It comes down to this: people who can't afford health insurance don't get any. People who can't afford health care get it anyway when life or limb is on the line.
Insurance companies generally make decisions when all is relatively calm. Even a time of crisis for an insurance company is a slow-motion crisis, such as deciding whether to cover on-going cancer treatment. It lacks the urgency of a bullet hole to the chest, for the insurance company if not the patient.
Rarely, if ever, do people writhe, retch, seize, or bleed on an insurance company's floor. But they do exactly that in ambulances, ERs, and ICUs every day. Insurance companies enjoy the luxury of saying 'no.' Hospitals do not.
My lab, and my practice, are located in Griffin Hospital in Derby, CT. Griffin is a Yale-affiliated, not-for-profit, community hospital. It is also a model for its industry, with no offense to any others that are as well.
Griffin routinely achieves almost unprecedented marks for patient satisfaction; it routinely bests its peer group for clinical benchmarks; it has, traditionally, done well financially; its inclusion among Fortune's '100 best companies to work for' has become little less than an annual tradition; and it is the international headquarters for Planetree, an organization dedicated to patient-centered care that routinely attracts delegations from around the world to see how it's done. Not too shabby for a fairly small hospital in one of the smallest cities in one of the smaller states in the US.
But my hospital -- my well-run hospital -- is now hurting. Confronted by the recession that we all know is a difficult burden, and the failure to reform health care which some but not all of us recognize as fiscally toxic -- my hospital is hurting. I am confident Griffin will weather the storm successfully. But the challenges and strains are considerable, and undeniable.
Leaving aside this particular patient and its particular prognosis, let's talk about the pathology. Our health care system is what's sick. The rest is just the inevitable contagion that occurs when a spreadable malady is not treated at the source.
Those writhing, retching, seizing, bleeding patients get treated. Thank goodness, despite the egregious deficiencies in our approach to healthcare, for all that make us the stand-out disgrace among civilized countries, we don't just leave people to bleed in the street. Our common humanity kicks in, and they get treated -- even if they have no insurance.
They get treated if they are poor. They get treated if they are not poor, but self-employed and uninsured. They get treated even if they are unemployed. They get treated if they can't afford their co-pay or deductible. They get treated even if the charges will drive them to bankruptcy. They get treated in an emergency no matter what, and the bill comes later.
But when it does come due, it doesn't get paid. So hospitals -- which have to say yes when insurance companies say no -- simply have to absorb those costs. In what other industry do you have to provide services to those who can't pay for them? How can healthcare be treated like any other 'commodity,' when its 'manufacturers' are obligated to give it away for free?
Hospitals may try to pass their unpaid bills on to the rest of us by charging more for their services than they otherwise would. These charges are passed along to insurance companies which, of course, pass them back to us. Are you worried about paying for the care of the uninsured out of your taxes? You are paying for that care right now out of your insurance premiums.
And, since the uninsured and under-insured don't seek discretionary care, but rather wait until they have no choice because they are in a real crisis, the care you (and I) are paying for is ... lousy. We pay to manage a crisis that need never have occurred if only earlier, discretionary, preventive care had been provided. But that doesn't happen, because nobody is paying for that. So the uninsured and under-insured wait for a crisis -- and the huge bill that comes along with it. And then all of us pay that bill.
It's a tax, but not called a tax. It's a tax over which we have no control, a tax not subject to our vote, a tax that is insidious, invisible, and unidentifiable. And, it's a tax that pays for the worst possible kind of care -- crisis intervention for preventable crises. And, yes: it is taxation without representation (unless you have a friend on your insurance company's board of directors who cares about representing you).
Remember the direct cause of the original 'Tea Party' in Boston? Taxation without representation! Health care premiums bloated by the unpaid bills of the uninsured are a tax, and you are paying it now.
For better or worse, insurance companies have more than one means to deal with hospital charges. They can, up to a point, pass those expenses on to us. But their other option is simply to refuse to pay them in full. Hospitals charge Y, and insurers pay X. Once again, hospitals are left to absorb the difference. Why? Because they don't have the luxury of telling a patient retching, writhing, seizing, bleeding up to 'Y' to just knock it off when they get to 'X.' "You've met your insurance company's quota for hemorrhaging -- stop bleeding now!" doesn't seem to work.
