So apparently Susan Cassidy at Progressive Libertarianism saw my entry in reply to her blog entry because she has now written a new entry.
She’s vaguely back-peddling now saying she wishes me well but completely missing the point that her statement was not only absurd but heartless. As such, her comments WERE idiotic. In a fantasy world, it shouldn’t cost so much for any medical treatment. I know that doctors and hospitals charge that much simply because they get so little back from the insurance company. The system is hopeless bloated and ineffective as a result. Um, duh. That’s not in dispute.
But what SHE doesn’t seem to understand is that wishing it were more reasonable is not the same as being faced with needing obscene amounts of money to get the treatments and surgery needed. And the bullshit idea of paying it in cash misses the reality of how utterly and completely impossible that actually is. (Not to mention, she’s opposed to government oversight and regulation of the healthcare industry, saying such presence has made things worse rather than better. Really? You think without any government regulation the insurance companies would simply STOP overcharging and STOP focusing on their profits out of the good of their hearts? Of course not! And that is a major failing of people who think we should let the corporations or “market” decide these things: they will ALWAYS decide in the name of their stock value and profit margins; NOT for the welfare of the people they insure.)
As a cash-paying patient, you have some wiggle room (with SOME providers) on discussing fees but NOWHERE NEAR the power of the insurance companies. On a $1,000 bill, the insurance company might immediately take off $900 in “negotiated rates” right off the top, then pay $35 and leave the person with a $65 co-pay portion. So the final total amount on the $1k might be only $100. As an individual however they will in no way, shape or form accept $100 on the $1,000 service. If you’re lucky, they’ll take $100-$200 off which still leaves an unreasonably large amount to pay out-of-pocket. Times that by a dozen or more separate providers for one stay in the ER and you have impossible medical bills that are the cause of 75,000 Americans each and every year.
I have long said I wish we got even MORE reform done. I would love a single-payer system. (And yes, RUN by the government like any other civilized country.) I don’t expect it to be free anymore than I expect my roads, schools or fire department to be free. I expect we ALL chip in via taxes to provide resources and structure that otherwise cannot be created by individuals. It’s the “United” part in our country’s name. But, knowing how hard of a fight it’s been even for the changes we got, I understand this is merely winning a battle, not victory in a war. But we’ll never get ANYWHERE if we don’t start making changes.
Ensuring coverage for the vast majority of our citizens is a start. Providing more consumer protections with health care is positive momentum. And allowing for expansion of programs to assist in those who otherwise fall out of qualifying range – such as myself! – is a long-overdue help to many in need. And all of this, and more, is part of the Affordable Care Act.
Many people opposed to it may want everything now, but the government does not now, nor never has worked that way. And holding your breath until you get your way doesn’t win you any accolades. And right here and right now the changes that HAVE been made do positively impact millions of “between the cracks” Americans.
I shared my story because too few people not directly involved in a health care crisis realize how bad it is out there without insurance or access to medical care. They think there are all these programs and safety nets and that you’ll just get the care you need regardless of your ability to pay. NONE OF THAT IS TRUE.
So while you can knock the ACA and the benefits it brings simply because it’s not all rainbows and kittens, the reality is, it’s a LOT for a LOT of Americans who need help now. Not imaginary, potential possibilities of an overhauled system in some vague future, but rights and protections and access to care like anyone else NOW.
And that is progress.
16 thoughts on “Follow-Up – Why You Can’t Afford to Get Sick In America”
What you don’t seem to understand is that you’re advocating STEALING from one group of people to give to another. I have compassion for the poor and sick, I am part of the poor and sick, and I still don’t think it’s anyone else’s responsibility to make sure that I have healthcare. That’s 100% my responsibility. Your story is sad but that doesn’t give you the right to demand other people take care of you. The problem with the ACA is that it forces people to participate. Force is a form of aggression and is always wrong (unless in self-defense).
What YOU don’t seem to understand is that right now, every single person without insurance is ALREADY being paid for by people who DO have it. People with insurance are paying more simply to cover the costs of those who are uninsured. By getting MORE people into the collective pool of insurance and reducing the number of people without insurance, the burdens are more EVENLY split.
Why is this so hard to understand? If there are 100 people and only 70 are paying for all 100, those 70 pay more. But, if 25 more people are able to get into the system and 95 people are paying for 100, everyone pays less.
