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Ozgrade3
25th Sep 2018, 12:21
I'm in Australia and just spent a day in ER after a particularly nasty bout of influenza.

7 hrs in a hospital bed
multiple IV's
kidney ultrasound
Xray - checking for bleeds from recent surgey
Epic series of blood test, some were cultures - the equipment required a whole trolley
2 x urinalysis at pathology

How much did i pay for this out of my own pocket?
$0.00

The 3 follow up visits to my GP to look at the pathology report and fix any resulting problems
$0.00

How much would this hospital visit in the USA cost. I was estimating anywhere between 7-13,000 USD.

ZFT
25th Sep 2018, 12:40
..but someone paid on your behalf!

Ozgrade3
25th Sep 2018, 13:06
That argument is as intellectually vacuous as a foot stomp and a "you smell' retort to win an argument.

But lets play the game, how much can YOU afford. C'mon. You bit, so back up your argument.

Your car catches fire on the freeway, you call the fire brigade, do you pay them, the road that your burning car is sitting on, who paid for that. That road crossed a river on a 1000m suspension bridge (no tolls), who paid for that. The policeman who took your report, did he also issue an invoice for his services.. You now have to take the bus, who paid for the bus, who paid for the train system. You contemplate your recent excitement down at your local park, beautifully cut grass and free drinking water, who paid for that, did you help fund the Dam that brought you that water. In the distance you see an F15 climbing away in full afterburner, a magnificent sight. Who paid for that, who paid for the pilot training. For all these services and public utilities you use on a daily basis, do you even pay for the marginal cost (look it up if you don't know what it means).

if you got cancer and required 2 million dollars worth of treatment, could you afford that? What happens if you don't have the money, I guess you just die.

I have 2 step daughters with genetic heart defects, both under 25 years old. They have had way over 2 million dollars worth of medical care..........EACH. Yes I'm sure their mum who was a single parent at the time on $471 a week could have paid for that.

In Australia we pay a 1.5% Health Care Tax (called the Medicare Levy). That money goes into a single pot, and it's accounted out to medical personal as services are rendered.

I haven't even mentioned the Royal Flying Doctor Service. If you're way out in the bush. they send a Doctor in Kingair 250 or PC12 to you...for free.

ADD: How does 97 year old Aunt Maggie pay for her hip replacement, After all you assert everyone should be 100% self sufficient Aunt Maggie should be made to get a job and pay for it herself i gather.

You can't possibly justify your position in logic.

Ozgrade3
25th Sep 2018, 13:08
https://www.youtube.com/watch?v=RsJi9Vau5ic
RFDS has 27 bases.

ian16th
25th Sep 2018, 13:23
..but someone paid on your behalf!
Yep,
The hospital was built and the builders got paid.
The X-Ray equipment was installed and the suppliers got paid.
The staff get their salaries.
It all 'free'.

Ozgrade3
25th Sep 2018, 13:30
https://www.youtube.com/watch?v=D0HwJ_KoBnU

Ozgrade3
25th Sep 2018, 13:42
So, what is your model for the perfect system. You have crapped on several times about who pays, so who pays when the amount is demonstrably greater than any ordinary person can afford. If you get sick, do they take your house to pay the bill. What if you are a renter, Do they throw you in jail for stealing healthcare. It's not wonder Australians think Americans are as mad as cut snakes. It must be debilitation to know that complete financial obliteration is only 1 headache away. Insurance doesn't seem to help much either, had a friend in CA pass away last year after hi insurance ran out and he couldn't pay for his 3 times a week kidney dialysis or anti-rejection drugs. the drugs are $1000 a month. He was dead in 6 days. Problem solved, that's the way to clean out that filthy sick scum.

I wonder if anyone can address ANY of the points I raised(even one would be good, yes just one), Lest i think that the education system in the US is more propaganda than fact.

It's quite clear than they don't do a good job teaching economics in the US school system. Straight A's for propaganda though. Some of the arguments I hear from Americans defies logic.

How much would my hospital visit have cost.

anxiao
25th Sep 2018, 13:57
People who do not have such a system will bag it as "Socialism" and the end of the world as we know it. Those who live under such a care system be it in Aus, UK or Cuba, appreciate what they get and understand the inequalities.

If I keep myself fit and healthy with a good lifestyle and good genes I will never take much out of the system. If you are unfortunate and have neither of those or a bad accident you will take much. That is the social contract we enter into.

If you have lived under such a health care organisation you would understand. If not it is an alien concept. I am hoping that with my good health and contributions I will have kept the system going, so that if I did need an immediate intervention, it was there and available. It is buying insurance. The fact that it is a state scheme should only gratify you that the excess profits are not going into some private equity guys pocket, but ploughed back into the system, for all its government department inefficiencies.

Yes somebody pays. All of us. thats why it works as well as it even does.

(Experience alert. I was in SYD North Shore ICU today visiting a friend. The staff and organisation are doing a brilliant job.)

nonsense
25th Sep 2018, 14:09
I'm in Australia and just spent a day in ER after a particularly nasty bout of influenza.

7 hrs in a hospital bed
multiple IV's
kidney ultrasound
Xray - checking for bleeds from recent surgey
Epic series of blood test, some were cultures - the equipment required a whole trolley
2 x urinalysis at pathology

How much did i pay for this out of my own pocket?
$0.00

The 3 follow up visits to my GP to look at the pathology report and fix any resulting problems
$0.00

How much would this hospital visit in the USA cost. I was estimating anywhere between 7-13,000 USD.

the plural of anecdote: when the data aren't enough (http://www.pluralofanecdote.com/)

The US healthcare "system" is barbaric.

bafanguy
25th Sep 2018, 14:26
How much would this hospital visit in the USA cost. I was estimating anywhere between 7-13,000 USD.

To answer your question: also $0 here and has been for 30+ years.

https://healthcare.uslegal.com/patient-rights/the-right-to-treatment/

My daughter who has no insurance has made a few ER visits costing ~$11-13K each. She paid nothing...nor did any collection agency attempt to get money from her.

Sorry we can't be quite as evil as you'd like us to be on this count but don't give up your quest.

Ozgrade3
25th Sep 2018, 14:34
MTVNPlayer (http://media.mtvnservices.com/embed/mgid:cms:item:comedycentral.com:413584)

Some hospitals are now putting debt collectors in ER rooms.

The US model is unsustainable. It will eventually collapse. Well its has started to already, we can see it.

13K per visit, they will come after her and take her house.

bafanguy
25th Sep 2018, 14:45
Some hospitals are now putting debt collectors in ER rooms.

13K per visit, they will come after her and take her house.

Hospitals have admin staff in the ER who are there to collect insurance info from ALL who enter. If told the patient has no insurance or ability to pay cash, the discussion ends right there.

And, sorry to disappoint you, no one will come after you and take your house. You just wish they would.

chevvron
25th Sep 2018, 14:55
People who do not have such a system will bag it as "Socialism" and the end of the world as we know it. Those who live under such a care system be it in Aus, UK or Cuba, appreciate what they get and understand the inequalities.


We do appreciate it in the UK, so do all the visitors to our shores who are not entitled to free treatment but get it anyway due to the hospital managers not collecting payment.

Pontius Navigator
25th Sep 2018, 15:15
Free health care in Europe varies greatly. Many years ago, in France, on a Sunday, we visited a hospital as my daughter was in distress. A professor was called in, made a diagnosis and asked that we return on Monday for further tests. There were no charges and his diagnosis was correct and different from earlier NHS ones.

