Health-care costs shoot up, millions in U.S. left gasping

July 4, 2004 10:03 AM

Health-care costs shoot up, millions in U.S. left gasping"...there are signs of growing frustration. The Gallup Organization reported in January that for the first time since 1992, when Americans are polled about urgent health problems facing the country, the cost of health care is No. 1, ahead of issues such as cancer, obesity, and smoking..."
posted by Postroad (76 comments total)

Health Care is expensive for the same reason divorce is expensive: It's worth it. Anyone who doesn't want to pay for health care doesn't, of course, have to use it. The vast majority of the human race does not have access to American-quality health care, nor anything close to it. Human beings from the beginning of time have somehow managed to get by without America's superb health care. So can you. If, however, your doctor or hospital has some service you really, really want, the situation is not unlike if your car dealer has an automobile you really, really want. To get it, you have to pay for it. And you have to pay the going rate. If some particular political party decided to make car prices their bugaboo, they could jump up and down and scream "cars should be free! All people deserve free access to a good car." They might even be able to get the price of cars down to about nothing. But after all the cars in existence were taken, nobody would ever build a new car again, since there was no money in it. Same with health care. Right now, health care is a great social investment. Eighty percent of health care costs are salaries. That means money that's spread across the whole social spectrum, from doctors to nurses, to the guys who mop out the ORs and tend the animal labs. That's money that stays in your community and enriches local businesses. Most pharmaceutical companies and medical device manufacturers are American, or so highly invested here that they may as well be. Health care careers are a great avenue of social mobility, from poverty to the working class, from the working class to the middle class and beyond. If anyone in America wants a good job, just go to nursing school, or train for an allied health position, or go to your local hospital and see what's available. It's a great field, a great industry, and an arena with stupendous potential for you, as an individual, to do good for humanity.
posted by Faze at 10:27 AM on July 4, 2004

Anyone else smell a rotting red herring?
posted by Space Coyote at 10:30 AM on July 4, 2004

Don't get the two problems confused: the rising cost of healthcare, and the rising cost of healthcare insurance.
posted by ilsa at 10:34 AM on July 4, 2004

"For years, the Findlay-area woman spent tens of thousands of dollars on medical insurance premiums. Then she got the letter."

That pretty much sums up the article. Even with regulation laws, insurance companies have the wherewithal to hire an army of actuaries and lawyers (and lobbyists), and therefore easily have the power to brush aside anyone who actually needs the payout. And with the profit motive being chief, that is exactly what they'll do.
posted by weston at 10:37 AM on July 4, 2004

Faze: you're totally right. We should let all those poor people die.

You might be singing a different tune if this happened to your loved one.
posted by bshort at 10:39 AM on July 4, 2004

The car purchasing analogy is poor at best.

To extend it:

If I get car purchasing assistance from my employer, I can pay a mere fraction of the car's price that is charged to those who walk off the street with no employee car purchasing coverage.

If my employer has a bad plan, then I will pay a much larger fraction of the purchase price.

The "full price" of health care only applies to those who have no health insurance, because they haven't negotiated rates with hospital conglomerates that result in the hospital losing money everytime someone covered by said insurance walks in the door.

Furthermore, Medicaid and Medicare have negotiated such ridiculous reimbursement rates that in the end, it costs the hospital every more money to provide services to those covered by it than private insurance. And to add insult to injury, in order not to be declined on principle when submitting claims to them, you have to hire and staff a business office that makes the old Communist offices look lean and mean.

I know this because I consult with these companies. No one wins. Everyone loses, and the people who do the worst are the ones who cannot afford it.
posted by ltracey at 10:50 AM on July 4, 2004

I'm just gonna wander in here, mention the NHS, and feel superior. The whole American healthcare insurance mess is a great illustration of why socialised healthcare works well -- if you don't like the NHS, you're free to go private, but at least everyone is covered. It's ironic that the main reason for not having socialised healthcare in the US seems to be concern over taxes, and yet a huge part of the population is happy to pay $3,000 per family (or whatever the exact figure was) to fight a pointless war...
posted by reklaw at 10:50 AM on July 4, 2004

Faze: the article isn't about the cost of health care services alone.

When I go to a doctor, I don't have a problem paying $50-$70 for a half an hour of his time, more for the performance of a proceedure which uses his skills. What I do have a problem with is paying hundreds or thousands of dollars to an insurance company who then, when it comes time to uphold their end of the deal, does everything in their power to avoid it. Which is why I'm beginning to think that running a risk-pool that actually protects its members and running a risk-pool for profit are diametrically opposed endeavors.

Get the last part of the article:

Tom Volk is a business owner. He's healthy. His balance sheet isn't...He pulls out a sheet of his company's health-care costs:

# Monthly premium he paid for family coverage for one of his employees in 1999: $621. Monthly premium today: $1,056.

# Full drug coverage in 1999 with $10 co-pay. Drug coverage today: None until employee meets $1,000 deductible. After that, employee pays 20 percent of the cost.

# In 1999, full health coverage with a large selection of physicians and with no deductible for employees. Now, 80/20 plan (insurance covers 80 percent), smaller choice of doctors, $1,000 deductible, and a $10,000 out-of-pocket maximum for family coverage, up from $6,000 last year.

All of these changes, he says, have come without any major health claims from any of his workers.

So here's the question: has the cost of providing health care *really* gone up 100% in the last 5 years? If not, where is the money going?

One answer is, of course, investment difficulties. But I'll tell you another story: in 1997, I signed up for private, individual catastrophic insurance as a perfectly healthy 25 year old. Inside of a single year, my premiums went up 100%. No claims, no change in health status, I don't think I even saw a doctor that year, and I can't concieve of my risk group being a problem. What did their letter cite? "The rising costs of medical care." 100% in a year? At a time when irrational exuberance meant investments were often returning that much? I dropped them as soon as I could, but doesn't the question linger: where is the money going?
posted by weston at 10:51 AM on July 4, 2004

I pay cash for my health care and make sure the doctors keep my medical information private. I ask upfront if they will give a discount for cash since it saves them a lot of time and money and they get paid right away. I am finding out there is a network of doctors who only deal in cash they are opting out of the insurance level of patients, too much overhead.

Don't have the cash? It's called being fiscally responsible and saving your chips for when the day comes as it always does. It's called taking responsibility for yourself and not relying on the crap-shoot of the insurance business. I'm not saying it's for everyone, but if more people did that it would solve a lot of problems for the rest of those who really do need help.
posted by stbalbach at 11:18 AM on July 4, 2004

Health Care is expensive for the same reason divorce is expensive: It's worth it.
- Yep, but there are a variety of methods which allow us to pay for it.

Anyone who doesn't want to pay for health care doesn't, of course, have to use it.
- Although they may of course harbour infection, posing a public health threat, and because treatment, prophylaxis and education will be unavailable to them - they will pose an increased threat to those WITH insurance.

