Ignorance Goes On...

Today I attended a lunch for society ladies. Interesting stories always emerge when I tell society people about wanting to work in health policy, and this meal was no exception.

The current display of ignorance was on the reality of being uninsured. The woman I talked with didn't truly understand what it meant to be uninsured until her housekeeper had a health problem and couldn't get seen by a doctor.

She turned to me, "Did you know that if you're uninsured the hospital and doctors won't see you? Isn't that unbelievable? I had no idea! I just thought they'd see you!"

I responded, yes I knew that. Hospitals and doctors are only required to see you if you are in immediate danger of dying or giving birth. And even then they're allowed to bill you for the services you used. There are 46 million people in this country without health insurance, and that's how hard it is for them to get care.

"But we cover kids, right? Kids have insurance."

"Yes, we cover kids. Not that it does a lot of good if their parent is so sick they can't work or if they die. A healthy kid doesn't mean much without a family. So what happened to your housekeeper?"

"Oh, we got her into see [insert well known wealthy KC doc here]. He saw her no problem."

That was the real kicker -- this woman was unlucky enough to be uninsured, but lucky enough to work for some of the wealthiest people in the city, and therefore go in to see a family friend for treatment. If the housekeeper needed surgery or expensive treatment, this family wouldn't help her. Not that they should -- $70,000 is a lot to spend on your housekeeper. But the simple fact that she's employed by them is one major reason she doesn't have health care. I didn't get the impression that the housekeeper was an immigrant. Maybe she wouldn't have been able to find a job that provided insurance -- but she certainly has no chance staying where she is.

It's unbelievable that people in this country still don't realize how serious it is to be uninsured. A member of the upper echelons of Kansas City wealth was shocked, shocked that her housekeeper might not be able to go to the doctor at all. I hope she lost sleep over it.

Comments

[Jim S]

My employers are your basic conservative Republicans. In a discussion on this issue the CFO says that if someone can get into the ER then they have health care and it's OK. It really amazes me that they don't understand what that really means, that the ER will do nothing for anyone unless it's as dire as Kate posts.

[nancyirving]

By the way, if I find a lump in my breast, or blood in my stool, that is not an "emergency," by the definition of emergency that applies here.

It's not clear at what point cancer becomes an "emergency." I guess not until you're screaming with pain, can't breathe, have fallen into a coma, etc. What is clear is that you wouldn't be entitled to treatment until long after the point where treatment would have a chance of curing you. So effectively, you are sentenced to death.

[ArchTeryx]

Yep. That's what people don't seem to really understand about being uninsured. Yes, if you get hit by a bus, the ER will give you lifesaving care no matter what your insurance situation. They'll save your life at the cost of your financial future -- or bankruptcy at the least.

But if you get ANY sort of chronic disease, be it cancer or ulcerative colitis (as I have) it's a sentence to death by slow agony, unless you're lucky and persistent enough to find and get into a free care clinic. They do exist, but are extremely spotty, overwhelmed with patients, and going downhill fast in our laissez-faire society.

[C Smith]

My mom doesnt have health insurance. She had some kind of kidney stone, went to the hospital, and then got a 7,000 dollar bill in the mail. As an added bonus, she got a staph infection that they initially refused to treat, but relented when she threatened legal action.

The weight of the uninsured is hanging over our country like a building about to collapse. Eventually the pols will have to notice. Hopefully. If not, then this country isnt worth saving.

[stillonmt]

I also think that part of the problem is that many people do not understand how expensive it is to get health insurance. My dad who is in his mid 80's just cannot absorb that for two adults and two children I pay over $1000 a month. That is with a a BCBS group and since I am self employed I pay all of it.

[Scorpio]

Heck, even with insurance sometimes our vaunted "system" is a real pit. One person I know found a breast lump, and the doctors in her city told her it would be a month before they could fit her in. Fortunately she had family in the medical profession in KC which was an hour down the road, and they got her in to see a doctor the same afternoon. She was out of surgery a month before the "normal" system would have given her a first look.

Another guy I know waited to see a doctor until he had health insurance, despite vomiting blood and losing 100 lbs. He had his insurance two whole weeks before he was dead of cancer.

There's a lot wrong in this country. Insurance only helps some of it.

