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(Time)   Snake bite causes $89,000 hospital bill. It would have been less but the snake demanded a private room   (healthland.time.com ) divider line
    More: Asinine, North Carolina, hospitals, uncompensated care, medical bills, Mooresville, emergency rooms  
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6337 clicks; posted to Main » on 31 Jan 2014 at 8:26 AM (2 years ago)   |   Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



Voting Results (Smartest)
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2014-01-31 08:31:31 AM  
8 votes:
Universal single-payer.

NOW!
2014-01-31 08:51:15 AM  
5 votes:
Translation: We knew they had insurance, so we charged as much as possible, knowing that the patient wouldn't really care.
2014-01-31 08:38:35 AM  
5 votes:
I got a medical bill that seemed too high, so I asked for an itemized bill to be sent. It's been three goddamn months and they can't send me a bill for services *they already performed* and *have already billed me for*.

Now I'm trying to figure out the estimated cost of a future procedure, and it's a total clusterf**k. Three separate providers need to be contacted as well as the hospital, and while the doctors can give a fairly straight answer, the hospital is a nightmare. Everything they say is entirely contingent and full of weasel words, I still do not have a good idea about what services they might actually end up billing me for.

The general attitude among doctors is that health and care should always be the first priority. What happens when that care costs my family $2000 out of pocket? What about $5000? What about $80,000? Healthcare is expensive enough that lots of people seriously have to consider the trade off between quality of life and the cost of treatment. Meanwhile, some people do everything in their power to make sure that medical billing is an impenetrable secret.

I am not above saying that the medical industry as a whole is a bunch of crooks. I understand that stuff costs money, and medical grade stuff is inordinately expensive, but when you can't even give me a ballpark figure on how much a procedure costs, or justify your bill for three months after the fact, you have lost all my trust and respect. The single greatest thing we could do for healthcare in this country is to legally require that patients be given a price quote prior to an operation with a +10% upper bound on what they'll eventually be charged.
2014-01-31 08:32:26 AM  
5 votes:
It's their own fault for not utilizing the free market and shopping around for hospitals to get the best price. Hard to feel sorry for dumbasses that probably just went to the first hospital they found.
2014-01-31 09:41:02 AM  
4 votes:
No kidding? Lol, this racket between the government, medical, and insurance has been blatantly going on for years; the ACA is just a new spin to add to the coffers.

Most hospitals are non-profit business that receive funding from city, state, and federal governments - in other words we fund them.

Most businesses set price points by what the market will bear, the profit determined by how low they can get the wholesale below the retail. How do you figure the wholesale cost when the funding comes from outside? You don't, you just charge what the market will bear and try to figure out ways to invest all that profit to keep non-profit status. Hospitals and insurance partner together to charge as much as they can, while making the customer feel they got a bargain. If the customer knows a business pays next to nothing for raw material, will they pay more? Nope.

We don't see the true cost of a hospital visit. I think what they do is figure out what the overhead is for the various procedures, or products, and this dollar amount is what we are charged for in our deductible and co-pays. Instead of thinking about this like we usually do, we get a big bill, insurance cuts it way down, and we pay a percentage - think that we pay for the total service when we go to the doctor and insurance premiums are just theft. For example in the article the original bill was $89,000, cut down to 20 grand by insurance, with the customer paying $5400 out of pocket. I think the true cost with reasonable profit was $5400. All the rest of the tens of thousands just went in peoples pockets.

Wife and I went to Canada where our insurance doesn't work and she went to the emergency room of a large hospital with a sinus infection. We had to pay out of pocket for the whole thing. The hospital figured the cost for the procedures needed and that's what we paid - $160. That's what it cost and that's what we paid.

Now, I'm sure I'll get flamed with responses like, "but that's not the cost, think of all the doctors and expensive equipment involved!" Yeah, well, remember all the funding the hospitals get?

Think about this; when you take your car in for alignment the computerized machine they use can cost over a hundred thousand+. The mechanic has years of training and experience, the guy at the counter gets paid, and someone has to pay for the TV and couch you hang out on while the guy working on your car uses $50,000 worth of hand tools to make your car drive straight. If this procedure cost over a hundred bucks, you would be pissed. What if they handed you a bill for $9 grand? You would be running to the lawyer. The guy at the counter might say, "Hey look, we really should charge $100,000 for your alignment, but we're cutting you a break." Would you fall for that?

