital prices.

See? A counterinsurgency against the squirrels can succeed.

Well, I imagine if you had made a video of the Great Squirrel Hunt you could have paid for that ER visit. I know I would pay a dollar to see it.

She doesn't bother to have up to date insurance, and you go off on a riff about "the American health care system"? And if she didn't have car insurance, would you blame her problems on "the American car care system"?

ostap, she has the option not to have a car. She doesn't have the option not to have a body. And compared to the health care system, US auto insurance is amazingly cheap, simple and straightforward.

Yeah. Only in America. Whatevs. Look, there are plenty of problems with American health care - namely that third party payers obscure costs to consumers, who make bad choices, with the unintended effect of driving up costs.

The law in the U.S. is that you cannot be refused treatment at the Emergency Room. Now, if you do have your insurance card, great. If you don't, you still can't be refused treatment. You will not be billed or charged at the Emergency Room. They will send you a bill after the visit. If you have insurance, you send the bill to the Insurance company who then pays its part, with you paying the deductible or co-pay. If you don't have insurance, then you pay.

You may know quite a bit about foreign policy, but about health care policy you know shit.

"Yeah. Only in America. Whatevs. Look, there are plenty of problems with American health care - namely that third party payers obscure costs to consumers, who make bad choices, with the unintended effect of driving up costs."

Sure. That's the problem. It's not a problem that folks without insurance die when they have treatable problems, fucktard.

Squirrel in Wall Tangent

We had an addition on our house once which the former owners had first removed and then, in a panic, put back. So, there was a squirrel access point between the addition and the main building. And squirrels in the neighborhood took advantage of it. Enough to live in there and die in there. One summer, whew, the reek of dead squirrel in the downstairs bathroom was ferocious. Except we didn't know at the time what it was.

A couple of years later, we had water damage and decided to replace the drywall. The hammer claw went in at the top of the damaged drywall, and we stared pulling it down. About halfway through, several dessicated squirrel carcasses fell out from between the studs.

Bye. Gotta go.

Years ago my wife had a bike accident, went over the handlebars and broke her jaw. Fortunately some people came along and took her to a nearby hospital. As she's standing at the ER desk holding her face together with her hands and bleeding the intake person is saying, "Honey, you've got to tell me what your insurance is."

And it's EMTALA that covers Emergency Rooms not COBRA. They don't have to cure you if you walk in with cancer. Stabilize and release.

Now, if you do have your insurance card, great. If you don't, you still can't be refused treatment.

But that treatment extends as far as stabilization and no further. Yeah, whatevz, lam3r.

And ostap: does your apple pie contain a pound of oranges? I suspect so. Fuckwit.

"she has the option not to have a car. She doesn't have the option not to have a body"

So? If she has a car, she should insure it. If she has a body, she should insure it. It's not as though she can't afford it, or that she's not intelligent enough to deal with the complexities of health insurance. She just didn't bother. Boo, hoo, hoo.

Pseudo, I'm humbled by your wit.

And if you are getting coverage through an employer you will pay group rates anyway and your previous health history will not matter, at least not as far as your out of pocket goes).

Yeah, but a company with a lot of oldies or sickies on staff will pay a lot more to keep them insured, cutting benefits somewhere else if necessary or even dropping coverage altogether. One way or the other, it's getting taken out of your end, not the insurance company's.

3 years ago I had an angioplasty done. I was covered and thankful. But I saw that it cost over $20,000. I commented to the doctor while in the hospital that that was what my parents spent on their first house. And I asked him what if a person didn't have insurance or the money. Flatly he said, "we'd do it anyway"

I think essentially the problem has become that medical care isn't designed in this country to heal the sick, it's designed around insuring that The Blessed make money.

So, ostap, since you are the expert on Ms. A's finances and her options for coverage, could you direct her to that individual health insurance plan available in DC that she can afford until she's worked at her new job long enough to qualify for her group plan? Then again, most affordable basic health insurance plans for individuals are government-subsidized, so that might thrust her too deeply into the claws of socialism. But your main point still stands; the government should put massive funds into practical alternatives to car ownership.

And I asked him what if a person didn't have insurance or the money. Flatly he said, "we'd do it anyway"

Yes, and then take their house away, if need be, in order to claim what they're owed (got Yale-New Haven into some hot water for a while). Well, hey, if they couldn't afford the operation, what where they doing with shelter? Boo-hoo-hoo.

Re: I have been -- unless you mean "as long as the gap hasn't been 62 days," in which case I'm just not reading right.

