ONTD Political

Bitter Pill: Why Medical Bills Are Killing Us

1:58 am - 02/28/2013

Bitter Pill: Why Medical Bills Are Killing Us

1. Routine Care, Unforgettable Bills
When Sean Recchi, a 42-year-old from Lancaster, Ohio, was told last March that he had non-Hodgkin’s lymphoma, his wife Stephanie knew she had to get him to MD Anderson Cancer Center in Houston. Stephanie’s father had been treated there 10 years earlier, and she and her family credited the doctors and nurses at MD Anderson with extending his life by at least eight years.

Because Stephanie and her husband had recently started their own small technology business, they were unable to buy comprehensive health insurance. For $469 a month, or about 20% of their income, they had been able to get only a policy that covered just $2,000 per day of any hospital costs. “We don’t take that kind of discount insurance,” said the woman at MD Anderson when Stephanie called to make an appointment for Sean.

Stephanie was then told by a billing clerk that the estimated cost of Sean’s visit — just to be examined for six days so a treatment plan could be devised — would be $48,900, due in advance. Stephanie got her mother to write her a check. “You do anything you can in a situation like that,” she says. The Recchis flew to Houston, leaving Stephanie’s mother to care for their two teenage children.

About a week later, Stephanie had to ask her mother for $35,000 more so Sean could begin the treatment the doctors had decided was urgent. His condition had worsened rapidly since he had arrived in Houston. He was “sweating and shaking with chills and pains,” Stephanie recalls. “He had a large mass in his chest that was … growing. He was panicked.”

Nonetheless, Sean was held for about 90 minutes in a reception area, she says, because the hospital could not confirm that the check had cleared. Sean was allowed to see the doctor only after he advanced MD Anderson $7,500 from his credit card. The hospital says there was nothing unusual about how Sean was kept waiting. According to MD Anderson communications manager Julie Penne, “Asking for advance payment for services is a common, if unfortunate, situation that confronts hospitals all over the United States.”

Why?The total cost, in advance, for Sean to get his treatment plan and initial doses of chemotherapy was $83,900.

The first of the 344 lines printed out across eight pages of his hospital bill — filled with indecipherable numerical codes and acronyms — seemed innocuous. But it set the tone for all that followed. It read, “1 ACETAMINOPHE TABS 325 MG.” The charge was only $1.50, but it was for a generic version of a Tylenol pill. You can buy 100 of them on Amazon for $1.49 even without a hospital’s purchasing power.

Dozens of midpriced items were embedded with similarly aggressive markups, like $283.00 for a “CHEST, PA AND LAT 71020.” That’s a simple chest X-ray, for which MD Anderson is routinely paid $20.44 when it treats a patient on Medicare, the government health care program for the elderly.

Every time a nurse drew blood, a “ROUTINE VENIPUNCTURE” charge of $36.00 appeared, accompanied by charges of $23 to $78 for each of a dozen or more lab analyses performed on the blood sample. In all, the charges for blood and other lab tests done on Recchi amounted to more than $15,000. Had Recchi been old enough for Medicare, MD Anderson would have been paid a few hundred dollars for all those tests. By law, Medicare’s payments approximate a hospital’s cost of providing a service, including overhead, equipment and salaries.

On the second page of the bill, the markups got bolder. Recchi was charged $13,702 for “1 RITUXIMAB INJ 660 MG.” That’s an injection of 660 mg of a cancer wonder drug called Rituxan. The average price paid by all hospitals for this dose is about $4,000, but MD Anderson probably gets a volume discount that would make its cost $3,000 to $3,500. That means the nonprofit cancer center’s paid-in-advance markup on Recchi’s lifesaving shot would be about 400%.

When I asked MD Anderson to comment on the charges on Recchi’s bill, the cancer center released a written statement that said in part, “The issues related to health care finance are complex for patients, health care providers, payers and government entities alike … MD Anderson’s clinical billing and collection practices are similar to those of other major hospitals and academic medical centers.”