Much more recently Mrs PN was admitted to a clinic in Cyprus. We were advised to avoid the public hospital and the EH1C. The nursing care was first class and less than €400/day. Care did not extend to potable water or food, that was the responsibility of the family.

In UK the food is included. It can be argued that food is an integral part of recovery and of course in UK family support is not automatic.

ZFT
25th Sep 2018, 15:15
That argument is as intellectually vacuous as a foot stomp and a "you smell' retort to win an argument.

But lets play the game, how much can YOU afford. C'mon. You bit, so back up your argument.

Your car catches fire on the freeway, you call the fire brigade, do you pay them, the road that your burning car is sitting on, who paid for that. That road crossed a river on a 1000m suspension bridge (no tolls), who paid for that. The policeman who took your report, did he also issue an invoice for his services.. You now have to take the bus, who paid for the bus, who paid for the train system. You contemplate your recent excitement down at your local park, beautifully cut grass and free drinking water, who paid for that, did you help fund the Dam that brought you that water. In the distance you see an F15 climbing away in full afterburner, a magnificent sight. Who paid for that, who paid for the pilot training. For all these services and public utilities you use on a daily basis, do you even pay for the marginal cost (look it up if you don't know what it means).

if you got cancer and required 2 million dollars worth of treatment, could you afford that? What happens if you don't have the money, I guess you just die.

I have 2 step daughters with genetic heart defects, both under 25 years old. They have had way over 2 million dollars worth of medical care..........EACH. Yes I'm sure their mum who was a single parent at the time on $471 a week could have paid for that.

In Australia we pay a 1.5% Health Care Tax (called the Medicare Levy). That money goes into a single pot, and it's accounted out to medical personal as services are rendered.

I haven't even mentioned the Royal Flying Doctor Service. If you're way out in the bush. they send a Doctor in Kingair 250 or PC12 to you...for free.

ADD: How does 97 year old Aunt Maggie pay for her hip replacement, After all you assert everyone should be 100% self sufficient Aunt Maggie should be made to get a job and pay for it herself i gather.

You can't possibly justify your position in logic.

I do have cancer and luckily insurance to cover treatment.

Not sure where I asserted everyone should be 100% self sufficient, I just stated someone has to pay for it. Whether that is insurance, the state or oneself is immaterial. It isn't free.

lomapaseo
25th Sep 2018, 15:24
Ozgrade3

I wonder if anyone can address ANY of the points I raised(even one would be good, yes just one),

What points??, all I see are musings and a single question about cost

The responses from others seem to cover the subject quite well

obgraham
25th Sep 2018, 15:50
Ozgrade, though your objective was clearly to provoke a fight, you did ask a question.

Here is my answer, from experience:

ZERO

I am over 65. For care like yours, I would pay nothing out of pocket.
Anyone living in the US with no health insurance is a fool. However folks in your countries seem to think that everyone here gets enormous medicsl bills. Simply not so for the overwhelming majority. Half the population is covered by Medicare or Medicaid. Another 40% has private coverage through their employer.

Yes we have a problem with costs, overutilization, and the insurance fiasco. No, the majority are not without coverage.

esa-aardvark
25th Sep 2018, 15:57
On a Cruise recently, lots of colds about. One chap (American) paid $9000 for 3 days of treatment.
Others also many thousands. Standard treatment was an intravenose drip, saw people walking around
with them. Gather on many ships medical attention is a franchise, and your costs are written on your forehead.
Some people died (not of cold), but they still had to pay for the ship to be diverted.

sitigeltfel
25th Sep 2018, 16:06
There are regular stories of UK citizens having accidents or illnesses while abroad and having no insurance to cover even the most basic treatments. They think nothing of spending thousands on their holiday but are too mean to take out medical insurance. Maybe they have been weened on the free healthcare myth and always expect to have it handed on a plate. They then send out appeals via crowdfunding sites and mugs actually give them donations.

I read a quote somewhere along the lines of, "If you want to know how much free healthcare costs, just wait until you have to pay for it".

charliegolf
25th Sep 2018, 16:08
On a Cruise recently, lots of colds about. One chap (American) paid $9000 for 3 days of treatment.
Others also many thousands. Standard treatment was an intravenose drip, saw people walking around
with them. Gather on many ships medical attention is a franchise, and your costs are written on your forehead.
Some people died (not of cold), but they still had to pay for the ship to be diverted.

Other than that, how was the trip?

Uplinker
25th Sep 2018, 16:14
............How much did i pay for this out of my own pocket?
$0.00
The 3 follow up visits to my GP to look at the pathology report and fix any resulting problems
$0.00
How much would this hospital visit in the USA cost. I was estimating anywhere between 7-13,000 USD.

Don’t know how the Australian system works, but the UK NHS system is only “free” at the point of use. It is not actually free at all, and UK taxpayers pay a hell of a lot for it. Patients are not asked for bank details after treatment, nor do they receive an invoice*, but taxpayers most certainly do pay.

*There are exceptions in some non life threatening areas such as dentistry etc.

WingNut60
25th Sep 2018, 16:20
There are regular stories of UK citizens having accidents or illnesses while abroad and having no insurance to cover even the most basic treatments....

Part of the trouble there is that many of the international travel insurance policies are not worth the paper that they're written on.
Also, medical assistance in many of the resort areas is pure scam.
You see people being forced to sell their house after breaking a leg in Bali.
Distraught family standing around wringing their hands... ching ching - bonus.

If I did the same in Balikpapan I would expect better medical care than that available in Bali and at a small fraction of the price.
I would never pay more than $100 for a simple consult and a shoebox full of tablets.
Try that in Bali?



Good travel insurance is expensive......but not if you need it.

WingNut60
25th Sep 2018, 16:27
Other than that, how was the trip?
:D:Dhttps://www.pprune.org/images/infopop/icons/icon14.gif

esa-aardvark
25th Sep 2018, 16:49
charliegolf,
I was one of the survivors. 78 days at sea, voyage good, got a bit bored with the food.
Drink package was superb, but I don't think the shipping line realised how much booze
a shipfull of elderly cruisers could consume.

KelvinD
25th Sep 2018, 17:21
Some years ago, my girlfriend picked me up at Mobile airport and on the way to her place, we got rear ended at 50 mph or more (estimated by highway Patrol officers). To cut a long story short, we got her mum to give us a lift to the hospital with them claiming the ambulance would be expensive.
Checked into A&E, I with my face slightly rearranged and blood all over it and when it came my turn for the paperwork, I was asked about insurance. It's OK, said I, my employer takes care of that world wide. And who is your employer? British Airways. "Who are they" came the response. (I should have remembered I was in Mississippi!). Well, I got nowhere and was not going to be seen. I then spotted a notice on the wall saying that "in order to qualify for Federal grants, this hospital must treat a percentage of patients as charity cases. I leaned over the desk, just so I could drip blood over the woman's paperwork, pointed out the sign and said !I am a charity case. Now will you treat me?" OK sir, let's just have some details!. After a wait of over 4 hours without seeing a doctor, nurse or even a spectator, we got fed up and walked out. On the way out, the idiot who had run into the back of our car was lying on a gurney near the door. And just as unconscious as he was when the ambulance brought him in 4 hours earlier!

bafanguy
25th Sep 2018, 19:24
Ozgrade, though your objective was clearly to provoke a fight, you did ask a question.

