Re: An example of unexpected medical bills
 

Pre-ACA 75% of bankruptcies were due to an inability to pay medical debt. Don’t know what the current figure is.

As for declaring bankruptcy good luck on that if you have anything but a small amount of assets. It’s a very effective route for the assetless though...

And what a stupid system whereby every unpaid bill contributes to the cost of those that can. At least with single payer systems the vast majority are making a contribution to medical costs.

Re: An example of unexpected medical bills
 

A stupid, inefficient and heartless system. Quite annoying those who try to defend the system generally those with money or good private health care. While I am not a knee-jerk anti-Republican ( or anti-Democrat for that matter), it is quite unbelievable the opposition to Obamacare without proposing a viable alternative.

And even some programs in place, such as Medicaid, have severe limitations- specialists who refuse Medicaid patients, or drugs etc not covered. I find American doctors often very obnoxious at their heartless disregard of those in need.

Re: An example of unexpected medical bills
 

Sorry but as a physician myself disagree with some of the points on here. Every hospital has a plethora of options for dealing with medical bills - charity care, emergency medicaid emergency this that blah blah

Bizarrely in a lot of hospitals they give charity care to illegals!!

Also all hospitals have on call specialists that have to see everyone with or without insurance. Frankly medicaid is a good deal zero copay on ER and most meds. A lot of expensive meds are frankly a lot of hype over benefit thats why insurance doesnt cover and forces generics.

In my experience these bills never get paid massive amounts get wrote off, what insurance pays doesnt cover the hospital costs thats why a lot go under. People need to have rational expectations here putting grandma who is 95 on a ventilator is total waste of resources yet happens so often here is a tragedy :(

Re: An example of unexpected medical bills
 

One area I agree with you is the medical care for illegals, I was astonished to find out-when helping doing some translation work for some illegals- that the hospital offered free medical care at the hospital and local clinics owned by the hospital for any medical care within their system and prescriptions something I never could have received under the same terms. The ONLY support they had to provide ( and asked for with a wink) was a copy of a paystub ( which was never verified). So it was learned very quickly by illegals ( I don't blame them) to get a paystub one way or another.

Try being the recipient of collection actions by hospitals and doctors either directly or through their collection agents. If doctors had to go through that for one day they might appreciate how messed up the current system of health care is. A very high percentage of bankruptcies in America arise from hospital bills.

Or try having a chronic illness and only place for medical care is the emergency room. Or having Medicaid and find out it doesn't cover the prescription needed, or having Medicaid and doctors refuse to treat you because they don't want Medicaid patients. Or the disrespect at doctor's offices can show when they see someone has Medicaid and not private insurance.

I agree there are often more options than people are aware of, but overall it is a heartless and inefficient system- and maybe if many working within the healthcare system had more empathy what the working poor have to go through there would be more impetus for change, and less resistance by the health care industry.

Re: An example of unexpected medical bills
 

Yeah and statistically you are also most likely to be sued by medicaid patients sad to say so there are also other reasons some wish to steer clear of them they also tend to have complex multi system pathology that hasnt been managed well over the years multitude of factors really

Re: An example of unexpected medical bills
 

With all due respect, those are excuses for the apparent lack of empathy and disregard for the lower classes that many find obnoxious in doctors and hospital administration.

I agree though that tort reform , as well as cost control, are both necessary. But doctors do well regardless, while many people do not get adequate medical care. Turning away Medicaid patients who may have no where else to go is hardly a decent system. The rural area I lived I knew a Medicaid patient who had no car, and there was no busses available, might have to go 30 or even 50 miles a way to find a doctor who would see them. I knew another who lost their insurance after a doctor performed an operation, the person just needed a simple post -operation review - the person then switched to Medicaid and the same doctor refused to make an appointment because he didn't take Medicaid patients- it took threatening a lawsuit for a follow up appointment of 16 minutes, and then the doctor sent a bill for $250. Just anecdotal evidence, but this type of experience is had all over the country.

Re: An example of unexpected medical bills
 

Bottom line is that those able to pay end up paying one way or another, or the taxpayer ends up with the bill.

So let's ignore the poorest and sickest when it comes to health care access. Great system!

Re: An example of unexpected medical bills
 

from my inpatient experience as a clinician i can say that everybody has been treated equally regardless of ability to pay or status (legal or otherwise) it would be highly illegal to do otherwise with federal law such as EMTALA etc in place

Re: An example of unexpected medical bills
 

You’ve already acknowledged that many doctors don’t accept Medicaid patients. Ergo, your point is meaningless.

Re: An example of unexpected medical bills
 

In an outpatient setting you can refuse I was talking about in patient care where you cannot refuse anyone (!) read my comments first i.e the bit at beginning saying 'inpatient!!' then proceed please

so clearly my point makes a lot of sense if you care to read the whole sentence clearly that is beyond your cognition

Re: An example of unexpected medical bills
 

Huh? The comment you responded to with your "inpatient" experience very specifically was a general comment about access for the poorest and sickest. So saying that there can't be inpatient discrimination is, as I pointed out, essentially meaningless given you've acknowledged there can be for outpatient. No wonder that the poor, as you point out, "tend to have complex multi system pathology that hasnt (sic) been managed well over the years".