The hospital’s hard-nosed approach pays off. Although it is officially a nonprofit unit of the University of Texas, MD Anderson has revenue that exceeds the cost of the world-class care it provides by so much that its operating profit for the fiscal year 2010, the most recent annual report it filed with the U.S. Department of Health and Human Services, was $531 million. That’s a profit margin of 26% on revenue of $2.05 billion, an astounding result for such a service-intensive enterprise.1

The president of MD Anderson is paid like someone running a prosperous business. Ronald DePinho’s total compensation last year was $1,845,000. That does not count outside earnings derived from a much publicized waiver he received from the university that, according to the Houston Chronicle, allows him to maintain unspecified “financial ties with his three principal pharmaceutical companies.”

DePinho’s salary is nearly two and a half times the $750,000 paid to Francisco Cigarroa, the chancellor of entire University of Texas system, of which MD Anderson is a part. This pay structure is emblematic of American medical economics and is reflected on campuses across the U.S., where the president of a hospital or hospital system associated with a university — whether it’s Texas, Stanford, Duke or Yale — is invariably paid much more than the person in charge of the university.

I got the idea for this article when I was visiting Rice University last year. As I was leaving the campus, which is just outside the central business district of Houston, I noticed a group of glass skyscrapers about a mile away lighting up the evening sky. The scene looked like Dubai. I was looking at the Texas Medical Center, a nearly 1,300-acre, 280-building complex of hospitals and related medical facilities, of which MD Anderson is the lead brand name. Medicine had obviously become a huge business. In fact, of Houston’s top 10 employers, five are hospitals, including MD Anderson with 19,000 employees; three, led by ExxonMobil with 14,000 employees, are energy companies. How did that happen, I wondered. Where’s all that money coming from? And where is it going? I have spent the past seven months trying to find out by analyzing a variety of bills from hospitals like MD Anderson, doctors, drug companies and every other player in the American health care ecosystem.

When you look behind the bills that Sean Recchi and other patients receive, you see nothing rational — no rhyme or reason — about the costs they faced in a marketplace they enter through no choice of their own. The only constant is the sticker shock for the patients who are asked to pay.

Yet those who work in the health care industry and those who argue over health care policy seem inured to the shock. When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?

What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab? Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?

Recchi’s bill and six others examined line by line for this article offer a closeup window into what happens when powerless buyers — whether they are people like Recchi or big health-insurance companies — meet sellers in what is the ultimate seller’s market.

The result is a uniquely American gold rush for those who provide everything from wonder drugs to canes to high-tech implants to CT scans to hospital bill-coding and collection services. In hundreds of small and midsize cities across the country — from Stamford, Conn., to Marlton, N.J., to Oklahoma City — the American health care market has transformed tax-exempt “nonprofit” hospitals into the towns’ most profitable businesses and largest employers, often presided over by the regions’ most richly compensated executives. And in our largest cities, the system offers lavish paychecks even to midlevel hospital managers, like the 14 administrators at New York City’s Memorial Sloan-Kettering Cancer Center who are paid over $500,000 a year, including six who make over $1 million.

Taken as a whole, these powerful institutions and the bills they churn out dominate the nation’s economy and put demands on taxpayers to a degree unequaled anywhere else on earth. In the U.S., people spend almost 20% of the gross domestic product on health care, compared with about half that in most developed countries. Yet in every measurable way, the results our health care system produces are no better and often worse than the outcomes in those countries.

According to one of a series of exhaustive studies done by the McKinsey & Co. consulting firm, we spend more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia. We may be shocked at the $60 billion price tag for cleaning up after Hurricane Sandy. We spent almost that much last week on health care. We spend more every year on artificial knees and hips than what Hollywood collects at the box office. We spend two or three times that much on durable medical devices like canes and wheelchairs, in part because a heavily lobbied Congress forces Medicare to pay 25% to 75% more for this equipment than it would cost at Walmart.

The Bureau of Labor Statistics projects that 10 of the 20 occupations that will grow the fastest in the U.S. by 2020 are related to health care. America’s largest city may be commonly thought of as the world’s financial-services capital, but of New York’s 18 largest private employers, eight are hospitals and four are banks. Employing all those people in the cause of curing the sick is, of course, not anything to be ashamed of. But the drag on our overall economy that comes with taxpayers, employers and consumers spending so much more than is spent in any other country for the same product is unsustainable. Health care is eating away at our economy and our treasury.

