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Author Topic:   Health Insurance in the U.S.
Posts: 3833
From: Duluth, Minnesota, U.S. (West end of Lake Superior)
Joined: 11-11-2001

Message 1 of 7 (833905)
05-28-2018 2:21 AM

Couldn't find a suitable existing topic.

Pretty much a bare link, but I'll quote the first part of a rather lengthy article.


Michael Frank ran his finger down his medical bill, studying the charges and pausing in disbelief. The numbers didn't make sense.

His recovery from a partial hip replacement had been difficult. He had iced and elevated his leg for weeks. He had pushed his 49-year-old body, limping and wincing, through more than a dozen physical therapy sessions.

The last thing he needed was a botched bill.

His December 2015 surgery to replace the ball in his left hip joint at NYU Langone Health in New York City had been routine. One night in the hospital and no complications.

He was even supposed to get a deal on the cost. His insurance company, Aetna, had negotiated an in-network "member rate" for him. That is the discounted price insured patients get in return for paying their premiums every month.

But Frank was startled to see that Aetna had agreed to pay NYU Langone $70,000. That's more than three times the Medicare rate for the surgery and more than double the estimate of what other insurance companies would pay for such a procedure, according to a nonprofit that tracks prices.

And from further into the article:

Frank could have paid the bill and gotten on with his life. But he was outraged by what his insurance company agreed to pay. "As bad as NYU is," Frank said, "Aetna is equally culpable because Aetna's job was to be the checks and balances and to be my advocate."

And he also knew that Aetna and NYU Langone hadn't double-teamed an ordinary patient. In fact, if you imagined the perfect person to take on insurance companies and hospitals, it might be Frank.

For three decades, Frank has worked for insurance companies like Aetna, helping to assess how much people should pay in monthly premiums. He is a former president of the Actuarial Society of Greater New York and has taught actuarial science at Columbia University. He teaches courses for insurance regulators and has even served as an expert witness for insurance companies.

My "bolding".

Much more at source.


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 Message 2 by PaulK, posted 05-28-2018 4:09 AM Minnemooseus has not yet responded
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Joined: 01-10-2003
Member Rating: 2.6

Message 2 of 7 (833907)
05-28-2018 4:09 AM
Reply to: Message 1 by Minnemooseus
05-28-2018 2:21 AM

There’s worse out there.

A young woman who was prescribed an opioid for pain relief while recovering from surgery was charged more than $17000 for a urine test to confirm she wasn’t abusing it.

Ars Technica

This message is a reply to:
 Message 1 by Minnemooseus, posted 05-28-2018 2:21 AM Minnemooseus has not yet responded

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Posts: 6171
Joined: 06-23-2003

Message 3 of 7 (833912)
05-28-2018 9:58 AM

My son is epileptic (well under control now). Many years ago, driving through Rye New York he had a seizure in the back seat. We scooted to the nearest hospital. He was in "status epilepticus" which means they couldn't stop the seizure. A neurologist came in and ordered him to be put on a breathing bag and left.

$1,500. On our insurance, of course.

My wife called up his office and BCBS and pointed out the absurdity. It took a lot of back and forth but finally they dropped the charge.

Member (Idle past 802 days)
Posts: 7789
From: Manchester, UK
Joined: 05-01-2005

Message 4 of 7 (833920)
05-28-2018 10:25 AM
Reply to: Message 2 by PaulK
05-28-2018 4:09 AM

A young woman who was prescribed an opioid for pain relief while recovering from surgery was charged more than $17000 for a urine test to confirm she wasn’t abusing it.

I wouldn't mind that charge if it was explicitly mentioned before hand.

"We need to issue you with a urine test to ensure you aren't abusing this drug"

"Erm, but you know how much you are giving me."

"Yeah, but we still need to test or we might get into legal trouble."

"OK, whatever"

"It'll cost you $17,000"

"I'm not paying $17,000 to cover your ass."

"Then you can't have the drugs."