[Bob Burkhart]

I developed a quarter-sized tumor on my right cheek in March of this year. I am unemployed and uninsured. I went to Lahey Clinic here in Massachusetts, where surgery for skin cancer was performed within two weeks. I was asked about my insurance status before I was diagnosed.

I'm now free of cancer, without any sign of facial surgery, thanks to a skilful surgeon and her assistants.

As I wrote, I'm unemployed, hardly well connected.

For those who read blogs as I do and still are surprised at the confident passage of misinformation.

Bob Burkhart

[Kate]

Bob, no offense, but how did you pay for that surgery? Because it must have been extremely expensive.

[Lis Carey]

Lahey Clinic prides itself on not turning away patients in need of treatment. Not everyone lives in close proximity to a first-class medical facility with similar policies and similar fundraising abilities.

[Onetrue]

With all due respect Bob, just because you were seen, doesn't mean everyone is as lucky as you.

FYI, even having insurance doesn't guarantee being able to afford health care. This past March I had a bicyle accident that in addition to care for a rib injury caused me to have to root canals. I'm on the hook to the tune of $1600 even though the dental work was a direct result of my accident. At $50/month, I'll be paying on this for quite a while.

[Kevin]

You should've asked her if she provided any kind of health coverage/insurance assistance as an employer... mildly fatuous question, but it would've been nice to see her squirm

[Kent]

If you have insurance, you MAY not be able to see a doctor. But you may. It all depends ... on a lot of things.

I didn't have insurance when I got an ingrown toenail (twice), but I got in to see a doctor. It cost some money each time, but way less than even a month's worth of health insurance!

I know, I know -- this isn't a serious case. But Bob Burkhart is correct. Saying "no insurance = no see doctor" is false.

[Dick (no, not that one)]

There's no doubt one can see a Dr. without insurance if one can pay for it up front. Most primary care physicians where I live have a pay up front policy. The problems arise when there are conditions more serious than in grown toe nails. For example, if a person has a herniated disc in their back, he can pay a family practice physician $100 to examine him and be told he needs an MRI, and a referral to a nuerosurgeon.

The hospital will not perform the MRI without insurance or $3000 up front. The nuerosurgeon will not see the patient at all without insurance. The hospital, the Surgeon and the anasthesiologist will all refuse the surgery without insurance because although the condition causes extreme, unrelenting pain, it's not life threatening. The patient by this time is not working and unable to provide for basic needs, much less $50,000 in medical care.

Most people can handle the routine matters without insurance. It's the conditions which require diagnostic testing, specialists or surgery that no one can handle without insurance and can't be seen for.

[Mara]

Bob was lucky. We shouldn't have to depend on luck in a country as wealthy as ours. We need single payer health insurance where everyone is covered. It's not as if what we have now is anything to boast about: we spend 14.2% of our GDP on healthcare, have higher mortality at birth than most other European countries, shorter life span, and still have 46 million people who don't have access to the systm. That's just nuts.

[Cal Gal]

If Congress won't go for single-payer, why don't they just let all of us into the federal employees health system (the one they're in) if we're willing to pay for it?

[Mara]

Cal Gal,
Good idea. Is it gonna happen anytime soon? Don't think so. We've got the best guvmint money can buy.

[J Bean]

My aunt is crazy. She is also a Republican and feels that Medicare is "socialized medicine". So even though she is over 70 she pays cash for all of her care including a partial colectomy for Duke's B colon CA. Fortunately she is also a trophy widow (she was a trophy wife, but the old guy died) and can do stuff like that. She'd be surprised to find out that she can't get medical care because she doesn't have insurance.

I used to pay cash for my Pap smears because I didn't want the guys that I worked with putting their fingers down there. Gross, but my employer only provided HMO insurance so I would walk across the street to another OB and pay cash. They never refused to schedule me; when they asked for my insurance I just told them I was paying cash. Perhaps things are different in California? I used to pay for my non-plan dentist when I was an engineer too. It was cheaper than getting the dental insurance that would cover my dentist. Again, no problem paying cash.

[Kate]

J Bean,

I'm glad you and your aunt can pay cash for your health care. Most people are uninsured because they can't afford insurance, let alone colectomies.