NO ONE is asking for anything to be free. Just the same kind of access to the resources that only SOME are privileged to have now. It benefits EVERYONE.
You seem to not grasp that all of those people who don’t have the insurance to pay and are getting treatment anyway are simply written off by the hospitals as a tax credit. If they were not, every single hospital in the country would be bankrupt within a week.
I feel bad that you are incapable of understanding the actual economics behind this scenario. It is obvious that you not only have not read about it or studied it, but you are so blinded by your contempt for any ideology but your own that you miss the main point entirely.
Below is a list of frequently asked questions and answers about hospital bills, compiled by 60 Minutes producer Michael Rosenbaum.
How many Americans don’t have health insurance, and who are they?
About 46 million Americans don’t have health insurance, according to the latest figures from the U.S. Census Bureau. The number has grown steadily since 2000. According to the Kaiser Foundation, four out of five (81 percent) of the uninsured are in working families with at least one full-time wage-earner.
Don’t hospitals expect the uninsured not to pay and just write off their bills, anyhow?
Hospitals get certain accounting and public-relations benefits even when they don’t collect from the uninsured. For-profit hospitals get a tax write-off on uncollected debts. Non-profit hospitals (85 percent of U.S. hospitals are non-profit) cite their uncollected debts in fund-raising efforts and to the government in arguing for higher Medicare and Medicaid reimbursement payments.
What can happen to an uninsured patient if he or she can’t, or won’t, pay the bill?
Hospitals are required by federal regulations to make a good-faith effort to collect bills sent to all patients. At least until recently, many hospitals went to great lengths to do that. Hospitals, or collection agencies they retained, sued patients for uncollected bills, put liens on their houses or, in a few instances, had them thrown in jail. Collection agency actions can result in a ruined credit rating.
The American Hospitals Association contends that the most heavy-handed tactics are now the exception, rather than the rule. Some hospitals do, however, continue to refer cases to collection agencies.
One important study, published in March, 2005, has documented the financial impact medical bills have on Americans. Harvard professors Elizabeth Warren, David Himmelstein and Steffie Woolhandler, found that “medical problems contribute to about half of all (personal) bankruptcies” in this country.
What patients are charged a hospital’s full list-price?
Only the uninsured are billed the full sticker price, and the uninsured comprise only about 5 percent of a hospital’s patient-load. Most patients (95 percent) are covered by insurance, Medicare (for those over 65) or Medicaid (for the poor). The hospital price-lists, called “charge masters,” are irrelevant to these so-called third-party payers: Medicare pays a fixed rate for every procedure, based on Medicare’s cost estimates plus a small percentage. Medicaid pays slightly less. Insurance companies also negotiate fixed-price discounts.
Won’t hospitals go broke if they give discounts to the uninsured?
That’s highly unlikely, according to our research. The hospital industry made near-record $26.3 billion in profits in 2004 (the last year for which figures are available), according to the American Hospitals Association. As many as 25 percent of hospitals – particularly municipal hospitals which handle mostly the poor – lose money, the AHA claims. But other hospitals – both non-profit and for-profit hospitals – make handsome profits. According to the AHA, the average hospital’s profit margin is 5.2 percent, the highest in six years.
One state – Maryland – actually imposes price controls on hospitals, setting maximum prices they can charge above cost. As far as we can tell, these price controls have not forced any hospital in Maryland out of business.
By Michael Rosenbaum
Copyright 2009 CBS. All rights reserved.
I’m not even sure you read Susan’s post as most of your article here was making arguments against points which she did not bring up. Susan did not back pedal, she expressed a heartfelt sympathy toward your troubles, and acknowledged your point. She also stated that her own opinion was not changed, but did seem misunderstood. It is not “wishing” things were different but the knowledge that there are alternative routes of reform to what has been given (forced) to us.
I remain confused about much of this bill and its apparent opposition, being a from another country but looking to immigrate in the near future this still strikes me as strange. In my country the idea that access to basic food, clean water, shelter, education and healthcare is a simple human right is one that we take as obvious. As a nation we say that no child should go hungry because market forces make buying food too expensive, no one should be blocked from the opportunity to excel brcause despite having the intelligence they can’t afford the schooling and that no one should die simply because they cannot afford life saving surgery. As a nation we fall short, far too often, but we continue to strive for the ideal that we are stronger as a people when we work together to become better. It is is strange to me to visit, and look to immigrate to, a country that has such fierce pride in itself, that holds itself as the greatest, most free nation on the planet; whose citizens speak of patriotism to a nation and its ideals but don’t see their fellow citizens as a part of that, who apparently don’t believe that each and every citizen makes up that nation and that what weakens the individual weakens the country they claim to love. It is strange to see a people so caught up about how this “might” lessen them in some way than see the opportunity to improve their neighbors and on doing so strengthen the whole which is their nation.
