Here’s a scary thought: What if you have health insurance and still get stuck with a million dollar hospital bill? That’s what happened to Jim Dawson after a staph infection spread throughout his body.
From the WSJ Health Blog:
Part of the problem is that insurance caps — the maximum amount of a patient’s medical bill insurers will pay — haven’t been keeping pace with rising costs. The story says the average cap is $1 million per person, the same as it was in the 1970s.
Dawson’s cap was $1.5 million but after a staph infection spread throughout his body, he was still stuck with a $1.2 million bill from California Pacific Medical Center. He and was wife were outraged to learn about the hospital’s marking up of items.
“For instance, CPMC charged Mr. Dawson $791 for stockings designed to improve blood circulation,” the story says. “The same pair can be purchased on the Internet for as little as $12.”
Even more perplexing was the fact the Dawsons were told it would cost $1,030 just to get an itemized copy of Jim Dawson’s bill. The medical center was nice enough to send a letter — free of charge — seeking donations to the hospital.
Of course once the Wall Street Journal called to inquire about the bill, Mr. Dawson suddenly qualified for assistance under the hospital’s charity and they wrote off his entire bill.
Even With Insurance, Hospital Stay Can Cost a Million [WSJ Health Blog]
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The two hospital/clinic monopoly where I live (both non-profit) practically own the city. They keep building new buildings, some of them are sitting unused. They have built golf domes, multiple fitness clubs, sponsored naming rights on every athletic facility in town, bought the city holiday parade and offered up land and large donation for a new city arena. Both are also building new buildings, multiple new wings and new stand alone specialty hospitals. This is in a state with 750,000 residents. They are making that much freaking money off of a patient base smaller than most cities.
Prices for care here are considerably higher than elsewhere, more along the lines of the Mayo Clinic prices quoted by someone else.
Our hospitals are rolling in money, both own the the two major health insurance plans in the state and most people carry a huge out of pocket medical debt.
It is insane and has to stop.
We have to get national health insurance. This would not have the government running hospitals but it would assure everyone has insurance and they would be able to demand realistic fees from hospitals. They do this right now with Medicare. Hospitals can’t try to get Medicare to pay some crazy inflated price like $300 for a pair of $12 socks.
Right now I am in my third week of trying to get my health insurance to cover an expensive pain medication. They refuse to cover it because I have not tried the other medications they say I have to try first. The medications they say I have to try first are for shingles, I don’t have shingles so trying these other medications would do absolutely nothing for my back injury. This is all over formulary rules and stupid insurance company staff making these decisions yet have no medical knowledge.
The entire system is beyond help at this point. The only thing that will work to fix it is radical reform. And good luck getting that through the lobbyists.
Seriously, it’s gotten so that it’s basically impossible to know what your bills will be like if you go into the hospital or even an outpatient clinic. There is NO price transparency and NO functioning free market for health care. I’m so sick of people claiming that the “market” works so much better than an actual regulated system of healthcare when we don’t have a real free market. If you think that the healthcare economy is functioning in a way that promotes price competition, etc, you are out of your mind.
I’m not sure I follow being non-American. How can you rack up a 1.5+ million dollar bill? Surely that price has been inflated beyond any semblance of reason. At 1.5 million dollars, I assume a decent hospital could turn you into bionic man/woman no? At the very least, robotic arms with built in lasers.
@mycroft2000: Seconded. No Canadian seriously complains about the Canadian system unless they’re a retarded right wing goofball.
The only serious problems are such:
1) Shortage of trained doctors. This is because we a) withdrew a lot of Government sponsorship for training doctors maybe 10 or 15 years ago, and are paying for it now. That’s most of the reason for the waiting periods here in canada
2) Chronic UNDERfunding of the medical infrastructure. A lack of proper equipment explains the rest of the waiting periods.
Seriously though, the system works, and works well. If the Governemnt gave the health industry the support it needed to work properly, it would be a thing of beauty.
@bustit22:
Screw off. That’s a ridiculous example. Do you think a 4 week head start is going to make a difference to terminal lung cancer. My grandmother died of the same thing, so don’t even bother answering. A 5 year headstart? Maybe. 4 weeks. Bullshit.
