Health Care and your experiences

[T.G.G. Moogly]

What you are saying is that no one knows what the actual costs are.

Think how fucked up getting food or buying a car or taking a vacation or going to a movie would be if those things and everything else worked the same way, and not to mention how much more expensive.

In the case of having a baby, there are many variables that will result in differences in costs. These include whether the delivery is a simple vaginal birth with no anesthesia to many levels of anesthesia and other medical intervention or treatment, whether the delivery is by c-section and type of anesthesia used, as well as amount, any complications for mother or child, whether a circumcision is performed, whether mom is in a private or semi private room and for how long--just off the top of my head.

I understand all that, and it can all be itemized and quoted.

 

[Toni]

In the case of having a baby, there are many variables that will result in differences in costs. These include whether the delivery is a simple vaginal birth with no anesthesia to many levels of anesthesia and other medical intervention or treatment, whether the delivery is by c-section and type of anesthesia used, as well as amount, any complications for mother or child, whether a circumcision is performed, whether mom is in a private or semi private room and for how long--just off the top of my head.

I understand all that, and it can all be itemized and quoted.

Apparently you do not understand the reality and the variables in giving birth at an American hospital. Yes, it is possible for hospitals to bill a flat rate for labor and delivery and a per diam for daily stay for mother and hospital but there are still many, many,many variables for a simple labor and delivery.

 

[beero1000]

I understand all that, and it can all be itemized and quoted.

Apparently you do not understand the reality and the variables in giving birth at an American hospital. Yes, it is possible for hospitals to bill a flat rate for labor and delivery and a per diam for daily stay for mother and hospital but there are still many, many,many variables for a simple labor and delivery.

That's not what he said. If you get a bill afterward, then the hospital has a way to itemize the cost of each of those variables. On the other hand, most of those cost quotes are for emergency contingencies that don't apply to most deliveries. If those occur to you then you'll opt for them, no matter what they cost, which is why it's batshit crazy to charge people individually for health care.

 

[T.G.G. Moogly]

I understand all that, and it can all be itemized and quoted.

Apparently you do not understand the reality and the variables in giving birth at an American hospital. Yes, it is possible for hospitals to bill a flat rate for labor and delivery and a per diam for daily stay for mother and hospital but there are still many, many,many variables for a simple labor and delivery.

Actually I do, being a dad and being right there in hospital for the whole enchilada. Did the natural childbirth thing, rooming in, breastfeeding only, and did all this at a local hospital in the south that had never seen anything before in its life. Made the front page of the local paper. They almost gave her a shot of Pitocin, routine, but we stopped that at the last second. Wouldn't let the doc clip the monitor to the kids scalp either during delivery, upon which he glared at us and asked, "Who's the doctor here?"

But then we did it all over 18 months later, same place, same doc. Shit can work. We're still married buds 40 years on.

 

[Toni]

Apparently you do not understand the reality and the variables in giving birth at an American hospital. Yes, it is possible for hospitals to bill a flat rate for labor and delivery and a per diam for daily stay for mother and hospital but there are still many, many,many variables for a simple labor and delivery.

Actually I do, being a dad and being right there in hospital for the whole enchilada. Did the natural childbirth thing, rooming in, breastfeeding only, and did all this at a local hospital in the south that had never seen anything before in its life. Made the front page of the local paper. They almost gave her a shot of Pitocin, routine, but we stopped that at the last second. Wouldn't let the doc clip the monitor to the kids scalp either during delivery, upon which he glared at us and asked, "Who's the doctor here?"

But then we did it all over 18 months later, same place, same doc. Shit can work. We're still married buds 40 years on.

You know YOUR experiences at the hospital where YOUR wife gave birth TWO times. Apparently heathy, easy, natural events. Not only is not every birth like that, but not every hospital or doctor like that, nor is every woman or every child.

Did your insurance cover the birth? Did you see an itemized bill?

When our oldest was born, we paid for ALL of it, down to the last piece of gauze. Itemized.

Our next child was born at a different hospital, covered by insurance. We only say our very tiny co-pay. I have no idea whether the actual delivery charges were the same or not. First time, we spent more time in the hospital, because of a minor complication (not predictable). Second time around, also a c- section, different doctor let us go home earlier than usual because no complications and it was my second child. Also a different doctor/different philosophy.