Yet with medical, you're damn happy to pay the thousands. We are a democracy, so we go to our reps - and they make it legal to rip us off.
2014-01-31 08:49:59 AM  
4 votes:

RedPhoenix122: Headline:   Snake Bite Costs North Carolina Couple $89,000 Hospital Bill

FTFA:  Though their Blue Cross Blue Shield Insurance reduced the bill to a little over $20,000, according to the Charlotte Observer, and they only ended up paying about $5,400 to cover their deductible and co-pay, the couple said they were shocked by the price of treatment.

Then it didn't cost them $89,000, did it?  That's how insurance works.


Right, but that's still an example of the stupidity involved in health care pricing. That magical $89,000 number that no one pays? It's to prevent the insurance companies from trying to fark them. It's also the reason that even CASH patients can't get any clue what it's actually going to cost them.
2014-01-31 10:24:25 AM  
3 votes:

Too Pretty For Prison: fish hook in the thumb last summer cost me $4,200.  Which actually pissed me off.  By the time I got the final bill, I had to pay $100 and my insurance company wrote them a check for $483.  I never understood why insurance companies can get away with paying 10% of a bill while the uninsured will be driven to bankruptcy and not given an inch.


Because they raise that price to skim more money off Medicare/Medicaid.  Seriously, just about every insurance company gets discounts, but government assistance pays full price.

But who cares, as long as the rich get richer, the poor get farked, and the middle class stay scared enough to work those shiatty jobs.
2014-01-31 09:40:31 AM  
3 votes:
singlepayernow.net
Single Payer, its what Jesus would want you farking idiots.
2014-01-31 09:01:44 AM  
3 votes:
Typically, when I'm bitten by a venomous snake of going into cardiac arrest, I shop around for the best prices. Living in Virginia, I try to visit hospitals in North Carolina, West Virginia and Maryland and negotiate fees. Once I negotiate the best price, I collapse in front of the triage nurse and allow treatment. It's a little time consuming, but I feel I'm getting the best deal in the end.
2014-01-31 08:54:18 AM  
3 votes:
At some point everyone decided that what they do merits them becoming millionaires. We need doctors. I respect doctors. But let's be real. I grew up in the 1970s. My dad worked in a factory. We had a decent house in a decent neighborhood of a small town and in the same neighborhood lived several of the town's doctors. Their houses maybe were just a little nicer, but more or less the same. Maybe they had a more expensive car or they had a small boat or they took fancier vacations, but they weren't millionaires and they still lived pretty well.

Now, the same town, more or less the same population, more or less the same number of doctors, and the younger doctors all live in mcMansions in new, never-before-done-in-our-town gated communities.

It's kind of absurd. And I know it's not all them. It's also hospitals that have to pay dividends to shareholders and that's a big part of the problem, too. But we do have a problem with outlandish expectations of how we should live nowadays.
2014-01-31 08:31:33 AM  
3 votes:
following the introduction of the American Care Act

Really, Time?
2014-01-31 10:02:25 AM  
2 votes:

RyansPrivates: Fubini:
I am not above saying that the medical industry as a whole is a bunch of crooks. I understand that stuff costs money, and medical grade stuff is inordinately expensive, but when you can't even give me a ballpark figure on how much a procedure costs, or justify your bill for three months after the fact, you have lost all my trust and respect. The single greatest thing we could do for healthcare in this country is to legally require that patients be given a price quote prior to an operation with a +10% upper bound on what they'll eventually be charged.