And it was answered with documentation.

ian16th
25th Sep 2018, 19:45
Some simple advice.

FOR FREE!

Anyone planning on visiting South Africa, buy medical insurance before you leave your home country.

chuks
25th Sep 2018, 19:48
We had a pilot going on recurrent training in Wichita, Kansas from his base in Abuja, Nigeria.

He was feeling a bit ill when he left Nigeria, but he assumed that it was just a hangover. It turned out to be cerebral malaria, something the doctors in Wichita had little idea about so that they thought it was typhoid at first. 21 days later he was dead, leaving a bill for $50,000 to be settled between his employer of record, the company he was flying for, and his widow.

German insurers will not cover Germans for extended stays in the States; you need to arrange extra cover because of the disparity between German costs and US costs, of healthcare.

Last year we were on holiday in Croatia when my wife took a funny turn, what turned out to be mostly just dehydration along with perhaps hyperventilation, on a very hot day. She suffered a sort of "panic attack" then that looked a lot worse than it was.

A short trip to the local hospital in an ambulance, a thorough exam, and an all-clear later, the doctor wanted us to settle the bill then and there because their system did not take the German health insurance card, even though Croatia is in the EU. I was a bit apprehensive about how much money they wanted, when that turned out to be something like $35! We were out of there in less time than just getting the billing information would have taken in the States.

West Coast
25th Sep 2018, 19:54
Some years ago, my girlfriend picked me up at Mobile airport and on the way to her place, we got rear ended at 50 mph or more (estimated by highway Patrol officers). To cut a long story short, we got her mum to give us a lift to the hospital with them claiming the ambulance would be expensive.
Checked into A&E, I with my face slightly rearranged and blood all over it and when it came my turn for the paperwork, I was asked about insurance. It's OK, said I, my employer takes care of that world wide. And who is your employer? British Airways. "Who are they" came the response. (I should have remembered I was in Mississippi!). Well, I got nowhere and was not going to be seen. I then spotted a notice on the wall saying that "in order to qualify for Federal grants, this hospital must treat a percentage of patients as charity cases. I leaned over the desk, just so I could drip blood over the woman's paperwork, pointed out the sign and said !I am a charity case. Now will you treat me?" OK sir, let's just have some details!. After a wait of over 4 hours without seeing a doctor, nurse or even a spectator, we got fed up and walked out. On the way out, the idiot who had run into the back of our car was lying on a gurney near the door. And just as unconscious as he was when the ambulance brought him in 4 hours earlier!

I’ve had my fair share of hospital visits, to include urgent care and have never had an experience like that. Glad you had a story to fit the thread however.

Before you get holier than thou that they hadn't heard of British Airways, you want want to look at a map. What you should have remembered is Mobile is in Alabama, not Mississippi.

Gertrude the Wombat
25th Sep 2018, 20:02
How much did i pay for this out of my own pocket?
$0.00
Our visit to an Australian ER. On leaving:

"Isn't there any paperwork?"

"Oh yes, that's fifty dollars for the staff Christmas party ... ... ... only joking, there's nothing to pay, I can tell by your accents that you're British and there's a reciprocal arrangement."

Gertrude the Wombat
25th Sep 2018, 20:05
I haven't even mentioned the Royal Flying Doctor Service. If you're way out in the bush. they send a Doctor in Kingair 250 or PC12 to you...for free.
Possibly. But if you're a walk-in at their clinic at Ayers Rock you get a bill. Not a very large one - think it was twenty dollars or so - we kept the invoice as a souvenir rather than send it off to our insurance company.

Gertrude the Wombat
25th Sep 2018, 20:13
Oh, and something Brits may not realise is that the Channel Islands give you nothing at all - no UK cover, no EU cover. So you either buy insurance, or you take a punt on not getting anything wrong with you that won't survive an air ambulance ride (which you'll have to pay for) to France.

Hydromet
25th Sep 2018, 22:05
..but someone paid on your behalf!

Sure, and I'm sure that in the past, the OP has paid, through tax and the Medicare levy, for others who were in need at the time. It's called looking after each other.

Apropos Chevvron's #13, the UK and Australia have a reciprocal agreement. Their citizens each receive free treatment in the other country. Normally they'd have to pay then be reimbursed, but it is possible to register (not sure how) and you pay nothing. We had visitors from the UK. Heading out for a farewell dinner, she tripped and broke her femur, which led to a hip replacement. They'd pre-registered, so didn't have to pay. During her long convalescence, he worked (probably illegally) as a volunteer driver at the rehab facility.

chevvron
25th Sep 2018, 22:14
Sure, and I'm sure that in the past, the OP has paid, through tax and the Medicare levy, for others who were in need at the time. It's called looking after each other.

Apropos Chevvron's #13, the UK and Australia have a reciprocal agreement. Their citizens each receive free treatment in the other country. Normally they'd have to pay then be reimbursed, but it is possible to register (not sure how) and you pay nothing. We had visitors from the UK. Heading out for a farewell dinner, she tripped and broke her femur, which led to a hip replacement. They'd pre-registered, so didn't have to pay. During her long convalescence, he worked (probably illegally) as a volunteer driver at the rehab facility.
Wasn't intending you to think I was referring to our antipodean cousins.
Every week there's a story in our papers about persons from certain West African countries and even sometimes middle eastern countries coming here, getting medical treatment and scarpering before they pay. Once they're gone, they're gone; there's no hope of 'chasing' them once they go back to their own country.
We call it 'Health Tourism'. I blame the hospital management (every hospital nowadays has several tiers of management pulling 6 figure salaries for doing very little) for not ensuring the bill is paid for those not entitled to free treatment for which I have paid all my working life and indeed am still contributing to through my income tax..

Loose rivets
25th Sep 2018, 22:20
I miss my life in America. I miss the grandchildren more than words can say. I could not stay.

My bill for 4 hours was over $17,000. On a drip, and 30 minutes with a doctor.


https://www.quora.com/Why-hasn-t-the-UK-adopted-America-s-healthcare-system/answer/Rob-Benham-2

West Coast
25th Sep 2018, 22:46
I miss my life in America. I miss the grandchildren more than words can say. I could not stay.

My bill for 4 hours was over $17,000. On a drip, and 30 minutes with a doctor.


https://www.quora.com/Why-hasn-t-the-UK-adopted-America-s-healthcare-system/answer/Rob-Benham-2

Were you here for a period of time?

currawong
26th Sep 2018, 01:38
What is the difference?

1.5% Medicare Levy (healthcare tax) or paying 1.5% of your income on the health insurer of your choice?

The end result is the same.

Hydromet
26th Sep 2018, 02:39
What is the difference?

1.5% Medicare Levy (healthcare tax) or paying 1.5% of your income on the health insurer of your choice?

The end result is the same.
Not sure how it works in the states, but down here, even if you don't have an income, you're still covered by Medicare. Do your private insurers do the same.

Chevvron, no problems, I knew what you meant, my post was just by way of clarification.

ExSp33db1rd
26th Sep 2018, 02:48
....that they hadn't heard of British Airways

Flew a BA ( actually BOAC ) 707 into New York, alerted ATC that we had a medical case, attended by doctor passenger on board but requested ambulance and medics to meet us. Door opened, first question was not about the patient, but " Who is going to pay ?" In this case clearly the Airline - as far as the present situation was concerned.