So in conclusion, do like the Brits do and get treated in India.
@bustit22: “She had to wait 4 weeks for an MRI, turned out it was cancer. Maybe if she had gotten an MRI sooner, she’d be alive.”
This is, to be honest, the first thing I think of when people talk about how great the Canadian health care system is.
I, in the US, went to a walk-in clinic on a Thursday, and had prescriptions written for a blood test and an ultrasound, and got a referral to a urologist. Blood test was done the same day, ultrasound done Friday. Saw the urologist on Monday.
He diagnosed me with testicular cancer, and wrote a prescription for a chest/abdomen/pelvis CT scan. The scan was done two days later, on Wednesday, and I was in surgery (not just at the hospital but in surgery) at 8:00am on Thursday.
Meanwhile, CBC in Canada says “A shortage of urologists has become so pronounced that patients’ lives are at risk“, partially because there are only about seven of them in all of Newfoundland.
Y’all can keep that on your side of the border. I went from “I think I should see a doctor” to being basically cured in a week. Sounds like in Newfoundland I would have died from it after it spread to my other organs while I waited for surgery. My urologist was adamant that I not even wait until Monday for the surgery, 4 more days (I had a trip planned), nevermind waiting a year!
@5cents:
We have considered this or Thailand. If we could find a verifiable Indian pharmacy we would be buying our medications and having them shipped here. They cost less than our copays there.
@bustit22: The difference is these people got treated faster (gouv sent them to an external hospital in US), and didn’t go broke. They wouldn’t be able to get ANY coverage in US because of pre-existing conditions. So they would be dead for sure.
(I prefer to sue, that to get a guaranteed sweet and hearty funeral.)
@donnie5: Do you live in a country with universal health care? Because as was stated here, ask anyone in one of those countries if they would trade systems with us, and they will say no. That should tell you something. People love to trot out universal health care horror stories, but our own horror stories are looking much worse these days.
@Indecision: You know, population in Newfoundland in half a million. It’s like a small city. And Quebec is just neighboring, so many people get treated there, too.
And MRI scans, you can get them in private care (which does not offer insurance, but the prices are still cheaper than paying insurance all your life.) So if you feel urgency, there are always ways of proceeding.
Canada does need a lot more doctors and nurses and more funding. But a parallel system exists in private sector, too. It’s not as popular, but regular insurances still cover some of private expenses anyway.
Unfortunately perfect system does not exist, but I prefer seeing Canadian government gradually improving the current health care, then losing everything I possess halfway through my life, because of some freak accident or hereditary illness.
@badteaparty:
Geesh,
I even admitted we had a broken health care system. And I stated that I was not a fan. I never stated why, I just said I was not. One of the reasons I am not a fan; I do not want people going to get a band aid at the ER because “hey, its free.” I also like the idea of capitalism encouraging Doctor’s to be the best they can be. I am sure there are plus sides as well as negative sides. But on the internet, I should only be on your side and not hold my own opinion.
I like the idea of personal responsibility for healthcare as opposed to government handouts. If you are really in need, maybe the government can help you out (free clinics, medicare, welfare, etc.) but for the rest of us, we should stop being lazy and expecting handouts and work for a living, earn money, and pay for our own healthcare.
JUST MY OPINION. I am sure lazy-asses everywhere will disagree while they wait for their handouts.
By not a fan, I am saying I am not a fan of universal healthcare.
@chouchou: “You know, population in Newfoundland in half a million. It’s like a small city. And Quebec is just neighboring, so many people get treated there, too.”
Ok…but I’m not the one who said it’s a problem. According to the article I linked to, even the Health Minister thinks it’s a problem.
@donnie5: For the record, my economics teacher is an American immigrant to Canada, and apparently supports Michael Moore’s viewpoint.
Charity care has nothing to do with WSJ. It deals with your income from the last year and is a sliding scale based on federal poverty guidelines.
The only thing the WSJ could’ve done was expedite the processing of his application at the risk of bad PR for the hospital involved.