I would agree with one small caveat: I really don't think it is the doctors.   It is mostly the insurance providers, with hospitals on board to so they can get paid.  Insurance providers are incentivized to make the process as byzantine as possible to protect their profits ; the more difficult it is to actually find out where the money is going, the better for them.  The problem is healthcare is a product that everyone needs at some point in their lives, so they also have no incentive to really compete, and it is very a regional business.  You generally end up at hospital 20 miles within your home if you live in a metro area, 100 miles or so in a rural area.  This means hospitals aren't competing with each other very much, and the barriers for entry are very high.  There is no "Costco" of healthcare to come in and undercut the local stores.  The effect is what you experienced,


I work in a doctor's office. It used to be a private practice, so you better believe the Doctors/owners know how billing works. The doctors will always play ignorant about prices and billing because people give them the benefit of the doubt because, lifesavers.
In fact if you pay attention, you'll notice that many if not most of the people in charge of hospitals and insurance companies are MDs.
2014-01-31 10:00:57 AM  
2 votes:
CSB

Had to get carted from one hospital to another in 2012. The ambulance company sends me a bill for $750.00 for the trip. I already had my deductible and co-pay met so I called the insurance company to ask what was up. The ambulance company never billed them for the ride so I called the ambulance company. It was as easy as that. I gave them the insurance information so they could bill the insurance company. Here's the kicker. The lady on the phone said that since the insurance company was paying the bill it would now be $1276.77.

CSB/
2014-01-31 09:32:58 AM  
2 votes:

Fubini: Healthcare is expensive enough that lots of people seriously have to consider the trade off between quality of life and the cost of treatment.


Um, good? It's unfortunate that this extends down to (for some people) whether or not to get a broken leg fixed, but this, to a degree, is how it needs to be. Frankly, I don't want to be paying for someone's brain-dead grandma to stay on $50,000/day life support, but this happens EVERY DAY, since the family knows that Medicare is picking up the tab. You can be damn sure that if the family had to pay for it, it would be time for Grandma to go, and they'd be right, since her quality of life is basically zero. We, has humans, need to get over this whole "every second of everyone's life is valuable" nonsense.

Fun fact: Regardless of other health issues, dialysis treatment for ESRD/585.6 patients costs $150,000/person/year. NIH estimates that there are 20 MILLION people receiving these treatments, the MAJORITY of which are on some form of Medicare/Medicaid. How many of these people would still be receiving treatments if they had to pay for it themselves, I wonder? Again, I'm not talking about 54-year-old Joe, with a job and health insurance and a family and two kids, I'm talking about  97-year-old Great Uncle James, the majority of whose weekly activity comes in the form of being wheeled into a clinic and hooked up to a machine.

I'm not saying healthcare in this country isn't completely farked- it is. I'm not saying Insurance companies aren't greedy, obfuscating organizations- they are. What I'm saying is, with costs what they are, we really need to reevaluate when it's no longer worth keeping someone alive relative to their quality of life.

/I get what you're saying, and I'm not talking about trauma care, obviously
2014-01-31 09:09:26 AM  
2 votes:

Fubini: The general attitude among doctors is that health and care should always be the first priority. What happens when that care costs my family $2000 out of pocket? What about $5000? What about $80,000? Healthcare is expensive enough that lots of people seriously have to consider the trade off between quality of life and the cost of treatment. Meanwhile, some people do everything in their power to make sure that medical billing is an impenetrable secret.


I'm not an expert, but I don't think it's your doctor's fault that he or she doesn't have the slightest idea what anything costs.

For the most part, i'ts not because the doctors don't care. If doctors spent the time to figure out how billing worked, they'd never have time to actually see patients. To find out costs, doctors would have to deal with exactly the same people you're dealing with -- the people who can't give you the straight cost of anything, and who give answers that are wrong far more than they're right. Billing rates are negotiated between insurance companies and the billing departments, and every single person who touches them from beginning to end participates in a giant clusterfarks of greed, bureaucracy, greed, incompetence, and more greed.  It's just a god damned mess.
2014-01-31 09:02:25 AM  
2 votes:
This is why, if I am ever diagnosed with cancer, I'm going to go find a quiet body of water that is 60F or less and soak in it for a few hours with a bottle of whiskey, even though (thanks Obamacaare), I have insurance. The CO-PAY for 12 hours was over $5,000! I have no idea about what to do if I am in a car wreck (or get bitten by a snake). I just hope I drop dead of a massive heart attack on my lunch hour like my grandfather.
2014-01-31 08:56:55 AM  
2 votes:
Our costs for providing uncompensated care are partially covered by higher bills for other patients.


