Atlanta .NET Regular Guys

My employer sends me a statement yearly that shows me how much they paid for various things in my name (includes healthcare).

I can't speak for the drug market, but I know how hospital charges work.

Say you go to the ER for something and the total bill is $5000. You pay your $100 co-pay. The insurance company has a contractual agreement with the provider and they pay $500. The other $4400 is written off by the provider as per the agreement with the insurance company.

Same situation but you don't have insurance. This time you can either pay early and get a prompt pay discount (say 20%) so you pay $4000, or you work out a plan and pay the full $5000.

Does that make your more angry or less angry?

I agree that insurance has become very high, but who do we blame?  

Not the companies, they make ZERO money off of giving you insurance and they do everything they can to keep costs minimal to keep their employees happy.  I work in HR, and I see the insurance bills, they are astronomical. So if your company pays any part of your insurance, be thankful, not angry.  

So who is left?  Doctors, Nurses, medical supply companies, hospitals, drug companies, Medical staff, pharmacies, etc....these are the people making billions of dollars every year.

People in Canada get free Medical, but our employees that we hire from there say it could take you 3 months to get in to see your internest......so you pick?  I would rather be out of pocket some money, see my Dr., and keep my health intact.

Kim-

The doctors, nurses, hospitals, and medical staff don't make any money off healthcare for the most part. The non-profits spend everything which isn't that much. We can't even get proper PCs and servers here because there's never any money due to the shoestring budget. I don't know for sure but I suspect the for-profits make most of their money off investments. Doctors that don't have their own practice (not including plastic surgeons) don't really make all that good considering the loans they're left with after school and the cost of their malpractice insurance. The pharmaceutical companies and medical supply companies are the ones getting rich.

Insurance companies pay far, far less for a medical procedure than you would pay yourself so I suspect they do pretty well too.

We (speaking generally) actually drive up the cost ourselves also though. Matt mentioned he rarely goes to see a doc (same goes for me) but the majority of people grossly abuse their insurance. You've got people who take their kids to the ER because they passed gas. People that go to an ER because they have a cold. I could go on all day..

First, let me state uncategorically that I agree that the costs of health care and insurance are out of control in this country, so I'm in no way criticizing that conclusion.  I do however have take issue with your idea that because you are young and have not had many problems then you should be insured for less.  I don't claim to know the actual numbers, but for argument's sake lets say hypothetically we can expect 1 out of 100 previously healthy young people to experience a severe medical problem this year.  That might be due to any number of unavoidable problems that can arise, whether it be health conditions like cancer or some type of accident.  Now lets hypothetically assume that these severe cases average $250,000 in medical expenses, including doctors, hospitals, labs, drugs, etc.  Yes, that's a very large average cost, but again keep in mind that I'm only talking about the 1 in 100 that have end up with a severe medical problem, and given that assumption I can tell you from personal experience that costs do in fact add up very quickly.  So given these assumptions about costs and frequency of occurrence, then we should expect insurance to at least be $2,500 per person, which would be $10,000 for a family of four.  Now add in the much more frequent moderate problems, that might hypothetically occur 1 in 10 cases and maybe average only $25,000 in expenses, and you end up with another $10,000 for a family of four on average.  I'm of course just guessing, although I think they are off the top of my head reasonable guesses, and we haven't even considered that insurance companies are allowed to make a fair profit, but I don't honestly think $28,000 for a family of four is all that unreasonable -- given the current system anyhow.

Then there's another issue that is of a moral nature -- the idea that younger people should pay less because they are healthier, and conversely that older people should pay more.  This is where people are simply not like cars -- cars are property and you should pay more when you choose to buy more, but most of us accept that people are something very different, and that we should value those of all ages.  Do we really expect 20 year olds to pay less than 40 year olds and that they in turn pay significantly less than 60 year olds who in turn also pay significantly less than 80 year olds?  I think most of us do accept that such a system would be very wrong, not to mention a system like that would affect you personally soon enough as you age since before long you would find yourself making far less money each year due to increasing insurance costs.  Now that's not to say that some differentiate cannot be made on other bases, and indeed they already are -- for instance, you will pay more if you are a smoker seeking personal coverage, although you don't typically see that difference in corporate group plans -- and that may be something you can debate.  Actually, even in those cases there are some pretty valid statistical reasons to ignore such things in group plans since the whole point is that groups are more statistically balanced and therefore can be insured for cheaper, but I agree you can debate some of the finer details, and some companies do in fact acknowledge such issues with differences in costs.  Anyhow, I would hope that you reconsider your statement that you should pay less than your co-worker that is taking chemotherapy drugs, and note that I left off the "older" part since you're making a very big assumption that cancer only affect older people.

While my wife may be a little older than you, she's not that much older, and its only a matter of "luck", or divine providence depending on what you believe, that she got cancer and you did not.  I'm sorry if that's a little too personal, but can health insurance really be discussed without talking about real people and how it affects their lives.  Yes, my wife was diagnosed with *** cancer about 1 1/2 years ago, and the various types of cancer can hit just about anyone at any age.  My wife had 8 rounds of very expensive chemotherapy, along with the very expensive drugs that accompany it, followed by 5 weeks of very expensive radiation, followed by very expensive surgery to remove the cancer, followed by yet more surgery for reconstruction (which will still have further minor surgeries).  We had good insurance, but we still paid over $15,000 for our share of medical expenses and insurance, on top of all the lost pay that my wife incurred after she used up all her paid leave, and I'm pretty sure the insurance paid more than $100,000 of medical expenses -- and those estimates don't yet include the ongoing costs this year.  I don't think my wife anywhere near as bad as the 1 in 100 case, although she may be worse off than the 1 in 10 case, but insurance must statistically accomodate all types of cases, and I know quite a few people of all ages and genders affected by cancer and heart problems.  I'm also aware of the much bigger problem since I hear about a lot of these people from my wife since she is a nurse -- there are many stories of the very young affected by serious and expensive problems that could just as easily be the young and healthy young man that you believe you are today.