What's weird is the way the insurance works here. When I worked in insurance a similar conversation might have gone like this

"We recovered your vehicle after it was immobilised after an accident. We needed to perform radiological tests to make sure it didn't contain hazardous levels of Uranium, Plutonium etc. That'll be £500,000, please."

"Take it up with my insurance"

"Hey insurer - that'll be £500,000"

"We're paying you £350"

"But the radiological tests cost...."

"That's your business, we don't think they were necessary. We're paying you £350 for the vehicle recovery."

"We'll take you to court."

"Fine. You can issue proceedings to the following address...."

"I mean, we'll sue your insured."

"The loss incurred by this incident is ours, not theirs. You'll be trying to extract half a million from a large insurer with more funds than you. The £350 is on it's way. Goodbye"

It seems insane that this doesn't happen in the USA. I hear competition is much less significant there, so maybe they don't care too much since they'll be compensated through higher premiums anyway and there are fewer - if any - competitors to undercut them.

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Joined: 07-20-2006

Message 5 of 7 (834252)
06-01-2018 6:57 PM
Reply to: Message 1 by Minnemooseus
05-28-2018 2:21 AM

Health Care/Insurance in America
As an indication of how health care insurance works in the US, I will indicate who/what is involved in my (and my wife’s) insurance:

1) My previous employer (I am retired and have retiree benefits) Lockheed Martin which gives me and my wife each $900 towards our health care costs;
2) Medicare, towards whom I and my employer paid insurance premiums (which were erroneously called Taxes) for 30 years, and which now pays most of our medical costs;
3) Via Benefits (which used to be called One Exchange), a health care exchange hire by Lockheed Martin, which is NOT a health insurance provider, but acts as an agent, i. e., a go-between between beneficiaries and health insurance providers,
4) FlexPay, a company hired by Via Benefits, to take care of the actual heath cost payments (I think that they and Via Benefits are owned by the same holding company);
5) My actual health insurance company, which bills Medicare and Via Benefits for costs that they covered are paid by FlexPay;
6) My actual health care provider.

In my case, 5) and 6) are separate divisions of the same organization, Kaiser Permanente Health Services, but for most people, these are two separate corporate entities.

Some things to note about this list:

a) of the six organizations involved, only one, #6), actually has any doctors, medical equipment, hospital rooms, etc. to provide actual health care.
b) just one of these entities, #2), is a government organization. Medicare is, of course, part of Social Security, by far the worlds largest insurance company, and it was set up and is wholly owned and operated by the federal government. I. e., it is a socialist organization. (But then, 40% of the US is socialist.) The other 5 are profit making private capitalist organizations.
c) the Social Security Admin is headed up by Carolyn W. Colvin, who earns $179,700 a year for managing the worlds largest insurance company and over 65,000 employees. All the top executives of the other 5 companies have total compensations in the $Millions.
d) when Melania Trump, wife of the US president, required surgery for a kidney problem, the president, wishing only the best and safest medical care for his wife (I’m assuming) he sent her to Walter Reed National Military Medical Center, which is wholly owned and operated by the federal government. And all their doctors and staff are government employees whose paychecks are signed by the US treasurer. I. e., Donald Trump chooses socialized medicine for his family. This option is also available to all Senators and Congressmen and their families and is the option they usually choose, particularly the conservative Republican members.
e) If you take all the medical costs in the US and divide that amongst all US citizens - including even those that have no medical insurance and the estimated 45,000 who die annually for lack of adequate care - it comes out to over $10,000 per US citizen. The same costs for all the other leading market economies (the g20, for example) varies between $4,000 and $6,000. I. e., the US pays twice what everyone else in the developed world pays for health care. This comes out to well over $3Trillion per year.

But that is perfectly okay, because the US has by far the best health care system in the world. At least that’s what we are told by the representatives of the 5 non government companies I listed above and Republican politicians. But, the quality of a countries health care system is easy to measure because what we want from that system is very simple: a long and health life. I. e., we can look at the longevity, mortality, and morbidity statistics for those developed countries, statistics published annually by the World Health Organization (WHO) of the UN. What we find is that for the most developed countries life expectancy ranges from about 79 to 84 years. Japan is at the top at 83.7 years. Wow, look who’s last, in 43rd place at 78.9 years! Good old Let-The-Market-Set-The-Price U S of A! Not a big spread, but the US is certainly not at the top. The story is no different for morbidity and mortality rates. The US is at or near the bottom in almost every category.

