Hospital bill!

January 14, 2011 • 7:45 am

A while back I had surgery for a chronic sinus condition, and reported on it here.  I had what was called a balloon sinusplasty, which is the equivalent of an angioplasty, but up the nose.  They insert a balloon catheter up the schnoz and, when positioned properly, it’s inflated, moving the bones back into their correct position.  I opted for that instead of the usual cutting because it was less invasive and less traumatic to the system.

As surgeries go, it was a minor procedure. It took only a few hours and I was out of the hospital that day, within an hour after waking up.  And all went well: I’m fine now.

But the bill came yesterday.  I’m putting it up just so you can see what these things cost in America.  The cost of just the surgery was $32,094.84.  That doesn’t include the pre-operative and post-operative visits, the fees for the awesome anesthesiologist, nor the two MRIs I had to produce scans to help guide the surgeon.  All told, the total bill would be close to forty thousand dollars.

Part 1:

Four thousand bucks for a balloon! (To be fair, I’m sure it was a pretty fancy balloon, all sterile and stuff.)

Part 2, with total (click to enlarge):

Look at all those drugs! It looks like Michael Jackson’s pharmacopeia, with some of the same stuff.  $1400 for ketamine, and $76 for cocaine, which I wasn’t even awake to experience.

Now I didn’t have to pay all that: my university has a good insurance plan, and I paid about 5% of the total cost.  That’s still a bite, but it was a bargain given the cost of medical care in the U.S.

But think of all the people without insurance!  Many of them have to pay either the full cost or a substantial portion of that cost.  People who have no money usually get treated for free—though I don’t know if they’d be allowed to have a sinus operation.  It’s the people with some money, but who can’t afford insurance (or don’t have it provided by their job) who get screwed.  And if you have to pay forty grand for a sinus operation, imagine what it would cost for something more serious, like heart surgery.

That’s why many Americans get bankrupted by medical costs, and why some have to choose between medical treatment and food.  Some folks even lose their homes because they can’t afford both a mortgage and medical care.

I don’t know what the solution is to exponentially increasing medical costs.  But I do know that all Americans need health insurance, and I see good medical care as a right, not a privilege.  Other countries have done it; why not America?  One reason, of course, is the Republicans, who care more about tax breaks for the rich than medical care for the poor.  At this moment they’re vowing to overturn Obama’s health-care bill.  They pretend that they just have to “fix” the bill, but in reality they could give a hoot if poor people went without medical care.

Maybe if people were faced with bills like this one, and had no insurance to cover the costs, they’d see why we need affordable medical care for all Americans, or mandatory insurance.  Obama’s on the right track, and his opponents on this issue are simply callous and uncaring.  I for one would gladly pay more taxes if it would provide medical care to those who weren’t as fortunate.

182 thoughts on “Hospital bill!

    1. I’m putting this at the top of the comments (I hope) because I think you should “know” Single Payer is the way to go. You are too smart to get away with saying you “don’t know what the solution is…”

      Nor has Obama turned out to be the nice guy I thought I was voting for… His healthcare plan is worse than the mess we already had.

      1. I don’t think it’s a worse mess than before but it was badly bungled from the messaging, goal setting, and inappropriate concessions with nothing in return, and Americans will be stuck with it for a long time. Few politicians who lived through this mess will want to revisit it for another decade at least.

  1. You could knock me down with a feather!

    In September I had a non-cancerous but constantly growing lipoma removed from my jaw/buccal pouch (like a smaller Dizzie on one side!). I was mucked around a bit – because it was non-urgent my op was cancelled in April, May, June, July & the week before I finally had it I waited all day until it was cancelled at 6pm. However I think I got a good deal – I paid my tax & it was free at the point of service. Opposite me was a young Polish guy who hasd had a laryngectomy & was unable to speak – he was going to have chemo-therapy with no guarantee that he would be free of it after, so I felt quite insignificant waiting for my minor ssurgery.

    1. …& minor typos…
      The total cost of JC’s surgery is probably about what I earn after tax in a year, or maybe more! When my parents were having carers at home they paid £30,000 a year for the last two years of their lives.

    2. In 2008 I had a TURP (TransUrethral Prostate Resection – a common operation for older men) on New Zealand’s public system. I was in theatre for two hours, in hospital for three nights and I can’t show you the bill because there wasn’t any – in fact money was never mentioned. The care and service was excellent.