The vast majority of the human race does not have access to American-quality health care, nor anything close to it. Human beings from the beginning of time have somehow managed to get by without America's superb health care.
- So? The vast majority of Europeans currently have free, or low cost, refundable medical care. Is that fact relevant to this discussion? [Which I guess should be entitled 'How should Americans organise health care']

So can you. If, however, your doctor or hospital has some service you really, really want, the situation is not unlike if your car dealer has an automobile you really, really want. To get it, you have to pay for it. And you have to pay the going rate.
- NB: This is not a law of the universe: it could be different.

If some particular political party decided to make car prices their bugaboo, they could jump up and down and scream "cars should be free! All people deserve free access to a good car." They might even be able to get the price of cars down to about nothing. But after all the cars in existence were taken, nobody would ever build a new car again, since there was no money in it.
- I'm not gonna argue about cars - the analogy is not persuasive, as one is inanimate construction and the other is a product of life.

Same with health care.
- Nah, it's not: just cos you say it's so, don't make it so.

Right now, health care is a great social investment.
- No, in the US it's a private investment. In Europe and other places, it's a social investment.

...
posted by Faze at 10:27 AM PST on July 4
posted by dash_slot- at 11:25 AM on July 4, 2004

Don't have the cash? It's called being fiscally responsible and saving your chips for when the day comes as it always does.

I've heard this called the "corpses in the streets" scenario. It's running a healthcare system the way, say, Nigeria or Bangladesh does, except without CARE packages or Mother Teresa.
posted by gimonca at 11:29 AM on July 4, 2004

And nowadays, the U.S. is fast becoming the only supposedly "wealthy" nation with a third-world healthcare system.
posted by gimonca at 11:30 AM on July 4, 2004

If some particular political party decided to make car prices their bugaboo, they could jump up and down and scream "cars should be free! All people deserve free access to a good car."

Exchange the word "highway" for "car", and you've just described U.S. transportation policy since 1950.
posted by gimonca at 11:33 AM on July 4, 2004

Health Care is expensive for the same reason divorce freedom is expensive: It's worth it.

Isn't health care just the flip side of national defense? No one seems to oppose that being subsidized.
posted by Ptrin at 11:44 AM on July 4, 2004

"Paying for prescription drugs is no longer a problem just for poor people. As the economy continues to struggle, health insurance is shrinking. Employers are requiring workers to pay more of the costs themselves, and many businesses are dropping health benefits altogether. Since prescription drug costs are rising so fast, payers are particularly eager to get out from under them by shifting costs to individuals. The result is that more people have to pay a greater fraction of their drug bills out of pocket. And that packs a wallop."

The entire piece demands to be read. It refutes so many of the tired clichés used to defend the American system -- a system that not even right-wing parties outside the US regard as a model. Calling it 'insurance' is itself a travesty of language.

stbalbach: you're missing the big picture. Poverty begets health problems begets poverty. Universal healthcare can be more focused upon preventative measures, and as such is more efficient. Having money in the bank for when 'the day comes' is like using binoculars while driving.
posted by riviera at 12:41 PM on July 4, 2004

Our pastors belong to some kind of health network whereby their premiums each month wind up going to whoever in the plan needs them. I don't know a whole lot how it is organised, and you can't smoke or drink if you are part of it, but apparently it works really well.

I can tell you that something has to give. I have no insurance now and unless my husband or I get a job where insurance is included I won't be able to have any by virtue of my "preexisting condition." Which I now basically treat on my own with no medical help whatsoever. Yay me.

Socialized medicine scares me on many levels too-I have heard too many scare stories from my bipolar friends in other countries. Yet I know that what we have now is just as screwed up. What we need is a NEW idea of some sort.
posted by konolia at 12:43 PM on July 4, 2004

Don't have the cash? It's called being fiscally responsible and saving your chips for when the day comes as it always does. It's called taking responsibility for yourself and not relying on the crap-shoot of the insurance business.

I've learned this lesson once the hard way and tend to subscribe to this philosophy: I'm slowly building up various savings accounts, including one designated medical, and I pay cash for my doctor's visits, and in some cases, for procedures. But the fact is, most middle class earners simply cannot afford to put away for a 6 figure medical event. Many would have trouble with a 5 figure event, especially the large portion of our workforce that earns less than 30 grand per year.

So it's either insurance at that point -- limiting your exposure to risk by paying a fixed cost -- or taking the risk. The frightening thing is that taking the risk increasingly looks like the better option, given that insurance companies are not upholding their end of the bargain. How much of this is caused by greed, mismanagment, or an impossible situation isn't completely clear at the moment, but what should be completely clear is that when we reach this point, the system is broken, and answering questions about why should be a very high priority for policymakers.
posted by weston at 12:48 PM on July 4, 2004

If you are uninsured, all you need to change your perspective on health care is one big catastrophic injury or illness. Car crash, appendicitis, serious viral infection, pick one. Its great if you can pay your doctor with cash, and you take responsibility for your own health.

But health and injury are often unpredictable. This is why we have insurance. If you don't have it, and you experience a great misfortune, you will, belatedly, come to see how truly messed up our system is.
posted by 4midori at 12:57 PM on July 4, 2004

Socialized medicine scares me on many levels too-I have heard too many scare stories from my bipolar friends in other countries.

konolia: it's worth noting that public provided health coverage does *not* need to mean public-managed health care. The former has to do with providing a means for people to pay for medical care -- the later has to do with providing the care itself. There could be a system where the government's only role is administering a public insurance program, while medical providers compete for business from individuals (whether fully subsidized by public insurance, partially subsidized, or paying themselves).

Of course, in practice, there would still be some influence: what the government determines it is willing to pay out for a given procedure, for example. Not to mention that you're missing the force of competition to try to exact long term efficiency from the government in terms of how well their actuarial models pan out and how efficient their administration is.

But I don't think it's at all clear that our current system offers an advantage: how many people who actually *need* insurance can really switch from one provider to another (and if they can't, where's the competetive force then?) And are the advantages of the competetive force totally sandbagged by the profit motive and many-times-over redundant administrative costs?

Sometimes I wonder if the Credit Union model might not be a better one for insurance -- by and large, in my area, at least, it seems like credit unions are thoroughly trouncing banks in terms of offerings. Presumably, because they exist not to provide a profit to private investors, but because they exist to provide good financial services to their customers and put profits back towards that end. Perhaps it's time for insurance with the same philosophy.
posted by weston at 1:10 PM on July 4, 2004

Healthcare is expensive because the incentive system for costs is completely broken. Employer-provided insurance gives the worst of both worlds -- the inertia, overhead and lack of competition of a public system and the unsubsidized expense of a private one. And nothing gets done because most americans have no concept of good policy and bad policy, only large or small programs, and because politicians here have no accountability -- a democrat will invariably vote democratic, a republican will always vote republican, and there's no viable 3rd party.
posted by Tlogmer at 1:32 PM on July 4, 2004

For the record: Canadians pay far less per capita for their universal health care than Americans do for their limited, corporate-controlled private health care that leaves thousands uninsured. Why Americans want to pay so much money to live in that kind of unstable environment is beyond me. Socialized health care is never going to stop covering you just because you get older or sicker.