My cancer op. and hospitalisation was covered in NZ by my private insurance - just read of a local case whereby the patient had to wait over 1 year for colostomy to confirm that his rectal bleeding was indeed cancer. Now operated on by Public System, but ... is it in time ?

In my own case I had everything done expeditiously,privately, but between Chemo and operation happened to be in the USA and attended a public lecture about my condition, at the end of which I approached the lecturer and suggested that he may be prepared to review my clinical notes and give an opinion that what I was about to return home to endure was in fact the best treatment ? No problem, ring my sec. for an appt. Did that, and was told to put $600 on the counter before the Dr. would see me. He confirmed that I was doing the right thing, but he wasn't a colorectal surgeon, would I like to see his colleague, who was - $1400 for a 10 minute visit ? I declined that.

OK, nobody has to work for nothing, my wife would like to return to live in the USA, I could accept life there but can't afford to be ill there. I have a NZ public service lifetime supply of free colostomy bags and impedimentia, for a start.

Would any US reader like to express an opinion as to whether any sort of Medicare / Medicaid, would cover me as a eventual resident, should we decide to go that path, who has never paid one red cent of tax towards US tax budgets for health care ? I think not ? But maybe maybe ?

krismiler
26th Sep 2018, 03:17
If you can’t afford travel insurance, you can’t afford to travel - simple as that. In Thailand they are sick of treating uninsured foreigners and there is talk of having to produce proof of cover on arrival.

The USA invented “medical bankruptcy” due to health care costs being so high that an emergency operation would wipe you out financially. Anyone visiting the US without proper health coverage is stupid. Prices vary in hospitals for the same procedure depending on your insurer. A secret master price list is maintained and discounted from based on the insurance company’s bargaining power. An uninsured person pays FULL PRICE where as an insurance company providing millions of dollars a year in business negotiates reduced rates.

The insurance companies are in it for the money and exclude pre existing conditions and anything else they and their lawyers can get away with.

obgraham
26th Sep 2018, 03:59
ExSpeedy:
Let me weight in, from two perspectives.

First: since you do not have US residency and did not pay into Medicare/Social Security, a big part of me says NO, I would not expect my taxes to pay for you to move here, then run up big medical bills on Medicare. I'm sorry about that. But then, I'm a selfish Trumpian, so there is that.

However, reality is significantly more complex. Normally you have to have paid into Medicare for 10 years to be eligible to be covered by Medicare. Except that may not be the case if you are a spouse of a US citizen, and have legal residency in the US, and if said spouse is herself eligible for Medicare.

So the correct answer is "maybe". I would suggest a visit to US Consulate, who could either answer the question or point you in the direction of the answer. Medicare regulations are extremely complex. By and large us geezers are the most content with the health care situation in the US, but not a single aspect of it is simple or easy to figure out. I generally can't sort out the red tape, and I am a real doctor!

Medicaid is a different story. Think Welfare, or The Dole. You can't get on Medicaid until you've spent up your assets. Each state has their own system for Medicaid.

abgd
26th Sep 2018, 04:10
I don't know what the perfect system is, or if it exists. However a few observations would be that:

Insurance companies are less trustworthy than used aircraft salesmen

Somebody always pays, but some systems are much more expensive than others. A lot of this has to do with either administrative overhead or perverse incentives.

Systems where people get paid for work done tend to do a lot of unnecessary and sometimes harmful investigations/treatment. I see a lot of people who have been treated abroad who get sent home with unnecessary plaster casts, for example, and some of them end up with DVTs. I recently saw a man who had an external fixator and a CT scan for a fracture that, in the NHS, would have been diagnosed with a simple X-ray and treated more safely and much more cheaply with a plaster cast.

Most people can't tell whether they're getting good treatment or not.

People who live healthy lifestyles cost more in the long term, because they live longer and need more treatment overall. If you want to save the NHS smoke, ignore your chest pains and die quickly and decisively of something incurable the week after you retire.

krismiler
26th Sep 2018, 04:35
US Doctors have to do a lot of unnecessary tests which are mandated by THEIR insurance provider to avoid being on the hook for millions in the event of a wrong diagnosis. The tests are paid for by the patient and his insurance company anyway.

In the event that a doctor is sued, sympathetic juries often award for the patient even if there is not fault on the doctors part. Premiums for an obstetrician can be mind blowing due to the cost of lifetime care for a disabled child.

KelvinD
26th Sep 2018, 05:07
westcoast: Stop assuming all posters here are stupid! We will leave that honour to you. I know where bloody Mobile is. I also know, as I shared an apartment with my then girl friend that Pascagoula is in Mississippi! We were driving from Mobile to Pascagoula. Get off your high horse before the vertigo gets you!

obgraham
26th Sep 2018, 05:18
A simple example might illustrate what we are up against. Appendicitis. Pretty routine condition, with a standard treatment.

In my day, the classic case was diagnosed by (1)Examination by a surgeon, with point tenderness and rebound tenderness in the right lower quadrant (2)Low grade fever, and (3)Elevated white blood cell count. On that basis, off to the OR with you, preferably quickly. Expect a good result and rapid recovery.

Nowadays, my daughter, who is an ER doc in a major urban hospital in the US, tells me that the procedure is (1)Get an ultrasound, CT scan, or preferably both (1B) Discuss this with a radiologist (2)Get a white blood cell count, maybe look at the result (3)After that, go in and talk to the patient, then find a surgeon, and schedule OR sometime in the next 24 hours. Virtually NONE of them get a belly exam, but the imaging procedure is required in all cases. The percentage of complicated (i.e. ruptured appendixes) cases is higher now than before. True, due to the laparoscopic approach uncomplicated cases recover faster now.

The condition has not changed. Nor has the proper treatment. But the resources expended has skyrocketed, and the efficiency has plummeted.

ExSp33db1rd
26th Sep 2018, 09:22
obgraham ... thank you for the comments, I appreciate your points of view and don't disagree with either, which means that we are probably going to stay where we are, unfortunately "double taxation agreements" sound OK, but actually mean that you end up paying the highest rate of both participating bureaucracies, if not "double taxation" itself in some areas, and as Mrs. ExS cannot ever escape USA tax, no matter where in the World, she feels somewhat hard done by, but I have more or less shaken off the UK taxman, after some 36 years absence.

Should we decide to give the USA a go, my best bet would be to fly to Mexico City and walk across the border ( or scale the wall ?) - I'd eventually be pardoned and get it all, plus some Welfare Handouts ? Or ... at my age, live long enough to participate in a few deportation orders and constant appeals whilst my case is considered. ( tho' ,maybe the legal costs of that might exceed the cost of a few medical bills, so maybe "legal" entry could be the cheapest in the end ?)

West Coast
26th Sep 2018, 10:34
westcoast: Stop assuming all posters here are stupid! We will leave that honour to you. I know where bloody Mobile is. I also know, as I shared an apartment with my then girl friend that Pascagoula is in Mississippi! We were driving from Mobile to Pascagoula. Get off your high horse before the vertigo gets you!

You got caught KD, nothing wrong with simply admitting it, no need to add on to the story.

WingNut60
26th Sep 2018, 10:36
westcoast: Stop assuming all posters here are stupid! We will leave that honour to you. I know where bloody Mobile is. I also know, as I shared an apartment with my then girl friend that Pascagoula is in Mississippi! We were driving from Mobile to Pascagoula. Get off your high horse before the vertigo gets you!