Yes, that's what I said. If your coverage has not lapsed for longer than 62 days (and you were continually covered for, I think, the year previous to that), then you cannot be denied coverage. Exceptions exist when you are eligible for COBRA, for coverage under a spouse's policy, or for a public program like Medicaid. This was enacted in the HIPAA (Kennedy-Kassenbaum) law of 1996. Nothing however prevents insurers from raising the premiums sky-high to discourage people with pre-existing conditions (though generally the severity and nature of the condition is taken account of; something like mild asthma will lead to a higher premium but not an impossibly high one). Also, this usually only affects individual rates. Group rate coverage, as through an employer, is unaffected (but still governed by the 62 day guaranteed issue rule).

Re: I qualify for my fiance's insurance once we marry, but with a one year exclusion period due to my preexisting condition. They don't deny me outright (for once), but we do pay my premium while at the same time receiving no coverage for me.

I assume what they are excluding is your condition, not all coverage (in other words would pay for something unrelated to your condition).

Re: But really, everybody acts like it's irresponsible or wasteful to actually get care when you need it.

Emergency rooms are for EMERGENCIES. Anyone who uses them for routine care is not only saddling himself with an unnecessarily large bill, but is also compromising the care of people who may be in worse shape and really do need immediate attention.

Re: No matter where you go, you'll get thrust the f***** clipboard and pen to fill out the relevant details.

Um, you're going to need to give the provider info about yourself no matter what sort of healthcare system we have.

Re; One way or the other, it's getting taken out of your end, not the insurance company's.

Believe it or not insurance companies are not richer than Midas. Some in fact are on the ragged edge of bankruptcy themselves. They basically bet the farm that their income will exceed their payouts and business costs. If they bet wrong, the chapter 11 trustee is waiting at the end of the road for them.

Um, you're going to need to give the provider info about yourself no matter what sort of healthcare system we have.

Um, in many healthcare systems you don't need to repeatedly give providers the same info about yourself.

They basically bet the farm that their income will exceed their payouts and business costs. If they bet wrong, the chapter 11 trustee is waiting at the end of the road for them.

Or, long before that, they've merely passed the results of their wrong bets on to their customers via higher premiums, as with malpractice insurance providers. And unlike individuals that are bankrupted because they can't afford to pay for that angioplasty, corporations can emerge from Chapter 11 none the worse for wear. Also, I'm not really shedding many tears over how badly, e.g., UnitedHealth Group is doing, where $100+ million a year still wasn't enough for the CEO, and options were backdated to generate even more profit for executives. But yeah, Midas was richer.

"So, ostap, since you are the expert on Ms. A's finances and her options for coverage, could you direct her to that individual health insurance plan available in DC that she can afford until she's worked at her new job long enough to qualify for her group plan"

I wouldn't know her from Eve, but if she can afford Northwestern she can afford health insurance.

It's the fucking clipboards that, from my expat perspective, symbolise everything that's rotten about American healthcare. No matter where you go, you'll get thrust the fucking clipboard and pen to fill out the relevant details.

Trying being left-handed. Then you will really know anger over the clipboard: in addition to the gymnastics MY described, you have to find a place to put the clipboard since, otherwise, you can't fill out the top of the forms, i.e., your name.

A friend of mine is uninsurable because of a major industrial accident that left him damaged but wealthy. (A very long story.) He had a growth on his neck and was sent by his physician for an MRI. When he told the MRI clerk that he had no insurance he was quoted a price of $1300 for the MRI. When he said he was paying in cash the price was $325.

I wouldn't know her from Eve, but if she can afford Northwestern she can afford health insurance.

Touché. I had forgotten that Northwestern doesn't give out financial aid.

Still, it might help if you could come through with a specific recommendation for a DC-available individual health plan she could afford if she cut back on the Cabernet Sauvignon. I'd recommend one of the HMO plans I was on as a postdoc (currently only $855/month for individual coverage), but that's in upstate NY. I'm trying to find out if there's an equivalent of NY's Family Health Plus for DC, but (1) that has pretty low income limits that are probably exceeded by this young woman and her diamond car, and (2) it's socialist.

"Emergency rooms are for EMERGENCIES."

Emergency rooms are also the only place folks who are financially in bad shape WITHOUT HEALTH INSURANCE can get access to a doctor.

In my own version of socialized medicine, I have to admit that I have told patients to give a fake name and social to avoid all the money problems.

Insurance info aside, I hope Catherine is okay.

As for the rate difference between insurance fee schedules and what doctors charge to uninsured patients, my understanding is that there's a bit of a "nobody pays retail" mentality in health care. Insurers (including Medicaid) expect to pay physicians and specialists 25% - 50% of the nominal rate, so physicians make their nominal rates 2x - 4x what insurers will pay. It makes negotiating fee schedules easier for physicians, and maximizes incomes off of out of network patients. Maybe I'm totally off base on this, but that's my understanding as to why procedure costs for the uninsured are so much higher than they are for the insured.