@TIMMUS
I would certainly like to see your proof that doctors don’t have high malpractice bills.
I worked in health care for a number of years as a Respiratory Therapist and I had high malpractice bills. I was paying almost $3000/yr for my malpractice insurance, and no I never had a suit brought against me. I made the unfortunate career “choice” of working with premature infants and attending high risk births. For that reason, my malpractice insurance was really high.
I’m friends with a number of doctors and every one of them has left private practice because they cannot afford the $15-30,000/yr they have to pay in malpractice insurance.
Most of the doctors (all have been in practice for more than 10 years) that I know make less than $200,000/yr, have $500,000 or so in medical school debt, work 60+ hours/wk and dislike our health care system with a passion.
Why not have a loser pays system specifically for malpractice suits? If a jury trial confirms that your suing was a waste of the people’s time, you have to pay the bill of the doctor’s lawyer.
@dirtymoney: “What happens when you owe an insane amount that you could never ever pay?”
My husband does some collections work for a local hospital and he hates it, because there are two kinds of people who end up in hospital collections — absolute assholes driving Ferraris who CAN pay, but decide not to and hide all their assets (usually transferring them to mommy dearest), and middle class families who’ve had catastrophic illnesses that have usually required one wage earner to quit work to deal with the illness (either of self or of child) who now own over a million dollars and who are flat broke and facing losing their homes because of medical debt and loss of income.
And while I don’t agree with everything the hospital spends money on, their charitable aid program is pretty generous, and their write-offs of unpaid care is high for the region (but their prices are equivalent to places writing off much less). There’s simply a point at which even at the most generous hospital, middle class families are going to get fucked.
What usually happens is a “payment plan” is worked out where people are paying $80/month on a million-dollar debt.
@bustit22: “She’ll be needing an artifical knee in the future. The wait time? 18 months.”
Wait time is not that much lower in many parts of the U.S. People always bring up these wait times in socialized systems (which are always for surgeries that are necessary, but not life-saving), but they’re usually pretty much the same in the U.S. unless you are extremely wealthy. And if you’re extremely wealthy, my understanding is you can buy yourself care outside the Canadian socialized system ANYWAY.
@Indecision: “Meanwhile, CBC in Canada says “A shortage of urologists has become so pronounced that patients’ lives are at risk”, partially because there are only about seven of them in all of Newfoundland.”
This is also common the American system. When I lived in NC, there were NO ob/gyns in the entire western half of the state outside Charlotte, which meant up to 4-hour drives to deliver a baby (or get routine prenatal care). Where I live now, in downstate Illinois, they routinely remind us we have no brain surgeons south of I-80 (that is, outside Chicago), and it’s a 2.5 hour life flight from some places to a hospital that can treat that kind of injury. (Ergo we should drive more safely is the point of the reminders, since catastrophic brain injuries will not receive prompt treatment. And then we should vote for tort reform is the second point of the reminders, because it’s all the lawyers’ faults.)
I don’t know a single person who’s come to the U.S. from a socialized system and who’s been happy with our system, even highly-paid executives with excellent PPO coverage and very low premiums. They still don’t like it and find it very insecure and stressful.
as someone who is about to lose health insurance at the end of the year, it is to the point where the only difference between having and not having insurance is that if i have insurance, i’ll go bankrupt a little later than i would otherwise. if i had a major medical situation, i would almost certainly go bankrupt, insurance or not.
@Indecision: He’s a politician. That he’s job to make ”we take it very seriously” statements to get re-elected.
@donnie5: I understand why you think capitalism works well. I don’t understand why you think it has anything to do with our healthcare system when the system doesn’t function as a free market. The fact is, our system doesn’t work. And there already is no “personal responsibility”. Healthcare providers can’t refuse to provide some treatments to people just because they can’t pay. So you are already paying for all the poor people, but you are doing it in a very inefficient way that actually encourages the system to adopt practices that screw over everyone. This is a big reason why we pay so much more for healthcare here in the U.S. than in other countries when you look at all the costs including taxes, insurance, out-of-pocket expenses, etc.
