Everyone likes to complain that healthcare costs too much, and then complains about the “healthcare system” as if it is some sort of unified national entity that is controlled from the top. It isn’t. What we call healthcare in this country is a marketplace made up of hundreds of thousands of companies, each reacting on an individual basis to market conditions.
The largest of these changing conditions is CMS, the Centers for Medicare and Medicaid Services. They set the conditions under which they will pay for medical services. For example, if a person comes into the hospital with signs of sepsis, that person must receive a blood test for lactic acid levels. If that level is greater than two, the person must be tested again within 6 hours, or the hospital doesn’t get paid. This is repeated all over the entire field of payments from CMS. They regulate everything.
They tell hospitals what procedures must be done, how they will be done, and what each provider can charge for all of those procedures and tests. They also dictate that CMS has to be charged the same amount as every other patient. With CMS directly controlling 32% of all healthcare spending in the US, and indirectly controlling another 40% of medical spending by dictating policies to insurance companies, they are the 800 pound gorilla in the room.
If a provider doesn’t play ball, they don’t get paid, and can be added to the national list of “CMS doesn’t let this person be involved in medical payments” blacklist that effectively ruins your career by making sure that 72% of patients can’t use insurance, Medicare, or Medicaid to pay for your services. No one will hire you. It’s even a question on hospital job applications- “Are you on the CMS naughty list?”
So the market responds to that by doing what they are told to do by the Feds.
Then there are the patients themselves. I can’t tell you the number of times that a patient comes into the hospital every day with COPD but is still smoking. There are the diabetics who come in complaining of numbness in their feet, blurry vision, and stomach pain with a blood glucose level over 500 and an A1C of 12, but will lie and tell you that they are watching their diet and taking their medication. There are the drug addicts who come in twice a week because they overdosed, and the drug seekers who come in nearly every day looking for a pain med fix. (We have one woman who has already been in the ED 14 times this month, and it’s only 17 days into December.) The person having a stroke who has a history of high blood pressure, but doesn’t take their medication. Yes, each of these were patients I saw during the last week, and each of them blamed doctors for not fixing their problems in an hour or less, even though their problems were entirely self created.
There is an endless parade of patients who come in with cannabinoid hyperemesis syndrome who won’t stop smoking weed, or STIs because they won’t stop mating with every person who will take their clothes off, Mental health patients, homeless who want free sandwiches, and illegal immigrants who use us as their primary care.
All of these people get seen under a law called EMTALA, which mandates that hospitals have them evaluated whether or not they can pay. Once they are evaluated, those CMS rules we talked about earlier dictate that they have to be treated. Then the entire thing gets paid for by your taxes.
Then after all of that, people then sue the practitioners, workers, hospitals, and drug makers who followed all of those rules and win millions of dollars in payouts.
The problem isn’t healthcare- we as a nation have the best healthcare in the world. What is screwing things up is market manipulation by the government. Imagine for a moment that the Feds were doing the same with the “restaurant system.” That is, 72% of all food was paid for by the government, who set standards on what everyone could eat, how much they could eat, how that food must be prepared, and under what conditions grocery stores and restaurants would be paid. Then they also dictated that anyone who went to a restaurant that had a drive through would have to be served whether or not they could pay for it, but then reimbursed the restaurant for the meal cost. All of this regulated to the point that there are hundreds of thousands of rules, each of which must be followed to the letter. What would a restaurant look like, and how much would a meal cost?
I don’t think most people have a problem with the care they are getting, and those who do frequently misunderstand why they got what care they did get. Most people are upset at the cost, and that cost is directly related to the government distorting the market, and the market’s entirely rational response to that manipulation.
What makes me laugh the most is that everyone then blames the doctors and other facilities, then demands that the government step in to fix the problems that the government created. That’s true whether you want more regulation, single payer, or some other government intervention.
32 Comments
JimmyPx · December 18, 2024 at 10:04 am
“When someone else is FORCED to provide a good or service then that is an entitlement NOT a RIGHT”.
Ergo when people crow about “the right to healthcare” or “the right to free housing”.
It is not a right like the right to free speech that doesn’t force anyone else to do or provide anything. No, people want stuff and they want it FREE.