I know where Pascagoula is too because of Ray Stevens aunt Bellum Woodrum.

CargoMatatu
26th Sep 2018, 10:53
westcoast: Stop assuming all posters here are stupid! We will leave that honour to you. I know where bloody Mobile is. I also know, as I shared an apartment with my then girl friend that Pascagoula is in Mississippi! We were driving from Mobile to Pascagoula. Get off your high horse before the vertigo gets you!

:D:D:D:D:D:ok:

cattletruck
26th Sep 2018, 10:55
Yes healthcare is expensive there but I wouldn't be too hard on the US. The only thing I loathe about my annual holiday in Southern Europe is knowing the doctors at the local hospital are only their because daddy made the right donations to the political party of the time, and said doctors are too busing doing the nurses - and what gorgeous nurses they are - top of the gene pool sort of stuff. Should you be unfortunate to need a visit then the chances are against you coming out alive, and if you do and they botched you up badly by applying a wrong diagnosis or procedure then you cannot even sue.

radeng
26th Sep 2018, 12:42
Three years ago, a friend of mine was visiting relations in New Orleans when he collapsed. Flat line on the cardiograph three times. Rushed into intensive care and at 0800 the next morning, the cardiologist told him he was being fitted with a pacemaker and at 1000, he was! Top of the line model too. My friend has a house in France as well as in the UK and a box by the bed: at about 0200 each morning, the box wakes up the radio in the pacemaker and asks it ' What have you been doing?' So my friend got a telephone call from the UK hospital asking what he had been doing some three weeks before when there was unusual activity. After thinking back, he told them that he was dashing through an airport in France......

It was pleasing to hear that it was working - I did a lot of the systems engineering on the radio transceiver in the pacemaker that tells the bedside box what has been happening..

His US bill was $220,000. He paid $50 for the drugs he needed after discharge. Krismiler (#40) is right - his insurance company assured him that they would negotiate the price for the operation down, but he wasn't to worry....that was up to them. Moral is that if you can't afford health insurance, you can't afford to go.

ian16th
26th Sep 2018, 13:46
Apropos Chevvron's #13, the UK and Australia have a reciprocal agreement. Their citizens each receive free treatment in the other country. Normally they'd have to pay then be reimbursed, but it is possible to register (not sure how) and you pay nothing.

Sorry for being pedantic, but this is not quite true.

It is legal residents!

As a UK expat resident in SA, I wouldn't get cover if I visited Oz.

Slow Biker
26th Sep 2018, 19:39
Couldn't agree more with RADENG, although nowhere near the scale of cost his friend rang up, or indeed the medical emergency, I got a feel for the costs after spending the night in the sick bay of a US registered cruise ship. Having had a heart attack some years ago, the pain I was suffering was not a mile away from what I felt then. Happily all was fine, and I was presented with an itemized bill for +$3000 including 30 cents for an Aspirin. The itemized bill was handy for the claim, which was paid without question. Sadly the cost of insurance that will cover in the US my various ailments has risen so much that after 20 years of visiting reluctantly we have had to call it a day. But there is still plenty to see in the UK and mainland Europe.

Pontius Navigator
26th Sep 2018, 19:53
We did an aeromed of a Polish seaman (during cold war) from the Falklands to Brazil. The crew night stopped but the following morning the Brazilians would not let them leave without the passenger.

The Foreign Office would not accept the Pole for a flight back to FI unless the Polish Embassy stumped up the airfare, around £10k. Impasse.

Don't know who paid the medical bill but the Embassy reluctantly paid the air fare.

Gertrude the Wombat
26th Sep 2018, 20:21
As a UK expat resident in SA, I wouldn't get cover if I visited Oz.
Unless you use the hospital in Perth that we did - "I can tell from your accent that you're British, no paperwork". Not even asked to show ID to prove that we were British.

ian16th
26th Sep 2018, 20:51
Unless you use the hospital in Perth that we did - "I can tell from your accent that you're British, no paperwork". Not even asked to show ID to prove that we were British.

Not a risk that I'd take, or need to.
My SA Med Insurance covers me overseas for 3 months a year.

lomapaseo
26th Sep 2018, 21:44
I just spent last week in the hospital

Mt bill came in today at $100,000 (fortunately zeroed out due to some form of insurance)

I just don't understand why I am worth saving for that amount. All Ii do is contribute gibberish to this forum

Apparently they don't offer easy outs like suicide and are forced to do something positive.

ExSp33db1rd
26th Sep 2018, 23:41
...........would not let them leave without the passenger.

Took a dead passenger into Cairo,died on board despite all best efforts. The crew taking over were told ... " Get that stiff out of here" and weren't allow the body to be unloaded, it was suggested that they left it strapped into the seat and just throw a blanket over it. I am not joking.

West Coast
27th Sep 2018, 02:23
Lom

Hopefully you’re back in fighting form.

India Four Two
27th Sep 2018, 02:59
I have followed this thread with interest. I have lived off and on, within 200 miles of the US border for nearly 50 years, visited many times and lived there for five years in the 90s.

To reinforce what several people have said, you would have to be mad to visit the US without comprehensive medical insurance. There are horror stories of Canadian residents who didn't have insurance, having bills for hundreds of thousands of dollars due to being taken ill in the US. I even discovered recently, that if visiting other provinces in Canada, it is recommended to have insurance since although the Canadian system is very comprehensive, there are differences between provinces when it comes to non-residents of the province.

Since I travel quite frequently, I take out an annual policy which allows me unlimited 30-day trips out of Canada. What I found surprising recently was that a policy for 60-day trips was much more than double the cost, but the very helpful agent told me to take the 30-day policy and then apply for an extension when on a trip. The extra fee was much less than the extra cost of the 60-day policy!

My policy has two options - travel anywhere in the world, including the US or anywhere excluding the US. The difference in premiums is staggering. Although I mostly travel to the Far East, but occasionally transit via US airports, I always take the US coverage.

n5296s
27th Sep 2018, 04:29
I've lived in the US for 18 years now. Mostly - fortunately - covered by excellent employer-based insurance schemes. But if you happen to lose your job AND get ill, you are in DEEP trouble, and likely bankrupt. One of my employers closed down instantly, on the 28th of the month. Health insurance terminated 3 days later. Tough luck. Luckily I was using my wife's insurance anyway, but not everyone has that luxury. Getting private insurance is both expensive and difficult. Prior to Obamacare, if you had a pre-existing condition, you could forget about it.

Now I have Medicare (essentially mandatory at 65). So far it has refused to pay for every single thing I have asked it for. Nothing major - fortunately - but the usual routine kind of thing, blood tests, routine examinations. It pays NOTHING for any kind of preventative medicine. It's not cheap either - it is costing me about $500/month.

I (we) share the view that this is not a country you can afford to grow old in. Our plan is to return to France in the next few years, where health care is universal, and the standard of routine care is much higher than in the US also.

double_barrel
27th Sep 2018, 05:55
I often think that one of the most astonishing achievements of modern times was persuading the average American that a government health care system is an evil liberal plot and that they will surrender their ability to 'choose' to the government - as opposed to the insurance companies.


