Re: Stupid Medical Care

1

...five dollar bill on the sidewalk?

Feel better LB! It's only a week.


Posted by: mcmc | Link to this comment | 06-11-10 6:49 AM
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...keyboard eating monster?


Posted by: heebie-geebie | Link to this comment | 06-11-10 6:57 AM
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Did you die?


Posted by: Walt Someguy | Link to this comment | 06-11-10 6:58 AM
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Maybe the griping got her heart rate up, and she popped a stitch. You okay there, elbee?


Posted by: Jesus McQueen | Link to this comment | 06-11-10 6:58 AM
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... big fierce dinosaur just coming through the door.


Posted by: OFE | Link to this comment | 06-11-10 7:00 AM
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Death Panel!


Posted by: oudemia | Link to this comment | 06-11-10 7:00 AM
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oudemia wins!


Posted by: OFE | Link to this comment | 06-11-10 7:02 AM
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From my RSS reader, I recovered:

story in the Times on efforts to increase transparency in prices for medical care. It amazes me how nontransparent it is now -- checking in for surgery, I signed a bunch of forms saying

But it stops there. LB, what were you saying?


Posted by: md 20/400 | Link to this comment | 06-11-10 7:12 AM
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How insensitive can you be, md 20/400? LB has clearly died at her keyboard, and all you care about is finding out the end of the sentence.


Posted by: Walt Someguy | Link to this comment | 06-11-10 7:17 AM
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OMG somebody dial 911!


Posted by: alameida | Link to this comment | 06-11-10 7:20 AM
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The suspense is killing me.

In a related note, I'm finally reading through the 2015 thread (you people are insane), and it seems to be interesting. If I think of any noteworthy comments on it, well, until/unless LB finishes the post this seems to be where they will go.


Posted by: Cyrus | Link to this comment | 06-11-10 7:24 AM
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And I still didn't find the end. I guess she was in the throws of dying when she made the html error. But she couldn't get beyond "saying". Still, she generously left us a topic to talk about (or, as we are wont, not).


Posted by: md 20/400 | Link to this comment | 06-11-10 7:26 AM
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Can one of the front page posters put up a memorial post about LB? I want to grieve her passing more ostentatiously.


Posted by: Knecht Ruprecht | Link to this comment | 06-11-10 7:31 AM
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Even though she could not type more, in her dying moments she found the strength to click "post", so we would not be denied her final communications. LB loves us all. Ahhhh....


Posted by: W. Breeze | Link to this comment | 06-11-10 7:33 AM
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NMM to LB? Not that, you know, like I evahevahevah


Posted by: bob mcmanus | Link to this comment | 06-11-10 7:34 AM
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I can see the whole post with my SUPER POWERS!


Posted by: heebie-geebie | Link to this comment | 06-11-10 8:00 AM
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Man, she is brilliant. This is a game-changer, you guys.


Posted by: heebie-geebie | Link to this comment | 06-11-10 8:00 AM
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I don't want to edit the post in case this is performance art.


Posted by: heebie-geebie | Link to this comment | 06-11-10 8:02 AM
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18: Your edit could make it a collaborative performance.


Posted by: Mary Catherine | Link to this comment | 06-11-10 8:06 AM
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Aaugh! Enough with the third degree! It's up! It's up!


Posted by: heebie-geebie | Link to this comment | 06-11-10 8:08 AM
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Also, those papers say that you are totally screwed if your provider fails to send those forms in and your insurance company doesnt cover it bc the forms were sent in late.


Posted by: will | Link to this comment | 06-11-10 8:09 AM
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Ugh, tell me about it, LB. I just went to the stupid doctor for a checkup and a blood test. I paid a $10 copay at the doctor, and was led to believe it didn't matter what the rest of it was because I had insurance. Then I got a $400 bill from the doctor and an $800 bill from the lab. Once the finally figured out how to bill my insurance, the doctor said my "obligation" was $104. Fine. I pay it. Now I'm getting another bill for $94 from them. Nevermind that the lab never figured out its billing.

Anyway, this all happened back in November and I never ever want to go to the doctor again. Who could imagine it would cost anyone, even if I had insurance, $1200 to spend half an hour figuring out if I'm dying?


Posted by: A White Bear | Link to this comment | 06-11-10 8:12 AM
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One that drove me crazy is that I was not allowed to submit the paperwork to add Hawaiian Punch as a dependent until after she was born. And then you have a 3 week window.

Because it would completely break their computers to have paperwork submitted that the super pregnant patient was about to add a dependent. No possible way to factor in that kind of advance planning.


Posted by: heebie-geebie | Link to this comment | 06-11-10 8:15 AM
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11: Given that there was more heat than light on that thread, in large part because I was focused on one thing to the exclusion of all other considerations, including the fact that I was inadvertently offending a bunch of people, it might be better not to revive the thread. To the people I offended: I am sorry. I will try to be more careful in the future. If anyone wants to take it up with me let's do it in email.


Posted by: togolosh | Link to this comment | 06-11-10 8:17 AM
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Oooh, sorry about the worrisome post, and thank you heebie for fixing it (our home internet has gone all weird, so that was an iPhone post, making editing tricky. I sort of knew doing the link was pointless and increased the odds of screwing something up, but I did it anyway.)


Posted by: LizardBreath | Link to this comment | 06-11-10 8:21 AM
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Even though she could not type more, in her dying moments she found the strength to click "post", so we would not be denied her final communications

IT SEEMS A PITY BUT I DO NOT THINK I CAN WRITE MORE.


Posted by: HYPOTHERMIC R. SCOTT | Link to this comment | 06-11-10 8:21 AM
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FOR GOD'S SAKE LOOK AFTER OUR PEOPLE SOMEBODY SEX MUTOMBO.


Posted by: | Link to this comment | 06-11-10 8:22 AM
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I might have been able to get a price quote if I'd buttonholed one of the busy admins and asked, but it clearly wasn't an expected part of the process.

Chances are, you can't. You may have heard horror stories of people who went to an in-network hospital and ended up being responsible for $1,000's in unexpected costs because an out-of-network doctor happened to be working a shift in the hospital that day? Well that happened to me once. The next time I was in the ER with my child, I asked the attending doctor to verify that he accepted my insurance before allowing him to treat my child. He appeared very put out by the question, said he would check, left us waiting for another 45 minutes (at 2 in the morning), then returned to tell me he didn't know the answer and couldn't find out, so did I want him to look at my child or not.

I can't imagine another industry in which consumers have so little protection and recourse. It's like you're signing a carte blanche.

While I strongly take issue with the more spectacular claims made in favor of consumer-directed health care, I do believe that a mandate of price transparency is indispensible to getting health care costs under control.