This woman couldn't get seen because she didn't have enough cash upfront to pay for the vist. The problem with being uninsured is much different if you have money. Although if you get in a bad accident, few people have the cash lying around to cover that kind of treatment.

[Eclectic]

Always nice to see people prove the poster's point. Here comes the relatively affluent claiming that since they can pay cash for health care they are let in the doctor and somehow this disproves the poster's point. How sad. So many people, including a couple commenters here, have no idea what it is to be part of the rest of the country, without cash on hand for surgery (!) or medical insurance. Sometimes I hope these folks end up in a world of hurt just so they can wake up and feel empathy for once in their lives, even if it is only empathy for themselves.

[Mara]

And yet, it's these folks with money who don't want universal coverage for those who can't afford to pay for treatment. That's compassionate conservatism for ya'!

The sign of a civilized country is not how they care for the healthy and wealthy. It's how they care for the sick and the poor. We rank with the likes of Burundi and Tasmania (actually, Tasmania probably has better health coverage than we do as it is probably on the same plan as Australia).

[nancyirving]

J Bean, you didn't answer my question: would you let them run a tab?

[hmmmm]

here's to your universal health care, via wsj (i know, satan):

London's Daily Telegraph reminds us why the idea of government-controlled health care is a terrifying one:

People who are grossly overweight, who smoke heavily or drink excessively could be denied surgery or drugs following a decision by a Government agency yesterday.

The National Institute for Health and Clinical Excellence (Nice) which advises on the clinical and cost effectiveness of treatments for the NHS, said that in some cases the "self-inflicted" nature of an illness should be taken into account.

If you aren't scared by the idea of Hillary Clinton or Mike Bloomberg deeming you unworthy of medical care because of your bad habits, imagine how the "religious right" would treat AIDS patients if they gained power under such a regime.

[nancyirving]

Bob, you are lucky to live in Massachusetts which, as the Publicans keep telling us, is a socialist state. Not to mention one of our wealthiest states, and bursting at the seams with medical facilities funded by rich philanthropists. Most of them Deocrats, by the way. My advice to you is, don't move until you get insurance coverage. Boston is the medical capital of the world; you don't want to know what it's like out in the hinterlands.

[Nancy Irving]

The point being, Americans shouldn't have to be lucky to get medical care.

[Can't Get Insurance]

It's astonishing to read posts by people with some money who say that not having insurance is no problem. What the hell is wrong with you people? You think having the money to pay for a freakin' hang nail is the same as having the money for heart surgery? I don't know if these people are stupid or deliberately ignoring reality. Or perhaps they have a psychosis arising from a significant disconnect from reality.

I don't have insurance and can't get it. I have the money to pay for it, but no one will sell it to me. I seem to have a mild, benign neurological condition -- it's not been diagnosed, a doctor just suggested that I have it -- and can't get insurance as a result. Carriers refuse to cover my daughter because we took her to the doctor when she complained of painful periods. She had some tests done and they all came back negative. The OB-Gyn said that she was fine, just having painful periods. Too bad . . . no coverage for her. My wife was injured at work almost two years ago, so she's on workers' comp -- we can't get her any other health insurance. Our son (19 years old) is the only person in our immediate family who can get coverage. Just as he got coverage at work -- he got laid off.

Since I make a pretty good living, we've been able to pay for some fairly expensive experiences -- such as our daughter's tests -- ourselves. But, that's just because we're lucky. I feel like I'm walking a financial tight rope. The first significant gust of wind will blow us into the abyss. We'll loose everything.

And for you dumbnuts who think it's just grand to pay for hospitalization yourself, instead of having an insurance company pay -- here's a fact I haven't seen in these comments yet: Hospitals routinely charge uninsured people 5-10 times as much as insurance companies. I'm not kidding, it's true. So that woman who paid for serious surgery herself -- she probably got royally screwed.

Oh, and you guy who thinks you got off so well with getting surgery without paying for it up front. If the hospital, and doctors, who performed those services for you are anything like the vast, vast majority of medical providers in the country, they will hound you for the rest of your life for the money. They'll charge you ten times more than they would have charged an insurance company, they'll charge you interest and collection costs. They'll sue you, get a judgment and take your wages when you're working again. And don't think about going bankrupt, that safety valve is largely gone. Man, I hope for your sake, that medical provider is the one in the country that will actually just give you such services.

