« Tragedy | Main | Health Affairs Blogging »

December 08, 2005



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.


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.


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


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.


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!


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.


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.


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!


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.


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?


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.


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.


Very nice site!


Very nice site!

The comments to this entry are closed.

Site meter