I just can't understand American fears around socialized medicine. It makes no sense to me at all.
posted by Hildegarde at 1:40 PM on July 4, 2004

Hildegarde: it's part distrust of authority (fear the government is going to dictate what kind of care you receive), part general disparagement of bureauocracy (will medical care achieve the efficiency of a DMV?), and finally, part aversion to personally subsidizing programs that do everyone good (especially if you personally can pay for something better). Any case for public health care has to address all three fears.

Tlogmer: Employer-provided insurance gives the worst of both worlds -- the inertia, overhead and lack of competition of a public system and the unsubsidized expense of a private one.

I'm interested in this idea, but not totally convinced yet. The standard response is... why would a business be any less likely to respond to a poor offering by taking their business elsewhere than an individual? My own guess is that much in the same way that group insurance is a protection against individual catastrophe, so is a group less sensitive to individual pain/trouble (hence the inertia), and so individuals can't make choices that drive competition anymore. However, I'm not sure that articulates the argument all the way through.
posted by weston at 2:04 PM on July 4, 2004

I am very proud to live in the one state in the union where Universal Health Care will soon be the norm. The Dirigo Health model, while not perfect, will take an enormous step forward in cutting the cost of access to health care for everyone in the state. It will reduce the amount that businesses currently pay for health insurance, provide an affordable insurance option to small businesses and individuals, and, most importantly, insure that everyone in Maine has both access to necessary care and freedom of choice as to what medical provider they are treated or evaluated by. Here's the FAQ.

Look, Anthem Blue Cross Blue Shield announced in April that their CEO was getting a bonus valued at 42.5 million dollars (including $21.2 million in cash and a restricted stock award totaling another $21.2 million), in addition to his salary of 1.04 million. While I fully support the right of businesses to pay their executives a living - or even exorbitant - wage, that bonus amount is shameful during a period when they also increased by and average of between 10% and 20%.

Why Americans want to pay so much money to live in that kind of unstable environment is beyond me.

I work for a grass-roots organization that helped to bring Dirigo Health to pass. What we've found is that most Americans (or, at least, most Mainers) don't want the healthcare system we have, its just that they've either a) been frightened by the propaganda from the big companies that basically tells them that USP will cause them harm or cost them money and b) very few politicians have the balls to stand up against the system and create a viable alternative. Like so much else in life, we mostly use the option we have because no one has provided an alternative. Well, now we (in Maine) will have an alternative. Hopefully we can be a model for the rest of the nation.
posted by anastasiav at 2:14 PM on July 4, 2004

weston: it's part distrust of authority (fear the government is going to dictate what kind of care you receive), part general disparagement of bureauocracy (will medical care achieve the efficiency of a DMV?), and finally, part aversion to personally subsidizing programs that do everyone good (especially if you personally can pay for something better). Any case for public health care has to address all three fears.

While I can understand worrying about the government dictating care, socialised healthcare doesn't have to mean abandoning the private route. I see my local doctor for everyday ailments, but when it came time to get more specialised care, I paid the money and went private, partly to avoid the lengthy waiting list, but mainly so that I could have complete control over that aspect of my care. After my privately-funded consultations I came away with a prescription that I handed to my local doctor, and which I now receive, subsidised, from the NHS. It's neat. People with the same illness who can't afford to go private will wait a little longer and be a bit less pampered, but they'll get treated all the same.

The third fear, though, I cannot understand. I happily pay my NHS contributions in my paycheque, and I don't mind paying extra to skip a waiting list or whatever. I've paid an enormous amount less than I would have had I insurance on a US model, and I've always had adequate care when I really needed it and first-class care when I really wanted it, all on tap.
posted by ArmyOfKittens at 3:00 PM on July 4, 2004

The health care industry is not like any other business. You can choose not to buy a car, and somehow get by in life, but beyond optional procedures, you can't really avoid having to buy needed medical services. Your choice is to buy the procedure or medication, or die (or suffer terribly). This is not a free market. It is profit at the point of a gun.

There is no incentive in the health industry to bring down costs, or even keep them reasonable. There is every incentive to maximize the cost of everything. After all, the customers are a captive market. The demand for angioplasty will not cut in half if you double the price.

I don't think any gains towards socialized medicine in this country will be made until health insurance costs more than rent or mortgage payments. People are just too docile. They won't care until it personally hurts them, in masses too large to ignore. The grousing is getting louder lately, but it'll be awhile before we see any real action on this front. I fear lots of people are going to die & suffer without care before this gets the attention it deserves.

All that said, I have to give props to my county mental health service. For free (when I am jobless) or for a small fee ($60 or so per visit when I have a job at $12.50/hr), they keep me alive, and pay for my medication. Without them, I would almost certainly be dead.

Sometimes even when you supposedly have coverage, you get screwed. I still have a $5,000 hospital bill hanging over my head - my HMO assured me I was covered when I checked into the hospital, then six weeks later changed their mind. I will probably end up declaring bankruptcy.

I think I remember reading recently that medical expenses are a factor in something like 50% of bankruptcies.

Get ready for the powers that be to make it even harder to declare bankruptcy. Heh.
posted by beth at 3:09 PM on July 4, 2004

As a Canadian, I've paid exactly $140 "cash" for hands-on health care over the past 36 years, and perhaps a thousand on medication. The $140 was for an ambulance ride (80-odd kilometers); my medicines have generally been at least partially covered under various group health plans and government programs.

All else, from doctor's visits to surgery, have been free of payment. It's all covered by my taxes.

Taxes which, it turns out, aren't all that onerous. I believe my federal+provincial taxes worked out to 22% last year, after deductions & etcetera. That's pretty much what an American would pay... plus they'd have to purchase health insurance on top of that.

There are only a few things I think our Canadian healthcare system needs to focus on:

1. Reducing administrative overhead. I've never met an overpaid or underworked front-line healthcare worker: they generally seem to me to be busting their asses. I'm not so sure the same can be said of administrators.

2. Introduction of minimal, dodge-able user fees combined with a self-help education campaign. Let's not waste our resources by going to the doctor when some virus is giving us the sniffles: he can't do anything about it. Educating people on how to take preventative steps, by eating well, exercising, and not doing stupid things should be a part of that.

3. Incentives for family doctors to live out in the sticks. Canada is a mighty big country with a lot of very remote territory. I'd like those who live in the sticks to have reasonable access to the most-needed healthcare services.