The so-called health care system in this country is a travesty, a daily violation of human rights, a quintessential example of taxation without representation, a farce, a tragedy, a national embarrassment. It kills people daily. Sometimes, it also kills hospitals. And if it kills a hospital that was doing a good job, it kills even more people.
If you are worried about taxes and the costs of health care reform, you should ask yourself for whom the current unpaid healthcare bills toll. They toll for thee.
Dr. David L. Katz; www.davidkatzmd.com
Follow David Katz, M.D. on Twitter: www.twitter.com/DrDavidKatz
I have spent a 13 hour day infusing enumberable units of blood into a man and not once was I asked to consider if he had insurance as you mention in your article but...........what the world does not know is to get Medicare funding hospitals are slaves to The Joint Commission.
As a Registered Nurse of 19 years I have seen the system transform into a charting machine while basics of care go unattended. The Joint Commission has added many hidden costs into the system intstituions create entire departments just to remain in compliance with 'their' standards. When the day is done a bedside care provider will be reprimanded for not charting while the patient goes unturned, unbathed, and unattended to. Medicare has made the fiscal decision not to pay for Hospital Associated infections (HAIs) while The Joint Commission sets standard of care by adding hours of charting. Joint Commission hog tied their most valuable resources of quality to a computer and Medicare states they will not pay for lack of quality.
Pricedoc.com is a new company that offers discounts for a huge number of medical services for the uninsured or underinsured patients for cash payments. Hospitals are also able to list their services, and collect the income up front. This does not always work in emergency situations, but can help recoop lost revenue sources. Check it out and keep writing.
kari
Michelle Obama is the one fighting the bigger more important fight with her campaign to reduce obesity in children. This needs to be expanded to everyone in America. Because if you still have 2/3 of Americans who are overweight and sick you still have a healthcare crisis regardless of the legislative fixes you put in place. To learn more and to find specific resources we can all use to make an even bigger impact on our nation's healthcare system please read my article on healthcare reform below. It turns out that we all individually have much more control over what happens about this issue than we think.
A healthcare professional's view on health care reform - http://bit.ly/9QLV8
http://graciouslivingdaybyday.com/
"This is what change looks like"
Way to go dems, I knew you had it in you..
It is also an undeniable argument for single-payer.
Thanks.
Problem solved.
a hospital without a picture ID such as a driver's license.......lots of hospitals
even take your picture when you check in.......
This bill is a GIANT STEP BACKWARDS, much worse than no bill at all because it strengthens rather than loosens the chokehold of the very profiteers who have plundered the system into chaos and dysfunction.
The benefits for the insurance industry are numerous and ironclad: a conscripted “market” of tens of millions of Americans who are now forced to buy their extortionate, gap-filled, lousy policies—the kind that drive so many families into bankruptcy with their deductibles, copays, and coverage gaps—all with no limits on price gouging .
There is not one “benefit” of this bill for ordinary Americans that is not riddled with loopholes http://www.huffingtonpost.com/jane-hamsher/fact-sheet-the-truth-abou_b_506026.htmll).
SYSTEMWIDE health-care costs, already bleeding the economy white, will continue to skyrocket--the CBO estimates apply only to costs to the federal government, not the costs to consumers and to the economy as a whole. The estimated savings of $13 billion a year are a droplet when you consider that Medicare for ll would save $400 billion per year--$4 TRILLION over ten years!
20 million Americans will be left with zero coverage.
This bill is a reactionary horror.
See this Bill Moyers interview with Dr. Marcia Angell of Harvard:
http://www.pbs.org/moyers/journal/03052010/watch3.html
MEDICARE FOR ALL NOW
So we find ourselves farther from real reform now than if we had had no bill.
Do you understand this? I have my doubts.
http://fdlaction.firedoglake.com/2010/03/19/fact-sheet-the-truth-about-the-health-care-bill
Excerpts:
Bill is almost identical to the plan written by the insurance company trade association, in 2009. The original Senate bill was authored by a former Wellpoint VP. Since Congress released the first of its health care bills, health care stocks have risen 28.35%.
