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What’s wrong with the health care system?

I don’t know, but I can offer one strange symptom.

A friend showed me the receipt from his HMO. He had gone for a test recommended when one passes age 50, and received the statement advising his copay. The bill from the hospital was $1200. The HMO allowed only $200, and so they paid the hospital $180, leaving my friend with a $20 copay. What’s wrong with this picture? If someone with no insurance received the same test, they would be stuck with the original $1200 bill. Worse, they might not get tested at all, and potentially face a life threatening illness that could have been avoided.

I’m used to seeing HMOs discount a $150 doctor visit to $120 or other bills reduced by 10-30%, but this just seemed to be over the top. I don’t have the answers on this issue, I just recognize the system is broken.

  • DG in BigD January 29, 2008, 4:26 pm

    Very true. I switched jobs and my medicines were twice the amount for the same pills without insurance as with insurance and I haven’t met my deductible. It’s a joke.

  • Ken September 14, 2009, 9:36 pm

    One does not realize that 1) Employers pay health care costs directly but indirectly; and have insurance companies fight and account for those health care expenses for those companies. My employer uses a Blue Cross plan to minimize its health care costs then pays Blue Cross a fee for that service and a fee for reducing that very same cost. 2) An employer or pool of employers, pays a hospital or health care group or doctors, a predetermined annual amount to preform a guaranteed amount of services for an agreed amount of patients. e.g. The example above. The test may very well have cost $1200, but it may have been part of the agreed upon service that was to be provided by that provider for $1000 as part of the annual fee. The remaining $200 was treated as normal expense and required a co pay. The interesting part to all of this is when a couple both have same but separate health insurance plans to different employers, and because of the birthday rule, the same service is paid different amounts because who covers it first.
    Ultimately it all boils down to this: There are always going haves and have-nots; and the haves are always going to be overcharged so they can pay for the have-nots. Doesn’t matter if it’s the present system or Obamacare or Hillarycare. What does matter is the ultimate cost in 1) dollars, 2) cuts in services,3) choice of doctors, 4) choice of care or treatment and 5) use of personal or public money.

  • JOE September 14, 2009, 9:46 pm

    Ken – thank you for your comment. I can’t argue against anything you wrote, I think you understand the issue(s) pretty well.

  • Elle September 16, 2009, 10:46 am

    The reply here was detailed and of sufficient length that I posted it as The State of Healthcare.

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