      The downside is, I was on the waiting list till I’d had a suprapubic catheter [a tube coming out below the navel] for five weeks, and they’d put that in because they were getting worried about my kidneys. If I’d gone private, or had health insurance, that wouldn’t have happened.

  2. I’m Canadian. In Jan. ’05 i slipped on the ice and broke my ankle in 3 places.
    Had surgery – plate & pins inserted.
    29 days later i had a bad asthma attack and had to spend one week in hospital, 4 days of that in ICU.
    The total cost to me: $44 for the cast on my leg.
    I can’t imagine what that month would have cost me had I been in the United States.
    I wouldn’t trade my health care for anything in the world.
    I can’t understand why anyone would fight it.

    1. Haven’t you heard? They’re going to put Granny in a death camp and make everybody wait for years before they can get their prescriptions refilled and all those wealthy foreigners come to America to get their medical treatment because our system is so superior to everyone elses, and it costs less, too.


  3. Wow! I’ve been unemployed since I graduated college so I don’t have any medical insurance. I broke my toe in August, it was almost “L” shaped. I snapped it back into place (sort of) myself, luckily I had booze around, instead of going to the doctor for something I could not afford (especially having to pay student loans, food, car payment, and rent with wimpy unemployment checks). It is still a little crooked and I can still feel a mild amount of pain if I press my toes.

    Then about a month ago I sprained my ankle and couldn’t walk for about 3 days at all and am still having a little difficulty walking now.

    This has been the only time in my life without health insurance and the only time I’ve actually needed it.

    1. It is unlikely doctors would have done much more than you did yourself – or rather they would have done more & charged you for it!

      1. Probably true. But would’ve been nice to have it done correctly for the $10-20 copay. That I could actually somewhat afford.

        1. have you looked into applying for indigent medical coverage?

          I was out of work for a couple of years post the internet collapse in 2000, and I found out CA has coverage for those who simply can’t afford it otherwise.

          I’m sure most states do.

          That said, and I mean this in all sincerity, I would ONLY do that again if there were absolutely no alternative; frankly, the medical care I got that way was, uh, less than adequate, to put it mildly.

          I CAN say that I lived through their surgery, and that’s about it.

          so, I wouldn’t recommend it say, for a busted toe… but for a busted leg? I’d probably go for it.

      2. Tell me about it. I had a “thing” removed from my skin and they had me come back a few weeks later to have the suture out — all they did was cut and pull. I could have done that! And they didn’t even sterilize it before they pulled one end out through my skin. I’m no doctor but I think it would have been prudent…

  4. While we were in Germany, my son was born in a German Hospital (my daughter too)and we had to pay 100% out of pocket. The bill came to $1200. The care and staff were worth that amount per hour! I am sure that in the U.S. the bill would have been $12,000 or more.

  5. I’ll say three words: National. Health. Service. Come to the UK, get ill, we’ll make you better. For free. Whoever you are.

      1. Here in Canada there are always debates about waiting times but all the studies show that Canadians only have longer waits than Americans for optional surgeries but everything which is urgent get taken care of faster. It would really surprise me if the UK’s NHS was much different.

        1. Didn’t you hear? Death panels! Death Panels!! DEATH PANELS!!!

          Or maybe if we look at what the people over 60 are waiting for, we’d see that the vast, vast majority are non-critical operations like hip and knee replacement surgeries. I don’t believe these are even really being rationed — there just aren’t the doctors and facilities to service the number of people demanding it, and it’ll be probably take the better part of a decade before we have that capacity (it takes a long time to train doctors).

    1. We’re never had to wait excessively for health care here. I’ve always been able to get an appointment when I wanted it, been able to see the doctor within 10 minutes of the appointed time, and I’ve had good service consistently.

      For “free” — or rather, paid for by a modest tax and administered at cost by competent people.

      1. Since not all of us can keep everyone straight, it would be handy if those talking about their own countries would identify where “here” is… 😀

    2. The National Health Service is great. Perhaps you are talking about people who move to the UK, but if you are only visiting the UK and you get ill, you may end up with a bill. The NHS websites explains who might have to pay and for what.

  6. You argue in favour of public health care on compassionate grounds and that’s all well and good, but don’t ever forget that those countries which have publicly funded healthcare get their healthcare significantly cheaper!. It’s not just morally correct, it’s actually far more efficient too.

    1. And better health outcomes!

      It’s a no-brainer. Unless you are a Republican who is willing to throw his body in front of the train to prevent taxes increasing on the top 1%-2% of earners (for example (the tax-cut extension “debate”)).