With those three items, I believe Canada can improve its healthcare system and reduce costs.
posted by five fresh fish at 3:28 PM on July 4, 2004

It's an indisputable fact that the cost of health care is going to continue to increase for some time: the population is aging; new diagnostic methods and therapies continue to arrive and tend to be more expensive than what they replace.

I think that in this context a single payer system like the one in Canada has a huge advantage over the patchwork of public and private interests operating in the U.S., principally because it allows the issue of cost to be addressed in a comprehensive, efficient, and fair way. In the recent Canadian Federal election it was an absolute requirement for each party to have a defensible policy for dealing with health care, which continued to be the most prominent issue in the national debate. It would have been political suicide for a party to advocate a system that failed to serve 100% of the population, regardless of their income. On the other hand, those parties that made overly generous promises were agressively questioned as to where the money was to come from--i.e. what other areas of government spending would have to be curtailed.

There are currently many problems with the Canadian health care system--waiting times for elective surgeries can extend to months or years, for example. The best American health care surpasses any available in the rest of the world. But I think the Canadian system has a much better chance of dealing with a problem that is not going to go away in either country.

And on preview I think what five fresh fish said dovetails quite nicely into this comment.
posted by Turtles all the way down at 3:36 PM on July 4, 2004

five fresh fish - Hear hear!

I've heard some people in this thread talk about putting money aside for medical emergencies. I'd be curious to know how much. I pay $55 a month to the government for my universal health care coverage, and another $55 a month in added insurance for some extras (chiropractors, etc) and additional prescription coverage.

That's $110 a month and I'm covered. How much are those putting aside for medical coverage in the US placing into savings account? I admit I'm really curious to see how it compares.
posted by Salmonberry at 3:36 PM on July 4, 2004

Salmonberry: what you've got sounds pretty good. If I were working under your system, I'd probably not only have better coverage for less money, but would also be able to put away at least double what I do now towards the possibility of financing private care should the need arise.
posted by weston at 4:29 PM on July 4, 2004

I believe my federal+provincial taxes worked out to 22% last year, after deductions & etcetera

You're either not adding in GST/PST or you're poor.

That's pretty much what an American would pay... plus they'd have to purchase health insurance on top of that

Well, not really. Most Americans get health care as a benefit from their employer. It doesn't cost anything on its face (unless you want family coverage and that's not included), it's just foregone implicit salary.

I (and my family) didn't have to (directly) pay a dime for my health care until I was 22 or 25 -- ironically, the one part of the US with real no-shit full-on commie socialist health care is the military. Of course, people in the military also generally get paid rather poorly, so it evens out in part.

It's precisely the people who are out on their own trying to buy their own individual health insurance who are fucked, because they're not part of a group plan and so the usual adverse-selection problem comes in.

It's worth pointing out that the US is more-or-less always going to have relatively large numbers of uninsured people because there are 8--15 million people here illegally who wouldn't be eligible for coverage under just about any health-care scheme.

That's $110 a month and I'm covered.

Well, no. Other taxes you (and others) pay are going towards covering your health care costs; they're just not directly billed. If everyone were directly billed per-capita, your bill would be ~CAD2500/year or more.

Which is all well and good, but don't go thinkin' that the check you write that says "health care" on it is all of what you're "spending" on health care.
posted by ROU_Xenophobe at 4:31 PM on July 4, 2004

ROU_Xenophobe, 22% doesn't mean poor. I paid that on $50k income (as self-employed, which meant I put the full 10% in towards CPP on top of my taxes). I don't think $50 k is wealthy, but it's hardly minimum wage.

GST is 7% and PST varies, Alberta doesn't have any PST at all, and some US states have comparable rates of sales tax to the provinicial levels.

Most Canadians have their health premiums covered by their employer, I pay out because I am a self-employed individual who has to pay for her own insurance. If I were employed somewhere, the company would cover it.

And yeah, I get that my taxes do help cover health care. But the US does have some systems in place for public health, so the sneaky secret is that on top of paying huge insurance rates you guys do put in some taxes towards a public health system as well.
posted by Salmonberry at 5:25 PM on July 4, 2004

It's precisely the people who are out on their own trying to buy their own individual health insurance who are fucked...

That's precisely who I am, but here "fucked" translates into paying $110 a month.
posted by Salmonberry at 5:26 PM on July 4, 2004

Most Americans get health care as a benefit from their employer. It doesn't cost anything on its face (unless you want family coverage and that's not included), it's just foregone implicit salary.

Until you lose your job, and then you're screwed, just when you're most vulnerable.
posted by Armitage Shanks at 5:47 PM on July 4, 2004

Let's concentrare on the concept of INSURANCE shall we ?

In theory and in practice, the train of toughs that started the insurance business is the following

1) nobody can foretell with 100% accurancy what will happen in the future (one year from now or one second from now)
2) we can just make some rational hypothesis based on analysis of data collected from the past
3) but even with infinite amount of analysis, we'll never be able to say an event will happen exactly like we predicted
and affirm that we are 100% sure of this.
4) that remains true even if we were able control ANY variable/costant involved in the event, because unknown variations
may still occour
5) therefore, we're subject to the RISK that our good plan will turn bad in a snap and ruin us

Insurance business was built to reduce the EFFECTS of the risk : you pay some money in advance and the insurance will
pay you money if a _certain_ event or _combination_ of event occours

Insurance business is, like any other for profit business, made to make monetary profits. Therfore at the end of the year
they MUST ABSOLUTELY check this disequation : (MONEY IN - MONEY OUT) > 0. If they don't, a lot of bad things can happen

a) they go out of business OR
b) somebody decides to BET on the company by keeping their investments in the company , but the next year they will want
MORE money because they want the profit they didn't receive in the last year. This puts MORE pressure on the company to
make more profits.

To do that, insurance can either (or make a combination of the following)
1) pay less money or NO money to insured people, by exploiting any trap/loophole in the contract OR
2) if they can't do that, fight with lawyers in hope that the insured person will not fight back OR
3) if the insurance is about a disease, hope that the insured person will die soon to reduce the payment of money. This process
can be helped by fighting the person with lawyers , so that the insured person hopefully doesn't have enough money to pay
for the drugs/treatement he needs and dies sooner.
4) drop people with an higher-risk profile (like the woman in the article) were high risk profile = getting older
5) rise insurance premiums using any excuse like "higher health-care cost"
6) attempt to strike deals (very difficult and risky) with private hospitals, trying to get discounts on treatements
7) attempt to get tax cuts / benefits from the government

The big realization comes HERE: they don't need to do that ONLY if they are in crisis, they can do that ANYTIME even if they're
having a botload of profits (cleverly hidden with creative accounting or by corruption of accounting analysts, see ENRON & Arthur Andersen).

Being private entities, they can cover much of their work under a veil of private secrecy (unlike the government, except for so called
national security) and minimize the risks of whistleblowing by paying their top managements (the only ones who really know what's going on) enormous paychecks.