In other words the middle class pretty much carry the burden of the uninsured and under-insured.
2014-01-31 08:53:17 AM  
2 votes:

RedPhoenix122: Headline:   Snake Bite Costs North Carolina Couple $89,000 Hospital Bill

FTFA:  Though their Blue Cross Blue Shield Insurance reduced the bill to a little over $20,000, according to the Charlotte Observer, and they only ended up paying about $5,400 to cover their deductible and co-pay, the couple said they were shocked by the price of treatment.

Then it didn't cost them $89,000, did it?  That's how insurance works.


Hospitals bill insurance companies way too much for procedures because customers won't care.

Insurance companies will charge too much to cover their costs.

Customers will complain to insurance companies because that is the cost that they see, not the overcharged hospital bill.

So while customers (and more recently the Government on behalf of the people) complain to insurance companies, the hospitals are free to over charge without being criticised.

Of course there could be more to it than that. Maybe hospitals aren't overcharging, or they have to charge more since the medicines that they use are protected by patents.

The patents allow drug companies to charge a premium for their medicines, and they use the profits to pay off elected officials in the form of campaign contributions and lobbyists to ensure the law favors them.

There is more to it than, "That is what insurance is for."
2014-01-31 09:32:08 PM  
1 vote:

BenJammin: Ficoce: BenJammin: Ficoce: BenJammin: Ficoce: BenJammin: RedPhoenix122: Headline:   Snake Bite Costs North Carolina Couple $89,000 Hospital Bill

FTFA....
I am not sure how computing an hourly rate based upon your copay figures into this, since it is how much your insurance benefit saves you over no insurance.  Were blood and urine tests also done?   Since you are 50+ish  are you going to get colonoscoped?  My annual checkup, which I pay nothing for, because it is part of their wellness program,  includes blood and uring lab work,  EKG  and chest xray (every other  year).  The colonoscope with anesthesia is $20 copay.
If you had some very expensive illness the only thing that really matters in calculating the benefit is how much you saved over not having the insurance.  Even if the insurance company had an agreement with a hospital so that a $50,000 charge only cost them $15,000.  the fact that without insurance you would have received a bill for the "retail" amount.
Insurance is not fun to pay, and there's always the tendency to feel you are not getting your money's worth (I am not in the insuracne biz, and my rates piss me off), but having worked and saved for the nicer things, it's easier to get upset over an expensive bill than over losing my house and a significant part of my life's savings from a catastrophic medical expenses.


Actually, blood and urine tests were done the next day. I'd had a bowl of cereal that morning, but skipped lunch - don't want to mess up those tests! Another $20, cha ching!.

I know you don't work for insurance company, because you would cost them money. And you probably don't work in the non-profit medical industry - why pay you when they get a cheerleader for free?

Any business, and I mean any business, that invoices $89,000, but will accept $20,000 as payment in full as a standard business practice are thieves and crooks. Don't you realize that's your money? These hospitals are non-profit, tax exempt. I'm not being conservative when I say millions of people go through life without any major medical issues. Most of the medical needs for people happen after they reach 50 - right at the time they can't afford medical; fixed pension, SS, they might have a home and a little savings. They've spent hundreds of thousands of dollars on insurance during their producing years that is just gone. They could really use that money now to make their own choice about long term care. Selling the house isn't going to cut it - you seen the price of rest homes? It can be $4 grand/mo without medical.  You think the kids want to deal with it? Just think if you had the house paid off, SS coming in, a little 401K plan to play with - and $150,000 to take care of any medical crap that comes along - the kids might just take care of you while approaching room temperature.

Yes, I've had a colonoscopy - The Silver Bullet. You bend over and some doc spends less than a minute moving the dingleberries and gerbils out of the way to check for polyps and other odd things. If it looks good a biopsy isn't even done. An inexpensive procedure at $2000+, lol. Anyone with minor training and finds it enjoyable can perform it. You can have it done in Mexico tomorrow for less than $350, and come home with a tan. Really, you could have a vacation for less than the procedure costs here.

You can't stick up for the crooks - maybe if we had the cheapest care in the world; sadly, that's not the way it is. They can still cap the dollar limit with ACA and stop paying, leaving you holding the bag - can you tell me what an essential medical procedure will be 5 years from now? Ten? Nope, and nobody's making any promises either.
2014-01-31 01:12:44 PM  
1 vote:

trappedspirit: MarshWoman: Thank goodness I don't live in the US any more.