Posted by: KR | Link to this comment | 06-11-10 8:35 AM
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This is going to be one of those threads where a bunch of UK commenters show up at some point and say "how the hell do you people live like this?", isn't it?


Posted by: essear | Link to this comment | 06-11-10 8:36 AM
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28: Yeah, that's sort of why I didn't ask -- I had initially confirmed that they take my insurance over the phone, and I couldn't picture a conversation about whether my insurance was going to cover exactly what they were doing giving me a satisfying answer.


Posted by: LizardBreath | Link to this comment | 06-11-10 8:40 AM
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Do you accept a Dutch substitute?

Girlfriend has been in hospital, with two ops and various expensive tests, for the past six months and is now at home with lots of equally expensive aftercare (nurses coming round twice a day and such). Not nice, but all it has cost us so far is 165 euros in "own risk" that's obligatory with her basic health insurance (state mandated and they can't kick you off nor refuse entrance), plus another 102 euros for some copayment which we should get back from the hospital as they accepted the blame for that part (long and more to the point, a private story).

Cost of insurance: roughly 100 euros a month. Feeling of not ever having to worry whether or not those horrendous hospital bills need to be paid by us: priceless.


Posted by: Martin Wisse | Link to this comment | 06-11-10 8:45 AM
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Is "transparency" really what we need here? The reason pricing isn't transparent is because the assumption that the patient doesn't ultimately bear the cost is baked deeply into the system, nevermind that that isn't really true, even for those with "good" insurance. If you have universal insurance, transparency doesn't really benefit the patient. If you have perfect transparency without universal insurance, then you'll just see more people forgoing preventative care and/or dying instead of going bankrupt.


Posted by: Yawnoc | Link to this comment | 06-11-10 8:46 AM
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Plus, the only way to achieve perfect transparency is single payer. Or to have uniform regulated co-pays for standard procedures (I don't think this is part of ACA, is it?).


Posted by: Yawnoc | Link to this comment | 06-11-10 8:49 AM
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If you have perfect transparency without universal insurance, then you'll just see more people forgoing preventative care and/or dying instead of going bankrupt.

Well, you have some potential, at least, for the sort of comparison shopping that conservatives drool about. The type of surgery I had on my basal cell carcinoma is called Mohs -- they take a slice, send it to the lab, look for clean margins, and if they don't get it call you back in (the same afternoon) and take another slice, until they've got it. I understood from the dermo that there's a simpler version (I guess they just take a bigger chunk to begin with? Dunno.) Possibly, if I had an easier way to do a price comparison, was responsible for the cost, and knew what the difference was in outcomes, I might go for the cheaper option. As it is, no chance at all.


Posted by: LizardBreath | Link to this comment | 06-11-10 8:52 AM
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Re: OP and 22, yeah, same deal for me. Three or four years ago I had a sebaceous cyst I removed. I don't think there was a preliminary appointment, although I can't remember with 100 percent certainty. But on the day of the surgery I walked in and pulled my collar down, and the doctor gave me some novacaine and started snipping. The whole thing from entering the doctor's office to leaving probably took about half an hour.

On the other hand, one year ago I had the same procedure done. Two cysts instead of one, but still. They had me change clothes and put me in a wheelchair to be wheeled down the hall from where I arrived to the surgery room, and had at least two nurses or something on hand during the surgery. I think the first appointment cost me more out of pocket just because my insurance was better one year ago than three years ago, but I honestly don't remember.

That's obviously not as serious a problem as blood tests and kids at the ER, but still, it's ridiculous. Good luck, you two.

24: Oh, OK, fine. I guess it's not like my input would have been all that enlightening.


Posted by: Cyrus | Link to this comment | 06-11-10 8:52 AM
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Right. Saying we need price transparency implies that we have an ability to shop around and select the best provider for our procedure, which is an absurd expectation.


Posted by: heebie-geebie | Link to this comment | 06-11-10 8:52 AM
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33 to 34.


Posted by: Yawnoc | Link to this comment | 06-11-10 8:54 AM
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Well, there's something awful about the position I and AWB and KR were in (and everyone insured is in pretty frequently) -- where you're almost completely sure you won't have to pay for something, but it's possible you might have to, and it's very hard to find out ahead of time what it costs. Pricing transparency would at the least alleviate that problem.


Posted by: LizardBreath | Link to this comment | 06-11-10 8:57 AM
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While I'm venting, the reporter gets one of the basic facts in the article badly, badly wrong:

A study published last month by Mercer, a human resources consulting firm, found that people on high-deductible health plans, with more exposure to the prices of doctor visits, spent less.... [T]he average expense in 2009 for patients on one of these plans was $6,393, compared with $8,570 for patients on a more traditional health maintenance organization plan.

First of all, that's not what the study found it all. It found that employers, not patients, spent less on high-deductible plans. Well, duh!

And even if patients ultimately pay less on average under a high deductible plan, that's exactly what you would expect, given that it is precisely the healthier people who don't expect high expenditures who self-select into these plans (though that is becoming less true all the time as more and more people are quasi-forced into consumer directed plans by the non-availability of affordable comprehensive coverage).


Posted by: Knecht Ruprecht | Link to this comment | 06-11-10 9:01 AM
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Holy shit, LB posted from beyond the grave, and it's about health insurance. I suggest instead haunting insurance company executives. Rattle some chains, tell them that all of the patients they killed are waiting for them on the other side.


Posted by: Walt Someguy | Link to this comment | 06-11-10 9:02 AM
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38: But a huge component of price opacity is uncertainty about what your insurance company will or won't pay for, which can't be encapsulated in a table of prices or even some fixed set of rules (as in 28).


Posted by: Yawnoc | Link to this comment | 06-11-10 9:03 AM
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If you have perfect transparency without universal insurance, then you'll just see more people forgoing preventative care and/or dying instead of going bankrupt.

How many people today foregoing necessary care because they have no idea what they'll end up owing before it's over? I'd bet a lot.


Posted by: Knecht Ruprecht | Link to this comment | 06-11-10 9:03 AM
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Saying we need price transparency implies that we have an ability to shop around and select the best provider for our procedure, which is an absurd expectation.

Mr. Alfred Marshall identified the fallacy in this argument a century ago. Price competition doesn't require every consumer to do the comparison shopping; just the buyers at the margin.


Posted by: Knecht Ruprecht | Link to this comment | 06-11-10 9:08 AM
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A century ago! I ought to be extra embarrassed.


Posted by: heebie-geebie | Link to this comment | 06-11-10 9:14 AM
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43: but even they don't have the ability to do so.


Posted by: ajay | Link to this comment | 06-11-10 9:16 AM
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The idea of shopping around for emergency care is inhuman, but it makes perfect sense for situations like my cysts, and there are probably a lot of conditions in a gray area between the two. An annoying but harmless skin rash, some spot you should get checked out just in case it's a sign of something bad but you can definitely live with if not...

