Private healthcare in the US - a question

[ss957916]

As the majority of people on these boards are American, I thought this'd be a good place to ask.

My understanding is that, in the US, one needs health insurance if they don't want to pay massive bills upon getting ill.

But, if someone gets ill/is involved in an accident etc., and finds themself in hospital - what happens if they have no money nor any insurance? Does the hospital simply turf them back onto the street and leave them to die? I can't believe that's true but... what does happen?

 

[glocke12]

I believe it is against the law here for a hospital emergency room to turn away an injured person. So no, people are not turned away.

Also, as someone who went a good ten years w/out health insurance I have found the following to be true in many cases.

1) If you are injured and without insurance, and are able to prove that you cant pay your medical bills, the hospital will "write off" a significant portion of your bill. This does not apply to private practiconers though.

2) There are also many clinics available that will provide healthcare at reduced costs to those that are of meager resources.

 

[bamaworks]

Coming from a medical professional they get treated just like a patient with insurance and then are billed for it later after the cost is underwrited, and most of the time the patient refuses to pay and the hospital eats the cost of the treatment and the patient's credit score takes a kick in the face...

 

[glocke12]

and most of the time the patient refuses to pay and the hospital eats the cost of the treatment and the patient's credit score takes a kick in the face...

I think in some areas there may be different programs available to people who cant pay. This was 20 years ago for me, so the details are murky, but in my case I had a bill of several thousand dollars. The hospital said they had some kind of "special program" for low income people, and most of my bill was written off. I think I may have ended up paying something like $40.00-$50.00 a month for a year or so to take care of the rest...If I wouldnt have paid that off it would have shown up in my credit score.

 

[anjinha]

Legally hospitals only have to "stabilize" you, not necessarily treat you.

 

[scottkifnw]

Not so

Sick people get treated, not streeted. If they are acutely ill and unstable, and without money/insurance, they get treated locally, and when stable, usually get transferred to a county hospital. If they can't pay, they can't pay.

Anyone with insurance (except in perhaps a few cases) will tell you that insurance is hugely expensive, and you still get huge copays and deductibles. Get sick/injured, go to the hospital, you get big bills. The insurance companies get rich, we get screwed.

The problem with the health care bill is that the politicians got it, jacked with it, and it is a terrible. The quality of health care will sink, the costs to most Americans will go up, the quantity of care will go down. Essentially, the standard of care will drop to the level of Medicaid (not Medicare which is much better). Doctors have been scapegoated as fat cat rich guys. Payments to them will also likely drop. Job satisfaction has dropped as law suits have increased along with paper work. Look for many of the best doctors to retire early, and others to just find other things to do. So, if the "reforms" pass things look grim.

sek

As the majority of people on these boards are American, I thought this'd be a good place to ask.

My understanding is that, in the US, one needs health insurance if they don't want to pay massive bills upon getting ill.

But, if someone gets ill/is involved in an accident etc., and finds themself in hospital - what happens if they have no money nor any insurance? Does the hospital simply turf them back onto the street and leave them to die? I can't believe that's true but... what does happen?

 

[GuyNextDoor]

In an emergency situation, hospitals are legally obligated to provide the minimum care necessary to stabilize the patient, but not necessarily cure them or restore their health to anything approaching whole. They are not required, and in the case of for-profit hospitals will never, provide the same level of care that an insured (or wealthy) person would get.

For example, if an uninsured person is brought to the emergency room with a condition that has cancer as it's root cause, the hospital will treat the immediate symptoms, but is not obligated to provide surgery, radiation or chemo-therapy. That person may receive medication to dull their pain, but in the end, will be sent home to die.

This is exacerbated by the fact that, without health insurance, many people have no access to doctors before the emergency room is needed; thus, many conditions that might have been headed-off in a more treatable state (infection, diabetes, kidney disease, etc) are instead only addressed when treatments are more extreme and more expensive and when recovery is much less likely, if not impossible.

(BTW - In many places, there are no "county" hospitals anymore. In fact, there are fewer and fewer non-profit hospitals, overall. For-profit companies, like the one run by former-Senator Bill Frist's family, operate hospitals in much of the country and are often the only option to patients. This profit motive on the part of hospitals adds additional costs to the patients)

Additionally, a doctor who worked as an administrator for an insurance company testified before a congressional committee that her job was to maximize profits by denying treatment to insureds as much as possible, and she knew for fact that PEOPLE DIED because treatments were withheld entirely or delayed until they were beyond help. The insurance industry has recently been lobbying their friends in congress to add provisions to any insurance reform legislation that would allow them to keep as much as 35% of every premium dollar as profit (for comparison, gambling casinos are only allowed to skim 20 - 25% of every dollar gambled). BTW - the administrative costs of Medicare are 3%; 97% of every premium dollar goes to treatment.