The health care industry seems to have the will and the means to keep it that way. According to the Center for Responsive Politics, the pharmaceutical and health-care-product industries, combined with organizations representing doctors, hospitals, nursing homes, health services and HMOs, have spent $5.36 billion since 1998 on lobbying in Washington. That dwarfs the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by oil and gas interests over the same period. That’s right: the health-care-industrial complex spends more than three times what the military-industrial complex spends in Washington.

When you crunch data compiled by McKinsey and other researchers, the big picture looks like this: We’re likely to spend $2.8 trillion this year on health care. That $2.8 trillion is likely to be $750 billion, or 27%, more than we would spend if we spent the same per capita as other developed countries, even after adjusting for the relatively high per capita income in the U.S. vs. those other countries. Of the total $2.8 trillion that will be spent on health care, about $800 billion will be paid by the federal government through the Medicare insurance program for the disabled and those 65 and older and the Medicaid program, which provides care for the poor. That $800 billion, which keeps rising far faster than inflation and the gross domestic product, is what’s driving the federal deficit. The other $2 trillion will be paid mostly by private health-insurance companies and individuals who have no insurance or who will pay some portion of the bills covered by their insurance. This is what’s increasingly burdening businesses that pay for their employees’ health insurance and forcing individuals to pay so much in out-of-pocket expenses.

1. Here and elsewhere I define operating profit as the hospital’s excess of revenue over expenses, plus the amount it lists on its tax return for depreciation of assets—because depreciation is an accounting expense, not a cash expense. John Gunn, chief operating officer of Memorial Sloan-Kettering Cancer Center, calls this the “fairest way” of judging a hospital’s financial performance

Read more at source: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us

(The article is many, many pages long and I'm not copying all of it for reasons of length, and that I'd rather not get ontd_p a nastygram from TIME for copying the entirety. It is, however, well worth reading. I think most of us, especially those of us who have been uninsured for any length of time, are probably aware of the issues raised but seeing the actual numbers is staggering.

Mods, why do we have tags for "health care" and "healthcare" separately? *confused* Also if any tags need adding/fixing, let me know. It's a very long article and a lot apply.)
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jaded110 28th-Feb-2013 02:08 pm (UTC)
My dad may need to file for bankruptcy because our medical bills for my mom ALONE are most likely in the millions, let alone the bills for him after his heart surgery.
bellichka The glories of for-profit healthcare! 'Murrica!28th-Feb-2013 02:17 pm (UTC)
I've read this before, and it's a damn good read. Our healthcare system is so broken, and people are so complacent about it that it just boggles my mind. I had no health insurance from 2006 to last month, and it was a scary time. I was in a serious car accident, and I didn't want the ambulance to take me to the hospital to check for internal injuries because I was worried about the bills (until I realized I was covered under my car insurance, and at that point I was like, do whatever the hell you want, I don't have to pay for it!). It's fucked up when you have to even CONSIDER not seeking necessary medical treatment, especially after a traumatic accident, because you're worried about affording it.

I've been having stomach/intestinal issues for almost the past year. I've seen two GPs, and one GI specialist. Those bills were $125-250 each. I thought I was on my parents' insurance at the time (they looked up my information and told me I was still covered, only to tell me afterwards that I wasn't). After the GI, I had an ultrasound, and labwork down. The labwork was a stool test to check for the H Pylori bacteria. I was already treated for H Pylori by Dr. #1, who didn't even test for it. So I didn't have H Pylori at that point (and if I ever did, I'd already been treated). Nonetheless, it's what the insurance company required. They didn't want to test me for Celiac, dairy allergy, anything that, you know, made sense. They wanted to test me for a bacteria that I'd already been on medications for and already knew that I didn't have. And now I'm stuck with a $500 bill for labwork & and ultrasound, both of which told me nothing.

I am so fortunate now to have health insurance through my primary employer (you know, b/c I have three jobs and my own business), even though I am only 25 hours a week and work for a non-profit. My checks have shrunk by about 25%, but it's nice to know that if I get sick I'm not completely and utterly fucked. Sort of.

I would never raise a child in this country, though, with healthcare costs what they are.
muizenstaartje Re: The glories of for-profit healthcare! 'Murrica!28th-Feb-2013 02:49 pm (UTC)
I would never raise a child in this country, though, with healthcare costs what they are.