To improve our health care system we don’t need to experiment or form committees to study the problem. We just need to see what those other countries are doing to get better and cheaper health care. I’ll let you, dear reader explore that one. Wouldn’t it be nice to get a few extra years of health life? And what could we do with that $1.5 Trillian? Some more aircraft carrier fleets; a few more stealth bombers; lots more tanks and missiles. Of course, if we had a progressive administration, they would just waste it on frivolous things like free college education for all or fixing the infrastructure mess.

Our health care system is so screwed up
because hospital costs are numbers just brewed up
numbers the insurance companies never question
they don’t care how much that gives us indigestion
and politicians don’t hear that we’re so pissed
‘cause they only listen to the lobbyists.
They know who’s paying the bill one way or another.
Yes , they know it’s going to be me or you brother.
Crap care for only twice the price.
Anywhere else that’s considered a vice.
But our health care costs are set by market forces,
giving us care not fit for pigs or horses.
And there will be no reform either simple or bold
because Americans believe everything we are told.

This message is a reply to:
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Posts: 33024
From: Texas!!
Joined: 04-20-2004
Member Rating: 2.7

Message 6 of 7 (834253)
06-01-2018 7:12 PM

A process to determine US Health Care Policy.
From The Trump Presidency

Thirty-two of the current Thirty-three Developed Nations have Universal Health Care systems.

Here is a list:


Some of these nations figured out how to do it before WWI.

It really is simple. Pick one and do what they did.

And what process should congress use to pick the plan?

The House has 435 members. There are thirty two countries on the list. Divide the House Membership up by drawing names out of a hat into thirty two teams of 13-14 members each. Assign one nation to each team and send them and their wives off on a vacation to their assigned nation.

When they return they must each prepare a Bill supporting choosing the plan from their assigned nation.

All thirty-two bills get sent to the Senate where the Senate passes one bill that then becomes the US Universal Healthcare Plan for a term of not less than ten years.

At the end of every ten year period the Congress can vote to repeat the process or renew the US Healthcare Plan.

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Replies to this message:
 Message 7 by caffeine, posted 06-04-2018 3:28 PM jar has not yet responded

Posts: 1799
From: Prague, Czech Republic
Joined: 10-22-2008

Message 7 of 7 (834383)
06-04-2018 3:28 PM
Reply to: Message 6 by jar
06-01-2018 7:12 PM

Re: A process to determine US Health Care Policy.
Thirty-two of the current Thirty-three Developed Nations have Universal Health Care systems.

I take issue with your source.

Not because I question the claims about health care, but because I cannot find any list of 'developed' or 'high income' or 'richest' countries which does not include the Czech Republic; except the Paris Club, which is fine since it only has 22 members.

If they said 'here are some high-income countries I would have no issue, but instead it says the high-income countries.

Your source writes in the footnotes:

For this list, those countries with UN Human Development Index scores above 0.9 on a 0 to 1 scale are considered developed.

but that's clearly not true. Nowadays there are only 18 such countries; but at the time the blog post was written in 2008 there were 28, not 33 (I assume the dramatic reduction is due to a change in methodology, rather than living standards plummeting in the last decade). Bahrain, incidentally, had a HDI of 0.866 in 2008. At no time have they had a HDI of .9 or higher. Nor, for that matter, have they ever had a HDI higher than that of the Czech Republic.

Not that any of this is relevant to the central point, but I question the research skills of your source.

Incidentally, we have a mandated insurance system here in our developed country, but I'm not sure that term adequately explains it. The 'insurance premiums' are taken out of my paycheck at a fixed percentage set by the state; and the small pool of insurance providers are non-profit organisations heavily regulated by the state, so in practice it differs little from a single-payer system.

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