All of this while there's still no cure for cancer and there will probably never be one as it's FAR more profiteable to sell treatement for diseases then a CURE for it, unless of course you have a new array of real or fictious diseases to "fight".
posted by elpapacito at 5:58 PM on July 4, 2004

22% doesn't mean poor. I paid that on $50k income

I may be misremembering, but I think FFF lives in Ontario, so he pays 15% GST+PST on ~everything he buys. So for him to be paying only 22% of his income in taxes, he must be in an income tax bracket no higher than 7--10%.

I was just reminding him that if he was paying 22% income tax, he was paying something over 30% of his income in taxes, and he was ignoring one of the prime sources of OHIP funding.

That's precisely who I am, but here "fucked" translates into paying $110 a month

No, you pay $110 a month as a health care premium, and some additional indeterminate large amount for health care in taxes you pay. And there's nothing wrong with that or anything like that, but I assure you BC isn't funding its health care system by having everyone chip in $110 or $55/month.
posted by ROU_Xenophobe at 7:17 PM on July 4, 2004

Until you lose your job, and then you're screwed, just when you're most vulnerable

Huh? Unless you work for a really weensy business, you should be COBRA'd. Which isn't the greatest deal in the world, you still have to pay what had been the company's premiums, but still.
posted by ROU_Xenophobe at 7:23 PM on July 4, 2004

Well, it looks like there is an upside to the high-cost of healthcare in the US.

In the CS monitor Sen John Warner says a new draft isn't coming, one reason is that "The cost of benefits would be prohibitive".

So, silver lining!
posted by Salmonberry at 7:34 PM on July 4, 2004

Is it me or is ROU_ X getting confused with who said what?
posted by dash_slot- at 7:35 PM on July 4, 2004

In BC, and I neglected to write the word "income" between "federal+provincial" and "taxes."

Either way, studies I've read that analyze the total sum of monies paid by Americans toward government services + health care ~= monies paid by Canadians toward government services + healthcare.

We could talk about automobile insurance, and I could likely make everyone outside of BC green with jealously over the rates I pay and coverage I receive. It's feckin' sweet.
posted by five fresh fish at 8:05 PM on July 4, 2004

you should be COBRA'd. Which isn't the greatest deal in the world, you still have to pay what had been the company's premiums, but still.

Isn't the greatest deal in the world?? That's an understatement. When I lost my job in March I was eligible for the maximum allowable benefit from unemployment ($292/week) and was offered COBRA from my employer. My COBRA payments would have been $900 per month, or over 75% of my unemployment benefit. Luckily, my boyfriend's employer offers insurance to domestic partners, so I was able to be insured under their plan for about $40 per week, but had that not been available I would have simply had to become yet another of the millions of uninsured in America and hoped that I didn't have any emergency medical bills that cost more than the equity available in our house.

For most people, COBRA is simply prohibitively expensive, especially if they lost their job without any kind of alternative severance package.
posted by anastasiav at 8:25 PM on July 4, 2004

So the long and the short of it is that the Canadian system may be a bit of a lame horse, but the American system has been put down and turned to dog food...
posted by five fresh fish at 8:55 PM on July 4, 2004

five fresh fish: regarding auto insurance rates in B.C. (ICBC) [for the USAians, the equivalent of a state car insurance regime, with no competition allowed]: Really? I thought B.C. provincial insurance rates were ridiculously high. I haven't insured a car in B.C. since the mid-90's so I'm seriously just asking. But I agree this has a bearing on the whole "is it possible that the government, with all its known inefficiencies, can ever match or beat the private sector in delivering services" question.

More pertinent to this thread, I ask the Canadians, Brits, Aussies and Europeans (and anyone else with a public health care sytem I've neglected to include): how much does money ever enter into your experience of health care? As a Canadian, I'll echo the comments previously made by my compatriots, which is: hardly ever--pay my income tax, pay provincial tax and G.S.T. and the monthly premium of about 50 bucks, but whether I've got a sore throat and need to go to my G.P. for a prescription or I end up having, let's say AIDS, which is going to inevitably require a whole bunch of lengthy hospital stays, the disease is bad enough; the financial considerations just don't ever enter into the equation and I know I'm *never* going to be denied treatment.

I just can't believe that Americans, regardless of who scares them, can put up with a system where you could be left completely on your own at a time you need help most.
posted by Turtles all the way down at 9:48 PM on July 4, 2004

I just can't believe that Americans, regardless of who scares them, can put up with a system where you could be left completely on your own at a time you need help most.

See Faze's comment to begin this conversation. Some people, for whatever reason, just cannot seem to accept the idea that poor people don't just somehow choose to be poor. They persist in thinking that if somehow the poor and disadvantaged all worked just a little harder they'd have houses in the suburbs just like the rest of us.

There is, I will admit, something of stigma to Universal Single Payer in the US which I think derives from the idea of "taking help" or "being on public assistance". Of course, the same (real or imagined) stigma was attached to Social Security when it was first introduced, but we seem to have gotten over that.
posted by anastasiav at 10:00 PM on July 4, 2004

There is, I will admit, something of stigma to Universal Single Payer in the US which I think derives from the idea of "taking help" or "being on public assistance".

True. But not only that... for Americans, there's this idea that whatever you have, there's always something better "out there" that you will someday be able to buy-- there's a "better doctor," a better treatment, a better health plan just waiting for you to find it (or afford, once you get that big promotion). The idea of "socialized medicine" for Americans implies that "this is all there is." A single-payer system in the mind of most Americans would make them feel as though there is no more "better possibility" just around the corner.

I have a feeling that some people would rather complain about their poor health plan in the hopes of someday finding a better one than to actually have a better one that they couldn't hope to "upgrade" from.
posted by deanc at 10:05 PM on July 4, 2004

Turtles, ICBC rates are still the lowest in the country, that's why ICBC is still the major insurer here even though private insurance companies have entered the market. (Naturally, they all walked in knowing full well what ICBC was and what it did, and now claim the playing field isn't fair. I say tough nuts, you knew what you were walking into.)

I have no idea how those rates compare to the US though.

anastasiav, is talk about universal health care really always about the poor? In Canada it's part of government dogma due to it's positive effects on middle income earners more than anyone.

With respect to worries about things like picking which doctor will treat you, and what your options are....under our care system, I can go to any doctor I please, I'm not forced to use any particular professional. If you can afford it and want it, I believe there are doctors in Canada that don't work on the system, though I can't remember on-hand.

Rich Canadians who want to be choosy can always head across the border, of course. I guess if you're an American and wanted private health care beyond what you had, you can always dream of Swiss clinics in Gstaad.
posted by Salmonberry at 10:10 PM on July 4, 2004

Insurance in the U.S. is really what we've let it become. It's a highly regulated industry, and those regulators work for us. They work from regulations drafted by legislators who, again, work for us. We have not stayed on top of this, and we've allowed our lawmakers to be bought and paid for by insurance industry money.