I think the USA is indeed quite scary to live in when you aren't very rich. I may not live in the most perfect country, but I would not want to live in the USA (for multiple reasons).
Last month my husband went to see our family doctor, he was referred to the hospital staight away and they found a tumour when he was there. It was removed the next day and a CT scan followed the day after. We were a wreck while waiting for the final diagnosis (lucky for us it was good news), but it must be beyond horrible if you can't get treatment or tests right away, because you must wait for a check to clear.
My husband and I won't be able to fork out the large sums mentioned in the article. I'm all kinds of thankful we only need to pay our insurance fees for the treatment my husband received and for the check-ups he'll need the next 10 years. That is as long as my government doesn't get any crazy ideas like Americanising national healthcare.
The thought someone in a developed and rich country dies or gets sick/disabled, because they can't afford medical treatment is too sad.
estella7 28th-Feb-2013 02:39 pm (UTC)
We spend two or three times that much on durable medical devices like canes and wheelchairs, in part because a heavily lobbied Congress forces Medicare to pay 25% to 75% more for this equipment than it would cost at Walmart.

This is a big part of the problem. Congress sucks. Why are they bought by lobbyists? How do We the People even allow it? Gross.

My daughter gets allergy shots. Our insurance was paying $39 a shot. We lost our insurance and I talked to the doctor about paying cash up front and was told it would cost $15. Why the huge markup for insurance? Sickening, and the Affordable Care Act doesn't seem to address this much at all because it was so thoroughly gutted.
bestdaywelived 28th-Feb-2013 10:45 pm (UTC)
It's not a markup for insurance, it's a discount for paying cash.
teacup_werewolf 28th-Feb-2013 03:02 pm (UTC)
I am going through something similar.

For those that read Shenanigans, a month or so ago I posted that I recently had ankle surgery. Everything went off without a hitch except at that time I had no health insurance. I was kicked off of United Healthcare because I turned 26 and I was pretty much 'screwed', but I was praying to friggin Jesus, Buddha and Odin that I would get on medicaid. A couple weeks ago, I did. I finally got on medicaid and I signed up for Molina healthcare which my GP was covered under. I thought the hell of a loom 11k in debt would finally go away.


turns out that while my Ortho (great people btw) could cover me. The surgery center that did my surgery couldn't I found this out on Tuesday of this week. I spent that afternoon sobbing. I finally got paper work to get financial assistance and see if I am under HCAP. But frankly I am so tired of paperwork and going through more red tape. But anything to make a 11k go away.

My father's insurance as pretty boss and covered my IUD I hope medicaid can too. *sigh*
nonnycat 1st-Mar-2013 04:26 am (UTC)
I'm so sorry you're dealing with all that. :(

Depending on where you live the state may have additional funding for birth control. That said I know several people who have had Medicaid cover their IUDs. But it's a state to state thing :-\
blackpuddle 28th-Feb-2013 03:07 pm (UTC)
I have health insurance and I'm still paying out the ass for a surgery I had in December. I'm like, wait, why am I paying into this at all if I'm getting tons and tons of medical bills anyway?

I don't even want to go into my friends that have EDS and need special wheelchairs and treatments. They're beyond screwed. This country sucks if you have medical problems weather you have insurance or not.
maladaptive 28th-Feb-2013 04:45 pm (UTC)
I'm like, wait, why am I paying into this at all if I'm getting tons and tons of medical bills anyway?

I'm having this feeling right now and I'm looking for new insurance. I pay for "dental" and had about $1,500 worth of work done... and my insurance covered $28.


That's less than I'd paid into the dental plan! Not to mention the rest of the medical plan at about $400/month... fortunately I haven't needed anything, though, because I don't want to know what happens when I get "we don't cover that."

Edited at 2013-02-28 04:46 pm (UTC)
shoujokakumei 28th-Feb-2013 03:13 pm (UTC)
The need for health insurance is keeping me trapped in a job that's so bad for my mental health that I've been out on medical leave twice in the past year. But if I quit, I suddenly have to pay $1500+ a month for meds out of pocket.