Part of the bigger astounding achievement of persuading average Americans that pure unfettered capitalism is great, that they must stand on their own 2 feet and that any pinko liberal support system would create a sense of entitlement and undermine the strength of USA. And that they were convinced of this by an ultra wealthy elite who enjoy the most socialist system on the planet in which government money and tax relief is directed to the wealthy and bankers are bailed out after mercilessly exploiting the poorest of the poor. I love that people like Trump can fail repeatedly and expect to be bailed out by the government, admit to this and STILL stand-up and lecture people about the importance of the free market!


Simply incredible.

chuks
27th Sep 2018, 11:25
My late mother was a Registered Nurse with her own take on doctors, and on the AMA (American Medical Association). She was quite down on the way that the AMA has lobbied successfully for many years against a system of government-provided basic healthcare. American healthcare costs are quite high, while American standards of healthcare are scandalously low, compared to other equally wealthy developed countries.

Have a look at the history of heathcare costs and the American auto industry, with particular attention to the role of the late UAW boss Walter Reuther in that, when you can understand how damaging these high costs can be to one major American industry. (Reuther, a far-seeing man, envisioned the US government being forced to introduce socialized medicine in order to rein in the high and rising costs of healthcare to auto manufacturers. His untimely death in a plane crash put a stop to his push for that.) In fact, it's healthcare costs that have made us uncompetitive in certain automobile market sectors, particularly small cars. (Why was Ford going to import the Focus from China, for example? Why are some car models built in Mexico?)

It's not a "liberal plot" but a "socialist plot" that has been and still is the bugaboo that is quite reliable in killing healthcare reform in the States, when socialism = Communism! It's a syllogism that is so simple it's stupid: "Senator Bloggs wants to introduce the same system of healthcare used in Russia, when Communists decide who lives and who dies!" Socialized medicine is another thing like gun control that no sane politician would touch with a bargepole, even though both are obviously highly necessary.

It's not that socialized medicine is perfect; no system is perfect. It is simply that it is overall much, much better than what the States now has. That starts, actually, with the costs of a first-class medical education (much lower in Germany, for example) and carries on throughout the entire system. Capitalism is a wonderful thing, but it might not be the best way to run the provision of healthcare.

krismiler
27th Sep 2018, 11:56
I remember watching a TV program about Americans crossing the border and pretending to be Canadian in order to obtain medical treatment which they couldn’t afford in their own country. I also read that some American hospitals are deliberately located near the border to cater for Canadians who are willing to pay to avoid the long waiting times at home. Apparently going private isn’t an option and everyone has to wait their turn.

Medical tourism is a growing field, allowing people to escape high costs and/or long waiting times. High quality care is available in countries such as Mexico, Malaysia and Thailand at a fraction of the cost of a western country. Once the lawyers and excess regulations are done away with, prices tumble and services improve. Capitalism as it should be.

lomapaseo
27th Sep 2018, 14:56
Now I have Medicare (essentially mandatory at 65). So far it has refused to pay for every single thing I have asked it for. Nothing major - fortunately - but the usual routine kind of thing, blood tests, routine examinations. It pays NOTHING for any kind of preventative medicine. It's not cheap either - it is costing me about $500/month.


My earlier comments above about last weeks $100,000 are totally covered under Medicare plus AARP secondary. The key being that the larger part of the bill must be for approved care and a fee schedule approved by Medicare. If the procedure is approved, but not fully covered by Medicare, then the overage is picked up by my secondary insurance.

The key to being an approved procedure is the Doctor's coding of the procedure against a real (not imaginary) diagnosis. For me (as well as most others) routine once a year blood test are all covered as well as once ay ear "Wellness visits. After that any add-on tests or procedures have been 100% approved based on a coding submitted by the doctors office against a defined diagnostic condition.

example: a typical once a year EKG might be charged @ $75 but Medicare only approves $50, but since it was an approved procedure in Medicare's eye my secondary insurance covers the residual.

Yes, I too have had some procedures rejected by Medicare and billed to myself. But in 95% of these a simple call to the doctors office has them resubmit the bill to Medicare with an updated coding of a health condition diagnosis that they will pay.

esa-aardvark
27th Sep 2018, 15:52
Someone(S) gaming the system here. My medical scheme covers me worldwide
for everything 90% or 100% coverage. Serious stuff is 100%. Costs 229euro this month for wife and self.
ex-employer pays about the same. Actuarial study every year or two to make sure contributions cover costs,
otherwise they go up. Reserve fund is sufficient for a few years of expected claims. We do not have that many people in USA.
I could travel to USA (or anywhere) for treatment, but they will not pay to get me there. I do have friends who went to USA
for advanced cancer treatment.
My scheme is essentially a mutual scheme.
Would also cover me on board ship, although I do also have a separate policy for that because of ship diversion, repatriation etc.

lomapaseo
27th Sep 2018, 21:04
Someone(S) gaming the system here

Yup that's called capitalism, charge what the suckers will pay, rather than what they can afford. by self sustained means.

sitigeltfel
27th Sep 2018, 21:16
Yup that's called capitalism, charge what the suckers will pay, rather than what they can afford. by self sustained means.

Socialism...get some other sucker to pay for it.t

lomapaseo
27th Sep 2018, 22:00
Socialism...get some other sucker to pay for it.t

Not quite, that isn't self sustaining unless you go back to the billing and force the price lower.to where the other suckers can afford it.

abgd
27th Sep 2018, 23:00
I've probably said it before, but a real problem with medical care is that it's very difficult for most people to judge its quality or whether something was truly necessary or not. Other than immediate colleagues, I would be very hard pressed to say whom I would trust (or not). Academic qualifications aren't always a good guide to ability. Outside of my own field I find it hard to know what's good up-to-date practice.

The assumption of complete knowledge, necessary for capitalism to function well, is very definitely broken when it comes to medicine. Other than for elective procedures, you don't always get a lot of choice in terms of whom you see or which hospital you're taken to.

The thing that worries me the most about privatised medicine is that I keep seeing people who have been harmed, or had their wallets harmed, by unnecessary investigation or treatment. Over and over. A colleague used to have a nice side-business in flying to the USA on behalf of travel insurance companies just to stop them over-investigating and over-treating people. Obviously this suits the insurance companies well, but I keep seeing people who come back from holidays having had CT scans for simple fractures where an X-ray would have been fine, or plaster casts that have contributed to DVTs or operations that simply weren't necessary (and sometimes mangle people up a bit too). I had a patient who sold his estate and moved to a new continent because the scans to look for recurrence of his cancer were so onerous. The risk of having twice yearly surveillance CT scans will have been far larger than the risk of his particular cancer recurring at his age. He booked himself onto the NHS and his new consultant said, 'why on earth are you having all this follow-up? You were cured long ago!".

Every time I have anything to do with private healthcare, I see the patients getting screwed in one way or another.

n5296s
27th Sep 2018, 23:28
> Every time I have anything to do with private healthcare, I see the patients getting screwed in one way or another.

And that's exactly the problem with the US system. Treating the patient is a very distant third priority after (a) not getting sued and (b) making money. And CURING the patient is a very definite non-objective - if you cure them, they won't come back, and you won't make money.