There is no reason why insurance companies should be able to broker deals with hospitals to pay them roughly 1/3 of what uninsured patients pay for the same procedures. (There's a word for that in just about every other industry, it's collusion and it's frequently illegal.)

There is no reason why insurance companies should be able to define what is and is not a "group" for the purposes of purchasing health care, or to limit the definition of group to the entirely illogical "people who work for the same employer." Tying insurance to employment is convenient for insurers, especially inasmuch as it hides real costs from the end user, but it doesn't make sense nor serve the needs of consumers.

There is no reason why there should not be health care coverage options which function more like auto or homeowners' coverage. Your auto policy doesn't come into effect when you get your oil changed, and you don't bill your homeowners' policy writer when your kids' horseplay leaves you with a wall that needs new plaster. There should be an easy way for people to get lower-cost coverage just for hospitalizations, for emergencies, for maintenance medications (the ones most likely to be budget busters) and high-cost, high-tech diagnostics which happen separate from hospitalizations. Let the people who use more services pay more for the privilege, but proportionately.

In that same vein, such tiered service should be available to members within a group; because you buy your insurance via your employer or via your community or via your place of worship or via your college alumni association shouldn't mean that you're locked into only one type of coverage.

The problem is that the industry doesn't want any of these measures and is willing to pay good money to make sure that none of them ever come to fruition. And if you think that they can, do and will lobby hard and heavy to prevent these minor changes from going through, how much moreso will they fight to destroy any move toward nationalized/single-payer health care?
posted by Dreama at 10:15 PM on July 4, 2004

With respect to worries about things like picking which doctor will treat you, and what your options are....under our care system, I can go to any doctor I please, I'm not forced to use any particular professional.

I gotta echo this. I moved from a scientific position in a Canadian university to one in southern California. The U.C. system had what was apparently a great H.M.O., the whole idea of which I was unfamiliar with. I was presented with a list of something like 200 G.P.s to choose from. After unsuccesfully making a couple of choice I was told that only *one* physician was taking new patients. That of course was the one I "chose".

And to be fair, this guy was a great doc (I'm a physician by training, and as a consequence a great admirer of those that do it well). But I couldn't help but consider the irony that at precisely the time this was occurring, Hillary Clinton's health care plan was receiving blistering attacks from those saying that any sort of government sponsored health plan would mean limited choice in who you could go to for care--just like in Russia (or Canada!) the government would appoint your doktor!. I'd just come from a province where I could literally choose any G.P., including the best one in town, as my primary care provider.
posted by Turtles all the way down at 10:24 PM on July 4, 2004

I have a question for people familiar with socialized healthcare. How do the salaries of doctors in countries with socialized healthcare, especially in the west, compare with the salaries of doctors in the U.S.?
posted by gyc at 10:46 PM on July 4, 2004

How do the salaries of doctors in countries with socialized healthcare, especially in the west, compare with the salaries of doctors in the U.S.?

As a very *very* general starting point, my understanding is that your gross income in the U.S. is probably going to be higher, but the hassle of dealing with insurance companies as well as the higher malpractice premiums end up making it not worth it to move.
posted by Turtles all the way down at 11:01 PM on July 4, 2004

As a corollary, many of my friends are physicians in British Columbia, and gross something between $100,000-200,00 a year. Out of that they have to pay office rent, staff salaries if applicable etc.

That said, one of my buddies from school always said his intention was to make as much money as possible. In 2001 he (an ophthalmologist) billed the government something like $950,000.

So they're not all eating baloney sammiches here in socialist-land. ;-)
posted by Turtles all the way down at 11:08 PM on July 4, 2004

Interesting point Dreama makes. My additional coverage plan is through my auto club. BCAA.
posted by Salmonberry at 11:28 PM on July 4, 2004

Faze

I hope you get cancer some day, I really do.
posted by delmoi at 1:35 AM on July 5, 2004

FFF:

Incentives for family doctors to live out in the sticks. Canada is a mighty big country with a lot of very remote territory. I'd like those who live in the sticks to have reasonable access to the most-needed healthcare services.

Aren't doctors who have recently immigrated required to spend X number of years out "in the sticks" before they can practice in a city? That's what I heard anyway.
posted by ODiV at 5:06 AM on July 5, 2004

delmoi, that is so callous, it's OTT. You should really have better manners than that. Go sit on the naughty step!
posted by dash_slot- at 6:24 AM on July 5, 2004

anastasiav, is talk about universal health care really always about the poor? In Canada it's part of government dogma due to it's positive effects on middle income earners more than anyone.

Well ... sort of. Yes, its true that its middle income earners who would see the most benefit in the US as well. (Actually, I have a study on my desk that says that the one group that will derive the largest benefit from Dirigo Health is actually small business owners - businesses that employ between 3 and 50 people.) However, much of the initial focus for enrollees has been tied to % of income in proportion to the Federal Poverty Level.

From the FAQ linked above: Dirigo Health "will arrange coverage for health care and provide subsidies to eligible enrollees whose income does not exceed 300% of the federal poverty level (e.g., about $55,000 for a family of 4; $27,000 for an individual). The program is designed to make coverage available to every nonelderly uninsured individual in Maine within five years." (nonelderly because there is already a federal program to assist them...)

I don't really think of $55,000 a year as 'poor' (or $27,000 a year, for that matter) but the reality is in America today that its very tough for an individual to make ends meet on $27,000 a year.
posted by anastasiav at 8:18 AM on July 5, 2004

in America today that its very tough for an individual to make ends meet on $27,000 a year.

really? even in smaller cities and if one is childless? that's seriously fucked-up, then.
posted by matteo at 9:01 AM on July 5, 2004

Some numbers to play with unfortunately a little dated:

Canada insured 100 percent of its citizens for $2,250 per person in l998 while the United States expended $4,270 per person insuring only 84 percent of our citizens.

This is from a Washington Monthly study of the two systems. I'm always glad never to have to worry about becoming part of the 16%. And yes I'll concede some of the 16% are voluntarily self insured but I'd be surprised if it was more than 1-2%.
posted by Mitheral at 9:07 AM on July 5, 2004

Insurance business is, like any other for profit business, made to make monetary profits. Therfore at the end of the yearthey MUST ABSOLUTELY check this disequation : (MONEY IN - MONEY OUT) > 0. If they don't, a lot of bad things can happen

For example, rates being rased to cover the CEO's 42 million dollar bonus, right? For most investors/high-rollers, your equation isn't going to be near enough. It should be (MONEY IN - MONEY OUT) > DESIRED PROFIT.