The health care system in our country is broken. People are dying and suffering so that others can earn obscene profits. Enough already. We need universal health care.

[Kate]

Can't get insurance -- What an impassioned response -- and exactly why our health care is so messed up. I pray nothing happens to your family. We can always raise a measly grand or two with a blog fundraiser!

Thank you so much for posting it.

[JM]

I don't have health insurance and have not had any for 25 years. Have paid dearly when I needed to go to hospital, even for routine tests. I try to stay healthy and in an emergency could sell my house.

Shopping for health insurance when you are not insured and not covered under a pre-negotiated system of charge rates is a nightmare. As an uninsured you can't get a price quote. Just try phoning around your county and asking the hospitals how much a basic bone scan costs? You won't be able to get a quote, even if you have the exact description of the scan needed and a prescription to back it up.

When you do use health services they think it fine to charge the un-insured 3 times the going rate. They say this is to make up for the people who don’t pay their bills. It's not, it's opportunistic price gouging.

You said "Yes, we cover kids, thank God." No we don't. Not unless they are in a poverty program. There are a lot of hard working, working class families, who, because they work hard and earn some income do not qualify for benefits, but have no health insurance. And if they don't qualify for benefits then their kids don't too. That's because support programs look at the family as one economic unit.

I have a friend who gets up at 5am to clean out horse stalls. Hard working and honest. He is makes too much for his kid to be covered by medicaid but not enough to get his kid to the dentist. Kid has bad teeth and probably a mouth infection. Kid cant chew, has not been able to for two years. Looked in kids mouth and all the back teeth are rotting away. Hollow, I could see through them. Probably needs a set of root canal jobs and caps. Bad way for a girl to start life, she has just turned 16.

I have another friend who works managing a coffee shop for a large retail chain. She thought she had insurance when she took her kid to the hospital. While there the kid expressed that she was depressed. When the doctor asked if the kid wanted to live or die the kid, in usual teenage fashion, said she did not care. That got her Baker-Acted (Florida - 3 days in a lock down ward under psychiatric evaluation) Mother got a bill for $14,000 from hospital and $1,500 from doctor for signing admission and discharge paperwork. Insurance said "sorry we don't cover mental health" It takes a long time to save $15,500 when your tips average about $8 a day.

It's not the very poor who are not covered, it's the working class and their children.

[Can't Get Insurance]

Thanks, Kate, for the nice words.

While speaking of raising a few grand with a blog fundraiser . . . how about Jason Looney?

While in Oregon last week, I visited a restaurant I like a lot. You know how restaurants will often post pictures colored by children? Well, this place has a large place on a wall for those pictures. It's always chock full of adorable art.

This time I glanced at the wall and saw something that was so disturbing . . . well, I took a couple of pictures. Take a look: http://www.orwelliantimes.com/jason_looney/jason_looney.html

The poor man is begging for $75,000 to pay for surgery and medication that he will die without.

I wonder what on earth Jason Looney did to deserve his condition. I guess he didn't have the good sense to be born to a rich, well-connected family -- a family that could promise him insurance, or the money, so that he could live.

Our health system is utterly criminal. And, oh, by the way, I'll be traveling to Costa Rica to have significant dental work done. I would cost us tens of thousand of dollars here . . . no insurance, y'know. But, I'm lucky enough to be able to afford the trip.

[Six]

I bought into COBRA when my company ceased to exist due to a merge. COBRA is good for 18 month and is very expensive after which you are on your own.

I had a little savings and a package so I though I was OK until I found another job. Unfortunately I got very ill and was unable to work. I used up the 18 months and I could not find any insurance plan that would accept me. I became sick enough to receive Disability but it took a while to be approved. I used up all my savings for the rent and food and living expensive and minimal medical care.

You are most definitely charged more for medical care when you pay cash because you are not in a position to bargain like the insurance companies. You don't think as well when your sick so it's harder to figure out what to do. Some of my doctors felt sorry for me and charged me less or nothing at all. Some waited for the money. But I could not afford tests or anything involving a hospital. I could not afford take all my meds. I got much sicker and was not diagnosed correctly until I got insurance under S.S. Disability.