And my father is suffering from what seems like COPD except his shitty local cow town doctors keep saying he doesn't have it... But his Tricare (he spent 22 years in the military) won't pay for him to see a specialist at any of the good hospitals we could drive him to.

Health care is too important for insurance companies to wield the amount of power they do. God bless America, where half the country is terrified that the government will create death panels, but doesn't mind insurance companies doing it.
munky_of_magyar 28th-Feb-2013 03:55 pm (UTC)
The worst thing is, when you go somewhere and ask, "do you participate with my insurance?" and they check everything and say, "yes" then turn around and schedule you with a doctor that doesn't. Then not tell you nine months; after which you have already racked up few thousand dollars in debt. I was able to pay it off with my stipend for school, but I still have health issues that need to be addressed.

I have PCOS and I know that my doctor is going to want to run a bunch of tests. So, when my prescription runs out next week, I am not going to spend the money to go to the doctor to have it renewed because, they are just going to take me off of it anyways and tell me to come back in a few months for blood work. I am not paying $300 to see a doctor for 5 minutes, to tell me what I already know.

Do not get me started on dental costs.
peace_piper 1st-Mar-2013 02:08 am (UTC)
Oh man, I hate that so much. I was in the ER recently and need a regular doctor, but I don't have one because I haven't been sick or had problems until this came up, necessitating an ER visit. He told me that there was in fact a doctor in my town that accepted Medicaid, so I scheduled a visit, only to be told by the front ladies that seeing doctor so-and-so ISN'T covered and I can only see a "mid-level" practitioner since "doctors don't see medicaid patients".

Dental costs are outrageous. I've had to go without care simply because I can't pay. A friend of mine has insurance, and yet she had to drop $600 for dental care today. Six hundred bucks. In a single DAY. I don't even spend that much in a month. x__x
mutive 28th-Feb-2013 03:58 pm (UTC)
I love this article. Thanks for posting it.

What amazes me is that the author never even proposes single payer. (Or what I think might be more palatable to many conservatives - let insurance companies flourish, as long as there are some standards as to what they have to provide - but allow people to buy into Medicare, too, if they prefer that to other options.) It's like he's thinking, "Well, it's so impossible that we'd win over special interests anyway that we shouldn't even bother trying."

jenny_jenkins 28th-Feb-2013 09:26 pm (UTC)
I think he may have considered it. But this is key, actually:

That so few consumers seem to be aware of the chargemaster demonstrates how well the health care industry has steered the debate from why bills are so high to who should pay them.

And I think he's hit on something.

He doesn't want to cloud the issue. He wants to explore the cost BEFORE discussing the means of paying.

Because if he discusses the means of paying the bills he's back to talking about the issue the way THEY want him to.
gambitia 28th-Feb-2013 04:21 pm (UTC)
There are some things that should never be for-profit, and healthcare and insurance are two of the biggies. The shenanigans that arise...I literally cannot understand the viewpoint that says that this capitalist* free-for-all is totes okay.

*not that this is actually capitalism, given the artificial lack of competition, but I don't know what else to call and it certainly resulted from capitalism.
ineverycolor 28th-Feb-2013 05:42 pm (UTC)
"*not that this is actually capitalism, given the artificial lack of competition, but I don't know what else to call and it certainly resulted from capitalism." Well said....
furrygreen 28th-Feb-2013 04:44 pm (UTC)
Why exactly are the bills so high?

Why do people keep asking that question? It's obvious. Because they can. What are people going to do? Refuse care and die?

Whenever I hear that question, I get a flashback to what happened when the gov't gave exclusive production rights to one of the most effective drugs that reduces the chances for premies (given in weekly shots.) It was $15 a shot when pharmacists mixed it but when the private company got its hand on it, they upped the charge to $1500.

When people protested that incredible markup (that raised the price of that drug to around 30k a pregnancy), the company said "well, the first year of care for a disabled child is around $50k it pays for itself in the end."

Hell, they even managed to drum up some irony in that it was the march of dimes "no more premies" that lobbied the gov't to give the drug over to a private company.