So we agree?


Yes, we do. Efficient health care delivery ranks: Canada- 17th,  USA- 46th right after Iran, but ahead of Serbia.
http://www.bloomberg.com/visual-data/best-and-worst/most-efficient-h ea lth-care-countries
2014-01-31 01:00:11 PM  
1 vote:

BenJammin: Ficoce: BenJammin: RedPhoenix122: Headline:   Snake Bite Costs North Carolina Couple $89,000 Hospital Bill

FTFA:  Though their Blue Cross Blue Shield Insurance reduced the bill to a little over $20,000, according to the Charlotte Observer, and they only ended up paying about $5,400 to cover their deductible and co-pay, the couple said they were shocked by the price of treatment.

Then it didn't cost them $89,000, did it?  That's how insurance works.

Absolutely right.  Bogus reporting.

Where did the little over $14,600 come from? It'll take the snakebite people 3 years to pay this back if insurance premiums are $400/mo, while the insurance company invests these premiums. Even if every bit of the premium these people pay goes to medical care, the insurance company still makes cash off investments. It's like a 401K plan you build for retirement, but you won't get any of the interest and only that principle you can prove you need. Retire and want to buy a fancy new car? Sorry, you can only buy the base model, but we allow substituting a generic fancy used car. But the car we want only costs $5400! Nope - it's really $20,000 and there's nothing you can say about it. Feel lucky you didn't have to pay $89,000 we're doing you a favor.

Not sure what you are talking about.   What 14,600?


That's what the bill was; little over $20K. Sure, the people only had to pay $5600 cash, but they've been paying medical insurance to pay for the rest. 20,000 - 5600 = 14,600, for years now. Medical insurance is a loan you pay forward on - these guys bought "health" for $5600 down and roughly $400/mo for three years.

I've been paying forward my medical loan for 32 years at an average expense of $388/month. This means the insurance companies are now stock trading almost $150,000 of my money. Because of the time value of money, they have probably turned this into a half million - of which I will see none of even if I get sick or injured. If I do get sick or injured, my deduct and co-pay will cover the actual cost of medical care, while the hospital tries to gouge the insurance company of the principle and interest my account holds.
2014-01-31 12:44:05 PM  
1 vote:
On a Sunday morning a few weeks ago, I went to the ER with crippling abdominal pain. After being taken back to a room (within about 20 minutes), I was examined, tentatively diagnosed with a serious infection, and whacked up with morphine. I was there for 10 hours, received four doses of pain meds, countless IV solution, 2 courses each of IV antibiotics, and a CAT scan. I went home that night in much better shape with an Rx for two different high-powered antibiotics. The next morning, my family doctor called to see how I was doing- The ER automatically sent the records to my own doctor.

How much was I billed? Nothing. I handed them my Nova Scotia health card. How high are my taxes? About the same as comparable cities in the Northeastern US. Oh- and the two Rx for antibiotics cost a total of $40.

Single payer is the way, folks. Delivering health care should not be a for-profit business. Thank goodness I don't live in the US any more.
kab
2014-01-31 11:20:07 AM  
1 vote:
This incredibly selfish couple needs to gather some empathy for the insurance companies that are barely keeping the lights on while providing reasonable costs to everyone.
2014-01-31 10:39:32 AM  
1 vote:
The underlying problem is healthcare is not a market.  Everybody is either spending someone else's money or they're doing everything they can to try to avoid paying what they're supposed to (eg. insurance companies trying to deny benefits).

What I find shocking is how people have come to accept these kinds of hospital pricing discrepancies as par for the course.  People would be livid if a car dealership charged between $9,000 and $90,000 for the same vehicle depending on who's paying.  Why are they not similarly angry with hospitals?  Because by and large, they're spending someone else's money.  Once a procedure is sufficiently expensive that your particular out-of-pocket deductible is met, you don't really care whether the hospital charges your insurance company $20k and while it charges the insurance company of the guy in the room next to yours only $10k for the same procedure.