Also: anyone have a good GP in DC?

Re; Um, in many healthcare systems you don't need to repeatedly give providers the same info about yourself.

I have never had to repeatedly give my doctor the same info. Usually I just make an appointment, show up, sign the appointment book and that's it.

Re: Emergency rooms are also the only place folks who are financially in bad shape WITHOUT HEALTH INSURANCE can get access to a doctor.

Bullshit. All they have to do is go to a doctor's office like the rest of us. One way or another they will end up with a bill they can't pay-- though a 60$ doctor bill might be a bit more manageable than a 300$ ER bill. And I have never yet met a physician who would throw a patient out the door.

Re: In my own version of socialized medicine, I have to admit that I have told patients to give a fake name and social to avoid all the money problems.

I hope you are not counselling people on how to commit identity theft. That's hardly fair to the innocent holder of those names and numbers.

so many misconceptions regarding managed health care. of course i'm coming to this from the mental health field where the disparity in coverage is criminal (because the depressed and the psychotic are unable to buck the system and so can be exploited ruthlessly to maintain the bottom line)

managed care companies 'allot' an amount of time for patient care in considering their reimbursement rates that is about half of what would be needed to do a minimally decent job of caring for a someone. this doesn't include the paperwork required to meet a minimal medical-legal standard, or to file for reimbursement of services or to pay support staff. also many insurance companies keep their 'in-network' provider lists deliberately short to force people to go out of network (and thus saving them money), or drive 40 or 50 miles to receive care (unless you're lucky enough to live in an major urban center), let alone wait 2-3 months to receive non-emergent care.

and yes, very few doctors will turn away a patient if they can at all help it, because despite all the stereotypes to the contrary, most people go into medicine because they care about people and want to make a contribution to society, otherwise they could take their smarts and energy into much more lucrative fields. but when you wind up carrying a patient load 2-3 times what you could reasonably manage because; a) very few people can afford to go without insurance and there are too few in-network providers, b) there are too many people who cannot get or afford semi-decent medical insurance, and similarly struggle to pay out of pocket, c) the economics of health care as it falls on the health care provider meaning that they have to see increasingly more people in less time, which in turn means they have to give the best care they can with increasingly hasty decisions so that the 'needs' of the insurance companies that teeter on the 'ragged edge of bankruptcy' (really now!) in turn results that the malpractice lawsuits go up along with malpractice insurance (i have a patient who is an ob-gyn who pays $110K a year in malpractice insurance!), and d) in the end and not the least by all means, these are people who have very real problems who need very real help. so i ask, is it really any more fair to ask the health care practitioner to carry the cost of your medical care? Granted i am no more (and probably less so) comfortable than the next person to engage in 'identity theft', but isn't the callous assumption that the doctor you see will not consider your ability to pay in providing services any less moral? Is there any other service industry that will extend service disregarding ability to pay? Does your auto mechanic fix your car without thought to reimbursement because you will lose your job if you can't manage to commute there?

Unfortunately very few people realize the disasterous state our health care system is teetering on, unless they are unfortunate to personally feel the bite themselves. I, myself as a health care provider, am unable to afford health care insurance and make less than my patients who are secretaries or auto mechanics (after my business expenses) despite many more years in education and many more hundreds of thousands in in educational debt.

myself, considering what i know of our healthcare system, am very much subscribing to the notion that when the line is stretched, that elective death is a much preferable option. I do, and don't, understand why the generations younger than myself are not in the street on this issue.

nevertheless, despite my somber and lecturing tone, am very, very much amused by the whole squirrel/Wreck escapade, having my own experiences with squirrels in the attic, raccoons in the laundry room, wood rats in the walls, 'possums in the sun room, foxes on the porch, chickens in bed (literally!) and feral cats in places I would have never imagined.

Who know about automatic system of compare health insurance quotes? May advice some site url? WBR LeoP

Well, how about that? The head Ditto head cant get some head without pharmaceutical assistance. He couldnt possibly have the stamina to engage in regular sexViagra or not. WBR LeoP

If group health insurance was more efficiently priced, and individuals paid premiums that truly reflected their unique risk of coverage... then I believe behaviors and attitudes towards obesity would begin to change. WBR LeoP

You have to blame the drug companies who tell doctors to dispense drug as if they were candy so that the drug company can make more money. WBR LeoP


Comments closed January 30, 2007.

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