I am much poorer now and probably worse physically because I was unable receive proper care in timely manner.

Unlike many people I did save for my retirement. That is now shot to hell. Even with insurance it cost lot to be sick.

We should put everyone on Medicare. Medicare does have competition. You have a choice of a basic government plan or several private plans at different prices. And you could buy supplemental insurance if needed. Offer at least minimum coverage all the time to everyone. Employers could offer retirement medical insurance though Medicare or a person could buy it individually. The is always Medicaid for the poor.

What we have now is totally ridiculous.

[Nancy Irving]

That hospitals may charge the uninsured patient several times what they charge the insurance companies is quite true; but this is the fault of the system, rather than hospitals' greed.

The way it works is, in order to treat patients covered by a given insurer, the hospital must negotiate a "discount" with the insurer. The discount is based on the "retail price" for a treatment, procedure etc.

Depending on the results of the negotiation, the insurer may be given a discount off the retail price of thirty, fifty, seventy or whatever percent. All insurers negotiate these discounts.

The catch is, the "retail price" can't just be a made-up figure. *Someone* has to pay it. And since all the insurers get discounts, only those without the clout to negotiate discounts--i.e., the uninsured-- pay "retail."

My understanding of the contracts between hospitals and insurers is that they *must* charge the "retail customer" the retail rate, or break their contract with the insurers. The hospitals know how horribly unfair it is, but there is nothing they can do about it.

It's not the hospitals, it's the whole #$%^&*@! system that's screwy.

[Can't Get Insurance]

Nancy,

You may be correct about how insurance companies and hospitals work their agreements. I, personally, don't know.

But, it seems to me that's a cop out by these huge companies. I'm aware of no laws -- and I am a lawyer -- which dictate the perverse contract model you described. These companies can negotiate any deal they want. They chose this model; they can choose another.

For instance, why negotiate for procedure "x" to 20% of "retail"? Why not simply price "x" at "y" dollars? The present system also gives the insurance companies a way to argue that they're slashing medical costs. "See, we only pay 20% of retail prices!" The fact that "retail" prices are entirely absurd -- because they're 5 times the real price -- is utterly irrelevant to these companies, because they're divvying up billions of dollars between themselves. And the fact that the little uninsured person dies or only suffers and has his/her family's financial lives destroyed matters not at all. That these prices utterly screw the little guy is an overflow benefit.

This is about greed. Deadly greed.

[Jim Caserta]

You don't know another man's situation until you've walked a mile in his shoes - loose quote from To Kill a Mockingbird. I walked a couple miles in uninsured shoes after I quit my first job and went back to grad school. I had great insurance working for Motorola - $20/month + low copays. I looked into COBRA, but it was a littlel pricey for a $15k/yr grad student income. Blue-Cross said they could insure me, but I'd have a rider on my "pre-existing condition" - asthma, which is the only reason I was seeking insurance in the first place.

So I'm without insurance and in a meeting for a student rock-climbing trip. The trip leaders ask who doesn't have insurance, and I was the only person who raised my hand. I was 24, had a patent and a couple journal articles to my name, and these 18 year old freshman were looking at me like I was homeless. Like, "who doesn't have health insurance?" That look summed up to me how our society looks at the uninsured. I was lucky and got a student insurance policy, but that look opened my eyes.

[Dawn]

I DO work for a big health insurance company, and see this from all sides. Like all the employees here, we pay part of our insurance costs and it's not cheap for us, either. But, in the areas I work, I have seen a lot of the reasons costs are so high--health fraud, abuse of the system, reckless use of the system. Yes, the CEO's of the company get paid ridiculous amounts (show me the CEO of ANY large company that doesn't)and that contributes to the costs. But, statistically, 70+ % of each dollar paid to health insurance goes right back out to hospitals, providers, and members. Contracts are negociated with participating doctors and hospitals. Nonparticipating places can bill the members for anything they want over and above what the insurance company pays. Greedy ones will charge huge amounts. Fair ones will charge reasonable amounts (and no,I am not saying negociated payments are reasonable...many of them are way too small for the service provided, but making them too high will increase healthcare costs above anyone's level to pay.) In "A Surgeon's World" by Dr William Nolan, back in the '60-70's, he discusses taking care of members with no insurance and the costs back then. Insurance is a help, not a cureall. Health care needs help. Maybe a national health plan like Canada's or Great Britain's isn't the answer, but we need to do something. Family example: my grandfather, 96 years old, developed a severe cardiac problem. A physician himself, he didn't want to be treated "just to live a few more months in a nursing home." When he went into a coma, the doctors pushed my grandmother into signing a consent for surgery that would "cure" his problem...they basically threatened her that she would be murdering him if she didn't sign the consent. They did not give her any time to consult with the family by stressing the "urgency" of the problem. Terrified, she did. He died a week later, from the surgery and pain. The hospital and physician billed Medicare for this unwanted and unnecessary surgery and got paid for it. That money (nearly $100,000) could have been used for needed care for several people. And one poster wants to put everyone on Medicare? Not without some boundaries, please!