Ok, so who pays for it ?
The government…well government has no money by itself it takes it from citizens by force if necessary.
Well then “the rich” should pay for it….the “rich” don’t have it and the uber wealthy have their money locked up in corporations and trusts and the poor are poor … so YOU Mr Middle Class are going to pay for it.
Also, everything is effected by supply and demand. When the cost is FREE, there is almost unlimited demand. See the welfare people who pay nothing who call an ambulance as a taxi to the hospital to treat their sniffle. Why…it’s FREE to them.
As EVERY single payer system has had to do, they HAVE to ration care to cut the demand down and to be able to function.
In the US today Insurance Companies are “the bad guys” who deny what they deem unnecessary procedures or treatments. Now they are profit motivated but look at people’s reactions when that United CEO was murdered…people CHEERED. Why ? Because United and other insurance companies are the gate keepers and gate keepers are hated when they say no.
Get single payer and see people go off on their government. Watch Prime Ministers answering questions in Parliament and there are ALWAYS questions about health care.
This country desperately NEEDS a national conversation about how we fund health care but people HAVE to be realistic and most are not.
Divemedic · December 18, 2024 at 10:12 am
And they never will be reasonable. See discussion about cutting Social Security as an example
TJ · December 18, 2024 at 10:07 am
That was our experience of a communist system – Uzbekistan, 91-94. Every little thing is surrounded with a raft of regulations. The thing you did with restaurants can be done with shoes, and cars and almost anything else. A ‘compassionate’ female whines about how unfair the current system is and then the government comes in and ‘fixes’ it. Resentment drives it. Evil.
Tom from East Tennessee · December 18, 2024 at 11:14 am
I’ve worked in healthcare for the past 25+ years as a radiation therapy physicist (treating cancer with radiation), after doing 8 years in the Navy as a submarine nuc guy. It hasn’t been what I expected, but for me personally I’m grateful for the opportunity to move into this field instead of nuclear power plant maintenance or operations which is where I’d originally been headed. I generally work with smart people (but not overall as smart as the guys I worked with in the Navy nuc program), the technical parts of the work are challenging and satisfying, and there’s also satisfaction with assisting in a difficult task helping very ill people.
From my start until now (>25 years) though, the .gov over-regulation and interference has been something to behold. Someone in this thread or the companion thread seemed startled that there was an entire college class in medical coding, duuuude it’s way bigger than that.
I am respectfully wary of all that admin stuff, I recognize that Bad Things like loss of license and livlihood, and even possible prison time await those who go afoul of the regulations and so I do my part in our organization to keep us between the lines. Working in a heavily regulated field is challenging especially if you come from an engineering or technical bent and are wanting to go around making things better: there are scads of hidden reasons why “this is how we do it” and if you innovate in the wrong way, we won’t be allowed to collect fees and pay our bills & payroll. If you break some of the regulations, you’re not just breaking rules but you’re even possibly committing Medicare fraud.
An example for instance. This blew my mind years ago when it first came up but it’s a pretty routine thing: we have various technical levels of complexity in the radiation treatments we can design and deliver. For many clinical situations, the problem isn’t putting X amount of radiation dose into the disease, it’s putting that dose X in while putting less than Y amount of dose into nearby normal tissues that can’t tolerate X amount of dose needed to sterilize the disease. We can often design a complicated plan (called IMRT or intensity modulated radiotherapy) to do that, but you know what not everyone can afford that maybe they can only afford the simple treatment that’s going to treat the disease but will also permanently damage part of their body (maybe something that’s really important too, like your spinal cord or both kidneys or part of your bowel). “No sweat” you say, “why don’t we just give this needy patient the complicated advanced treatment they need, but just charge them for the simple treatment which is all they can afford?” Well, here’s the thing, if you do that, you just committed Medicare fraud, by selling someone a service for less $ than Medicare pays for it. And that’s just a common example of why things get complicated. Imagine trying to do your own federal tax return with some complicated thing going on every week. Committing medicare fraud puts you on that naughty list and may well put you in federal prison too. What was it Ayn Rand said about how you’re doomed when, in order to produce something, you have to get permission from people who don’t produce anything themselves?