Thanks March of Dimes. Doing your best to make more premies.
lamardeuse 28th-Feb-2013 04:44 pm (UTC)
Absolutely sickening. And this is the way the Tory governments in Canada and the UK would dearly love to drag us if they get the chance.
soleiltropiques 28th-Feb-2013 09:29 pm (UTC)

That is completely true. In Canada, the publich healthcare system is managed by the provinces and is a provincial 'sector' or 'compentency'. Unfortunately many Canadians don't seem to realize that much of the money as well as the very structure of the healthcare system comes from the federal government and is determined by the Canadian Health Act.

In other words, many don't seem to grasp how big a deal it is that the current federal government want to REDUCE (money) transfers to the provinces, once they're no longer bound by the current deal with the provinces.

I don't live in the UK, but I do have family there. The current government there has done everything it can to increase all manner of inequalities. And the NHS is already flawed: I had a great aunt living in the UK (=my mother's aunt). She was just about the same age as Prince Philip (i.e. husband to the Queen), and she had roughly the same kind of problem requiring heart surgery at about the same time he did. He promptly got the treatment he needed, but my mother's aunt waited and waited... And is now deceased.

Finally, many countries with public healthcare systems are having the same problems as Canada: the budgets never stop increasing.

Do you what the real reason is for this? It isn't because public healthcare systems are unsustainable, as so many seem bent on telling (selling?) us right now. The problem is that many of the medications we use come from the same U.S. companies that vastly overcharge average Americans for medications (or, alternatively, from non U.S. pharmaceutical companies using the same strategies)... And most of what is paid for these medications actually goes NOT to R&D, but towards drug marketing (in Canada this is mostly directed at physicians). And the cost of these medications keeps increasing.

(This isn't an attempt at jingoism on my part, BTW. I truly hope it doesn't come across that way. But I can't help noting that one big culprit, although not the only one, with regards to both U.S. and non U.S. issues with regards to healthcare, are a direct result of the way things are done in 'big pharma'.)

Edited at 2013-02-28 09:33 pm (UTC)
shadwrayvn 28th-Feb-2013 05:34 pm (UTC)
My fiancee's medical bills scare me & after 2 yrs of fighting the courts finally gave him disability. 3 back surgeries that honestly I know we can never pay off & the pain management meds cost an arm & a leg. I myself had surgery for my TMJ about 2 yrs ago & was lucky enough to qualify for some help from my county or I never would have been able to afford it. Why does it cost so much because they can charge that much. I used to work in a hospital & the amount they charged for everything was a damn joke.
ineverycolor 28th-Feb-2013 05:37 pm (UTC)
I'm just going to die if I get really sick. I think I'd rather die from whatever tumor or disease in me than get trapped into the slavery of the healthcare system.
gothic_hamlet 28th-Feb-2013 05:42 pm (UTC)
I keep looking at these insanely high numbers, and I have no idea how this industry can possibly work.

Aside from the standard "we're not going to pay for that," if it's the hospitals and admin fees that are so high, how do even insurance companies stay afloat? I may pay into a plan all my life, but if I pass my deductible and rack up a million dollars in hospital fees, how do they afford to not go out of business? Do insurance companies get a discounted rate for this stuff? I just can't wrap my brain around how this entire model hasn't collapsed yet.
jenny_jenkins 28th-Feb-2013 06:04 pm (UTC)
Well judging from that documentary I saw a few years ago (I believe it was Michael Moore) your insurance company can probably find a way not to cover you by coming up with a reason that's in the fine print somewhere.

I only saw the film once, but there was a young mother with cervical cancer who didn't get covered because she had a yeast infection once and didn't declare it. So she came here (well - Ontario, I'm further West) and pretended to "marry" a Canadian friend of hers.

Because of the Canadian angle I remember that part of the documentary best. I think she would cross over to Windsor.
ook 28th-Feb-2013 05:51 pm (UTC)
This is an excellent (if depressing) article and the longest article ever to be published in TIME magazine.
ineverycolor 28th-Feb-2013 06:43 pm (UTC)
I know I was shocked. I was like wow real journalism? How long has it been since I read an article of this type of informative quality. My brain started to tingle!
jetgirl78 28th-Feb-2013 05:52 pm (UTC)
I recently went to the eye doctor to have my vision checked after six years of not going (four of the years I've been without health insurance), but with chronic eye problems, I was long overdue. After learning that I'd had no insurance, I was immediately asked to pay for the office visit before I had even seen the doctor (even though I had been a patient for almost fifteen years) and then had to pay $30 extra because I wanted a prescription for new glasses actually written out, a phenomenon that seems to be becoming the norm from what I hear. As I said, I've been visiting this doctor for the almost fifteen years and this was the first time I left feeling like I had visited an accountant rather than a doctor. It is all about the money and my health was almost an afterthought.
jenny_jenkins 28th-Feb-2013 06:01 pm (UTC)
This is one of the most horrifying things I have ever read.