 

[ss957916]

What's a county hospital? Is that run by the state?

 

[Zombie Acorn]

If you get ill you can go to a clinic and get meds, its really not that expensive. If you break your leg or get some disease you might be ****ed without insurance though (or are going to pay out the ass anyways).

 

[leekohler]

As the majority of people on these boards are American, I thought this'd be a good place to ask.

My understanding is that, in the US, one needs health insurance if they don't want to pay massive bills upon getting ill.

But, if someone gets ill/is involved in an accident etc., and finds themself in hospital - what happens if they have no money nor any insurance? Does the hospital simply turf them back onto the street and leave them to die? I can't believe that's true but... what does happen?

They treat the person, and if they can't pay they go bankrupt. Pretty simple.

 

[NT1440]

Its called Bankruptcy and apparently it's more of a right here in the USA than proper healthcare is.

 

[snberk103]

The sociology course I took at university in the early 1980s was taught by an ex-pat American who took a very, um - jaundiced view of his former homeland. (I'm Canadian. At that time many universities had large ex-pat American faculties.)

He was teaching us about statistics, and almost all of his examples dealt with American issues. Two statistics about American healthcare have always stuck in my mind. There is (was in the 80's at least) a correlation (as one number changes, so does the other - but there is no proof that there is a cause and effect) between when a patient in a hospital goes bankrupt, and when they die.

The second statistic I know is still valid. The largest single cause of personal bankruptcy in the US needing medical care and being uninsured, or underinsured.

I'm very interested to see how the healthcare debate between my southern cousins develops now that Kennedy's Senate seat went Republican... boy, was that a surprise, eh?!

 

[glocke12]

They treat the person, and if they can't pay they go bankrupt. Pretty simple.

I dont know if Ive just been lucky, or lived in the right places, or had just not been sick enough, but I never encountered that.

In my case, (20 some years ago), I was injured at a construction site (broken hand). I did not have insurance, was treated at the hospital (which later wrote off all but $400.00 of the bill which I paid over a period of a year), and recieved follow up care at a clinic that catered to low income people.

In other cases Ive always lived in areas where there was a clinic available that allowed people to pay on a sliding scale dependant upon your income. I think when unemployed the most I had to pay was about ten dollars a
visit. I know there were times I need medicine, but it was so long ago I forgot how that was handled, but I think there was some assistance available for those also.

Also, as far as insurance for elderly people go, I spent the last few years of my mothers life in charge of her healthcare, and she had a great medical plan that cost about $165.00 a month (personal choice 65 I think).

So, there are (or were at least) options available for the un/underinsured.

 

[Zombie Acorn]

The sociology course I took at university in the early 1980s was taught by an ex-pat American who took a very, um - jaundiced view of his former homeland. (I'm Canadian. At that time many universities had large ex-pat American faculties.)

He was teaching us about statistics, and almost all of his examples dealt with American issues. Two statistics about American healthcare have always stuck in my mind. There is (was in the 80's at least) a correlation (as one number changes, so does the other - but there is no proof that there is a cause and effect) between when a patient in a hospital goes bankrupt, and when they die.

The second statistic I know is still valid. The largest single cause of personal bankruptcy in the US needing medical care and being uninsured, or underinsured.

I'm very interested to see how the healthcare debate between my southern cousins develops now that Kennedy's Senate seat went Republican... boy, was that a surprise, eh?!

The more ill you get the more likely you are to file for bankruptcy, so of course there is a link between when you go bankrupt and when you die. It doesn't mean that bankruptcy caused your death.

 

[aloofman]

In many cases, if the patient truly has no ability to pay for it, then the hospital usually bills the state for Medicaid compensation. That was the case with the Octomom, for example.

 

[snberk103]

So now I have a question. From reading the comments above, there seems to be fair number of people who, despite not being able to afford it, received medical care were then billed. Subsequently the amounts owing were substantially written-off and/or absorbed by the medical facility. In other words, the costs were picked up by either other tax payers, or by passing on the costs to other paying patients.

How is this different from the health reforms currently being proposed by the Obama administration (and vehemently opposed by many)? Except that the reforms would make the system consistent, fair, predictable, allow the patient to keep their dignity?