41: In addition to a table of prices or a fixed set of rules, the problem in 28 would have been prevented by a list of names of doctors covered by KR's provider, and/or a list of insurance providers that doctor will work with. By now we're at four separate long, arcane lists/tables/formulae, and obviously there comes a point where proliferating them makes things less transparent rather than more, but if either such list existed at all and KR and/or the doctor had access to it, things would have been more transparent and it wouldn't have taken 45 minutes to answer his question.


Posted by: Cyrus | Link to this comment | 06-11-10 9:16 AM
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One other way to reduce prices is to allow people other than US-certified MDs provide care. Nurse practitioners can confirm that this is flu or a sinus infection, here's your amoxicillin without charging $150.

Right now, I suspect that MDs collectively don't feel like retreating because the insurance companies will benefit. Fee for service is a big problem.

People who have predictable surgery can shop around for it. There are clinics in India, Mexico, and Brazil that exist because of these patients. Retirees who can choose between the US and another country are another case-- my dad is like this; it's more complicated than just medical care, of course. But on that dimension, his choice boils down to potentially excellent cutting-edge techniques and pharmaceuticals in the US or a 5-10 year lag in best practices, but those consistently applied by intelligent practitioners who are not rushing with each patient in Prague, where he can actually discuss his care choices with a doctor and think about what he wants to do.

Two relevant facts in my mind are (yes the first post is from a conservative, but he cites a pretty clear fact) vet care is getting much more expensive, and that IS transparently priced. Second, ATul Gawande's article showing how some hospitals game fee for service to get rich was a nice survey of how the money flows now, I thought. I don't have some brilliant solution, but both enthusiastic spending and enthusiastic billing are pretty clearly factors.

Poor people usually forgo dental care. Abcesses are not rare, and can lead to a variety of really nasty outcomes. I don't have some magic solution, but conflicting interests between patient, doctor, insurance company, and hospital lead to a nightmare in the US-- too many actors.


Posted by: lw | Link to this comment | 06-11-10 9:17 AM
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All the world's a hospital.


Posted by: heebie-geebie | Link to this comment | 06-11-10 9:18 AM
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I guess a slow, non-heartrate-raising commute is out of the question? You know, pedal gently, walk up that mammoth hill, glide a lot? I mean, my doc told me to cut back recently and I've been pushing the envelope just a little with no probl


Posted by: bill | Link to this comment | 06-11-10 9:19 AM
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42: Is the number of people who forgo care because they think it *could* be too expensive greater than the number of people who would forgo care because they *know* it is too expensive? Uncertain.


Posted by: Yawnoc | Link to this comment | 06-11-10 9:20 AM
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I don't want to go as far as Knecht, in saying that I think price transparency would make a big difference in terms of consumer ability to control costs. But it is clear that it's not possible for consumers to control costs without price transparency -- there's no point even talking about it at all without that. And given the possibility of finding oneself on the hook for the full cost, the lack of transparency is sort of hateful and frightening: I probably won't have to pay more than the $20 I paid already. But there's some non-zero risk I might have to pay... $1500? Wouldn't be a nightmare, although I wouldn't enjoy it. $5000? That'd really suck. $15,000? I wonder if we can get a home equity line of credit in this climate.


Posted by: LizardBreath | Link to this comment | 06-11-10 9:20 AM
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I've been pushing the envelope just a little with no probl

Bikes are much heavier than envelopes, Bill.


Posted by: heebie-geebie | Link to this comment | 06-11-10 9:20 AM
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But it is clear that it's not possible for consumers to control costs without price transparency -- there's no point even talking about it at all without that. And given the possibility of finding oneself on the hook for the full cost, the lack of transparency is sort of hateful and frightening:

Sure, when it comes to navigating our FUBAR system, information about worst-case billing scenarios would help the patient.

But it's not reasonable to put cost control on the patient, in general, is it? No one loves getting frivolous medical procedures done; we're all just responding to our doctor's tone of voice.


Posted by: heebie-geebie | Link to this comment | 06-11-10 9:23 AM
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I wonder how contestable one of those assumption of liability documents would be in a legal dispute. Begin with the fact that making you sign the thing before essential medical treatment (an ambulance crew did this to me once before they would let me out of the ambulance) might be considered inherently coercive.

I have another theory that needs a toe-hold in the doctrine of unconscionability, which I realize is always a treacherous place to start. The theory is that you are not signing a true carte blanche, but merely an agreement to pay a reasonable and customary compensation for the care provided. Because making you sign a true carte blanche before they agree treat you would in fact shock the conscience, right?

So now we get to talk about what's "reasonable and customary". Let's say the hospital is billing me for a procedure at rack rates. How many people actually pay the list price? Virtually no one, I conjecture. Either patients are paying an insurance-negotiated discount rate, or an indigent care rate, or maybe they get billed the full amount but never pay, so the obligation gets sold to a debt collector at a discount. Empirically speaking, I doubt they could make a case that the rack rate is paid by more than a percent or two of patients, if ever. So how is that "reasonable and customary"?

Do I have a case, lawyers? (As a practical matter, I think the hospital finance department is ready and willing to negotiate down the invoice amount in exchange for prompt payment without making a legal dispute out of it, but I'm just wondering whether a patient would have a case for wiggling out of some of the liability if push came to shove.)


Posted by: Knecht Ruprecht | Link to this comment | 06-11-10 9:23 AM
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vet care is getting much more expensive, and that IS transparently priced

And yet I still want to find a way for my vet to be my primary doctor.


Posted by: CJB | Link to this comment | 06-11-10 9:25 AM
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49: I was thinking. But it's just awfully long -- to keep from getting elevated-heart-rate/blood-pressure I'd have to go really slow. If I had a better sense of what the odds actually were of popping a stitch, I might risk it, but I got a couple of flat "Just don't"s from the doc.

(Funny thing is that biking up the hill, while effortful, is actually much less total effort than walking up it. It's hard to do it at all, but I'm not nearly as tired after biking up as I am after walking up.)


Posted by: LizardBreath | Link to this comment | 06-11-10 9:27 AM
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the doctrine of unconscionability, which I realize is always a treacherous place to start.

Never seen an unconscionability argument work in practice. Now, I don't do, and never did, consumer litigation, so I've always been looking at sophisticated commercial parties, but I wouldn't rely on anything at all starting from an assumption that a contract was unconscionable. The 'sign this before we'll let you out of the ambulance' situation is much better, though -- I wouldn't think that sort of contract is worth much.


Posted by: LizardBreath | Link to this comment | 06-11-10 9:30 AM
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To be perfectly clear: I never claimed that price transparency is a panacea for controlling costs. I see it as a form of consumer protection. If it ends up having an impact on costs (which it well might for certain subsets of care), that's wonderful, but it's a big plus for consumers regardless.