I think if you read my posts you'll see I understand the concept of insurance. What I don't understand is insurers dropping people or otherwise denying payouts who payed their dues and played by the rules -- that's not insurance, that's stealing.
posted by weston at 9:36 AM on July 5, 2004

Everyone I know either uses a low-income clinic, or waits until they get really sick, and then goes to the ER with a fake name.

I have a suspicion that we're costing the American public more than it would cost to just insure us.
posted by cmonkey at 9:52 AM on July 5, 2004

in America today that its very tough for an individual to make ends meet on $27,000 a year.

really? even in smaller cities and if one is childless? that's seriously fucked-up, then.

It is indeed very possible to live on $27,000 a year. Rent and utilities cost me $4,140 a year. If you want transportation, figure in $30 a month for a bus fare card.

I make a lot less than $27,000 a year and I certainly don't feel poor. I don't have healthcare, but I probably could afford it if I made some sacrifices. As I am living in the now I prefer a prepared meal to beans and rice, and Blue Moon to Old Milwaukee.

I am fortunate that I am healthy and not living in pain most of the time. If there should be a time when I need medical assistance I will be up shit creek as they say. But it's not just about the money. I have a moral problem feeding this already gorged beast of a health care industry. If everyone stopped paying the insurance companies things would have to change. To the millions of Americans reading Metafilter I say this:

Boycott the healthcare industry!
posted by estey at 9:56 AM on July 5, 2004

really? even in smaller cities and if one is childless?

No, not really. Outside of a few expensive urban markets, you can live just fine on $27K/year. You probably won't be doing lots of saving, and you won't be buying a new SUV every 3 years, but you can live just fine.

If you don't mind splitting an apartment/house with others, you can just live like a grad student on $12--20K/year quite easily (again, outside of a few expensive urban markets). It's sort of austere, but hardly suffering.
posted by ROU_Xenophobe at 9:58 AM on July 5, 2004

turtle: the beauty of BC's ICBC auto insurance is that male or female, young or old, muscle car or beater, it's all about the same.

The rate is based on three factors: mostly, your driving record; secondly, the risk factor for your home district; thirdly, the typical repair costs for your vehicle model.

If you are a safe driver, your rates will drop every few years until you're paying only 40% of the base rate. If you have at-fault accidents, you go up the scale. If you are a bad driver, you could very well end up paying triple or more of the base rate.

If you live in Vancouver, a high-density, type-A driving environment, you pay more than if you live in rural Podunk.

If you drive a new Acura T3, you pay a little more than if you drive an old Honda Civic, mainly because the integrated full-width taillight component costs a couple thousand dollars to replace even if it's just cracked, whereas the Civic's individually-lensed taillights cost a couple dollars to fix.

If you're male, you pay the same rate as a female. If you are 20, you pay the same rate as a 40 year-old. If you drive the new Crossfire musclecar, you actually pay less than if you drive a new econobox Astrovan (there aren't many Crossfires and the drivers are usually pretty good, so they're not costing the earth to repair; Astrovans are all over the place and driven by cell-phone chatting soccer moms.)

If I remember, I'll grab my insurance papers and give the breakdown.
posted by five fresh fish at 10:10 AM on July 5, 2004

I am glad that Turtles has talked about their experiences with Canadian and US systems. For all the claims (on both sides of the border), I have never seen any evidence of superior health care in the United States. I grew up in Canada, and now I am a graduate student in the US at a major university; I am enrolled in their health care plan, and it is awful. I have several friends simply denied treatment or given a hassle about treatment in a way that would never have happened in Ontario. My fiance is also currently covered by Britain's NHS, and says that he doesn't understand the complaints - they have excellent service.

But it's not just anecdotal - the article itself notes that the US has a lower life expectancy than Canada. It also has a higher infant mortality than most developed countries with socialised medicine. (You can check out the CIA factbook or UN HDI pages if you care to dispute this).

As for the development of new drugs, it is very true that the US produces much of the research. But imagine how much more research could be done when they stop wasting all the money that is currently going to the administration of their private system? A study sometime ago found that while the US spent twice as much per person on health care, a much greater proportion was spent on administration, rather than care. Canada's problems with waiting lists (which are no where near as scary as the 15% of Americans who can't even get on the waiting list) would go away if we spent more on healthcare, but we still would not have to spend as much as Americans do.
posted by jb at 11:04 AM on July 5, 2004

Imagine how much more research could be done if the drug companies didn't spend 60+% of their budget on advertising...
posted by five fresh fish at 1:04 PM on July 5, 2004

Just random FYI, but anyone in the USA can walk into a hospital if you're sick and they must treat you. Doesn't matter if you give fake info, you're an illegal immigrant, nottin'. If you walk into the ER with something wrong and needed to be treated on, they have to take you on as a patient.
posted by jmd82 at 8:06 PM on July 5, 2004

I'm with Delmoi, Faze really got under my skin with his lead comment.

But, that's probably because I found out a week ago that my mom has myeloma. It's a blood cancer with no cure, although it can be "managed". She makes less than $31,000 and works for a small company with shitty benefits.

She's been symptomatic for 3 years, althought her diagnosis has only recently been confirmed. Agressive treatment is likely her only chance of surviving for any real length of time (her anemia now requires transfusions to keep her going), but she doesn't have much in savings, and she's going to be missing work due to treatment. Oncer her medical leave benefit runs out, she's fuxxored - Medicaid, Social Security Suplemental Income and my wife and I are gonna be her only income. She may not be poor now, but she certainly will be by the time her treatment is finished (if she's still alive).

If you're having too good a day, and need a downer, I suggest reading through the "Financial Issues" discussion board on the American Cancer Society's website.

So, yeah. I hope Faze someday does get a dose of the kind of compassion he's demonstrated up above.
posted by Irontom at 10:10 AM on July 6, 2004

Faze:

Do you have a citation for the quote you posted?

Eighty percent of health care costs are salaries. That means money that's spread across the whole social spectrum, from doctors to nurses, to the guys who mop out the ORs and tend the animal labs. That's money that stays in your community and enriches local businesses.

I would be extremely interested to know where this claim comes from. I'm quite suspicious of that statement as it contradicts practically everything I have ever read on the subject and would like to evaluate the source. It also contradicts common sense. If you look at the rate of increase in healthcare costs, you do not find a collating increase in the salaries of healthcare workers, nor a collating increase in the number of Americans employed as healthcare providers.

Unless by "salaries" you are counting pharmaceutical and insurance company executives - in which case it would certainly contradict your statement that the money is spread across the whole social spectrum, from doctors to nurses, to the guys who mop out the ORs and tend the animal labs. That's money that stays in your community and enriches local businesses.

In fact, the article itself makes the point that the administrative costs are a huge factor:
Some critics of rising U.S. health-care costs point the finger at administering health care, including the cost for insurance companies and bill collectors at hospitals. That administrative cost is staggering, according to Uwe Reinhardt, a health economist at Princeton University who just published a study on U.S. health-care spending.