Laws forcing hospitals to post up-front prices for common procedures is perhaps a step in the right direction but I'm too cynical to think that it'll make much difference.
2014-01-31 10:36:28 AM  
1 vote:

Fubini: No one is saying that doctors shouldn't be compensated well for what they do, but how much do they really need?


Also, bear in mind that the median doctor isn't a neurosurgeon who works wonders. The median doctor sees the same types of patients over and over and over all day. It's not a particularly creative or demanding process.
2014-01-31 10:33:43 AM  
1 vote:
zimbomba63:What you say makes a lot of sense, you know, if anybody could a medical degree from a coupon off a box of breakfast cereal.  But, if I had to do the whole medical school grind, I think I'd want a little compensation for the effort.  The idea of doing all that, and ending up just a smidge better off, than a guy who may not have graduated from high school and spends the day sweeping up on the loading dock, would be kind of stupid.  But, hey, that's just me.

This would be a better argument if medical schools didn't gate the number of applicants, artificially restricting the number of people available to be doctors.
2014-01-31 10:25:32 AM  
1 vote:
That's why you wait for happy hour, guys.

guinnesspours.net
2014-01-31 10:24:48 AM  
1 vote:

Too Pretty For Prison: fish hook in the thumb last summer cost me $4,200.  Which actually pissed me off.  By the time I got the final bill, I had to pay $100 and my insurance company wrote them a check for $483.  I never understood why insurance companies can get away with paying 10% of a bill while the uninsured will be driven to bankruptcy and not given an inch.


skreened.com
2014-01-31 10:22:17 AM  
1 vote:
fish hook in the thumb last summer cost me $4,200.  Which actually pissed me off.  By the time I got the final bill, I had to pay $100 and my insurance company wrote them a check for $483.  I never understood why insurance companies can get away with paying 10% of a bill while the uninsured will be driven to bankruptcy and not given an inch.
2014-01-31 10:20:45 AM  
1 vote:

The Larch: Your fun fact is not just not a fact, it's not even in spitting distance of the possibility of being a fact.


What part are you questioning? You'll note, if you reread my post more carefully, the words "estimate", and "majority".

These terms encompass the following: There are "up to" 20 million people receiving these treatments. It could be less. It almost certainly is, based on the way they collect data.

That the majority of them are on some form of Medicare/medicaid does not mean that 100% of the costs of the care of the entire 20 million are being passed on to the government. IIRC, it's about 54% of that patient pool on some form of MC/MC, and the ones on Care still have to pay (most of the time) a portion themselves.

The $150k is the billed rate- the government health programs pay far, far less than that, as a service provider to Medicare/Medicaid patients knows all too well.

You'll notice (or maybe you didn't) that I never cited a total cost, and for good reason. The math isn't as simple as this times this equals this, there are a huge number of mitigating factors that bring down the total cost figure.While this may lessen the impact of the numbers to a small degree, my point was how ridiculously overinflated costs for end-of-life care have gotten, and we need to be able to let go when quality of life nears zero.

/spent 6 years doing billing for a vascular surgery practice, I've seen the numbers from patients from all walks of life and situations
//does not anymore, since the whole industry is detestable
2014-01-31 10:15:18 AM  
1 vote:

uttertosh: YixilTesiphon: Well, you have to make an awful lot of money to have a net tax rate of 32% unless you live in California or New York.

I have no idea what that means. Are you saying that one's wage must be high in order to compensate for that high a tax?


All the states have different state income tax rates depending on how much they wan to spend and how they balance out sales tax, property tax (a percentage of your home value), and income tax. So a lot of people just look at the Federal Income Tax Rate, while ignoring State Taxes and Medicare and Social Security Payments (which also come out of your paycheck but aren't, strictly, taxes).

The Federal Income Tax rates are based off your income after it is adjusted for a whole heap of exemptions, deductions and allowances. For example you can deduct any mortgage interest from your income for the purpose of calculating how much tax you pay, and if you have a kid in daycare you can deduct a credit from the total tax bill.

The top Federal Income Tax rate is 39.6% and only applies to payroll income over $406,750, so to have an total tax rate of 32% you would have to have an annual income from their job somewhere in the region of a million bucks and have minimal deductions.
2014-01-31 10:07:29 AM  
1 vote:

uttertosh: YixilTesiphon: Well, you have to make an awful lot of money to have a net tax rate of 32% unless you live in California or New York.