I am a 46 year old woman, with a congenital heart problem. I am currently on the transplant list. I collect Social Security disability through having worked( albeit with difficulty) up until 3 years ago.
My husband has insurance which will cover 80% of the estimated $500,000 surgery/ first year’s expenses. I have no idea how we will pay for the balance. Currently, I am in arrears on current medical bills- I pay what I can, when I can.
We need a total overhaul of the system, but I don’t have the faintest idea where to start.
BTW I used to live near the Canadian border along New Brunswick and there were many people who came to the US for better medical care.
@masser:
Medicare/medicaid. Start speaking with financial counselors NOW, pre-transplant. You may be eligable without losing your house, and it’ll save you the 20% copays on the pre-transplant workups.
Here’s hoping you get a heart quick and have a fairly uneventful post-transplant experience.
@kretara:
The hospital system I work for doesn’t pay their doctors great (I know from hearing complaints from doctor-friends and my neurologist). It does, however, pay for their malpractice insurance 100%.
Being from Canada this story makes me sad. I still don’t understand why the whole “public health care doesn’t work” fear mongering still works on you guys.
I always thought hospital bills were so high because you’re not paying just your bill. You’re paying your bill and the next 3-4 uninsured/illegals that come through the door that they can’t legally turn away.
@timmus:
No, it’s completely true. My dad is a physician and my mother is a nurse and the amount of medical malpracitice in our state has driven doctors to move or just stop practicing. Those god-awful ambulance chasers on TV and sue-happy people who buy into it are making it even worse. The doctors are not the enemy (with the exception of a handful), the system, pharmaceutical companies and health insurance companies are.
@clementine: My dad retired last year after 42 years as a primary care physician. He was paying, when he left, $36,000 a year in malpractice insurance premiums.
That’s a shitload of money, excuse the expression!
Just say you’re an illegal immigrant next time so they won’t charge you.
I’m conflicted on the decision to go from a mostly privately managed healthcare system to a totally government run operation. I’m more on board with fixing the reasons why healthcare is expensive and moving it towards making it less expensive. That way insurance will be cheaper and in some cases people can afford it out of pocket.
One thing that always bothers me hearing from the lefties is how the government has borked the war. However, they are the ones begging the government to take over healthcare. This confuses the hell out me.
@spinachdip:
My ex-girlfriend (she’s from Heidelberg if you must know) says they have the same problem in Germany that we have in the states WRT people using their health care system but never contributing back to it. Here it’s illegal aliens, malpractice costs & people who go bankrupt trying to pay for care. There it’s Turkish immigrants & others who never bother to get a job to put tax money back into the system.
I’m not saying it’s a bad idea, I’m saying that we may not want to model ours after existing national health care systems. We can do better.
If had spent the last year in the states, I would be beyond screwed. I’ve had to see a neuropsychologist, four sleep specialists, and get prescribed a machine that, had I had to pay retail, would cost $1200. My TOTAL cost so far has been $260 – the amount that the canadian gov’t didn’t pay for the machine. Everything else was completely covered, and within 3 hours of it being SUSPECTED that I had this particular disorder, I had an appointment with a specialist and a sleep clinic – for that night.
My family has been in and out of canadian hospitals for years, and we have never had a single complaint – when my brother had open heart surgery at 6 years old, the WHOLE THING was covered. My parents had to pay gas to and from the hospital. That was it. There was no waiting period, even though what he had wasn’t considered immediately lifethreatening. There was no debate about whether it would be covered, no looking into what company would do what – honestly, how is oft-referenced canadian waittime any different or any more detrimental than that “is-it-covered?” time in the states?
My american cousin has the same problem as my brother – he can’t have surgery because his parents can’t afford it. Period.
I have NEVER heard anyone complain about having to wait a long time, UNLESS it is to see a depression counsellor in Toronto. Part of the reason there ARE wait times is due to prioritizing – it isn’t a first – come -first – paid – first serve situation up here. Those with serious problems get prioritized first, and those who don’t have them, get to wait a BIT. If, in the intervening time, there is a health-related breakdown, then two phone calls gets you moved up in the list.