You may have been present for the deliveries if your children and been a good advocate for your wife and children, but you sure were not counting gauze packs. And there were zero complications, no need for any interventions, any one of which costs $$.

You know your rather ideal circumstance and let's face it, you didn't do one iota of the pushing.

 

[T.G.G. Moogly]

Actually I do, being a dad and being right there in hospital for the whole enchilada. Did the natural childbirth thing, rooming in, breastfeeding only, and did all this at a local hospital in the south that had never seen anything before in its life. Made the front page of the local paper. They almost gave her a shot of Pitocin, routine, but we stopped that at the last second. Wouldn't let the doc clip the monitor to the kids scalp either during delivery, upon which he glared at us and asked, "Who's the doctor here?"

But then we did it all over 18 months later, same place, same doc. Shit can work. We're still married buds 40 years on.

You know YOUR experiences at the hospital where YOUR wife gave birth TWO times. Apparently heathy, easy, natural events. Not only is not every birth like that, but not every hospital or doctor like that, nor is every woman or every child.

Did your insurance cover the birth? Did you see an itemized bill?

When our oldest was born, we paid for ALL of it, down to the last piece of gauze. Itemized.

Our next child was born at a different hospital, covered by insurance. We only say our very tiny co-pay. I have no idea whether the actual delivery charges were the same or not. First time, we spent more time in the hospital, because of a minor complication (not predictable). Second time around, also a c- section, different doctor let us go home earlier than usual because no complications and it was my second child. Also a different doctor/different philosophy.

You may have been present for the deliveries if your children and been a good advocate for your wife and children, but you sure were not counting gauze packs. And there were zero complications, no need for any interventions, any one of which costs $$.

You know your rather ideal circumstance and let's face it, you didn't do one iota of the pushing.

Back in the early 1980's between those two deliveries I paid a total of $800.00.

The point I'm still trying to make is that I am certain the total costs were itemized somewhere, but that I never saw. I should be able to see those costs. I can see them itemized - and do - when we have dental or vision experiences because we have no insurance for those two things unless they involve major medical issues, which they have.

And that's my only point, that those itemized costs can and should all be known and available to persons wishing to obtain services. But they are not. The industry is smarmy that way, corrupt is a better word.

 

[Philos]

Folks,

Some Americans used to talk about 'death panels' in UK healthcare. What they missed out is that we have always had private healthcare for those that can afford it. We have both private and public healthcare. I've used both myself.

Just the same as in the US, except that they don't have the choices we have.

Alex.

Isn't triage death panels?

Dr Z,

I don't see cash in hand as a form of "triage" although I guess it is a form of rationing.

A.

 

[Toni]

The point I'm still trying to make is that I am certain the total costs were itemized somewhere, but that I never saw. I should be able to see those costs. I can see them itemized - and do - when we have dental or vision experiences because we have no insurance for those two things unless they involve major medical issues, which they have.

And that's my only point, that those itemized costs can and should all be known and available to persons wishing to obtain services. But they are not. The industry is smarmy that way, corrupt is a better word.

Your wife should be able to see those costs as she was the patient, not you. That's the first point.

But aside from that, what is dishonest is the insurance industry, not medical providers. And after the fact, you would use this information to make choices exactly how? Hospital A charges $X for gauze and hospital B charges $Y. You have no idea which gauze is better quality or whether the difference in quality matters, or how much will be used on average, in an ideal situation, in your situation. You simply do not. You do not know in advance if you will laboring for a few hours or for many; you do not know in advance if you will be in the delivery room for a couple of hours or for many. You do not know if there will be an emergency c-section. You do not know if you or the baby(ies) will require ICU care, or what services. You do not know for certain what kinds of medication will be needed, no matter how well you plan. Or if there is a last minute change in the plan.

In the case of labor and delivery, you pay for labor room, delivery room (often but not always different rooms), mom's room, baby's room, and the necessary care for each patient. Also for every single item used in providing that care. Some hospitals even charge for the 'baby gift' of starter supplies of various baby products such as diapers. Those are usually provided to the hospital as an advertising campaign by the companies making the products. And normally, one does not pay for 'gifts.' New mothers are provided with heavy duty sanitary pads to take care of the lochia. You pay for the entire pack, period. No pun intended. But what you are paying for expertise and also for compassion, etc. We specifically chose one hospital over another because of its 'family friendly' policies. It made no difference to our insurance company but we were clearly choosing the hospital that fit best with how we wanted to be treated.