I think of the healthcare “system” as more like a free range experiment, with a bunch of businesses and providers scrambling around “optimizing” their intake of the federal $$ falling from the sky. When they get a chance, they invest some $ in lobbyists and industry consultants and come up with ways to get more of the $$ falling from the sky, sometimes by hobbling a competitor and sometimes by getting a special favor. There has been some very expensive and very impressive innovation in the last 20-30 years, but unfortunately too much of it imo has been driven by innovating some tech piece to capture more of that fed revenue manna from the sky than it is trying to do things better.
There is some incentive for improvement, but many of the incentives are perverse. The incentive to give better care for less $ I think is best met by a free marketplace, but we’re not anywhere near that. So long as healthcare is considered as some sort of right like it has been for the past 60+ years, whoever provides the most $$ gets the most say and that’s I think mostly fedgov and maybe to a lesser extent the insurance companies. My elderly dad still gets angry when he has to wait beyond his appointment time to see his Dr or whichever medical provider, he’ll shake his fist kind of and sputter about how when he owned his business how his business would fail if he treated his customers that way and made them wait. “Dad, dad, you’re not the customer, your insurance company is, and they’re paying more for this visit than you are” I think we would be better off with fee for service, and some provisions for insurance for those responsible enough to buy it. But boy, you insert the .gov into it and let them start regulating it (and also have the .gov stipulate that everyone gets the service but they don’t have to pay) and you get this. DiveMedic, that restaurant analogy was spot-on, in a nutshell that gov regulation is what has to change for things to get better.
TRX · December 18, 2024 at 11:46 am
“Sure, we caused the problem, but if you let us regulate it even harder, we’ll… actually, we’ll make the problem even worse, but nobody pays any attention to the men behind the curtain.”
Silverfox · December 18, 2024 at 12:05 pm
“as if it is some sort of unified national entity that is controlled from the top”.
Sorry bub, it is: Look how the medical community responded to the government created Covid Scamdemic. Every one desiring now knows. And all for, what was it? 35k a head admitted; using a defective PCR test? And there were a number of professionals at my care center that left for other practice’; Some being forced out by retribution.
Anyway, from the total lack of interest in the, “suddenly died” phenomenon, to the documented deaths and disabilities associated with the so called Vaccine, it’s like: Mums the word. Suppression of low cost treatments; Vilification of medical professionals raising concerns associated with treatment methods?
There are some in the medical community that didn’t compromise, so, I’m not pointing at you, as I don’t know what your position was-is.
Silverfox.
Divemedic · December 19, 2024 at 7:35 am
No, it isn’t. COVID was an actual thing. I was there and held the hands of people dying, I saw it with my own eyes, albeit late in the game. I was still a teacher during the worst of it in 2020, but I saw enough of COVID in 2021 to tell you that it was a real illness that killed thousands.
With that being said, the government was paying hospitals extra to treat it, so of course, hospitals treated a lot of them. That isn’t control, it’s an example of more market manipulation. Going back to the restaurant analogy, if the government said they would pay a restaurant a $100 bonus for every fish sandwich sold, Ruth’s Chris would be selling nothing but fish sandwiches the next day.
That’s what made the numbers look so bad. It wasn’t enough that it was a deadly illness, to be really effective in scaring people into allowing the election to be stolen, it couldn’t just be something that killed the nice old man down the street, it has to be an illness that personally threatens the people in your house.
As to your other points about COVID vaccines: Who keeps statistics on deaths? (Hint- it’s the government). Who determines what treatments are permitted? The government.
Look, I don’t think that Ivermectin works on COVID. That doesn’t mean that doctors and patients should have been prevented from trying it. I also will freely tell you that COVID was a difficult illness to treat until it morphed into the less deadly strain that it has become. It was unlike any illness that we have yet seen, and it took some time to figure out effective treatments. That doesn’t make healthcare in this country some monolithic, top down arm of the government.
Just this week, I had a patient with breathing difficulties from long COVID. I have a fellow nurse who hasn’t been able to work since 2020 as a result of COVID lung damage. She can’t sleep in her upstairs bedroom because climbing stairs is too taxing. She’s in her 40s.