(a) and (b) both point firmly in the direction of doing as much as possible, especially on the investigation side. If there's a 0.001% chance that the patient has something terrible, and you don't test for it, and it turns out they do - bad news. Two successful lawsuits against a doctor and he/she is back to flipping burgers, because they are uninsurable.

lomapaseo
28th Sep 2018, 02:20
To continue from above. I would be the same today if they had skipped a lot of procedures and just got it done on one operation. The majority of the costs were all in the pre-ops of multiple x-rays, CT scans dye-checks, blood tests over weeks and the most specialized internal peeks one can imagine. This was all done against a single risk and that was stroke. Without the tests I had a 80% chance of surviving long enough to post on JB. With the extra tests and money my chances increased to 95%

Then there was the little stuff like pasting a bum-patch on me. I had been through major ops before and no bum-patch so I questioned why and nobody could answer, saying it was now a required procedure. What for?? So I wouldn't get bed sores for my hospital stay. They agreed with me that most of the year to year changes were driven by law suit pay-outs

layman
28th Sep 2018, 04:36
Just an observation. We carry world-wide travel & health insurance for less than $600(AUD) a year.

60 days in the USA more than doubles the annual cost. Hate to think what annual coverage would cost

ImageGear
28th Sep 2018, 06:07
I have friends in the US at both ends of the wealth scale.

Everyone has some form of medical cover HOWEVER, it's the whole business of having to "motivate" your health care provider to cough up, that grips my trachea. Arguments get going between Doctors, Surgeons, Specialists, the Provider, and you the patient, to decide whether payment for your specific illness can be avoided in some way. At the more wealthy end of scale, people we know just pay the account anyway because they can, to avoid the hassle of "Motivating". At the other end of the scale, it becomes a real struggle to cut through the morass of avoidance and get the provider to pay.

Even when a Surgeon states that the treatment is vital to the continued existence of the patient, the Provider may decide that Paragraph 327, Clause 219 Section D, specifically states that if the patient has ever missed taking a tablet in their lives, they don't have to pay. (Exaggerated to make a point)

We live in France and enjoy basic health care provided through a reciprocal agreement with the UK, We also top up with quite affordable Health Insurance to give us the best we can get. Some time ago, I went to my local doctor and she said I don't like the sound your ticker is making so I want you to go to a Cardiologist. "Just sit there for a minute while I set it up" - My Doctor calls a respected Cardio down the road and says: "I'd like you to see this guy soon", Cardio comes back "Tomorrow at 10?" I say fine, and walk out. This is normal. Some may remember I was hosted by the local hospital here last year. Cost not a penny, no motivation, no arguments, just checked in, stayed for 10 days, 3 months of home visits for dressings, etc. 1 month of Physio, all free.

Having lived in the USA on and off for around 7 years, I can truly say, it's not a place where you can easily afford to grow old, or would want to travel to, without really good health insurance.

IG

reynoldsno1
28th Sep 2018, 06:29
Retired in NZ recently, and cancelled my health insurance as it would be too expensive. It was probably inevitable that I would be struck down with renal colic a fortnight later. mrsr1 drove me to the local community hospital (3 minutes) and I threw myself on the mercy of the public health system - which would have happened initially anyway. A bum full of diclofenac, and I was sent for a CT scan an hour later - got back home,and the phone rang to tell me I was booked into the base hospital that night. Renal stents inserted the next day, and I then had to wait 7 weeks to have the kidney stones lasered away and a night in hospital. I was quite impressed, and they even fed me. My tax dollars at work. Private health insurance may have allowed the op to happen a little earlier, and the food would probably have been a bit better.
Travelling overseas without health insurance is plain dumb.

krismiler
28th Sep 2018, 10:05
Without insurance coverage, you could end up on a website like this:

https://www.gofundme.com/discover

WingNut60
28th Sep 2018, 17:24
I do not pretend to know how the U.S. system works, it all just seems too complicated and expensive for reality.

But I can not help but wonder what it is that has made it so expensive.
Is it simply and solely because of the extent to which insurance companies monopolise the whole shooting match.
Is it the U.S. litigation mentality that drives the prices through the roof.

I don't begrudge doctors even an exorbitant salary. I acknowledge their skills and training.
But is the money going to the doctors or the support infrastructure?
Multiple thousands of dollars for a few hours on a drip and a couple of antibiotics?

Where does all that money go?
If it's because of litigation then that means that, say, 80% of it is going to litigants. Is it?

Gertrude the Wombat
28th Sep 2018, 17:43
Is it the U.S. litigation mentality that drives the prices through the roof.
I heard/read somewhere (I think a throwaway line in a novel that was about something else?) of a US doctor who charged one quarter the prices that everyone else charged, on the grounds that he didn't have any malpractice insurance, so wasn't worth suing, and still made loadsamoney because he was no longer forking out 80% of his fees in premiums. You pays your money and takes your choice.

ian16th
28th Sep 2018, 20:43
A dentist I used here in SA was planning to emigrate to the USA, until he found out what his malpractice insurance would cost.

He's still practicing in Johanesburg.

n5296s
28th Sep 2018, 20:47
US doctor who charged one quarter the prices that everyone else charged
That's the kind of thing that works great right up until it doesn't. He presumably still owns a house, etc, and can still be sued.

My GP (or the US equivalent) doesn't accept any insurance. You pay her, and if your insurance will reimburse, that's good for you. She says that if she had to deal with the insurance companies, she would need to employ someone full time to take care of it. And I believe that - when I go to other doctors I see they have a whole office full of people who do nothing but haggle with the insurance companies. Just about any time you need anything done, the first thing is to figure out what your insurance will/won't cover, how to recode the procedure so they cover it more, and so on.

It's a mystery to me where the money goes. The doctors I know or know of, claim that they don't make vast amounts of money. Maybe top surgeons do (they can afford their own jets, so I guess they must), but they're the exception. I think the insurance companies make a healthy margin, but still not enough to explain the difference relative to other countries. My suspicion is that the system is just monstrously inefficient, for each doctor making say $150K, there are 5 people making $30K to deal with the inefficiencies of the system.

Slow Biker
28th Sep 2018, 21:32
I forgot to mention in my #53 the comment of my GP. I saw him for a follow-up after the cruise and mentioned the cost; he looked at the itemized list and narrative of treatment and remarked that converted to £ it was about what similar treatment would cost the NHS.

krismiler
28th Sep 2018, 22:31
I watched an interview with a doctor who claimed it cost $300 an hour to run his practice with all the staff he had to employ, before he took a cent for himself. Therefore he had to change accordingly and couldn't spend an hour doing a full physical for $100.

lomapaseo
29th Sep 2018, 00:00
There are some clever ways for doctors to recoup office expenses. The cleanest is to offer skin deep effects like getting rid of varicose veins. With some clever coding of DVT threats backed up by echo testing one of my doctors has turned over the drudge work of examining sick patients to assistants who are part of the office staff and have only to review with the doctor in an end-of-day briefing. When I see the paid-up itemize bill months later from medicare I find I have some interesting hidden-from-me conditions in the codings. My only care is that the assistants really do know what they are doing and if necessary I can move from doctor to doctor with those codings and find myself welcomed as a new patient rather than turned away because that doctor can't afford to operate an office against the low allowables from Medicare.
\

n5296s
29th Sep 2018, 00:06
couldn't spend an hour doing a full physical for $100.
My experience of doctors in the US (excluding my GP, who runs a one-woman practice) is that you are lucky to see one for 30 seconds, never mind an hour. You hang around for 30 minutes while random assistants come in and out measuring your blood pressure, height, inside leg measurement and various other things. Then the doctor pops his or her head round the door but never for more than a minute. Then various assistants appear to give you prescriptions, advice and so on.