Posted by: Knecht Ruprecht | Link to this comment | 06-11-10 9:30 AM
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starting from an assumption that a contract was unconscionable

But I'm starting from the assumption that a hypothetical interpretation of the contract would be unconscionable, and therefore an alternative interpretation must have been the intent of the parties. Is that any stronger?


Posted by: Knecht Ruprecht | Link to this comment | 06-11-10 9:33 AM
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59: It's not clicking for me -- not saying I couldn't cobble together an argument along those lines if you paid me, it's not self-evidently ridiculous, but it's not an argument related to anything I've ever seen work.


Posted by: LizardBreath | Link to this comment | 06-11-10 9:35 AM
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59: So you're saying something like, "Since it would be unconscionable to interpret this contract to mean you could charge me $6 billion for an aspirin, you cannot attempt to use it to claim I owe you $25 for an aspirin"?


Posted by: Yawnoc | Link to this comment | 06-11-10 9:40 AM
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61: That's pretty much it.


Posted by: LizardBreath | Link to this comment | 06-11-10 9:44 AM
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61: Bingo. The argument only works if I can show that no one ever really pays $25 for an aspirin, and actually the modal value is closer to $15, so $15 should be considered "reasonable and customary".

Whether there is any case law that establishes reasonable and customary as the appropriate standard in these cases, I have no idea. But it wouldn't surprise me. And then it's open to litigation on facts.


Posted by: Knecht Ruprecht | Link to this comment | 06-11-10 9:46 AM
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A social worker who was trying to get me to sign similar forms get perturbed when I insisted on reading them.

Then the nurse who ran the clinic said that all legal types do that and not to worry. She said that if I got a bill I should call her directly. The social worker woman pissed me off.


Posted by: Bostoniangirl | Link to this comment | 06-11-10 9:47 AM
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To be on the safe side, I think in the future, instead of signing my name, I'll just write "Under Duress" in nice cursive script.


Posted by: Knecht Ruprecht | Link to this comment | 06-11-10 9:51 AM
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Going all the way to genuinely free market, "consumer-driven" health care might in some ways be better than the system we have now. We're in an uncomfortable middle, with all the disadvantages of bureaucracy and all the disadvantages of a profit-driven system as well.


Posted by: PGD | Link to this comment | 06-11-10 9:57 AM
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63
61: Bingo. The argument only works if I can show that no one ever really pays $25 for an aspirin, and actually the modal value is closer to $15, so $15 should be considered "reasonable and customary".

IANAL, but it looks like that wouldn't work. The modal value of $15 doesn't just mean a ten-dollar bill plus a five-dollar bill, in your own scenario it also assumes a non-negligible amount of time fleeing from collection agencies, and/or collecting and filling out and filing forms and paperwork, and/or a non-negligible amount of money diverted from your paycheck to your insurance provider. The hospital does expect to get $25 or close to it for the aspirin, it's just that the difference doesn't come from you in most cases.


Posted by: Cyrus | Link to this comment | 06-11-10 10:12 AM
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||

Hey if anyone ever hears of somebody working to improve this stuff who could use a free intern to do some work on weekends let me know.

It would have to be someone who values passion over experience, though if university based I want to take a statistics class badly.

|>


Posted by: Bostoniangirl | Link to this comment | 06-11-10 10:29 AM
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Well, I picketed with the nurses yesterday, so hopefully that did some infinitesimal amount of good. I went over to the hospital complex where I've received probably 90% of the medical care I've had throughout my life. The nurses were very excited to be out, there was a lot of enthusiasm in the rank-and-file.
Now it appears that one of the union organizers, who was observing the return of nurses to work today, was assaulted by a security guard in the lobby of the hospital they were at -- she had to go to the ER with fairly serious injuries. It's really unfortunate that people can be so brainwashed by the bosses' ideology that they can't even figure out that they have more in common with each other than with some rich bastard.
Also, and I note this for the benefit of lefties here, there was a LOT of anarchist support for the nurses, even though they're a craft union, etc. We know which side our bread is buttered on.


Posted by: Natilo Paennim | Link to this comment | 06-11-10 10:32 AM
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To be fair, the people in the doctor's office aren't trying to hide this information from people, because nobody in the doctor's office knows what anything costs or who will pay for anything either.


Posted by: Cryptic ned | Link to this comment | 06-11-10 10:55 AM
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Never seen an unconscionability argument work in practice. Now, I don't do, and never did, consumer litigation...

I do a lot of unconscionability-related work in a very specific consumer litigation context, and unconscionability arguments work all the time, in quite a few (though not most) states, in that context. (Though likely not for much longer, thanks to a recent cert grant.)

I can think of at least one state (Tennessee) that has definitely found "procedural" unconscionability in a hospital admission agreement (because they are take-it-or-leave-it agreements, presented in the context of no meaningful choice), though in the case I'm thinking of it found the "substantive" unconcsionability in a term having nothing to do with prices or billing (in most states, you need both flavors to render an agreement unenforceable). Doesn't seem completely implausible to me, but I suspect that some/many states have statutory provisions covering billing for professional services that would rescue this kind of thing if the argument was otherwise viable.


Posted by: potchkeh | Link to this comment | 06-11-10 11:15 AM
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If you had brought a chicken like I told you, LB, you would have had no worries. They either would accept the chicken or not. If not, no other payment would have been required. Dem's da rulz.


Posted by: Tassled Loafered Leech | Link to this comment | 06-11-10 11:33 AM
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\\

this was an interesting article:

http://theunlikelyfan.blogspot.com/2010/05/disclaimer-im-new-to-this-site-and-im.html

I saw the end of the south africa/ mexico game.

I do like watching the world cup. It is excellent to waste time doing things that can't really become a life damaging habit.

>


Posted by: lemmy caution | Link to this comment | 06-11-10 12:24 PM
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My neck is sore. Waaahh.

|>


Posted by: LizardBreath | Link to this comment | 06-11-10 12:56 PM
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74: Death will do that to you.


Posted by: KR | Link to this comment | 06-11-10 1:04 PM
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75. esp. if you hang yourself. Zombie Lizardbreath, say it ain't so!


Posted by: Tassled Loafered Leech | Link to this comment | 06-11-10 1:05 PM
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It's probably just rigor mortis setting in.


Posted by: M/tch M/lls | Link to this comment | 06-11-10 1:12 PM
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Maybe she's Scottish

http://www.eurekalert.org/pub_releases/2010-06/bc-sp060910.php


Posted by: Tassled Loafered Leech | Link to this comment | 06-11-10 1:34 PM
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78: Racist.