I am glad you got the treatment you needed, and glader still to see the US moving to a more humane and civilized service of its citizens, but it saddens me to see how a country I hope to make my home treats the most helpless of its people and how resistant the people of this land resent and resist work towards a greater good for their fellows, and ultimately themselves
By “back-peddle” I mean in the first entry, she stated I could have simply paid out of pocket which is flatly untrue. In this second post, however, she says she understands why I had to go about it as I did and that it was clearly the only option.
Insurance companies will never look out for people’s well being at the expense of profit on their own. It takes regulation and government oversight to force that. The ACA is not perfect; I’ve never claimed it was. But it does have over 400 provisions within – most of which are consumer protection clauses that BENEFIT individuals. From ending discrimination against pre-exisiting conditions, to ensuring access to millions more Americans, refunds if insurance companies don’t spend at least 80% of their premiums towards your health care (ensuring doctors get paid MORE rather than the money going to insurance company’s “administrative” costs), and more. These are the kinds of things we ALL not only should want, but deserve.
It’s certainly a lot to understand, especially from an outside perspective to be sure! It’s hard enough for people within the US to understand and that’s why there’s so much confusion, misdirection and flat-out lies being told about it by those opposed to reform. At the end of the day though, the system is broken and this is a small step towards fixing some of the worst problems. To me, and to millions like me, that is a victory.
Miss M, I have two questions for you that come into my head every time I read about people without health care coverage. First, WHY don’t they have coverage? Out of all of the people I know, the ones who don’t have health care choose not to pay for it. They are mostly young people and rarely, if ever, go to the doctor. They choose not to spend their limited budget on health care, gambling that they won’t have a catastrophic event. My own son didn’t get health insurance until he was 30 and started thinking about getting married. He didn’t need it then, and has still not needed it since, but is choosing to pay for it anyway. The second question I always ask is why it seems that some entity besides the insurance industry is to blame for this mess. I am not a politician, an eloquent writer, or in the health care field in any way, so I may be way off base, but it seems to me that buying into the health insurance racket MORE is completely the wrong way to go. Shouldn’t we be limiting the influence insurance has in medical care? My insurance company has refused to pay for 3 drugs that I have used for years and that I need, despite the fact that my doctor says they are the best ones for me. I have had to accept lesser generics that don’t work as well. This is completely outside the proper role for insurance. My insurance company has never met me but they are making decisions about my care. Insurance is the problem, not the solution.
M, hon, I applaud you for allowing the confused people to post. It shows just what you are made of! I am proud of you.
I am so shocked at the level of ignorance that is still out there regarding healthcare. I am appalled that so many feel that healthcare is not a right. The USA is so far behind the rest of the first world on this issue. Keep up the fight Miss M, I am standing with you ALL the way!
First – I think it’s highly presumptuous that “most” people that lack health insurance do so because they chose not to have it. That’s just not the case. The reality is that many people who don’t have health insurance do not have it due to the cost. When an employer provides insurance, not only do you get a better rate on your policy due to it being a group policy, but the employer typically pays some or all of your premium costs. So reduced rate + subsidized cost = the vast majority of insurance for Americans. Being an individual, you don’t benefit from the group rate. You pay a much higher premium. Additionally, you pay the ENTIRE premium. If you’re working a job that doesn’t offer you health insurance, you likely are getting mediocre income, no benefits of any kind (i.e. no sick days, no paid vacation, etc.), and are going to be stuck in a situation where it’s not possible to pay several hundred dollars a month for a policy. Even worse, if you have ANY pre-existing condition – even something like migraines, or allergies or asthma or high blood pressure; it doesn’t have to be serious or major – they can either deny you completely or charge you even higher premiums. AND if you’re a woman, you’re likely to pay as much as 50% MORE than a man of similar age and health does for the exact same coverage! (Something the ACA puts a stop to.) Because you’re working, likely you make too much for assistance, but not enough to pay for a policy. So you’re stuck. Estimates are as high as 51 million Americans lack health insurance. Yes, some are college kids who aren’t working full time and thus don’t have insurance (but who now can stay on their parents’ policy until age 26) but many are just the “working poor.”