Marking up prices like that. How can this possibly be legal?

Your insurance companies shouldn't be allowed to exist in the form that they do.
deborahw37 28th-Feb-2013 06:12 pm (UTC)
This makes me even more determined to fight tooth and nail for the NHS ... our current government would just love to make it an insurance based system.

On Tuesday the sight in my left eye went dramatically wonky... bits of my vision blacked out.. other bits were covered in strobe lights.

Now optical care is one of the few bits not fully covered free at the point of use by the NHS .. like dentistry it is free for the young, the old, the disabled and the unemployed but the rest of us pay ( in the case of dentistry up to a set maximum of £209 for " a single course of complex treatment" which includes things like bridges, crowns, root canals etc) . In the opticians we pay between £10 and £24 for a sight test and then buy glasses so most of us have a back up insurance plan.

Mine costs £10 per month from Boots.

But when my eye went wonky I was away from my home town so popped into the nearest opticians who sent me straight to a local opthamologist.

He saw me straight away and spent an hour and a half running every test under the sun.

I was told it was a harmless occular migraine, my GP was informed and I was booked in for a follow up.

I expected to pay but was told that this had been a medical emergency and that, had there not been a local consulting opthamologist, they'd have sent me to the hospital eye clinic.

It was therefore free of charge.

When I mentioned this on my LJ an American friend said she'd had similar symptoms but diagnosed herself via Google because she was scared of the cost.

The tests BTW were to rule out damage to the retina or optic nerve, glaucoma, stroke, blood vessel damage etc and to determine whether an MRI brain scan was needed.

It scares the heck out of me to think that cost deters people from getting help with symptoms which, in my case, turned out to be nothing to worry about but which could equally be stroke, tumour, or a host of other nasties, Including a detached retina which could lead to the loss of sight in that eye!

corinn 28th-Feb-2013 09:41 pm (UTC)
Wow, your friend's story is familiar. A few weeks ago I had what I'm pretty sure was an epic migraine aura. I've had migraines since I was twelve and as I get older the trend seems to be less pain, more bizarre auras. This episode was like taking every aura symptom I've ever had, tossing them together, and dialing them up to eleven. I recognized the symptoms, but it was so much stronger and so terrifying that if I had insurance I would have gone to the ER to get an MRI or whatever just in case. I was reading an article online when bam. Vision went jerky, vertigo, nausea, very weak all over (like "puppet whose strings have been cut" weak), and I lost all hearing aside from a loud dual whine and buzz. All I could really do was flop my head onto the desk and close my eyes to cut the visual stimulation that makes those migraines worse. It passed in perhaps ten minutes, but I was so terrified during it that I got hot all over from my blood pressure skyrocketing with the adrenaline and I damn near hyperventilated.

But even while I was having the episode and terrified that I was having a stroke, I was thinking of how I could not afford to go to the ER-- I haven't had insurance since 2007. So when it passed, I looked up stroke warning signs and did all the FAST tests over and over for a couple hours while mentally chanting "please be a migraine, please be a migraine, please be a migraine."
rebness 28th-Feb-2013 06:30 pm (UTC)
I understand that there are sometimes massive medicine costs for the hospitals/healthcare providers, but such an unjustified mark up on something someone needs just to survive is incredibly cruel.

It sticks in my throat that I have to pay for prescriptions for a chronic skin condition here in the UK (which is less than £10 a month, to be fair) but my GP will always tell me to go to the chemist and buy something over the counter if it's much cheaper. That they charged $1.50 per tablet is insane!

My dad has oesophageal cancer, but the dreaded Communist Stalinist Healthcare System has literally saved his life several times in the last few years, and we haven't had to pay a penny. My family could never have afforded even £10,000 for his extensive treatment over the last six years. I'm grateful every day for the NHS, despite the scare stories, despite the Tory agenda, despite the flaws. I wish everyone had access to support like that.

