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BlackPhx -> RE: Hospital and Dr's fees are getting insane! (11/13/2008 8:01:05 AM)
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~Fast Reply~
1. Insurance companies work on a pool system. You are placed in a pool of people with similar ages and other characteristics, and they figure out the cost spread. Your premium as well as all the others pays for the health care of the sickest. Some people stay healthy and others fall ill. Overall, the insurance company makes a healthy profit. If one out of every 32000 people has a devastating or long term illness, paying out on a negotiated rate to the Dr., Hospital, Rx still leaves them the income from the majority of people in that pool. Additionally, part of every pool is invested in stocks and bonds to continue growth and profit. It works the same way for Home and car insurance.
2. Malpractice Insurance works the same way. The outrageous premiums that Doctors pay do end up paying for the malpractice of others. They pay for the Lawyers used to defend those Doctors and to pay for those who do receive awards as victims of malpractice. The person who graduates 900 out of a class of 900 is still called a Doctor and can enter private practice. Doctors are not gods and they do make mistakes. Unlike your mechanic who if he replaces the wrong part isn't going to kill you or your car on a general basis, a doctor who cuts off the wrong leg, removes the healthy instead of cancerous kidney, or prescribes the wrong medicine can indeed kill you, affect your ability to work and support yourself and family or make you sicker. I am still suffering effects (massive neuropathy) from a period in a hospital where my bronchitis and asthma was treated with steroids, but the Dr. failed to order coverage for my diabetes. I suffered a raging UTI, bordered kidney failure, thrush, PID and intermittent mental disorientation due to blood sugars that were so high from the steroids they did not register on the glucometer but had to be measured in an A1C and other blood tests. If I had not insisted that my husband raise a ruckus and get a Dr. in there during a lucid period, I could have died or been on dialysis from his mistake. Another Doctor (Intern) overdosed me on a common Asthma medication during a hospital stay despite my telling him I was having a bad reaction to the dosage and I can no longer take the drug without a severe reaction. His response when I told him i was having problems was to pat me on my hand and say I know what I am doing, trust me..so what kind of dinosaur do I have on my tie today. My response was an Assholisaurus, and get me your Resident, your fired. He had figured the medication to body weight wrong. Nobody caught it.
3. Doctors errors are reviewed in hospital by a board. Their lawyers are in on the meeting with an eye towards minimizing the patients knowledge of the mistake. An Inquest Board can be called in case of death, or a Doctor may be censored by the AMA and a notation placed in their record, not just of malpractice suits that are successful, but of repremands and errors they have made that are not taken to court. Finding this information out is not easy not all states allow it and not all Dr.s are listed..this however is a good place to start. http://www.doctorscorecard.com/license-lookup.htm but please remember the Dr who is practicing in your state today, may have been in another state 5 years ago AND not everything may have been reported. Dr's close ranks as well as any other group. Sometimes the best question you can ask a doctor you trust is..'Would you send your wife, child or self to this Doctor.".
3a. Malpractice suits have a limited time to be filed, generally 2 years in most states. The problem with this is damage done can take as long as 5 or 10 years to show up. Before blood was routinely tested for HIV (and in many cities, blood donation is a source of income for the destitute), people were given transfusions with blood that was contaminated. Symptoms that would send them back to a doctor and expose the exposuure to HIV could take 5 years to show up and be diagnosed, well past any point where the person could sue for help with the medications, surgeries, or treatments that insurance companies would drop them like a hot potato for the minute they were filed, yet they would lose their jobs, their health and more because tests were not done then that are routine now.
4. Most 4 year colleges have medical centers for students. Emergency services, clinic services and in some areas Dental services are included in the tutition. They are supported by $$$$ from Tuition, Alumni, student fees, and state money (yep..right out off our taxes). Many students are also still covered by their parents insurance and therefore, it is real easy for a student to not consider the actual cost of an illness.
5. Many elderly and those with chronic illness can work with their Dr and need to to afford Rx.'s If a pill can be split a Dr. can prescribe double the dosage stretching the Rx $ of the patient to cover 2 months for the price of 1. When you live on less than 1K a month and have to pay for utilities, shelter and food..that method and samples can go a long way to helping out. Medicare advantage programs also help but none of them are free, some only get paid the medicare premium, but most require an additional premium some upwards of 100$ a month, plus copay's for all services. Hard to do when your income is limited.
5a. Medicare does not pay for many preventive services except through the Advantage programs. Dental is almost unknown but yet gum di ease is a contributor to heart problems. It has always been penny wise and pound foolish and while there has been Medicare Fraud, that is done by more Doctors than patients. If you know of a doctor committing fraudulent billing turn him in. You may actually get a percentage of the total recovery amount (before it is recovered but after it has been determined and charges filed) as a reward. Contact the Medicare CMS office to report it. Be sure to check your statements as you get them for accuracy in dates, services and charges. This IS how they slip through the cracks for years, people don't check or challenge.
Socialized medicine. Fighting words in the US apparently, but please consider. Whether it is Private Sector or Government subsidized we already have it. You don't get your premium back if you don't go to a Dr. all year. It's gone. It pays for others in your risk pool. Your job if it covers medical insurance ( many are dropping it as a benefit) pays approximately half of your insurance, so you are receiving their charity, you may pay more or less if you have family on there than they do, but they are paying as well. If you have but don't spend your FSA that you contribute into you lose the money. Poof..gone. Flexible spending accounts are “use-it-or-lose-it” plans. This means that amounts in the account at the end of the plan year cannot be carried over to the next year. http://www.irs.gov/publications/p969/ar02.html#d0e1967 Your employer is not permitted to refund any part of the balance to you. Many families who have children may have their insurance split..each parent covering themselves, 1 parent cover the children OR they may have their children covered through a Education Health Plan that has the children of the state school system as a pool and pays for well care as well as illness. That last plan tends to be low cost and very comprehensive and every child in school is eligible. (Neep I think that is a bit socialized don't you think?)
Our Government has excellent health care plans from the same companies that supply yours. State and Federal employees have several different plans available, often from different companies, that fit their health, their contribution ability to pay, etc. The reason they have such benefits is because the risk pool is so large and it is cost effective for the This is what to some degree Obama wants to open up to those who do not have insurance. Please, Please, Please make note of this point. MEDICAID a federally funded, State adminsitered program covers the destitute and low income. VA covers the Enlisted and Veterans (diplorably in some areas but it is coverage) MEDICARE covers the elderly and disabled, but, there are MILLIONS of people who work, pay taxes and DO NOT HAVE Coverage because it is too expensive or their employers do not offer it. A Family of 4 may have an income of 50K which is above the poverty level, but health insurance can eat up over 1/2 of that to cover them, not counting copay's, RX costs, and things not covered by their insurance ( they do like to deny even when it is supposed to be covered) but that are medically neccesary. Forget it if you have a pre-existing condition and didn't have health insurance for some reason, such as being unemployed for a period. COBRA coverage is outraegeous costing as much as $800 for a person and 1800$ a month for a family when your unemployment benefits may be only 600$ every 2 weeks and you have bills.
Something has to give. It really sucks when those in prison can get healthcare faster than your grandmother and at no cost.
poenkitten
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