It’s OK to hate your government. It’s OK to believe that there are enough evil people in it to make it an evil institution, but you can’t let it turn you into a slobbering moron who will believe every conspiracy rumor that you hear.
TakeAHardLook · December 18, 2024 at 12:14 pm
The attached essay addresses the “Healthcare Is A Right” mantra that passes for critical thought here in FUSA.
Picture a small town in East Podunk, IN (pop.2820) where the only doctor is a 70 year old GP.
Throw in 500 newly-arrived Haitians for effect.
Does anyone besides the FedGov and the Leftards of the Demo-Communist party believe that the GP must be available 24/7/366 for the health needs of those people? And, regardless of possible payment? Time off? Personal days? Family illness?
Healthcare is a Commodity. Period. Yet, as CMS attempts (at massive cost) to quantify diagnoses/treatments down to the last cent, it is evident to we MDs in the U.S. that the system as currently managed will fail utterly.
Like asteroid hits, it’s only a matter of time.
https://ari.aynrand.org/issues/government-and-business/individual-rights/health-care-is-not-a-right/
Bad Dancer · December 18, 2024 at 12:16 pm
I used to think that these things started by people throwing up their hands and pushing the problem on others. Like parents who blame the schools for why their little angel did X or Y or doesn’t know how to do Z. It may have been, probably was, but now that the rock is rolling and has all this momentum behind it I don’t know what can be done about it. Anything I can think of is small scale and on a personal level. That personal responsibility thing you like to talk about that I remember being a thing early in my life but now?
The resturaunt analogy is a good one thank you, gonna be passing that on to folks.
An aside, good LORD! CHS! Everyone seems to be willing to agree that heavy drinking can cause certain problems with the body and mind. The wallet too. But the second you switch from booze to the Satan’s Lettuce all bets are off! The fact someone throws up everything in their system down to that nickle they swallowed in the first grade after smoking can’t be all all releated nooooooo. I have full time and student workers who will miss enough days that there is grounds to terminate them but because HR Lady is a bleeding heart and a fan of jazz cigarretes herself she’s granted them FMLA, medical exemptions, and everything else you can think of to where they can keep toking up and throwing their lungs up and never be called to account for how its affecting the unit.
Aesop · December 18, 2024 at 12:50 pm
EMTALA in any other context: Imagine the government dictated that anyone who said they were hungry, regardless of ability to pay, had the “right” to a Big Mac meal at McDonald’s, which the government would not pay for in any way whatsoever.
1) What would the new price of a Big Mac meal be tomorrow?
2) How long before McDonald’s said “F**k it!” and quit the restaurant business, or was simply forced into bankruptcy, because they’re not a charity?
Every hospital you’ve ever been to with an emergency department, is the McDonald’s in this equation.
The main problem with health care is that users don’t pay cash for services.
Insurance, and particularly government payment, should be banned, and cash payments for treatment should be mandatory for everyone from cradle to grave.
Do that, and you’d solve 99% of the so-called “problems” with what you are and aren’t getting under the current bastardized socialist system.
Do that
Grumpy51 · December 19, 2024 at 5:51 pm
late 80’s, NW LA, Level I Trauma Canter. My recommendation was to charge everyone “just $5” and 80% would stop. And if it was true emergency, we’d give your $5 back……. no-go, fell on deaf ears. The system is broke because NO ONE (in power) WANTS TO FIX IT…..
Birdog357 · December 18, 2024 at 1:35 pm
I coulda used this post a week ago when I was arguing with a dumbass….
WallPhone · December 18, 2024 at 2:12 pm
In addition, the government dictates how many tables must be in the restaurant.
If you want to bring a competing restaurant to an area, the government first looks at the number of tables already there and the area population and rejects your endeavor because the lousy companies already in place said they’ll expand.
KB · December 18, 2024 at 2:48 pm
So happy to be OUT OF NURSING and retired. Good luck and good health to you.
lynn · December 18, 2024 at 3:56 pm
As a person going under the tender care of CMS in a couple of months, I like that they do have standards. Some of these GPs out there are off the reservation otherwise.