Edited at 2013-02-28 06:32 pm (UTC)
thrace_ 28th-Feb-2013 06:39 pm (UTC)
The cost of medical care in this country is ABSURD.

I hurt my neck playing rugby in college and the ambulance ride alone was $1400, covering a distance of less than 1.5 miles. I could have easily walked from the field to the hospital. Then I lay in the hallway strapped to a backboard for an hour despite it definitely not being peak hours at the hospital. Fortunately I was still covered at this time. But recently I cracked some ribs while I was uninsured and despite the pain I still didn't go see a doctor because of the costs. I was fortunate that it was one of those injuries that just needs time and rest, but if it had been any more serious I was fucked.

It's just scary how quickly your entire life plan can be derailed due to one illness or injury. Even if it's not a serious disease that racks up 6 or 7 figure costs, even something like $5 or $10k can wipe out the livelihoods of people who make say, minimum wage. One bad day and you're done.
xhollydayx 28th-Feb-2013 06:44 pm (UTC)
I have health insurance (COBRA, fwiw) that costs about 70% of my monthly income, and that's not including my co-pays. My co-pays are almost the cost of that. I had an allergic reaction a few weeks ago that sent me to the ER. That was $150+, minus the prescriptions I ended up with. I went over the bill with a fine tooth comb. They billed me for lab work... but I didn't have any lab work. So then I had to pay to get my medical notes from the hospital, and they showed no lab work.
tabaqui 28th-Feb-2013 07:05 pm (UTC)
I'm still dealing with bills incurred two years ago when i had my GI surgery. I got very, *very* lucky (or, you know 'poor') and qualified for the state Medicaid, but it took them almost a year to approve it, and in the meantime i'm getting stacks of bills in the mail, most of which i can't even begin to pay.
romp 1st-Mar-2013 07:31 am (UTC)
And then there's the stress of that debt.

I'm sorry. I'd buy your books!
umi_mikazuki 28th-Feb-2013 08:13 pm (UTC)
Even with insurance, the only reason I'm able to get my endoscopy (and possibly esophageal inflation) done next week is because my parents are paying for it. I'm damn lucky I have people in my life that are well off enough to help me. They've had to pay thousands of dollars to help me get my teeth taken care of, too.

I held off on even getting my acid reflux/swallowing issues dealt with because I couldn't afford it. My parents don't want to risk the same thing that happened to my dad happening to me: his esophagus had gotten so constricted that a piece of food got stuck and not even water would go down until he got an inflation at least twelve hours later. There's a chance, too, that the food could have come up and gone down his larynx instead, choking him to death.
tamingheadfauna You know what's scary?28th-Feb-2013 09:09 pm (UTC)
Medical debt, pre-existing conditions, the general fuckery when it comes to getting treatment... It seems to be staying the same or getting worse here in the US.

Behold, my personal experience and rant at the link. I wrote this about four years ago. (!)

The US healthcare system is pretty awful, even if you *do* have a good employer and decent insurance.

Edited for clarity.

Edited at 2013-02-28 09:10 pm (UTC)
paksenarrion2 Re: You know what's scary?1st-Mar-2013 07:46 am (UTC)
It is.

I mean, I'm lucky. I've got a job that has health insurance that is mostly covered by my employer. Of course, the deductible is $1000 and my out of pocket maximum is $4000 so I also have those expenses as well.

But I also suffer from chronic migraines and the only migraine specific abortive that works without horrendous side effects is Axert. My insurance company will not pay for it. My Doctor and I have been fighting with the insurance company for four years but they keep insisting that I should be able to take Imitrex or Maxalt. Considering the side effects I suffer if I try to take those drugs, thanks but no thanks. I can't afford to buy the pills I need without the prescription. My Doc gives me as many samples as he can. I manage the rest with narcotics (which the insurance company is more than happy to pay for). They would rather see me manage the pain with that apparently. And having to hit the ER every four to six months when they get so bad I can't stand it. Way to save money asshats.

I've only got to hang on for another two years before the patent expires and a generic can be manufactured. Then hopefully they will be okay with the prescription.
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