I have no idea what that means. Are you saying that one's wage must be high in order to compensate for that high a tax?


No, but the income tax you pay the national government depends on your income, this is for a single person in 2013:
b-i.forbesimg.com
I'm saying that you have to have a high wage to fit into the bracket where you get taxed anything like 32%.

Every state has a different (in a few cases, like Texas, none) income tax, and as others have mentioned there's property, sales, etc taxes at local and state levels.
2014-01-31 10:01:01 AM  
1 vote:
YixilTesiphon:

Well, you have to make an awful lot of money to have a net tax rate of 32% unless you live in California or New York.

That depends if you include state, payroll, medicare, ss, and property taxes into that number. I'm not sure what other taxes uttertosh pays but different tax systems fund those through other revenue streams.

That said, the sales tax rates in Sweden would probably cause a lot of Americans to go into cardiac arrest at the supermarket checkout.
2014-01-31 09:45:04 AM  
1 vote:
"Hospitals only collect a small percentage of our charges, or 'list prices.' We are required to give Medicare one level of discount from list price, Medicaid another, and private insurers negotiate for still others. ... If we did not start with the list prices we have, we would not end up with enough revenue to remain in operation. ... Our costs for providing uncompensated care are partially covered by higher bills for other patients."

That is a really farking stupid system that gives an especially epic screwing to the uninsured.
2014-01-31 09:37:09 AM  
1 vote:
"Cost them a whopping $89,000. The Charlotte Observer The four vials of anti-venom medication Ferguson received reportedly cost about $20,000 each. Ferguson and his wife Laura researched the price of the medicine and found its retail price was between $750 and $12,000 per vial. Medicare, they reportedly found, would have paid about $9,460 for the total treatment Though their Blue Cross Blue Shield Insurance reduced the bill to a little over $20,000,

It sounds like buying a rug from a merchant in Cairo - the sticker price has almost no correlation with how much money will eventually change hands, except in this case if you have to haggle on your own you'll die before a price is agreed on.
2014-01-31 09:34:41 AM  
1 vote:

vonmatrices: Hospitals bill insurance companies way too much for procedures because customers won't care.


While that is partly true and a holdback from the olden days where employer-based health insurance actually covered just about everything, insurance companies are now dealing not with individually owned hospitals, but large corporations made up of a "network" of different hospitals.

This actually gives them more leverage to say "we will pay X amount, or X percent of the list price for these procedures."  Just as they already do with Medicare and Medicaid reimbursements.

The hospital simply jacks up the "list" price so that the pre-negotiated percentage the insurance company pays covers the actual costs.  Unfortunately the patient does not get this discount for their co-pay.  Unless you negotiate it somehow and if you really push the issue, you CAN bring your end of the cost down.
2014-01-31 09:25:59 AM  
1 vote:
Fubini:
I am not above saying that the medical industry as a whole is a bunch of crooks. I understand that stuff costs money, and medical grade stuff is inordinately expensive, but when you can't even give me a ballpark figure on how much a procedure costs, or justify your bill for three months after the fact, you have lost all my trust and respect. The single greatest thing we could do for healthcare in this country is to legally require that patients be given a price quote prior to an operation with a +10% upper bound on what they'll eventually be charged.

I would agree with one small caveat: I really don't think it is the doctors.   It is mostly the insurance providers, with hospitals on board to so they can get paid.  Insurance providers are incentivized to make the process as byzantine as possible to protect their profits ; the more difficult it is to actually find out where the money is going, the better for them.  The problem is healthcare is a product that everyone needs at some point in their lives, so they also have no incentive to really compete, and it is very a regional business.  You generally end up at hospital 20 miles within your home if you live in a metro area, 100 miles or so in a rural area.  This means hospitals aren't competing with each other very much, and the barriers for entry are very high.  There is no "Costco" of healthcare to come in and undercut the local stores.  The effect is what you experienced,
2014-01-31 09:21:14 AM  
1 vote:

vudukungfu: Fubini: I am not above saying that the medical industry as a whole is a bunch of crooks

I am.


Me too.