Rick T · December 18, 2024 at 5:58 pm
All of the Fed interference with the medical market BEGAN with medical insurance becoming a deductible business expense in WWII to evade the wage controls in place. Until that is reversed the Customer will continue to be the business paying the premiums and the patient will stay the Product.
Milton · December 19, 2024 at 9:00 am
Once we recognize that healthcare providers are navigating the ever changing rules of the fedgov, and are not the bad guys, and desire to get to a place where the doctor/nurse/office staff gets paid in cash, it would seem that the only way to get there is secession.
Money is not the root of all evil, the over-reaching fedgov IS.
The way to end the manipulation of the costs to get medical treatment, is to end the manipulator’s power over medical service providers.
Move the manipulation to the 52 state governments.
Milton
And FJB and Trudeau
Divemedic · December 19, 2024 at 9:34 am
52?
chiefjaybob · December 19, 2024 at 10:31 pm
Forget it, he’s rolling.
Divemedic · December 19, 2024 at 11:34 pm
“Ooh, we’re afraid to go with you Bluto, we might get in trouble.”
milton · December 20, 2024 at 7:43 am
Yeah, fittytwo. After the liberal and conservative states of Can-a-duh achieve statehood.
Dan D. · December 19, 2024 at 7:31 pm
This is a funny story with a salient point: almost 25 years ago I was at the dentist, he examined a mole on my cheek and because he was an excellent doctor he asked if I’d performed a recent testicular self exam. “Uh, no?” “Yeah, well, get after it.” (my paraphrase)
The next morning in the shower I felt a lump so I made an appointment with my primary care physician. She palpated me and said “I don’t feel anything unusual.” Since I am, by nature a smartass, I said “Well I’m a machinist and used to testing surface textures. Maybe you haven’t fondled enough balls in your lifetime?” At least that is how I remember the exchange went – I could be embellishing.
Next day I am having an ultrasound. Positive.
Next AM I am prepped at Hoag in Newport Beach. A surgeon walks up to the guy prepped next to me and says “I’m Dr. XYZ and I’ll be replacing your heart valve today.” That struck me as notable. A few minutes later my urologist walked up and I said “Look, I don’t know what insurance is paying you but I’ll make up the difference in cash if you want.” He smiled and said it wasn’t an issue.
The point? I wanted the best care possible and was willing to pay for it. That is how things are properly exchanged in, oh, say, all of recorded human history. People are shocked at the crap they receive from Temu. DUH.
I want to learn · December 19, 2024 at 8:49 pm
I’m reading a lot of snarky comments from you & also Aesop in previous posts with regards to people turning up with through the roof blood sugars not knowing they are diabetic, issues with families ignoring symptoms with potentially catastrophic consequences such as stroke and wanting treatment for free for what you both seem to infer are consequences of self-inflicted, stupid behaviours. OK, I get it, a lot of this is just venting and good old-fashioned black humour to keep you sane under asinine working conditions. How your work place can possibly consider you fit for duty after a five hour break appears insanity to me. Surely they are wide-open for liability should you get a needlestick or provided sub-standard care due to fatigue?
No matter, here’s my ask:
1. Can you suggest a list of devices non-medical professionals can purchase and use at home to monitor our general health such as blood glucose and blood pressure so we can avoid needing your services?
2. Can you recommend a reliable source of information for general health we can access that is not in the pocket of big pharma/big ag/big medicine?
3. All care taken, but no responsibility assumed by you for these suggestions. Worth what we paid for them.
4. I cannot seem to find the owners’ manual for my body at the moment, so I hope you can forgive my blunt, naïve questions. Not trying to be dense, just wish to benefit from your vast professional experience in this essential field.
JimmyPx · December 20, 2024 at 12:30 am
I want to Learn, I’ll leave the detailed answer to the medical professionals but the easiest thing is have a primary care doctor and see them at least every 6 months. They will check your blood pressure as well as run blood scans that can tell if your sugar levels are too high, having kidney problems and if you have high cholesterol. Depending on the results they can do more tests or refer you to a specialist and prescribe medication as necessary.
The sad thing is that most of these conditions can be fairly easily controlled by a combination of medication, diet and exercise.