      They really are amazing. But for a party that considers Palin presidential material, it’s not too hard to see that the electorate for the GOP aren’t the sharpest tools in the drawer.

      It’s one of the most important facts about US politics in the 20th century: How the GOP has convinced white, low-income voters to vote against their economic interests. It’s amazing.

    2. What about “choice”?

      And getting bureaucrats out of the doctor’s office!

      (Apparently it’s preferable to have a corporate bean-counter who represents a company which is financially compensated by denying your care.)

  7. it’s called “paying through the nose” – ha!

    seriously, I think some of these costs are derived by taking the hospital’s total debt and apportioning it to each line item of a bill. crazy accounting! I tried taking my own tylenol after some surgery but still got charged $20-something for the ones the pharmacy dispensed but didn’t administer.

  8. There is an additional cruel aspect to such egregious medical costs:

    Those without insurance usually have to pay the entire bill; whereas for those with insurance, the insurance company negotiates the bill down by 50% or more.

    The majority of the citizens of the USA are STUPID! In the words of John Grisham, “They live poor, and vote rich”.

    1. A word to those without insurance: get an insurance card, even if it is no longer active. I had let my insurance expire (zero income, debt) but I carried my card with me. I cut my thumb on a bandsaw and went to the ER. I gave them my card, expecting a call back to the window in five minutes. No call. A month later (this is in Berkeley CA) I get a letter stating my insurance refused to pay. OK, I write back, send me a bill. Six months later I get a call. “Your insurance didn’t pay, and you have an outstanding balance!!” “OK, send me the bill.” Three months later, I get an offer to settle the $750 bill (for five stitches) for $325. All right. So fourteen months after the incident, I finally pay a reduced bill. If I’d stated “No Insurance” at the initial visit, I’m sure it would have been $2000-$3000 for the initial bill. The increased bill represents the overage required to collect for the high percentage that never pay.

  9. Nonetheless, we should be suspicious of Obama’s motive (real universal care is a long way off). Unfortunately, I think Matt Taibbi sums it up:

    “massive giveaways to Big Pharma in the form of monster subsidies, and an equally lucrative handout to big insurance in the form of an individual mandate guaranteeing a few already-wealthy companies 25-30 million new customers who would be forced to buy their products at artificially inflated, federally protected prices.”

    1. Those “giveaways” were the only way to get the bill passed. Otherwise those groups would have spent a massive amount of money lobbying and advertising against the bill. It barely passed without their opposition.

      Single payer (like Medicare) was DOA because of public opposition even though it is highly rated by its users. The bill isn’t great but that is largely the fault of the public voting against their interests.

      1. I disagree. I think that if Obama knew how to tell a story, had put some effort into this and got the Dems together, single-payer could have sold but almost no one ever tried. Obama is terrible at communicating and it really hurts his ability to pass legislation. Look at how he tried to sell the bill – it wasn’t about which principles he was after or what goals he had, rather it was about the dull mechanics of how bills got paid. Like the climate change bill is all about “Cap and Trade” which is implementation, not goal or vision.

        The public opposition was due to his inability (or unwillingness) to gather support and express a vision. The republicans are good at this in no small part because they boil everything down to simplistic, black & white reasoning and sell the concepts (“socialism, oh noes!”) without dealing with the nitty gritty implementation details which is all Obama seems to talk about.

        And as for being the only way to pass, Dems made a lot of concessions to Repubs without getting anything in return, not even any votes. It was clearly not the only way to get the bill passed. In the end, many Dems didn’t want to support it because it was such a terrible, watered-down bill. I would like to see what happens if the Dems could express a coherent vision and then work to get internal consensus and to hell with the Repubs. If they then needed to make compromises, then I’d agree with you and say it was the only way to get it passed.

        1. I think you are correct that he could have gotten a better bill. I don’t think that he could have gotten his party together for single payer. And even if he could, the fillibuster rules in the senate would have caused the same problems.

          The other reason I don’t think he could have gotten single payer is that he didn’t want it. The bill was based on the 1994 Republican health plan. President Obama is a moderate conservative and many of his party were conservatives. The “blue dog” Democrats are actually refugees from the Republican party. Single payer was too radical for him and many of his party.

      2. No, single payer was DOA because of the massive amount of job losses that would result in the short term from the elimination of most of the bureaucracy.

        Obama has said that if he were to design a country from scratch it would have single payer, but the economic disruption would make it very difficult.

        Personally I actually think that over time, it’s either single payer or economic death, but it’s going to have to come in either during a massive economic boom that can eat the job losses, or as part of a massive economic reform package focusing on reaching and maintaining full employment.