Typically, an insurance company will enter into an agreement with a provider to pay $X.00 for Y service. In the case of childbirth, the amount the insurance company pays is the same whether labor lasts 2 hours or 23 hours or 2 days. The costs in labor, supplies, etc. to the hospital varies quite a bit. Increasingly, are reimbursed less and less for any given service provided for any patient for any reason. This is a serious issue facing the health care industry: being reimbursed for only a fraction of the cost of providing care. It's long been a serious issue for Medicaid patients; it's becoming an increasingly serious issue with Medicare patients and frankly, private insurers are following suit. Why should BC/BS pay $150 for a service that Medicare only pays $98 for? BC/BS is only interested in their profits and their duty is to their board of directors and stockholders, not to the patient who is paying for the insurance.

My personal belief is that any entity--any insurer, any patient, should reimburse the same dollar amount for any given service. Period. It would greatly simplify billing, patient understanding of their medical bills, allow for more coherent choices--where there are choices because frankly, nobody is going to shop around for lower cost hospital in the middle of a heart attack, or for premature labor while visiting family outside of the 'provider network.' And frankly, going to hospital A for your stent because it is cheaper for the procedure than Hospital B but your doctor, carefully selected and with whom you have a great rapport and great trust only is at Hospital B is not going to happen if the patient has any say in their care at all. If we want the best possible care, the decisions must rest with the patient--and also with their providers. Not with the insurance companies. Or government, except to the extent that the government, in conjunction with providers and various regulatory bodies,, establishes best practices.

 

[ZiprHead]

I was Chargemaster at one of our local hospital systems for a little over twenty years.

Prices were set on a cost basis plus a multiplier. $.01 to $5 cost times 5 equals price on up to x 1.05 for devices costing more than $1000. Procedures were priced at 1.25 x Medicare APC (Ambulatory Payment Classification).

The hospital raised it's prices yearly across the board 5% which I thought was excessive, but I had no input into that decision.

 

[Toni]

I've done work load recording, accounting on a per minute basis the amount of human time it takes to perform a variety of tests. These were supposed to be included in the calculations for charging for the tests.

Here's what I know: the uncertainty in the amount that will be reimbursed for any service is creating havoc in the medical industry, at least in the provider side. It's a huge factor in merging practices and hospitals and closing hospitals and clinics, usually in more rural areas which are already under served. While the stereotype for someone living in poverty is a black or Hispanic urban dweller, rural areas also face significant issues with poverty and lack of social services, medical services, good insecurity, etc.

 

[Philos]

Folks,

Two of my daughter's friends are in hospital. One is under observation just about to have twins, the other is in intensive care after a major operation to remove ovarian cancer. Of course there are no cash payments, credit cards or insurance companies involved.

Alex.

 

[T.G.G. Moogly]

Folks,

Two of my daughter's friends are in hospital. One is under observation just about to have twins, the other is in intensive care after a major operation to remove ovarian cancer. Of course there are no cash payments, credit cards or insurance companies involved.

Alex.

But how many Tomahawk missiles can you launch from one of your aircraft carrier fleets?

Snarky I know, but that's the reality. I wish the U.S. was smarter.

 

[braces_for_impact]

Went to the ER last night in an attempt to get some pain relief. I've been without meds of any kind (except Kratom) for two months after my job was sent to the Philippines. I can't sleep, I'm not eating, and I'm trying to hold together a family, study for my upcoming exams, and generally not lose my shit while I look for a new job. My unemployment ran out, so I haven't been able to afford my kratom, so all I have is over the counter meds for my neuropathy. I was the lucky, lucky beneficiary of medicaid last week, but of course my doctor nor my pain relief clinic accepts medicaid, so I have to find a new Primary, go through everything all over again, get assigned to the pain clinic, and hope I can find some relief before I find a new job, and have to do it all over again once I get medical insurance.

The ER gave me two vicodin and sent me home. I understand why people go to the street to medicate themselves.