Posted by: M/tch M/lls | Link to this comment | 06-11-10 1:58 PM
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79: I wonder what comparable figures are for the rest of the UK, and for the US. I wouldn't imagine them to be that much lower.


Posted by: M/tch M/lls | Link to this comment | 06-11-10 2:15 PM
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I do like watching the world cup. It is excellent to waste time doing things that can't really become a life damaging habit.

Come and live in my house if you think football isn't a life-damaging habit. C had a day of mourning the other day on the 15th anniversary of his team losing a match.


Posted by: asilon | Link to this comment | 06-11-10 3:32 PM
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Never seen an unconscionability argument work in practice. Now, I don't do, and never did, consumer litigation, so I've always been looking at sophisticated commercial parties,

So for commercial parties, nothing is unconscionable? That explains a lot.


Posted by: politicalfootball | Link to this comment | 06-11-10 4:16 PM
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though if university based I want to take a statistics class badly.

Why not put in a little effort and take it well?


Posted by: Turgid Jacobian | Link to this comment | 06-11-10 4:26 PM
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Speaking of universities, is everyone else enjoying as much as I am the NCAA's latest round of self-righteousness over the idea that the people getting their brains scrambled in their multi-zillion dollar "amateur" athletics business might have made a buck or two in the process?


Posted by: Not Prince Hamlet | Link to this comment | 06-11-10 5:20 PM
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AWB way back up at 22: Then I got a $400 bill from the doctor and an $800 bill from the lab. Once the finally figured out how to bill my insurance, the doctor said my "obligation" was $104. Fine. I pay it. Now I'm getting another bill for $94 from them. Nevermind that the lab never figured out its billing.

I hate to ask, since I know the whole thing is fraught, but this came up once before: AWB, did you ever receive and have a look at the Explanation of Benefits form(s) you absolutely, positively should have received from your insurance? (If you didn't receive any EOBs, you definitely should have.)

If this is all so frustrating that you don't want to discuss it all, I understand, of course.


Posted by: parsimon | Link to this comment | 06-11-10 5:25 PM
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BUT THEY GET SCHOLARSHIPS!! THAT IS ENOUGH FOR ANYONE!!


Posted by: OPINIONATED PETE CARROLL | Link to this comment | 06-11-10 5:25 PM
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discuss it all s/b discuss it at all


Posted by: parsimon | Link to this comment | 06-11-10 5:26 PM
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The NCAA is really a despicable cartel, whose motto really should be "come ruin your health while we limit your pay."

And, I'm not (at all) a USC fan, but Pete Carroll really is a remarkably good guy. His charity does more good in my general area than just about anyone else I can think of -- except for Magic Johnson, and like Magic, he puts tons of time into it, in a thoughtful way.


Posted by: Robert Halford | Link to this comment | 06-11-10 5:40 PM
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Pete Carroll's halo definitely slipped with the hasty departure. The cynical may even believe he knew the sanctions were coming because he knew the accusations were true. I saw this as a fan of Los Angeles' professional football team.


Posted by: Tassled Loafered Leech | Link to this comment | 06-11-10 5:50 PM
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... and I see that the biggest idiot in the entire world, Bill Plaschke, has a predictable column out slamming Carroll. Which makes me even more sympathetic to SC. I can't believe I'm saying this, but, Fight On!


Posted by: Robert Halford | Link to this comment | 06-11-10 6:04 PM
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Also cute that the major conferences launch an M&A extravaganza at the same time the NCAA is emphasizing its commitment to amateurism.


Posted by: Not Prince Hamlet | Link to this comment | 06-11-10 7:09 PM
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Ok, is there anything more annoyingly SWPL than NPR's World Cup coverage?


Posted by: Robert Halford | Link to this comment | 06-11-10 7:10 PM
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Yes, complaining about it.


Posted by: JP Stormcrow | Link to this comment | 06-11-10 7:12 PM
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Everything after the apostrophe in 92 is entirely superfluous.


Posted by: Not Prince Hamlet | Link to this comment | 06-11-10 7:13 PM
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92, 93: Actually, I thought it would take a few more days before we got into the soccer wars here.


Posted by: JP Stormcrow | Link to this comment | 06-11-10 7:17 PM
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I thought about preemptively apologizing to Stormcrow.

Seriously, though, the NPR coverage is like a subversive plot to associate soccer with every bad stereotype it has in the US.


Posted by: Robert Halford | Link to this comment | 06-11-10 7:18 PM
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No worries, I haven't even told anyone to go fuck themselves in the ass with a meathook yet.


Posted by: JP Stormcrow | Link to this comment | 06-11-10 7:20 PM
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The night is young.


Posted by: Robert Halford | Link to this comment | 06-11-10 7:36 PM
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On the medical bill stuff, we have on ongoing medical situation in our extended family that would be comical if it wasn't so potentially serious. Among the highlights:

1) $24K (as billed, probably $10K reasonable and customary) procedure at a hospital denied by the insurance. Hospital says, "we don't care, doctor's problem--his payment", doctor's office says, "no record of that service it goes through the hospital". My counsel, "Don't worry more about them getting paid than they seem to care themselves" (It's not me who would pay, so I can be semi-cavalier and all about it), but then the insurance comes back and says "Ooga-booga! Ooga-booga! If claim not contested in 45 days we won't pay no matter what, and if you actually received the service you are liable if someone does ever bill you." And on and on from there. Current state, doctor's office finally has "contested" but after deadline, says, "don't worry they never really enforce the deadline"--it's more of a guideline I guess...

2) EOB has ~$500K hospital stay bill, insurance says R&C is $95K and pays, and says patient owes $0. Is hospital OK with this? I guess so, months later nary a peep. (I know those kind of ratios come up on EOBs a lot, just a little nerve-wracking to see it with those kind of numbers.)


Posted by: JP Stormcrow | Link to this comment | 06-11-10 7:48 PM
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98: Tomorrow may be the problem. I am going over to an English colleague's house to watch. He has two young sons so I'm working on my restraint. (Although, he's from Exeter and more of a Rugby and cricket guy and I actually have little in the way of expectations.)

And I really don't mean to defend NPR.


Posted by: JP Stormcrow | Link to this comment | 06-11-10 7:55 PM
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More soccer, a very well done World Cup schedule--visually stunning and great interactivity when you scroll around.


Posted by: JP Stormcrow | Link to this comment | 06-11-10 8:17 PM
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I've tried, but I really can't pay attention to any sport but college football and the yoga stuff on Fit TV.


Posted by: Moby Hick | Link to this comment | 06-11-10 8:24 PM
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You know I had to spend all fucking day actually working on real fucking stuff on a beautiful fucking Friday and then you fucks all fuck off when I ... never mind. Hi there, Mobihikku.