[Mara]

Very informative post, Dawn. It does seem that healthcare is profit driven and that seems to be the major problem with US healthcare. Healthcare doesn't fit the capitalist model because it isn't a choice and isn't consumer driven. This is a main reason why it ought to be a single payer system. Cover everybody. Take insurance companies out of the mix, cover your costs and dollars are going to be saved.

[VegasDoc]

I have an older copy of "A Surgeon's World", by a Dr. Max Thorek, from around the turn of the century--the same laments about paying for medical care existed back then as now.
I believe the system is a house of cards, ready to fall, without any viable fix in sight. I'm not optimistic.
Its not by the way, "greedy" doctors that overcharge the uninsured. The charge is the same, by law, for an insured patient as for an uninsured patient. Its just that in the case of the insured patient, the health care provider (doctor or hospital) has signed a contract agreeing to accept a lesser amount as "paid in full" for a particular service (often the provider doesn't even know how much)in exchange for access to a particular group of patients whose bill will presumably be reliably paid by the insurer.
The insurers, however, have institutionalized a system whereby bills are automatically denied, for the most esoteric of reasons, in hopes that the provider will not have the resources to challenge the ever-increasing number of denials. The private practicioner, facing a greater loss of income for services rendered but unpaid by insurers, is less and less able to see uninsured patients "gratis" as was customary in the past.
In fact, practicioners BREAK THE LAW when they see uninsured patients for free and not charge the same as they charge insurers or medicare. We do see them for free anyway, but insurance companies put up a stink when they think someone may be getting a better deal (free care) than the deal provided to the insurers' patients. Its written in contracts that there cannot be a variance in the amount charged for similar services among patients. Its like saying, I'll charge $200.00 for tonsillectomy in a blonde haired patient, but $300.00 for a red haired patient. That's discrimination.

[Name withheld to protect the guilty]

Dawn's quote: "abuse of the system, reckless use of the system"

The insurance thing has really been the kicker in this whole system, because it has reduced the amount of attention consumers pay to cost. When I had health insurance, I sure as hell took advantage of the $15 copay for Flonase and Allegra, allergy meds that would have been $60+ cash price. When insurance covers pricy treatments for non-life threatening illnesses, costs go up and up. That's why the coming thing is going to be companies giving their employees high-deductible policies and some cash in a tax-free HSA: when people realize how much a doctor's visit costs, how much Flonase costs, they're going to be better consumers. And that will bring down costs faster than anything. Imagine how much car insurance would cost if it covered your oil changes too.

[Hilary Isacson]

I'm surprised no one has talked about cost shifting yet -- how hospitals raise charges for paying customers, insured on not, to cover the costs of those who can't pay, won't pay, or are covered by a state Medicaid program that pays less than the cost (not charges) of delivering care. In my state, Medicaid pays about 70% of cost, so the difference gets made up in higher charges to everyone else. This only adds to vicious cycle, landing on the uninsured the hardest.

[Lisa]

You know, the state of health care today is quite dismal. Most of us know this; well, at least those of us who care enough to read the paper or search the Internet for blogs, etc. I think the most underserved population when it comes to health care is not the poor--they have Medicaid or other types of state funded assistance. NO, its not the poor, it is the working-class. Those of us who make just above the poverty-line. Those of us who are making about 30,000 dollars who have over 130,000 dollars in student loan debt and other credit debt and living expenses who can't afford the health care premiums of their employer-sponsored health plans. Why isn't our country looking at these issues? I think its because it is too hard of an issue for it to tackle. This is a serious problem and needs to be addressed. I mean, doesn't preventative care make sense? If we keep our working people healthy, doesn't that mean a more productive workforce? Geez!