Again, I do agree there's a problem with the system, and while I have my own ideas on how it could be better I can also readily admit that there are many possible ways to improve the system.  I just hope that we as a country get brave enough to get out of the politics to try something, as long as its reasonably fair and doesn't put the burden on those that are sick, older, or poor -- because we have to be moral as well as fair.  By the way, to add more personal perspective, my wife and I have also had to pay more than our fair sure of expenses in three very common cases where insurance did not pay anything at all -- definite proof that things need reforming.  The first case was that my mother-in-law was hit with early onset dementia, and while she did have very good insurance, it seems that the inability to take care of oneself is often not considered a medical condition.  That left us as caregivers at first and eventually paying out of our own pockets for an "assisted living" home, and since we were young and short on money ourselves we could not afford a real nursing home or assisted living home, so we still have nightmares thinking about how we forced her to live out her last few years when we were no longer able to care for her.  Next, during that same time frame, we found out that we were unable to naturally have children, so we took part in several rounds of fertility treatments, which insurance did not cover (some plans do, but of course those employers pay more for that).  By the way, please note that I am not even talking about the most expensive types of fertility treatments, as we could not afford those and since we decided it better to adopt at that point, but we still paid a heck of a lot of money out of our own pockets.  Finally, we did adopt our two children, and while it sounds terrible to talk about such things in monetary terms, lets just say that cost us a pretty penny which set us back financially for several years since we were already short on money from the other problems.  Note that while I agree that adoption is not a medical expense, its still fair to discuss it in the overall conversation since we effectively saved our insurance company from the very real medical expenses that would have been incurred with two pregnancies and childbirths that everyone else with insurance gets.

I realize that's a lot of very personal stuff, and my point is not to make you or anyone else feel sorry for me in any way -- my point is that even young and healthy people can have expensive medical problems.  I'm also trying to point out that I agree that our medical system does need some type of major overhaul, since the expenses are both spiraling too much out of control, and since many times even very common problems fail to get covered.  Finally, I've learned something else in my experiences, which is why we must bring the personal into these discussions -- and that is that the young and healthy don't even have a clue how many people around them are affected by these types of things.  I have met many people that have had cancer in the last 1 1/2 years, and heard stories of many more that are in people's families that I have met, and yet these people would never tell someone like yourself (young and healthy) about these experiences.  Sure you know academically that many people have cancer, and you probably even know some affected, possibly even in your own family, but I would bet that you fail to see how truly common it is until you or someone very close to you enters that world.  And the same thing is true of dementia, infertility, and adoption -- it amazes me how many people I personally know that have experienced one or more of these thing, and again I would bet that you fail to see how common these things are.  I'm sure the same thing applies to me also when it comes to the many health conditions that I don't have personal experience with -- some of them I'm aware of academically since I'm well read and since my wife tells me about people she see's as a nurse, but I'll never really know.  So the next time you're thinking that you pay far too much for medical insurance, directly or indirectly, since you are young and healthy, instead consider how lucky you are to be young and healthy -- and while you won't stay young for long, I do hope that you will lucky enough to remain healthy.

Oh, and for KDR, I can't speak about the rest of the health industry, but I don't know any nurses getting rich.  Nurses are often verbally abused by both patients and doctors, and they work in severely under-staffed conditions and get little respect from the hospitals that employ them.  They also have very physically demanding jobs (half the nurses I know end up with back and/or foot problems), are exposed to all sorts of sicknesses, and are lucky if they even get to go to lunch or get a bathroom break.  There also seems to be one or two terrible co-workers on every unit that makes everyone else's life a living hell, but those people are never dealt with by management that is more concerned about staff shortages, even though its often those same rotten co-workers that are actually causing some of that very shortage.  Nurses certainly are getting paid better than fast-food workers, so I don't mean to imply poverty, but they certainly aren't getting rich, and they certainly ought to make a lot more money for the crap they have to put up with, but they are the bottom of the totem-pole and therefore disposable and/or interchangeable as far as the decision makers are concerned.  By the way, unrelated, but I think the same could be said for teachers -- they aren't living in poverty either, but they deserve a whole lot more than they get for the crap that they have to put up with, and yet society tends to not value them very highly either.

This is a very interesting topic.

If you look at the statistics huge portions of the money are ending up in the hands of trial lawyers. Of course companies are using 4000% mark ups when if there is a problem with their service/medicine they get sued for hundreds of thousands of times the fee renderred.

Socialized health care has driven down the costs of care in many nations but I do not believe it was actually the socialization of health care that actually caused the effect. Tort reform is a necessity when socialized health care is implemented as it suddenly becomes the government's money that is being hit as opposed to the consumers.

"So who is left?  Doctors, Nurses, medical supply companies, hospitals, drug companies, Medical staff, pharmacies, etc....these are the people making billions of dollars every year. "

How about the trial lawyers? They are the ones making huge amounts of money.

Check out http://www.atra.org/

I agree with you to a point and most hospitals in our area are not-for-profit (just an FYI). I completely think it's BS those without insurance are expected to pay far more than what an insurance company gets away with. At the same time, probably only 20% of those people actually wind up paying and it eventually goes to collections or gets written off. In either of those cases the hospital usually never sees the money. It's really a lot more complicated than that but I'm not qualified to explain in detail as I just have a high-level understanding myself.