The thing that Dive Medic and Aesop can’t really say to the patient is if your blood sugar is sky high and you have no idea that you are a diabetic, you obviously haven’t been regularly seeing a doctor. To have sugar levels THAT high you have been a diabetic for awhile and it has done permanent damage to your body that most likely has cut down your life expectancy.
So my 2 cents, EVERYONE over 40 NEEDS to see their doctor regularly !!
Divemedic · December 20, 2024 at 6:43 am
– An annual checkup at both a doctor and a dentist goes a long way towards maintaining your health.
– It also seems to go without saying, but cleanliness is important as well. You should bathe at least once a day. With soap. I have noted that the people who are sickly don’t seem to understand what soap is used for and seem to have no idea that bathing or brushing their teeth is a thing. I have a fairly sensitive sense of smell, and people who frequent the ED usually smell like a rhinoceros’ ass.
– Don’t do stupid things like rub your genitals against anyone who smiles at you. People are germ factories. A vagina is like a spiderweb: the longer its out there, the more likely you are to catch something.
– Don’t use recreational pharmaceuticals.
Grumpy51 · December 20, 2024 at 9:52 am
Look up “functionhealth.com”
Caveat – shameless plug inbound and I don’t make a dime
I’ve been in healthcare/medicine since 1981 and am reasonably intelligent and well-versed. HOWEVER, I did NOT know about some of the tests being offered above. It’s $500 annually for surveillance testing only but the very first lab draw sessions (2) include tests that I can’t even get through myself or my internal medicine doc ordering (insurance wouldn’t pay, “no history of” so not paying).
The key to above is taking control of your own health and making decisions NOW to impact your health later. For me, my A1c was 5.8 (prediabetes, though there is NO family history of diabetes). As soon as I saw this, I radically changed my diet, lost 15#, and am awaiting the follow-up draw.
PREVENTATIVE medicine DEPENDS on the patient taking charge.
NOT like my patient last night, 62F with 80pack-year smoking history, still smoking, in acute respiratory failure with hypoxia and sepsis (besides COPD, also has multilobar pneumonia) who wants me to “fix me doc.” Ma’am, THAT ship sailed decades ago……
Wilson · December 20, 2024 at 9:59 am
If getting paid for services is your reasoning , why do hospitals bend over backward to treat illegals knowing more than likely they will have to eat the loss?
Divemedic · December 20, 2024 at 10:25 am
There are huge grants and tax breaks for treating the indigent in the ED. Our Byzantine tax code is riddled with things that businesses take advantage of. Yet another reason why it needs to go.
Aesop · December 21, 2024 at 3:12 pm
What makes you believe they do any such “bending over backwards”?
Srsly?
They don’t pay their bills, ever, and just require the hospital to look around for more funding from any source possible, like an elephant’s trunk looking for water.
Hospitals unfortunately have federal mandates requiring them to treat anyone who shows up regardless of ability to pay. This includes mamacita who jumped into a cab in TJ the second her water broke, and drove most of the way to L.A. to plop out another “anchor baby” American citizen; and the guy who has no license or ID, but was driving home drunk from his Home Depot parking lot ditch-digging job and hit a vanful of people, killing mom, and sending three of her kids to the ICU, because he ran a red light while DUI.
Those federal mandates were enacted by the Congressweasels you elected.
So the question goes right back to you:
Why did you elect them, and why do you let them get away with doing that?
Look who passed EMTALA back in the day, and then ask your current Congressweasel why they haven’t revoked it yet, and gone back to a system where every swinging Richard is responsible for their own treatment, including paying for it.
BTW, for those over 65, and those who will be, and think they deserve their Medicare:
Medicare pays 2¢ on the dollar for everything done in the hospital. IOW, if the cost of getting an appendectomy is $10,000, Medicare caps payment for that at $200.
An $80 office visit to the doctor? Medicare contributes $1.62.
Now ask me again why health care has gone up at 50x the rate of inflation, why a Tylenol on your medical bill costs $62, and why Grandpa has had to change doctors five times, because his last four stopped taking Medicare patients. Hmmmmmmm. What could it be? What could it be…??