[gene]

Many hospitals have been given tax free status in return for treating the poor. When they refuse to treat these people, then tax exemptions have to be removed.
I pay $1400.00 per month for very good insurance. I am not in a network or does my insurance make any fee arrangements with doctors or hospitals. If I have a catastrophic event, they will charge me100% more then the average HMO/PPO patient. My insurance will pay usually 50% more then any HMO or PPO but the hospital and doctor usually want that 100% more, even though they were paid higher then usual. So the rest comes out of my pocket. So in a catastrophic event it goes like this. While an HMO or PPO would be charged $25000.00, I am charged $100,000.00, the same as the uninsured is charged. My insurance pays $50,000.00 and the doctor bills me for the remainder of $50,000.00. Because I now have to pay the $50,000 hospital bill that they would not discount, I have to stop paying my health insurance premiums and go with out insurance. In this case the hospital actually assists in my loosing my health insurance because of the excessive fees they want to charge. As a side note, I have tried to buy additional insurance but cannot find one which will pay excessive fees. The only insurance I can find are those which would only duplicate the one I have now and pay no more.

[Dawn]

Just a brief response to those who responded to me:
Vegasdoc: most physicians aren't greedy and charge insured and uninsured reasonable rates. The rates paid by insurance companies are usually, in my mind, not reasonable, but are contracted and agreed by so both sides should stay within their agreement. The "greedy" ones charge WAY above what their fellow physicians in the area charge. Those are the ones I am talking about. I see the claims--when most MD's are billing $125 for a regular office visit, GD is billing $230-300, and, since most of our GD's are nonparticipating, they can balance bill the member for the remainder of the bill. And...many do. Member complaints are how we hear about most of these physicians. We can only stress to the member that they chose to go out of network and agreed to the contract with the physician. Many out of network physicians are fair; I don't want to tar them all. Just the unfair ones.
"name witheld"--you aren't really one of the problems. The problems are: the perhaps well meaning persons who put people on their policies who legally can't be there (whether I agree or not with the law, it is that way so I have to uphold it), the members and physicians who alter their medical records so their plastic surgery is paid for as medically necessary, the doctors who, like those who terrorized my grandmother, push for unnecessary treatment.

I agree the state of healthcare in the US is dismal. I wish I knew how it could be fixed. Canada and the UK have systems with flaws but couldn't the US look at them and see how they could work a similar system and maybe avoid the mistakes the others have made? NOT saying we wouldn't make some too, but maybe....Oh, well....who knows?

[larkspur]

I don't have insurance. I've managed to obtain several very expensive prescription medications via the pharmaceutical companies' own Patient Assistance plans. One sends a three month supply directly to my prescribing doctor at no cost; another issued me a card that allows me to buy a month's supply for $15 for each medication.

I don't know what's going to happen with the Patient Assistance Plans now that this new prescription drug plan is in place. I haven't had the heart to investigate it yet.

But here's the thing: I was only able to access these plans because I know my ABCs, I have an internet connection, I have some experience with the medical system, I am persistent, and I was able to figure it all out despite my illness.

If I'd been coughing up blood, or so nauseated I couldn't stand up, or in too much pain to think straight, it'd be a whole different story. I don't have money privilege, but I have the enormous benefit of growing up in the middle class, and having some education. Without that, I probably wouldn't even have imagined that there might be some way to work the system.

I do not know why exactly, but I just now remembered that Reagan-era quote that was so cheerful about the aftermath of a nuclear war.

"Dig a hole, cover it with a couple doors and then throw three feet of dirt on top. It's the dirt that does it. If there are enough shovels to go around, everybody's going to make it."

--Thomas K. Jones, U.S. Deputy Undersecretary of Defense, Strategic and Theater nuclear Forces, on surviving a nuclear war.

It's kind of like saying that the way to survive being uninsured is really simple: first, make sure you have lots of money. If everybody has lots of money, everybody's gonna make it.