My GP is a rare exception. She schedules 15 minute appointments and actually talks to her patients (and listens to them too). But that is very much the exception here.

I often wonder what doctors are doing when they aren't with patients. Maybe dealing with insurance issues.

obgraham
29th Sep 2018, 01:40
Well, you have all had a good go at the US again here, so here are some answers for you.

There are figures showing that about 18% of the payments for health care go doctors. Another 20% goes for pharmaceuticals, and that is the fastest growing sector. The rest...hospitals etc.

What is the doctor doing? Well he is not doctoring. Virtually every doc I know is unhappy.
They have been turned into entry clerks for billing insurance. That’s why there is only 2 minutes out of your 15 min slot for the patient. The rest is pissing around on the computer. The last administration passed a rule mandating electronic records in order to be paid anything for Medicare patients (over 65’s) And, you the doc have to show “meaningful use” of the computer. (I kid you not, that is the term) You must fill enormous reports on how you did this or that, which may or may not be relevant to the episode. For example, if you go in for say a stomach ache, they must record that they asked and you answered if you are “safe at home”, have been given weight loss advice, and told of the evils of smoking and the benefits of flu vaccine.

I worked in a relatively small hospital, 130 beds. Since I retired the hospital has bought up 90% of the local docs practices, and forced most of the rest out of business. For this, the CEO made 1.2 million last year. Most of the docs are making 150-250k, though there are some high rollers, like ortho, and GI, and cardiac surgery The adjacent town’s 80 bed hospital has spent 2 years in bankruptcy, but their CEO pocketed 875k.

Medical care in the US is superb. Paying for it and trying to get it done is abominable.

krismiler
29th Sep 2018, 06:44
With US costs, there might be a market for quacks just like third world countries. People can't afford western medical care and go to the informal sector of backyard practitioners.

Possibly, people could waive any claim prior to treatment in return for a greatly reduced bill as only the necessary tests would be done and no insurance premium paid.

fltlt
29th Sep 2018, 13:41
From my personal experience of an emergency room visit some years ago in CA, spending less than 2 hours with an ekg and a blood test only to find out, luckily, that my hours old chest pains were food related, along comes a bill in the mail for $7K and change.
Lines of codes, each with a dollar amount attached. Grateful to be checked out, but a little miffed at the total. There was only one nurse and one doctor that I saw, I sat next to the doctor as he reviewed the ekg, explaining all the squiggly lines.
Couple of days later, talking to another person that had managed to run up an extremely high ER bill, he gave me a phone number, said to call and explain the hospital bill to
them.
Did so, amazingly enough there were, and still are, companies out there that not only will review the bill, correctly code/review the allowances/rates etc., for the area the hospital is located, and iff you wish, and want to pay the fee for, go to bat for you directly with the folks that own the hospital, usually a medical group somewhere else in the country.
Obviously this service is not for run of the mill medical services, there are minimum dollar amounts, the cost to you varies with the amount and complexity of your bill.
in my case I opted to present their paperwork myself to the local hospitals accounting department. The lady explained that she would send it to their main accounts office in Texas and they would contact me.
Within a week I received a phone cal during which I was asked would I settle for the $2K and change in accordance with the review companies paperwork with 10 day’s?

Certainly did. Now my question to them was why the massive discrepancy and they accepted so easy, answer was along the lines of, well we do make billing mistakes, and if brought to our attention promptly with an offer to pay, we accept.

Make of that what you will.

Remember the sole Er doctor I sat with while he explained the squiggles, and signed my good to go paperwork?
Neither did I until 2 months later I get another bill in the mail for reading of my heart echocardiogram from a doctor whose office is some 40 miles away.
Call his office, must be some mistake, he wasn’t the doctor at the Er, reply was that their doctor had an agreement with the hospital I went to, along with others in the surrounding area, to “review” all their echocardiagrams and that they hadn’t been paid for doing mine. The thought to tell them that by the review date on their invoice I could have been dead by a possible arrhythmia did cross my mind, however my position was the hospital settled, paid in full, you have a problem with that, see them.

This episode opened my eyes to the somewhat incestuous referral practice inside the industry, and the absolute if you pay our bill without checking, oh well.

Caveat, the above is purely my own personal experience, yours may be better or worse, my cost for the review was well worth it.
i goggled Hospital bill review, the companies are still out there, you can too.

lomapaseo
29th Sep 2018, 15:09
several of the procedures that I just went through had a list of 4 doctors attending, when I only saw one in the room with me before I went out, Presumably they were waiting down the hall in a tea room (or first tee) in case I went tits up and they would rush in and sign the paperwork that all that could be done was done. I later found out that every week for the past month a group of several doctors were meeting once a week to review my latest test results before agreeing to give it a try to operate. It seems to have worked out (for me) so I guess Medicare will foot the whole bill.

n5296s
29th Sep 2018, 17:13
A friend of mine is married to a Bulgarian lady. Her mother was visiting and had a possible cardiac problem. No problem, admitted to Stanford (one of the top teaching hospitals in the country), overnight stay, problem sorted. A few weeks later, after she had returned home, arrives a bill for $50K. My friend says, "not my problem, the patient is in Bulgaria, good luck collecting". This goes back and forth for several months, with the hospital trying to get my friend to pay, and him saying it has nothing to do with him. Finally after six months or so, they write and say, "Look, if you pay $2K, we'll forget the whole thing." He did, they did, end of story.

Large medical bills are just a starting point for negotiation, much like an Egyptian carpet shop. It's very common to get a bill that says something like, cost of treatment, $1000, insurance standard payment for this procedure, $250, insurance paid $250, amount outstanding, $20. You send a cheque for $20 and it's over. But if you didn't have the insurance, you'd be liable for the full $1000. Unless you have the time, energy and strength to argue.

Ancient Mariner
29th Sep 2018, 18:01
I go see my local MD, pay 20 USD, he pushes me to a specialist, I pay another 20 USD.
Blood samples, exterior ultra sound, interior ultra sound, probes here and there, another USD 20.
CT next. Probably another USD 20.
That's socialism, terrible stuff.
Prostate and bladder in good shape. 😁
Per

flash8
29th Sep 2018, 18:47
I was once in the middle of Uzbekistan and developed (well it had been ongoing but I ignored it) a huge toothache that flared beyond the old slight ache and therefore had to see a dental surgeon immediately it was that bad I was trying to pull the tooth out with my fingers..

My bodyguard (sounds far more glamorous than it really was but US Govt policy) said he'd take me to a clinic, and expecting the worst was extremely surprised to find a a completely empty ultra-modern dental hospital (in the middle of nowhere) complete with patient chairs next to each other and a smiling Uzbek Dental surgeon who whisked me in to the chair, now in all my time in UZ this has been one of the most surprising episodes... it was almost surreal...

After fixing my tooth, pretty professionally it later transpired, I offered to pay what was the going rate, the Surgeon refused payment! It was only after much persuasion I managed to get him to accept a $100 bill. The bodyguard told me later that this would not be far off his monthly salary.

So, in some countries the experience is completely opposite!

treadigraph
29th Sep 2018, 18:58
I got toothache in Chicago in 2001. Went to a dentist near the motel, examination, x-ray and prescription for antibiotics cost me something like $30 to my huge astonishment, was expecting at least $100. Mind you, it wasn't the most salubrious part of town. Didn't bother the insurance with it, imagine there was at least £100 excess anyway.