Posted by: JP Stormcrow | Link to this comment | 06-11-10 8:28 PM
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Some days I work at my secondary office where I think they pay more attention to the intertubes.


Posted by: Moby Hick | Link to this comment | 06-11-10 8:32 PM
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103: Don't you guys live, like, two miles apart? You could meet at the Stormcrows and Moby could bring a bottle of rye or something.


Posted by: Knecht Ruprecht | Link to this comment | 06-11-10 8:34 PM
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I think we're on oppose sides of the city, but the city isn't that big.


Posted by: Moby Hick | Link to this comment | 06-11-10 8:41 PM
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"oppose" s/b "opposite".


Posted by: Moby Hick | Link to this comment | 06-11-10 8:42 PM
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102: Is Tae Bo a sport? I actually find it kind of mesmerizing. (And admire Billy Blanks--dyslexic, born in Erie PA, the 4th of 15 children.)


Posted by: JP Stormcrow | Link to this comment | 06-11-10 8:44 PM
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106: Not really opposite if I've understood your general location. About 7 miles.


Posted by: JP Stormcrow | Link to this comment | 06-11-10 8:49 PM
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I've never been to Erie. Is it as hard to overcome as dyslexia?


Posted by: Moby Hick | Link to this comment | 06-11-10 8:50 PM
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Anyway, I'm in Sq. Hill.


Posted by: Moby Hick | Link to this comment | 06-11-10 8:54 PM
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110: Possibly. Fred Biletnikoff, the former Oakland Raiders receiver was from there and once when he heard the city had given him some honor, he responded by saying something like the day he left Erie was the best day of his life. But apparently they've since patched things up since the stadium at his old high school is now named for him.


Posted by: JP Stormcrow | Link to this comment | 06-11-10 8:59 PM
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111: Yes, towards southern end I believe. Not that I'm stalking or anything like that, but I do notice geographical clues. Because I'm a locationist.


Posted by: JP Stormcrow | Link to this comment | 06-11-10 9:03 PM
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The northern end gets so expensive.


Posted by: Moby Hick | Link to this comment | 06-11-10 9:07 PM
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Computers hate me today and have decided to hide information from me, I think. I can't find the thread where people were suggesting things to do in the vicinity of Santa Fe (the hoohole strikes again!) and Mac OS X has decided to grey out the "Entire Message" option when searching in Mail.app. Which is a problem I've encountered before, and it's caused by Spotlight being awful, and I can't remember which of the twenty-odd different recipes for fixing it that I find on the internet actually work. (I know the "revert to a different version of Mac OS X from a few years back" option works, but surely there's a better choice.)


Posted by: essear | Link to this comment | 06-11-10 9:11 PM
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You could use this to find this.


Posted by: k-sky | Link to this comment | 06-11-10 9:14 PM
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116: Excellent! So it fell down the bingooglehole but I was wrong to blame the hoohole. Hooray for the 'hoo. Thanks.


Posted by: essear | Link to this comment | 06-11-10 9:17 PM
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(My trip got rescheduled and I'll now have about 3 days to kill, but it looks like there were enough suggestions in that thread to keep me busy.)


Posted by: essear | Link to this comment | 06-11-10 9:20 PM
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Mohs is excellent treatment for basal cell, depending on location: especially good on the face or other areas where skin is thin or movement would be a problem. It's time-consuming, yes, but it precludes removing more tissue than necessary while ensuring the entire lesion has been excised. A good and speedy recovery to you! You'll be back in the saddle again soon.


Posted by: honigessig | Link to this comment | 06-11-10 10:25 PM
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51

... And given the possibility of finding oneself on the hook for the full cost, the lack of transparency is sort of hateful and frightening: I probably won't have to pay more than the $20 I paid already. But there's some non-zero risk I might have to pay... $1500? Wouldn't be a nightmare, although I wouldn't enjoy it. $5000? That'd really suck. $15,000? I wonder if we can get a home equity line of credit in this climate.

I don't think the risk is worth worrying about given they told you you were covered. I have refused to pay medical bills and no serious effort was made to collect them (although they weren't for $15000).


Posted by: James B. Shearer | Link to this comment | 06-11-10 10:37 PM
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I have refused to pay medical bills and no serious effort was made to collect them

Yeah, no worries. I'm relieved to learn how well the system is working.


Posted by: Mary Catherine | Link to this comment | 06-11-10 10:48 PM
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. I have refused to pay medical bills and no serious effort was made to collect them (although they weren't for $15000)

The tracked an ex of mine down seven years later, across state lines and several addresses. It was a few hundred bucks.


Posted by: teraz kurwa my | Link to this comment | 06-11-10 11:56 PM
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Marginally apropos of this thread, I reiterate my recommendation of The Immortal Life of Henrietta Lacks but, having just finished the whole thing, upgrade it from "pretty fantastic" to "fucking amazing".


Posted by: essear | Link to this comment | 06-12-10 12:56 AM
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Too lazy to read all the comments, but . . .

I've often wondered whether, given their inability to provide any actual cost beforehand, a medical provider could actually force a patient to pay if the patient fought the charges. A contract is never really formed because they can never tell you what it costs. They agree to treat you and you agree to . . . pay some amorphous amount. I'd think the treatment would constitute a consumer credit transaction making the lack of transparency not only troubling but illegal . . . and would make liquidated damages a possibility . . . provided someone was willing to go through the trouble of suing.


Posted by: Laup Namertaw | Link to this comment | 06-12-10 1:58 AM
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I had to take girl y to the ER in NYC last summer, and as we were leaving I asked, can I pay? I have travel insurance that reimburses me, and I was just going to put it on my credit card. they were totally astonished and mystified, and said they had no way of even finding out how much it cost. result: they sent me the bill to singapore where I ignored it. now I have to pay it plus late fees, and it'll be too late to get reimbursed. that's my own fault, of course, but it was dumb on their part as well. singapore ER charges are SGD $80, no matter how many tests they do, and includes any medicine prescribed. I'm lucky to be living here.


Posted by: alameida | Link to this comment | 06-12-10 5:58 AM
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122: It's 25 years now and they still haven't caught up with me!


Posted by: peep | Link to this comment | 06-12-10 6:18 AM
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122

The tracked an ex of mine down seven years later, across state lines and several addresses. It was a few hundred bucks.

What does this mean? Did they file suit and obtain a legal order to pay? Isn't there some sort of statute of limitations about how long they can wait before suing?


Posted by: James B. Shearer | Link to this comment | 06-12-10 6:57 AM
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125: Singapore's interesting - conservatives cite it as a model because of its Medical Savings Accounts, but others say it gave up on MSAs as a means to control cost growth and had better results from supply-side policy (government hospitals consciously keeping prices down, capping the percentage of specialist doctors at 40%, etc.).