Had a few mrsa infections last year. $1500 for a 15 minute lancing and 2 prescriptions. First day I waited about 8 hours and 6 the second before I was finally seen. 2nd infection was the same, only 1 day and 6 hours. 5th infection was surgery, 3 days in isolation, iv antibiotics, and $15000.

Nothing the doctors did I couldn't do. Before you surgery guys chime in, I wouldn't have needed the surgery if it wouldn't cost $500 to see a doc to get antibiotics.

Infections 3, 4, & 6-9 I lanced myself and used antibiotics from friends/family (luckily I found the same kind I was being prescribed).

When I was 21 my dumbass punched a wall and got a cracked bone in my hand. Didn't initially go to the hospital cause I thought I could manage. 1am I went cause my left hand was swollen all to hell. 3am I finally see a doc who eventually misread the xray and accused me of trying to get pain pills. I went off on the guy...I don't even like pain pill BTW...and an older doc walked by, glanced at the xray, and said you don't see those two cracks right there, turned to me and said you must be in pain. Yep, but I'm just here for some kind of brace or wrapping, I don't want any pills if necessary. About 10 minutes later the old doc returned with a brace and a vicodin prescription. $3500.
2014-01-31 09:20:30 AM  
1 vote:

vudukungfu: Fubini: I am not above saying that the medical industry as a whole is a bunch of crooks

I am.


I've worked in the industry for 34 years.  I tend to agree with you.
2014-01-31 09:10:36 AM  
1 vote:

mekki: Fubini: got a medical bill that seemed too high, so I asked for an itemized bill to be sent. It's been three goddamn months and they can't send me a bill for services *they already performed* and *have already billed me for*.

Why would any hospital would want to send an itemized bill? So, you can learn that they ridiculously overcharged five hundred dollars for giving you two ibuprofen pills and then you can argue down the cost? That's how they make their money. By overcharging beyond scary amounts of money for things that should cost a few dollars. How this is legal, I don't know. The medical lobby?


Inelastic demand without regulation.
2014-01-31 09:08:50 AM  
1 vote:

uttertosh: Headso: Our costs for providing uncompensated care are partially covered by higher bills for other patients.


In other words the middle class pretty much carry the burden of the uninsured and under-insured.

I know, right? It's like some kind of dystopian communistist nightmare y'all are living in.


it's more a combo oligarchy/cleptocracy...
2014-01-31 09:05:37 AM  
1 vote:

vonmatrices: There is more to it than, "That is what insurance is for."


Greek: Right, but that's still an example of the stupidity involved in health care pricing. That magical $89,000 number that no one pays? It's to prevent the insurance companies from trying to fark them. It's also the reason that even CASH patients can't get any clue what it's actually going to cost them.


I completely agree, and that's a very reasonable argument to have.  That's what the article should be about.  Not a deliberate attempt to get page views with a misleading headline.
2014-01-31 09:00:13 AM  
1 vote:
2014-01-31 08:50:54 AM  
1 vote:
...they only ended up paying about $5,400 to cover their deductible and co-pay...


Yeah but let's claim it was more than 25times that to make headlines.
2014-01-31 08:50:08 AM  
1 vote:

RedPhoenix122: Headline:   Snake Bite Costs North Carolina Couple $89,000 Hospital Bill

FTFA:  Though their Blue Cross Blue Shield Insurance reduced the bill to a little over $20,000, according to the Charlotte Observer, and they only ended up paying about $5,400 to cover their deductible and co-pay, the couple said they were shocked by the price of treatment.

Then it didn't cost them $89,000, did it?  That's how insurance works.


I would pay 5400 to not have to die an agonizing death and kiss everyone in the ICU on the lips when I walked out of there.
2014-01-31 08:47:55 AM  
1 vote:
So..  No political slant to this article at all..


The couple visited the emergency room in August to receive treatment. The sticker shock comes as Americans continue to battle high health care costs following the introduction of the American Care Act

What does Obamacare have to do with this?

The article mentions this happened in the August.  So that's either some serious back billing by the hospital, or this issue all took place before ACA.
2014-01-31 08:46:43 AM  
1 vote:

Fubini: I am not above saying that the medical industry as a whole is a bunch of crooks


I am.
 
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