Also: Private insurance isn’t illegal in ontario. You can purchase, if you want, supplementary insurance, to make sure you get a private room and whatnot. Why you’d want to is beyond me, but you can. Be away from the proles, maybe.
I have had the weirdest experiences when talking with my american relatives about general cost-of-living between canada and the states. Inevitably, i mention going to the states to buy milk – it’s much cheaper down there than up here, where it’s currently about $5 / gal. They are horrified that canadians would pay so much for milk. Then, i say, yeah, but my health care is covered, and I don’t have to worry about it. and they say “well, i still wouldn’t live there, because everything’s so much more expensive.”
All in all, it’s a cultural mindset thing. And that is probably not going to change.
@spinachdip: Really? Have you heard of the VA?
@Hambriq: Transparency would be nice. I was recently in the hospital, and felt like refusing or getting information on treatments was out of my control. For example, a few hours after being moved out of the ER up to the hospital, a woman woke me up to take my blood. I had just had my blood taken in the ER, and they had told me that they had done all the tests they needed. I questioned the woman about it, but she wouldn’t say why they needed to test again and just took my blood anyways. Had I not been so, well, sick and weak, I probably would have been more firm in getting answers.
@Technotica: Not to get too sidetracked, but the problem with the war is not just that it was horribly mismanaged by a government that doesn’t know how to do anything right. The problem with the war is that it was a fundamentally bad idea from the beginning. The continuing problems in Iraq are caused by a lack of a political solution, something that military force can’t create by itself.
I think government can do a better job than the insurance companies are currently doing with healthcare because the insurance companies are doing an absolutely horrible job. We’re paying more and getting less for our healthcare dollar than people in countries with totally socialized medicine do. I’m not sure what the best solution is, but I do know that the status quo is not acceptable.
Malpractice insurance is a lot but in California they changed the laws capping malpractice amounts so the insurance is now a lot cheaper than it used to be.
I guess this guy can literally call himself the 1.2 million dollar man.
Glad to hear he was able to get the bill wiped clean.
@donnie5: For all your loaded language about “personal responsibility” people “being lazy” and “handouts,” you completely fail to acknowledge the fact that 1. There are plenty of people who work damned hard and don’t have access to healthcare and 2. under our system the insurance companies who pay for health care have a strong financial incentive to deny care.
Unless you’re willing to address those problems in a rational way without using Sean Hannity talking points, you have no argument.
@jamar0303: Watching Sicko in school…. Is it any wonder why we home school our children.
The Canadians can afford the health care system they enjoy because they don’t have to spend very much on defense. They know the USA will protect them from attack.
Most of the problem with insurance and why it is so expensive for us is because of the prices hospitals think they can get away with charging. Almost $800 for a $12 pair of socks? You’ve got to be joking.
@johnva: The real problem with the war are the ingrates that were given freedom and continue to blow each other up. The war was a great idea at the time and, really, the only option. Saddam had to get taken out. Now it’s time to bring our guys home and let the ingrates kill themselves off.
@trollkiller: Great point!
@Brad2723: Absolutely.
@trollkiller: That and the darn “Evolution” they keep trying to pass off as science!!!
@spinachdip: That and the darn “Evolution” they keep trying to pass off as science!!!
That is part of it, a lot of the “facts” on evolution have been disproved or modified. I find it is better to be able to show the children the current theories and then discuss why they may be wrong. It is better to make them think then it is to memorize the latest flavor of the week.
@trollkiller: Your point isn’t related to the discussion at hand. We are spending *more* on healthcare than the Canadians when you include both private- and public-sector spending. This argument has nothing to do with not being able to “afford” decent government healthcare. We could easily afford it and actually save money if we cut the waste caused by our private healthcare and insurance companies at the same time. Inefficiency and wastefulness is a huge problem here.