Posted by: Minivet | Link to this comment | 06-12-10 7:34 AM
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We're at the early stages of a major medical process- wife was diagnosed with a spinal tumor, so far there has been PCP, MRI, neurosurgeon, 3 more MRIs. Paperwork errors thus far- referral from PCP to neurosurgeon got lost and insurance complaints were made, but seems to have been resolved, so total cost so far is 2 x $10 copayments. A different neurosurgeon next week, surgery coming up in the next month. Even with reasonably good insurance- HMO so everything needs referrals and has to be in-network, but AFAIK everything is covered- we have to keep confirming all these referrals at every step. Does the insurance company really think people will just sign up for spinal surgery without checking with your doctor first?


Posted by: SP | Link to this comment | 06-12-10 7:36 AM
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that's terrible SP, all the best to you and your wife.
128: my impression is that the cost controls are the most significant factor. you can be a doctor with a private practice and have more latitude in what you charge, or you can work in a government-run facility and have a dependable salary and good job security. even in the first case you seem to be competing pretty fiercely for the business; my private clinic charges $80 per hour for a 1st visit, $50 after. the drugs are all very cheap, too.


Posted by: alameida | Link to this comment | 06-12-10 7:57 AM
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All good thoughts to your wife and you, SP.


Posted by: oudemia | Link to this comment | 06-12-10 8:03 AM
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That sounds very bad, SP.

Does the insurance company really think people will just sign up for spinal surgery without checking with your doctor first?

Many people seem to believe that the best way to manage medical costs is to build obstacles between patients and care,* if the popularity among conservatives of that old Malcolm Gladwell article about co-payments is anything to go by.

* Rather than, e.g., spending on prevention. It has occurred to me, in my pursuit of the Holy Grail the Questing Beast that issue of Detective Comics where Batman fights the professional skier who is half-yeti travels, that Americans look disturbingly less healthy than people in, say, the Scandinavian countries.


Posted by: Flippanter | Link to this comment | 06-12-10 8:59 AM
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Ooh! On transparency of costs, I have Secret Inside Information! Or, more accurately, a different chunk of knowledge.

Anyway, my mom works on coding policy for a major local hospital system. What's coding policy? Glad you asked. It's the elaborate and byzantine system that translates whatever it is that the hospital actually does to provide care (or the simulation thereof) into the umpteen different languages that Medicare, Medicaid and all the different private insurance companies speak. You may perform a fairly straightforward consultation and test, but in order to get paid for it you have to call it x with Medicare and y with BCBS and split it into three different things for Medica, none which are quite what you did, but close enough for lawyers. And it changes all the time. As a result, the coding and billing departments live in a completely different world from the direct service providers and only interact with one another through reports and reporting procedures.

Per Yawnoc, yes, single payer would presumably be the solution to all this nonsense. The things that gives hospital systems the knee-jerk freakouts about all that are a) the government run systems always pay them the least, and before the recent reforms, generally a money-losing ammount, and b) since their model is one of bargaining for payment and playing multiple insurance companies off against eachother, they figure with single payer they'd be over a barrel.


Posted by: Jimmy Pongo | Link to this comment | 06-12-10 10:00 AM
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Thanks for the comments- It's not too bad, there's a >99% chance it's benign, at least in the sense that it's probably been growing slowly for years and hasn't spread anywhere and is just a lump of tissue (size of a plum!) that has to be taken out from between and around some vertebrae. The bad part is going to be recovery, she's not supposed to lift anything over 15 pounds for 4-6 months and we have an 8 month old. We're looking into nannies or babysitters, which raises another health insurance issue as far as figuring out whether/how to pay benefits & taxes to a caregiver.


Posted by: SP | Link to this comment | 06-12-10 10:07 AM
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size of a plum!

Tumor size is nearly always described in terms of fruit.


Posted by: apostropher | Link to this comment | 06-12-10 10:12 AM
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Tumor size is nearly always described in terms of fruit.

Or vegetable: size of a pea! On an organ the size of a ping-pong ball apricot!

SP, best of luck to your wife and to you. The >99% chance that it's benign is very good news (relatively), at least. For this:

We're looking into nannies or babysitters, which raises another health insurance issue as far as figuring out whether/how to pay benefits & taxes to a caregiver.

Possibly look into a service that could assign you a nanny/babysitter/caregiver? It might be more expensive than hiring someone directly -- I don't know for sure -- but the service would take care of the taxes and benefits.


Posted by: parsimon | Link to this comment | 06-12-10 10:46 AM
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Wow, SP, sorry to hear it. But glad it's not worse.


Posted by: heebie-geebie | Link to this comment | 06-12-10 10:54 AM
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Best of luck, SP.

In case anyone else runs into the Mail problem I mentioned in 115: some combination of making Spotlight reindex my hard drive, telling Mail to rebuild my mailboxes, cleaning out some of my Inbox so it's closer to 3000 messages than 4000, and then waiting a couple of hours has everything working again. The important steps might just be "make Spotlight reindex the hard drive" and "wait".


Posted by: essear | Link to this comment | 06-12-10 11:27 AM
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Marginally apropos of this thread, I reiterate my recommendation of The Immortal Life of Henrietta Lacks but, having just finished the whole thing, upgrade it from "pretty fantastic" to "fucking amazing".

My reaction to her family members' shock and horror at discovering the truth led me to somewhat resent myself. I couldn't have any honest emotion other than "What the hell are you people talking about? What's the big deal? What are you...I mean...what do you want? I understand these words, but your sentences make no sense." I identified 100% with the doctors who the family members seemed to view as emissaries of Satan. I had to stop listening to the Radiolab segment because it was so frustrating.


Posted by: Cryptic ned | Link to this comment | 06-12-10 11:35 AM
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You and your wife will definitely be in my thoughts, SP.


Posted by: Blume | Link to this comment | 06-12-10 12:15 PM
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Best wishes to you and your wife.


Posted by: Moby Hick | Link to this comment | 06-12-10 2:52 PM
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SP, best wishes to you and your wife.

133: Yes, single payer eliminates a whole lot of anxiety about paperwork, referrals, and scary-looking bills that arrive in the mail. I realize it's tedious (as per essear's 29) when commenters from Britain/Canada/Europe show up and demand to know why people in the US put up with this. But it's so so frustrating when you have firsthand experience of one or more of several good alternatives to the American system (I've had experience with both the UK and Canadian systems), that you just want to say: Why do you put up with this!? even though this is the wrong site to do that, since everyone here (or everyone but Shearer, possibly) already agrees with you. And I now put up with the American system, too, of course. If I knew how to change it, I would. But I now have, I think, a much better understanding of why it's so difficult to change.


Posted by: Mary Catherine | Link to this comment | 06-12-10 7:16 PM
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But I now have, I think, a much better understanding of why it's so difficult to change.