"We spend about $300 billion annually on administration, which is three times what it would cost to cover all the uninsured," he says. "There is just simply no excuse for it. I think Americans are just plain stupid to tolerate this kind of administrative nightmare. This is madness."

Of course one needs to define what exactly counts as "administrative costs" - but it is obviously not money that stays in your community and enriches local businesses.
posted by sixdifferentways at 10:43 AM on July 6, 2004

Until you lose your job, and then you're screwed, just when you're most vulnerable

Huh? Unless you work for a really weensy business, you should be COBRA'd. Which isn't the greatest deal in the world, you still have to pay what had been the company's premiums, but still
posted by ROU_Xenophobe at 7:23 PM PST on July 4


ROU:
it is much worse than "isn't the greatest deal in the world." You lose your income, yet you have to come up with a huge monthly premium payment.
For a period this past winter, my wife and I were both unemployed. We paid over $600 a month on her COBRA plan for several months to keep our coverage. After taking such a large chunk of our monthly income, she had to pick-and-choose which of her perscriptions to take, because it did not leave enough extra to even cover he co-pays on all her medicines.
It also effects more than those who work for a "really weensy business." Millions of low-paid workers for major corporations and cannot afford health insurance even if it is offered - let alone COBRA payments if they lose thier jobs.
posted by sixdifferentways at 10:57 AM on July 6, 2004

So, not to ask a stupid, obvious question, but why the hell aren't you people doing something about it? Surely it's time to demand your representatives start acting in your collective best interests. Why isn't there a grassroots groundswelling of angry voters?
posted by five fresh fish at 11:37 AM on July 6, 2004

fff: two possible reasons:

(1) Does little-old-me have the knowledge or/clot to really lobby my legislators effectively? More effectively than the insurance industry?

(2) I suspect that most Americans spend so much time working (and working on professional goals) that they don't have a lot of time they're willing to put into anything but recreation. I'm essentially working two jobs right now, trying to not only recover from a period of financial difficulty (brought on by the one-two punch of unemployment and medical troubles), but add an extra layer or two of protection against vulnerability to risk. I know I should try to work towards changing the system, but a cost-benefit analysis of my potential actions says I'm probably better off spending my time trying to get ahead personally before trying to change the world.

Now, Metafilter threads like this can serve a purpose... some of the facts presented here are pretty compelling if they're true: the US has a lower life expectancy than Canada. It also has a higher infant mortality than most developed countries with socialised medicine or Canada insured 100 percent of its citizens for $2,250 per person in l998 while the United States expended $4,270 per person insuring only 84 percent of our citizens. So after reading them and gathering citations, I do feel a little bit emboldended.

But... even armed with those kinds of facts, I find that when having this discussion with people close to policy circles (and people in general), you tend to bump up against an underlying ideological issue in those that are opposed to it -- there are people out there who, when it comes down to it, just have a gut feeling it's the wrong thing to do...
posted by weston at 1:41 PM on July 6, 2004

Sorry for coming back after so long, but I just wanted to respond to jmd82's statement that hospitals in the US must treat all comers. This may be the law, but it's not always the way the hospitals act. My friend, a Yale University student, was hassled when he went to the Yale-New Haven hospital emergency room for treatment, simply because he came without a referral from the student clinic (which, being a new student, he didn't know about). Though I believe they eventually treated him, that was not after sometime arguing with the staff, while he was in great pain. He had even had proof of his student status, and thus coverage by the hospital. But had he been less sure of his rights, he might have easily walked out without treatment. I should say that this could be an outlier -- Yale-New Haven is notorious for being a nasty institution (they've had national press coverage for suing destitute people and conviscating their homes, as well as not telling eligable patients about state free bed funds), but that this should happen anywhere in a civilized country, particularly one that boasts about its healthcare, is unthinkable.

weston: A good source for infant mortality and life-expectancy statistics (as well as many others) is the CIA factbook. It is up-to-date and well organised - and no one could possibly argue that the CIA had a left-wing bias. The pages for the UN's Human Development Reports are also useful for comparative information on all of the domains used to determine the Human Development Index (but to make a point with some people, I do double check against the CIA, just so there is no question).
posted by jb at 8:04 AM on August 3, 2004

(Well, not easily walked out without treatment - probably hobbled out without treatment, and, as I said, in great pain).
posted by jb at 8:05 AM on August 3, 2004

jb: If you come back here, you are absolutely right that not all hospitals are kind to all patients. However, that is more a product of some hospital cultures (particularly for-profit hospitals). However, even with NHC, I highly doubt that the culture would change and some hospitals would still be most unpleasant to patients.
posted by jmd82 at 9:46 AM on August 3, 2004

There should be an easy way for people to get lower-cost coverage just for hospitalizations, for emergencies, for maintenance medications (the ones most likely to be budget busters) and high-cost, high-tech diagnostics which happen separate from hospitalizations.

It's called "major medical insurance." And yes, it's cheaper than HMO/PPO type health coverage.
posted by kindall at 12:24 PM on August 3, 2004

jmd82: Oh, I don't doubt that rudeness would happily continue with nationalized health care - I swear that nurses and medical receptionists are trained in anti-reception techniques, and the bigger the clinic/hospital, the worse - private versus public makes no difference. But at least where you have nationalized health care, you don't have to even think about whether you have the right - you just do. 15% of Americans without coverage cannot say that. Some places are better than others - in Ontario you must show your health card, which is only given to citizens and landed immigrants (and maybe refugees). Whereas I have been told that in the UK even visitors can go and get treatment if they need it.
posted by jb at 2:40 PM on August 3, 2004

jb: There is a definite difference between private/public hospitals. However, the difference is usually in out-patient care as private (for profit) hospitals tend to get patients in and out as quickley as possible. This also happens some in public hospitals, but is much more rampant in the private ones.
As far as US care for the poor goes in emergencies, I really couldn't tell you how it usually ends up from personal experience seeing as I've never had a problem, but rather from working in one and my mom's 25 years experience as an RN. However, I will say that the hospital I've worked at is very forgiving about medical costs if you don't have insurance and they will also try to work out a payment plan. I have known of a patient to just pay $1/month for 30 years for emergeny by-pass surgery. However, I do know this is just one hospital out of the thousands and not all of them are as appeasing.
Also, more popular and prestegious clinics such as the Mayo clinic tend to me more forgiving of financial hardship as they tend to have massive amounts of donations so they can take hits. One of the problems that hospitals are becoming for Scroogeish with their money is that as Medicare and Medicaid a) become more widely used b) the government pays out less than ever (to the sum of around 5-10% for Medicare now), and c) they cannot reject medicare/medicaid recipients, hospitals and clinics are having a very difficult times in keeping above the red.
posted by jmd82 at 10:40 PM on August 3, 2004