@ad8bc: It wasn’t the “only option” to attack Iraq. We’ve lost a lot more than we gained by doing so; Saddam was effectively contained as a regional threat before the war. The problems that we are now having in Iraq were entirely predictable and in fact were predicted by people who knew what they were talking about. The Iraqis aren’t “ingrates”; it’s just that they couldn’t be expected to smoothly transition from a totalitarian dictatorship to a democratic state when they had no history or experience with democracy. It’s really unfair to blame them when the problem was inflicted on them by Saddam and by a foreign invasion. Things won’t calm down until there is a functioning government and political process to fill the power vacuum. But they can’t know how to build that overnight.
health insurance is the worst. i almost wish i didn’t have it at all–at least that way, i wouldn’t have the expectation that anything would be paid for in the first place.
@Eyebrows McGee: My boss spent three years in Newfoundland, ten years ago. Her (now ex-)husband was a doctor there.
She BITCHES incessantly about her current (really not bad) health insurance and how much she loved the Canadian health system. She is the only person in my department with insurance (she’s salaried, the rest of us are hourly) and every time she complains to those of us who have no coverage at all, I just want to smack her.
My husband is also Canadian. His theory? Canadians complain freely and loudly about the health system because they’re well aware that they have a decent system that could be better. Americans complain less because far too many of us are in the ranks of “too poor for insurance, too wealthy for Medicare, bitching won’t FIX anything.” It’s the elephant in the corner nobody wants to talk about. (Although conversations like this make it clear that’s changing.)
The current uncertainty, perversely, makes things worse; it looks like we might get a MassHealth-style system in my state during the next three to five years, and so I’m afraid to even go to the doctor and pay out of pocket now and foul up my chances for actually getting treated for what might be labeled a pre-ex later on. If I had no real hope of ever being covered, I’d say the hell with it, go into debt to get my health fixed, declare bankruptcy, and start fresh. Instead I suck it up, work, hurt, and vote more left-wing than I’m really comfortable.
@Hambriq: I think you need to give doctors the benefit of the doubt and take your theory one step further to find out why health care costs so much. I’m a 3rd year medical student, and although I may be a bit naive at this point, I can tell you that 99% of tests and procedures are not done “unnecessarily.” We orders these tests for many reasons, your own health notwithstanding. In my own opinion, though, the reason health care is so broken and costs so much is because of LAWYERS.
In addition to the $80,000/year (not inflated, I’ve seen the check) my attending pays for malpractice insurance, he also has a family (!). He, like 100% of you out there, will not risk some money-grubbing lawyer coming in to sue him for everything he’s got and leave him and his family on the street because Mr. Smith got a viral infection and was in “dire agony” because he had to use kleenex to blow his nose for a day. So we have to order tests and obtain images, probably more than necessary in many doctor’s opinions, but they have to be done.
The bottom line is if doctors didn’t have to practice defensive medicine in fear of some frivilous lawsuit, they could do what’s best for the patient with the patient in mind. Instead, they have to do what’s best for the patient with the lawyers in mind. This leads to more tests -> increased costs -> insurance companies don’t want to pay -> 1.5 million dollar bills.
Well I can explain exactly why prices billed and paid are so different. I worked for a large Ca. Healthcare company. I saw bills everyday where the bill was for 6,000 and we paid 1,100, it was the contracted rate we had with the hospital. When the health ins. companies sign a contract with the hospitals and medical groups both sides decide what they can afford to pay and accept for payment. The prices you see on your bill for huge amounts are the amounts they charge people without health ins, its the non-contracted rate.
An example of it was when I had surgery on my knee because I tore several ligaments and muscles completely off the bone. The bill the Hospital sent was about 65,000. The contracted rate was 7,600, we sent a check for 7,580 to the hospital and I paid $20 as my co-pay. The rest is written off because it was above the contracted rate. It was funny to look at my own bills and see exactly how much the hospital inflated thier prices. It is presented in a way to make you glad you have insurance, even though most people could negotiate the price down to the contracted rate if they didn’t have health insurance.
@trollkiller: You’re new to the whole scientific method thing, I can tell. You’ll get the hang of it soon enough, don’t worry!
@johnva: Are we spending more total or more per person?