I did see #26 and considered it carefully before posting.
I have in-laws who are doctors and nurses and a wife who worked as an operating room clerk. I have heard plenty of horror stories about patients who could not pay and insurance companies that would not pay legitimate and supposedly covered charges.
Providers that stay in operation simply must raise rates to do so. They have to pay a large administrative staff to keep on top of the ever-more complex insurance claims procedures.
I have listened to plenty of bitching about $100,000 charges that were settled for $5000 rather than spend ten years fighting the insurance company in court.
That is why you can offer cash up front and sometimes get a 50% discount.
There is at least one national provider that lists their prices openly for major surgical procedures - paid in advance. Those prices are at 80% discount from the after-the-fact billings done by regular hospitals.
I would stand by the assessment that the "Health Insurance" system is what is driving medical costs up at uncontrollable rates. It's not an "Insurance" system. Its a "sticking someone else with the bill" system.
Certainly not arguing about over-billing by a doctors office or hospital to recover as much as they can due to non-payers (patients and Ins Co's alike) as I demonstrated that in one of my posts above.
Not arguing discounts or the ability for cash paying patients to negotiate discounted rates rather than full list price.
What I think we've been debating is "who pays for the non-payers?" I highly doubt your doctor and nurse relatives interact with a hospital's billing systems and deal with recovery rates as my friend's wife does, as she runs the billing department at the hospital. I can only relay what she's told me regarding non-payers at the hospital she works.
I don't think either of us can make broad based statements about what the hospitals or doctors offices on a larger scale are doing as a whole. Raise rates yes, how they handle write-offs due to non-payers probably not.
BTW, when you're in the hospital ER, you do know that after you sign the form that states you're liable for financial payment you receive treatment. The nurses and doctors don't know what your medical emergency is until they examine and treat you.
That information then put into the hospital's computer systems and a bill is generated, which you're expected to pay on your way out the door.
If you've provided proof of health care coverage, you're all set once a co-pay is made, assuming that's required.
The people who fall thru the cracks are those who sign the form and present credit cards or state they'll pay cash on the spot.
They still get treated based on the policies of the hospital, and receive their bill at the end like anyone else.
When you get to the end of the process and the patient states they don't have enough money or the amount charged to their credit card doesn't clear THESE are the people who end up either not paying at all, negotiate a lesser rate (after the hospital's billing staff spends considerable effort tracking them down) or pay the amount due in total.
Those WITHOUT INSURANCE who actually pay the full amount are a very, very small number. It is far more likely that the hospital will have to write off a significant part or ALL the bill if the patient is a complete deadbeat or indigent.
IIRC, your argument is those paying "list price" are subsidizing those of us with insurance, and that insurance is a scam.
My point based on the one source I have on this matter is that the people who end up paying full price out of pocket is such a small number, that it's not possible that they're subsidizing those of us with insurance.
My point is in-fact the exact opposite, that inflated insurance bills (as I demonstrated in a previous post using actual dollar amounts from my own recent experience) are actually one way Hospitals and Doctors try and recover for lost revenue due to those who are uninsured.
We both agree health care insurance is a scam. I think the rise of concierge medicine or Immediate Care Centers that don't take insurance and require cash/credit card authorization before treatment such as the one I used when I broke my elbow are going to fundamentally change how we receive and pay for our healthcare.
The example I made in a previous post on this thread where an immediate care center that did not accept insurance (cash/approved charge only) charged me only $79 for 5 X-Rays vs. my Orthopaedic doctor's office which charged $200 to do 4 X-rays.
The difference between the two was that one did not accept insurance and the other did. The one that does has to jack up their rates and pay for a staff to chase down payment from all the different insurance companies who have their own rules and billing codes before a payment is made for services. I got that invoice from my insurance company yesterday in the mail. Doctors office billed $200 for 4 X-rays. Insurance paid $119. Note that's higher than the Immediate Care center that charged me $79 for 5 X-rays the night I fell and shattered my elbow.
Yes, insurance is a scam, but they're not the only ones participating in the scam, and you can't hold them solely responsible. There are multiple actors here including doctors and hospitals who inflate their rates, as well as the uninsured who incur alot of loss in the health care system. (Especially in Emergency Rooms where the cost of care is the highest!)
It's taken me almost 30 minutes to type this with my left hand since my right arm is still in a full arm cast, shoulder to fingers. I'm kinda done typing for the day. :-)