[THAMALIPXU]

I see many of your readers are interesting about medications and medicines, so now I going to touch that theme
information about medicines:
Why is Flonase prescribed?
Flonase nasal spray is a remedy for the stuffy, runny, itchy nose that plagues many allergy-sufferers. It can be used either for seasonal attacks of hay fever or for year-round allergic conditions. Flonase is a steroid medication. It works by relieving inflammation within the nasal passages.
The Flovent, Flovent Rotadisk, and Flovent Diskus oral inhalers are used to prevent flare-ups of asthma. (They will not, however, relieve an acute attack.) They sometimes serve as a replacement for the steroid tablets that many people take to control asthma.
Most important fact about Flonase
Flonase is not an instant cure. It may take a few days for the medication to start working; and you need to keep taking it regularly in order to maintain its benefits. While you are waiting for Flonase to take effect, neither increase the dose nor stop taking the medication.
How should you take Flonase?
Flonase is taken in the nostrils. For best effect, take the prescribed doses at regular intervals. First, blow your nose. Then shake the spray bottle gently, prime the pump 6 times if it hasn't been used during the past week, tilt your head back, press one nostril closed, and insert the tip of the bottle a short way into the other nostril. Spray once, pull the tip of the bottle away from your nose, and inhale deeply through the treated nostril. Repeat with the other nostril. Avoid spraying in eyes.
Flovent inhalation aerosol is taken orally. Shake the canister before each use. Take a deep breath and exhale. Then, as you begin to inhale, put your lips around the mouthpiece and depress the canister. Rinse your mouth with water after each use of the inhaler. Avoid spraying the contents in your eyes.
Flovent Rotadisk inhalation powder is also taken orally. Assemble the Rotadisk Diskhaler according to package instructions. To use, exhale, then place the Diskhaler mouthpiece between your teeth (without biting down) and close your lips firmly around it. (Be careful to avoid covering the small air holes on either side of the mouthpiece.) Breathe in through your mouth as deeply as you can, then hold your breath while you remove the Diskhaler. Continue to hold your breath as long as you comfortably can, up to a maximum of 10 seconds.
Flovent Diskus is a disposable oral inhaler that contains 60 inhalations. It must be kept dry. Do not wash it or attempt to take it apart. Always activate the inhaler in a level, horizontal position. Do not exhale into it. Do not use a spacer.
--If you miss a dose...
Take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Do not take 2 doses at once.
--Storage instructions...
Flonase may be stored at room temperature or in the refrigerator.
Flovent inhalation aerosol may be stored at room temperature away from sunlight, or in the refrigerator.
Flovent Rotadisk inhalation powder should be stored at room temperature in a dry place. Use the Rotadisk blisters within 2 months after opening the foil overwrap or before the expiration date, whichever comes first. Do not puncture the blisters until you are ready to use them in the Diskhaler.
The Flovent Diskus disposable inhaler should be stored at room temperature in a dry place, away from direct heat or sunlight. Once removed from its foil pouch, the device should be discarded after 2 months if not used up (after 6 weeks for the 50-microgram inhaler).

Another medications are
Alprazolam is used to treat anxiety and panic disorders attacks, Anxiety disorders are characterized by unrealistic worry and apprehension, causing symptoms of restlessness, aches, trembling, shortness of breath, smothering sensation, palpitations, sweating, cold clammy hands, lightheadedness, flushing, exaggerated startle responses, problems concentrating, and insomnia. Panic attacks occur either unexpectedly or in certain situations (i.e. driving), and can require higher dosages of alprazolam.
Norco is prescribed for moderate to moderately severe pain. This is available in tablet, capsule, and liquid form and is taken every 4-6 hours by mouth.
The Lortab is prescribed for moderate to moderately severe pain. Hydrocodone binds to the pain receptors in the brain so that the sensation of pain is reduced. care must be taken to follow the doctor's instructions when taking Lortab.
Tylenol #3
Codeine is a prescription strength narcotic pain reliever and Tylenol is a
very effective over-the-counter medicine. .
If you want more information you can go to www.crdrx.com , 10/325 at www.10-325.com , Vicoprofen, www.1vicoprofen.com and Lortab, www.1lortab.com.
Thanks

[Pharm87]

Very nice site!
http://c.1asphost.com/topfarm7/232.html

[Pharm87]

Very nice site!