The bill will impose a financial hardship on middle class Americans who will be forced to buy a product that they can’t afford to use:
A family of 4 making $66,370 will be forced to pay $5,243 per year for insurance. After basic necessities, this leaves them with $8,307 in discretionary income — out of which they would have to cover clothing, other debt, child care & education, in addition to $5,882 in annual out-of-pocket medical expenses.
The bill is neither universal health care nor universal health insurance:
CBO:
* Total uninsured in 2019 w/no bill: 54 mil
* Total uninsured in 2019 w/Senate bill: 24 mil
Excise tax will result in employers switching to plans with higher co-pays and fewer covered services.
This bill does not bring down costs and leaves out nearly every key cost control measure, including:
* Public Option
* Medicare buy-in
* Drug reimportation
* Medicare drug price negotiation
* Shorter pathway to generic biologics
Older, less healthy employees with employer care will be forced to pay much more in out-of-pocket expenses.”
This is an example of the disparity in cost of EVERYTHING between the USA and the rest of the world. Devices, equipment, drugs, everything cost double here. The reason for this is that they CAN charge that much. No one seems to care about the price gouging. In fact some legislation makes it illegal to import cheaper (though otherwise identical) drugs from abroad. They spout a lot of B.S about not being able to guarantee quality, but it is just B.S. since these drugs are produced and sealed in the US. They just get a smaller price that way.
I would like to see legislation that would allow importation of any device, equipment or drug as long as the identical thing is more than a small (maybe 10%) increment above domestic price. This would put a downward pressure on prices instead of gouging us so badly.
All my life growing up, I heard people say things like "if you don't vote, then don't complain about anything the government does." I never thought too much about it because I registered to vote as soon as I turned 18 and I do vote, but it's true. That more that a third of eligible voters in the United States couldn't be bothered to vote in 2008 is disturbing. I wonder how many of them are Tea Partiers and Oathkeepers or or members of various other groups of malcontents.
Here's the list;
http://www.washingtonpost.com/wp-srv/special/politics/votes/house/finalhealthcare/?hpid=topnews
There is total absence of humility from this testimonial. A screaming silence on what is obvious. Doctors refuse to disavow fee for service, as doing so would shift the burden of coverage from the patient to the hospital. If hospitals disavowed fee for service, the burden of coverage would be shifted to government, and insurance companies would soon disappear. Why then, does the doctor seek to distance himself from those who are responsible for our evil health care system? I suspect it all comes back to his personal greed, at the expense of his patients.
Not sure where you found self-righteousness in this assessment of the interactions between hospitals and insurers, but the presumptuous leap to that conclusion looks rather like a 'total absence of humility' to me.
Colleagues and I, in fact, published a model last year in the Annals of Internal Medicine that provides one potential 'fix,' a reconciliation of those aspects of health care that are fundamentally a human right, and those discretionary aspects that may more reasonable be treated as privilege, or at least a commodity to be purchased by those with the means. See: http://www.hpfhr.org/
As one not inclined to make perfect the enemy of good, I favor the current bill as an initial step in the right direction. The rest of the journey will follow, but must begin with this first step.
This bill is much worse than no bill at all because it strengthens rather than loosens the chokehold of the very profiteers who have plundered the system into chaos and dysfunction.
The benefits for the insurance industry are numerous and ironclad: a conscripted “market” of tens of millions of Americans who are now forced to buy their extortionate, gap-filled, lousy policies—the kind that drive so many families into bankruptcy with their deductibles, copays, and coverage gaps—all with no limits on price gouging .
There is not one “benefit” of this bill for ordinary Americans that is not riddled with loopholes http://www.huffingtonpost.com/jane-hamsher/fact-sheet-the-truth-abou_b_506026.htmll).
SYSTEMWIDE health-care costs, already bleeding the economy white, will continue to skyrocket--the CBO estimates apply only to costs to the federal government, not the costs to consumers and to the economy as a whole. The estimated savings of $13 billion a year are a droplet when you consider that Medicare for ll would save $400 billion per year--$4 TRILLION over ten years!
20 million Americans will be left with zero coverage.
This bill is a reactionary horror.
See this Bill Moyers interview with Dr. Marcia Angell of Harvard:
http://www.pbs.org/moyers/journal/03052010/watch3.html
MEDICARE FOR ALL NOW