You have elected Congressweasels who have shifted the entire price of care for senior citizens onto the backs of those under 65, who have insurance, IOW the 40% of society who works for a living, rather than voting for a living.
And then when Granny or Grandpa shows up with a body they’ve effed up ten ways to Sunday, at age 75, instead of telling you to pony up, or suck it up, they give your Grans a VISA card with no limit, and send the bills to everyone else’s kids, when you want us to do $200K of work to squeeze another two weeks of “life” on life support out of someone who you haven’t visited for 3 years, but suddenly feel guilty about when they have a massive stroke and three heart attacks, and scream “Put her on life support, and break all her ribs doing CPR 17 times when she codes in the ICU, or we’ll SUE!!!!”
You want to know why your health care sucks?
Go down to Target, to the Homewares department, and stand in front of one of those full-length mirrors.
There’s your answer.
I can count the number of families who ever say “F**k Grandma, she smoked like a chimney and drank like a fish for thirty years, and always ate three servings of cake and pie even though she’s been to the ED 6 times for diabetic emergencies with blood sugar at 900, so this is all on her. Oh, and who should we make the check out to?” and tally up those times on the thumbs on my third and fourth hands.
The quickest way to sober society up is to start handing them their bar tab every time. When the price for anything is coming out of your wallet with 100% certainty, it’s amazing how frugal and sensible you become, unless you’re rich enough to be as stupid as you want to be.
Imagine every homeless guy knew that when he broke his leg from getting falling down drunk, he was going to be ankle chained to a chain gang, once he was healed, until he’d worked off his entire bill by filling potholes and picking up trash at minimum wage, and guess why such incidents would happen, at most, once.
Plus, we’d have the best roads and cleanest streets on the planet.
Personal responsibility and non-transferable accountability cures more problems than you can imagine\, and would, if only you’d let it.
But everyone wants a “free” healthcare lunch, until they get the bill for it.
TANSTAAFL
Danny · December 20, 2024 at 12:33 pm
Divemedic – your advice on having annual checkups and seeing a dentist regularly is something I’ve been doing over the years. Oral hygiene is absolutely important and just basically taking care not to overeat, get exercise, stay well hydrated … it’s just common sense.
I also stopped smoking tobacco and pot eons ago. But I still like bourbon.
Divemedic · December 20, 2024 at 3:04 pm
Dental infections can cause heart issues
Grumpy51 · December 21, 2024 at 9:02 am
Might as well bring this in – your FIRST hospital “bill” is NOT a bill, it’s an EOB (Explanation of Benefits). It is what’s been sent to insurance. And BEFORE you freak out, you NEED to understand what DM’s telling you. Health Insurance and HealthCare are NOT the same, despite what everyone tells you.
NO ONE is denied healthcare (per se). Go to ANY Emergency Room (Department) and look at the waiting room. See anyone being denied care?? Nope, because by law (EMTALA, as broached by Aesop), you are REQUIRED to have a medical screening exam (MSE) by a HCP (healthcare professional), either MD/DO/NP/PA, to determine if there is an emergency present or not.
Now to the billing – my numbers will be a bit dated as they change MONTHLY. BlueCross/BlueSHield (BCBS) had over 2 THOUSAND various plans (that’s just BCBS, there’s also Aetna, United HealthCare, etc etc). How am I (provider) supposed to keep up with what each plan is??
Insurance pays a provider/facility contracted or “usual and customary” or billed – whichever is LOWER. So you come see me – I charge $50. IF your insurance would have paid me $75, they only pay me $50, since my billed is lower. To prevent this, and because I have ZERO clue what your insurance is paying this month, I bill $1000 – knowing that I’ll be paid between $65 and $100.
So the next time you see that $50K EOB (NOT a bill, READ the top of the paper), just know that we have to play the game in order to collect something….. Like playing a poker game and leaving money on the table, I don’t do that.
Also think of this – MCaid pays me 11%. Meaning a $75 office eval (I refuse to call it a “visit”, we ain’t friends, it’s business), I’ll make about $8. Now go to Walmart, put $75 worth of groceries in your cart and when you get to check0out, offer them $8 and tell me what happens.
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