Except it doesn't. Too bad you have to resort to insults though.

Re: An example of unexpected medical bills
 

Like wise clearly go read EMTALA law which applies to 'inpatient care' only making any 'in'patient discrimination of care illegal if there was then frankly hospitals could turn people and ambulances away at the door but they dont! Get it? clearly not

Re: An example of unexpected medical bills
 

I certainly don't "get" how a lack of inpatient discrimination against Medicaid patients means that there isn't discrimination against Medicaid patients in general - in fact, you've already acknowledged that there is, making your point about inpatient care moot.

I would also point out that emergency rooms are only required to "medically stabilize" patients, nothing more, nothing less.

Re: An example of unexpected medical bills
 

So you acknowledge that doctors and clinics can, and from personal observation do, refuse Medicaid patients - and in many parts of the country, again from personal observation, it can be difficult to get to a doctor who does accept Medicaid patients due to the distance involved and transport issues. Then to add insult to injury, it is not uncommon- and maybe something as a doctor you haven't closely observed- how Medicaid or poor patients are treated by front office staff. Then on top of that you gave a reason that due to the nature of Medicaid patients , doctors may shy away from treating them- not sure but sounds like justification to me, and quite abhorrent that the typical well-off doctor can sleep at night with such an attitude especially as I suspect a great percentage of doctors have had their medical school training funded by the taxpayer.

As far as discrimination once a doctor accepts a patient, you may be completely right though your comments and those of other doctors I have come across do tend to raise the question (a) of how n general they consider the poor and working poor and whether this effects their attitude and treatment (b) whether the type and amount of reimbursement may affect treatment. I can also say from personal observation that if one changes or loses one particular insurance during treatment, it can be problematic further treatment by the doctor for on-going treatment.

Hospital emergency rooms only need to medically stabilize the patient, so the idea often expressed hat everyone in he end can get medical care they need is quite untrue in America. My understanding about Obamacare was the rationales for it was it would reduce the cost of all the people going to emergency rooms because they couldn't afford to see a doctor- whether the statistics show his or not I don't know. Then again from my own personal experience and others I know, the premium increases during the period of Obamacare made insurance unaffordable to many. Compounding the issue, high medical insurance premiums, driven by what many including myself consider outrageous medical costs, made some companies shed full time workers and hire from temporary agencies to avoid providing medical care- and the agencies simply raised the workers premiums they had to pay that often it is completely affordable to have medical insurance even if working full time.

The system is immoral , stupid and terribly inefficient. Roughly the US spends 17% of GDP on medical care, in the UK with the NHS ( and not uncommon private insurance schemes) the total is around 10%.

It may be that having lived in two rural areas in America that my experiences and observations not applicable to the West of East coast, but I was appalled by the system I observed and its effect on the poor and working poor. And for drug addicts seeking to get off their addiction, the system is woefully inadequate- I knew one person seeking to get off an addiction who was on Medicaid. The only doctor who would give her the required treatment under Medicaid and prescription, was 50 miles away ( and three hospitals in between and multiple clinics), and no public transport ( she didn't have a car at the time) - then Medicaid wouldn't cover the prescription ( which was $10 a day at a "free clinic" 50 miles in the other direction). And some former addicts would end up stealing or other activities to pay not for drugs but the prescription medicine to get them off the drugs ! I also observed mothers who from a middle or upper class family ( or doctor's family) could routinely take their children to the doctor when necessary or they felt like ( I admit many mothers take their children to the doctor at the drop of a that), that the poor or working poor didn't have that "luxury".

So please perhaps consider the people less fortunate than the doctors and other medical personnel simply do not have reasonable access to medical care in America. Any doctor or politician who justifies the current system , or their own lack of concerns for other human beings perhaps should re-evaluate their opinions and actions.

Re: An example of unexpected medical bills
 

@morpeth any high risk case a doctor is going to think twice because quite simply the liability involved in this country means that one bad result is career over and that applies to any insurance.

'great percentage of doctors have had their medical school training funded by the taxpayer.' completely untrue most dont get a cent and given the average debt of a US grad going through medical school is $300k+ is testament to that and drives up the type of fields they pursue (procedure driven etc) to simply pay the debt back

'Hospital emergency rooms only need to medically stabilize the patient' this a gross over simplification that in reality no clinician thinks about because to stabilize a patient in most instances involves resources beyond the ER e.g the OR, MICU, SICU, cardiac cath lab. Also due to those people called 'lawyers' saying I only had to stabilize them isnt going to cut it when things go wrong afterwards and the multi-mill $ lawsuit hits your doormat.

Have never worked rurally here only sticking to cities on the East its hard to get an idea of what goes on there. But there are a dime a dozen jobs in these places that offer doctors $400k plus and yet no doctor wants to touch them so go figure :(

Also easy to forget what is going on across the pond but given that most hospital car parks there are turning into ambulance parking lots with hospitals constantly on alert the system there is broken too but perhaps for different reasons