Because people can't imagine anything better being possible?


Posted by: Cryptic ned | Link to this comment | 06-12-10 7:26 PM
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||
Vuvuzela.
|>


Posted by: JP Stormcrow | Link to this comment | 06-12-10 7:42 PM
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Best of luck to you and your wife, SP.

One benefit of price transparency is to the payers (that is, not the consumers). Hospitals and health plans generally claim that the rates they contract are proprietary, but making those rates public would be a big help to, say, a state Medicaid agency trying to make a point about how widely payment rates vary within the state.

Also, it's true that generally speaking on average the public insurers (Medicare and Medicaid) reimburse below cost, but it's rather frustrating that the only solution to this problem that hospitals are willing to accept is to increase the payments. There are, I keep pointing out, two numbers in a pay-to-cost ratio.

This stuff is all politically impossible, because reducing payments is really the easiest leverage a state has to try to slow cost growth, but reducing payments means reducing revenue, which raises the threat of layoffs, and in this economy, etc, etc.

I've had a frustrating few weeks, is what I'm saying.


Posted by: emdash | Link to this comment | 06-12-10 8:00 PM
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I realize it's tedious (as per essear's 29) when commenters from Britain/Canada/Europe show up and demand to know why people in the US put up with this.

I wouldn't really say that it's tedious. Just, as you say, frustrating. It would help if every American knew a bunch of British/Canadian/European people who could tell them stories about a saner system. The people who need to be convinced are not the people who have hordes of friends from around the world.


Posted by: essear | Link to this comment | 06-12-10 8:04 PM
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144: I am just going to post ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
after each comment.
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Posted by: oudemia | Link to this comment | 06-12-10 8:12 PM
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Last fall my father had a surgery; and he had, amongst other health care practitioners while in hospital, a male nurse from Russia whose bedside manner didn't exactly translate for us; and so I made an un-PC and entirely inappropriate joke about our "Soviet-style health care system," with specific reference to the American debates that were raging at the time, and then we all laughed like fools. The way you'll laugh, gallows-humour-like, when you see your father splayed out on a hospital bed like that, like some sort of specimen for science or something, and you'd think you might die to see that, but no, you're not dead, just very very sad, and it makes you feel strangely defeated.

I'm convinced the majority of Americans would vote for single payer if given the chance. It's the power of health insurance lobby that prevents this ever coming to a vote, those bastards.


Posted by: Mary Catherine | Link to this comment | 06-12-10 10:16 PM
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143

Because people can't imagine anything better being possible?

Because health care providers have a strong interest in preserving the present system in which they are paid more than in other countries.


Posted by: James B. Shearer | Link to this comment | 06-12-10 11:10 PM
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149: Shearer gets this one exactly right. If it were only yhe insurers opposed to single payer, we would have gotten it in the recent reform.


Posted by: Knecht Ruprecht | Link to this comment | 06-13-10 5:53 AM
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Every good thought to you and your wife, SP.


Posted by: bill | Link to this comment | 06-13-10 11:06 AM
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SP, good luck.

I second parsimon's recommendation of a nanny, especially since it's meant to be a short-term arrangement. You won't have to worry about health insurance or payroll taxes, and the person will be likely to have an easier time getting work when you no longer need him or her.


Posted by: Bostoniangirl | Link to this comment | 06-13-10 12:34 PM
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Because people can't imagine anything better being possible?

The health care industry is a huge sector of the economy, and provides employment to a lot of people. For some cities/regions, the medical sector is just about all that they have left (similar to the prison industry in that respect, come to think of it). So it's not just the profit-seeking insurance company CEOs, there are a lot of people invested in not reforming (or only minimally reforming) the current system.


Posted by: Mary Catherine | Link to this comment | 06-13-10 1:50 PM
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It's the power of health insurance lobby that prevents this ever coming to a vote, those bastards

I wish this were true. It's easy to demonize the health insurance lobby. The problem is that in this particular story, the villains wear white coats.


Posted by: emdash | Link to this comment | 06-13-10 6:25 PM
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152: 4-6 months is still long enough to have to worry about payroll taxes (providing health insurance should be optional, though). I can recommend GTM Associates (http://www.gtm.com/gtm_household/household.html) to handle the payroll and tax details of household employment - we used them for years. They are based in New York, but handle all 50 states. From experience, it's best if you can agree with the nanny to pay one week in arrears - you enter the hours in GTM's system at the end of the week, GTM runs the payroll on Monday and mails you the check (drawn on your account), which you then sign and give to the nanny on Friday.

Also from experience, most nanny services operate as brokers - they make the referral and do screening, but the nanny is employed by you, not by the service.


Posted by: Dave W. | Link to this comment | 06-13-10 8:06 PM
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The good news, I guess, is that there must be a hell of a lot of waste in there if the system is functionally unpriced, and it's presumably possible to get at it.


Posted by: Alex | Link to this comment | 06-14-10 7:35 AM
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156: With doctoring being the ultimate high-paid prestige profession, but often accompanied by hundreds of thousands of dollars in loans to attend medical school, it's complicated.


Posted by: Cryptic ned | Link to this comment | 06-14-10 7:39 AM
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157: it's complicated

Facebook | American Medical System
Relationship Status:
It's Complicated with
High-paid Prestige Professionals


Posted by: JP Stormcrow | Link to this comment | 06-14-10 7:59 AM
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Yikes, best wishes for a quick recovery to Mrs SP.

A thought about help with the little one:
An FOB Au pair probably won't be right for your situation ( too much risk that it wouldn't work), but in most large cities there's a population of recently out-of-contract au pairs that want work. There are internet forums for finding them, allows for an f2f interview and reference and would be much cheaper than an above-board nanny (about half-price 5 years ago); if money's not an issue, probably not worth the hassle.

IME brokers are little more than a listing and paperwork service, add no value above screening the very worst applicants. greataupair.com was a forum like this a few years back, there may be others that are alternatives to craigslist.


Posted by: lw | Link to this comment | 06-14-10 2:21 PM
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152 I meant to write agency. Of course you need to pay payroll taxes if you hire someone directly.


Posted by: Bostoniangirl | Link to this comment | 06-14-10 3:21 PM
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Whoa, I'm late to the party, but hope you're feeling better LB.


Posted by: Ile | Link to this comment | 06-15-10 3:38 PM
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Oh, I'm fine -- making a fuss about this at all was wild bloggy self-indulgence. My stitches itch like crazy though. If I were a dog I would totally need the big plastic cone on my head.


Posted by: LizardBreath | Link to this comment | 06-15-10 3:56 PM
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If I were a dog I would totally need the big plastic cone on my head.

Something something dog penis something because they can


Posted by: Ghost of Ogged | Link to this comment | 06-15-10 4:00 PM
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