And second, until we completely overhaul the ENTIRE health care industry in America and move to some sort of single-payer/universal system, the best we can do is continue to create laws to benefit the consumer within the existing structure. The ACA is not perfect. I’ve openly said that countless times. But it does provide include over 400 provisions – many of which are aimed at consumer benefits and protection. (An end to discrimination, an end to lifetime limits, an end to dropping people when they get sick, an end to limitless profits, an end to premium increases without justification, an end to having no recourse in judgements and rulings by your health care company, etc.) For now, working within the system to make it better and more accessible to more people benefits more people.
Sadly, the country is not ready for so-called “socialized” health care. (Despite the fact we’re fine with “socialized” public schools and “socialized” highways, etc.) That would be the ultimate victory but, until we can get people to even agree to changes that benefit them, we’re not going to be able to radically change the system that much. Maybe – hopefully – some day we can.
I still contend that it is choice. I completely understand that some people – most even – have insurance that is at least partially subsidized by employers. However, my husband and I pay out of pocket for his insurance since he no longer has another option. We don’t have cable tv, we drive old cars which we maintain, we live in a fairly small house that we can afford and that we maintain by being frugal. A very large portion of our income goes to insurance. It’s a priority for us, and we don’t want other people to have to work to pay for our needs. We are capable of taking care of ourselves, and we choose to. If we needed more money to do so, we’d find a way to earn it. I’m sure there are some people who truly can’t afford any insurance, but I’m also pretty sure it’s far fewer than you would have us believe. Those who are really in need already qualify for Medicaid.
It’s great you have been able to manage. But you’re dead wrong on it being a choice. And even more wrong about Medicaid being an alternative. Fact is, only EIGHT STATES in the entire country will even offer Medicaid to childless adults. Period. EIGHT. The other 42 states it doesn’t matter what your health or income level, if you don’t have kids you are not eligible. Florida is one of the FORTY-TWO states that don’t offer ANY options to childless adults like myself which is why I was completely turned down for Medicaid.
THERE ARE NO SAFETY NETS. That’s what people need to understand. Without health care reform, not only are there not any programs for the vast majority of people, there are often times no options at all at any cost. (i.e. prior to the reform, insurance companies routinely denied people completely for having any form of pre-existing condition which could be something as “simple” as asthma or migraines. At best if they did accept you, they would exclude any treatment related to the condition and charge you more for the exclusion.)
I wish I could own a home. I don’t; I rent. I also drive a 1999 Pontiac Grand Am. Which is a major step up from my Grandmother’s 1990 Buick Century I was driving before this one. People always assume that those without health insurance are living some high roller lifestyle and that’s just a dirty tactic to put the blame on the poor rather than face the realities of how bad the system is for 51 million uninsured Americans.
What is your education level? What kind of job do you have? The reason Medicaid isn’t offered to adults without children is because they are capable of getting more education and a better job if they need to. If you are able-bodied, you should take care of yourself.
“If” and “should” are wonderful in theory. Lots of things “should” be a certain way but they’re not.
I’m only about a quarter of the way through reading the 200,000 page healthcare bill, but the reformation does much more than just force everyone to have health insurance. This is only what we hear about because it makes libertarians go bananas.
I’m one of those people who have a pre-existing condition as well. I’m perfectly healthy and never need doctor visits but when I ask for health insurance coverage, they look at my last surgery bill, their eyes go bug-eyed, and they either say “no way!” or they will but will take more than half of each paycheck.
I can agree that some insurance companies are not concerned with our best interests but under the new law they will have to compete much more with other insurance companies, and whenever companies compete the customers benefit(I think that’s one of the libertarian codes).
In direct response to Kim, if your insurance company is not giving you the quality you pay for, guess what, pretty soon you can shop around very easily and find someone who wants to keep you as a customer, and get you the good drugs. I know what it’s like to have to work with a terrible drug dealer that doesn’t know the difference between good drugs and bad drugs.
I think everyone can agree that healthcare reform is needed. A logical first step towards that in my mind is making sure everyone is covered, and the next step would be addressing the absurd over-inflated costs. Maybe my logic is flawed though, perhaps I need more education to see a better logical first step of healthcare reform.
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