I'm just asking, ya know....

 

[leekohler]

So now I have a question. From reading the comments above, there seems to be fair number of people who, despite not being able to afford it, received medical care were then billed. Subsequently the amounts owing were substantially written-off and/or absorbed by the medical facility. In other words, the costs were picked up by either other tax payers, or by passing on the costs to other paying patients.

How is this different from the health reforms currently being proposed by the Obama administration (and vehemently opposed by many)? Except that the reforms would make the system consistent, fair, predictable, allow the patient to keep their dignity?

I'm just asking, ya know....

It would go a along way toward lowering costs, for one, just by avoiding personal bankruptcies. That costs the economy a lot.

 

[splitpea]

One thing that's bothering a lot of people is that the bill would essentially force everyone to purchase private insurance -- it's like a huge giveaway straight from our pockets to those of the insurance companies. Those who didn't buy insurance would pay a significant tax penalty. Insurance premiums can be extremely expensive.

In my state, the most barebones plans (basically just there to limit your liability to $10,000 in case of significant injury and disease leading to massive bills) cost $130/mo for a single healthy person. A plan that covers basic preventative care and prescriptions (with large co-payments) starts at almost $300/mo and goes as high as $750/mo for a comprehensive plan -- and that's for someone who's in perfect health or part of a large "risk pool." Health insurance for a family of 4 can be easily $1,000/mo.

It used to be that most employers provided health insurance to their employees as part of the compensation package -- which is how we ended up with this system. The trouble is that more and more employers are cutting out insurance benefits because they cost a LOT; or if they do provide insurance, they're requiring the employee to cover a significant portion of the premium.

A lot of people not covered through their employers remain uninsured because they just plain can't afford insurance, and because unless you do get badly sick or injured, insurance is not a good deal. Heck, even 3-4 doctor's visits per year at full rates (insured people pay lower rates even if they aren't on a copayment plan) cost less than the least expensive insurance.

Being forced to purchase insurance seems like an unwarranted subsidy for the private insurers, and accomplishes very little for most individuals.

There's a huge divide over the pending legislation because of the "socialized medicine" paranoia that prevents us from even implementing an *option* for publicly-run health insurance (and that's just public insurance, not public care); combined with the fear of the public option undermining the private insurance industry.

On the other side, it's easy to see that private insurance companies are middlemen whose interest is not to keep people healthy (except to the degree that general health reduces the need for more care) or heal them but to collect the highest premiums they can and provide the least possible care at the least cost in order to maximize profit.

 

[leekohler]

One thing that's bothering a lot of people is that the bill would essentially force everyone to purchase private insurance -- it's like a huge giveaway straight from our pockets to those of the insurance companies. Those who didn't buy insurance would pay a significant tax penalty. Insurance premiums can be extremely expensive.

In my state, the most barebones plans (basically just there to limit your liability to $10,000 in case of significant injury and disease leading to massive bills) cost $130/mo for a single healthy person. A plan that covers basic preventative care and prescriptions (with large co-payments) starts at almost $300/mo and goes as high as $750/mo for a comprehensive plan -- and that's for someone who's in perfect health or part of a large "risk pool." Health insurance for a family of 4 can be easily $1,000/mo.

It used to be that most employers provided health insurance to their employees as part of the compensation package -- which is how we ended up with this system. The trouble is that more and more employers are cutting out insurance benefits because they cost a LOT; or if they do provide insurance, they're requiring the employee to cover a significant portion of the premium.

A lot of people not covered through their employers remain uninsured because they just plain can't afford insurance, and because unless you do get badly sick or injured, insurance is not a good deal. Heck, even 3-4 doctor's visits per year at full rates (insured people pay lower rates even if they aren't on a copayment plan) cost less than the least expensive insurance.

Being forced to purchase insurance seems like an unwarranted subsidy for the private insurers, and accomplishes very little for most individuals.

There's a huge divide over the pending legislation because of the "socialized medicine" paranoia that prevents us from even implementing an *option* for publicly-run health insurance (and that's just public insurance, not public care); combined with the fear of the public option undermining the private insurance industry.

On the other side, it's easy to see that private insurance companies are middlemen whose interest is not to keep people healthy (except to the degree that general health reduces the need for more care) or heal them but to collect the highest premiums they can and provide the least possible care at the least cost in order to maximize profit.

My bold. This is the exact reason the free market and health care don't mix. We need to get out from under this, and quickly. It's going to kill our economy eventually if we don't. Health care should be treated like our fire and police departments- necessary, not optional.