  10. Had what turned out to be a very small kidney stone in early 2010. Damned my new found love for Spinach!

    I was in the ER for maybe 5 hours. Thankfully I had good insurance. However when I received the bill it was 7500 dollars. I can’t imagine the choices that have to be made if you don’t have insurance these days.

    Another thing I never understand is why they are allowed to get away with the huge mark ups? Most of the time the cost is at least 50% greater than what insurance will pay. And most of the time the hospital will knock 50% off the bill if you pay cash. But there are some doctors refuse to knock 50% off if you pay cash.

    So not only do you have to pay it out of pocket if you are uninsured, but in some cases, the doctors will make you pay over 50% more than insurance companies have to pay.

    We live in such a messed up system. On the bright side, having an argument with someone against changes to health care is very easy to win. They just scratch their head, unless they are willing to look like a super greedy person.

  11. I fit in the ‘have money but no insurance’ slot due to being self employed and having preexisting conditons.

    I have mixed feelings about this. Insurance operates on mathematics and they walk a fine line between being screwed by fraud, providing insurance, and maintaining profitability.

    To me, it’s the actual medical costs that seem insane, but there is a lot of R&D that goes behind the modern medical advances.

    What I have found is that hospitals provide deep discounts and payment plans for the uninsured that have money. They told me insurance companies never pay them the full amount anyhow.

    1. To me, it’s the actual medical costs that seem insane, but there is a lot of R&D that goes behind the modern medical advances.

      FYI, that really doesn’t explain the excessive profiteering on medical supplies in the US.

      it’s about 10% of the cost for most medical supplies in just about any other country.

      I’ve compared Canada, the UK, Germany, and now New Zealand for basic costs of medical supplies.

      the US just has a ton of profiteering middlemen that basically ruin any chance that a reasonable and affordable healthcare system will ever be implemented there.

      …and good luck getting rid of profiteering in the US.

  12. But think of all the people without insurance! Many of them have to pay either the full cost or a substantial portion of that cost.

    Waaa waa waa, you libruhls are so whiny. Us real conservatives, when we’re faced with a $30k+ hospital bill and no insurance, we take it like a man and pimp our daughters out on the street for extra cash. That’s what Real ‘Mericans do, y’know?

  13. I had a surgery recently too. I spent 5-6 hours in the hospital recovering afterward. I haven’t seen the bill yet but I did see that my insurance was billed $10,000 for my day in the hospital, and the cost of the anesthesia was over $2,000. The anesthesia actually cost more than the 3-hour surgery, oddly. I too won’t pay very much in the end, but it’s just unbelievable.

    I wonder if there’s any correlation between having spent time in a hospital and being for/against health care reform?

  14. U of C has great medical insurance. The spousal unit worked at the GSB for 8 years, and we never wanted for anything. Now she’s at a state school (UIC) and although not quite as good, we’re still much better off than going through my workplace. I try not to think about one of us losing our job and then getting sick. We’d lose everything. I know people in this situation, and they still vote Republican.

  15. I’m a doctor working in the state (public) sector in South Africa. We have state national health care that’s free if you can’t afford it – this in a country in which only about 11% of people pay tax, and the per person GDP is $5000!

    If we can afford it (sorta!), there can be no motivation other than greed or malice for the US not to do so.

    So bravo Obama, and down with the Republicans!

  16. I am recovering from a triple heart bypass which I had just before Christmas. I spent nearly five weeks in hospital with lots of tests including an angiogram and around four hours in surgery. Also I am now on a whole raft of drugs. I am attending two hours of rehab each week. Total cost to me? Zero, zilch, absolutely nothing. Long live the NHS.

    1. I had quintuple bypass surgery two years ago (take that! I win!) anyway.
      Are you still freezing? I was unable to get warms for a month or two after mine. Keep doing your cardio, brother.

  17. It’s quite a racket the hospitals have going for them, isn’t it?

    $1400.00 for ketamine when the actual cost to the hospital was probably no more than 2 bucks. (It’s a horse tranquilizer that you used to be able to buy at bulk chemical prices from Mallincroft)

    Or how about $73.00 for a gram stain, which takes about ten seconds and less than twenty cents in materials. Or $143.00 for an aerobic culture – whats a pre filled disposable Petri dish these days – $4.00?

    And all this, mind you, on top of the hospital room charge fee, which is at least $2000.00 per day, which is so high because it must cover, you know, extraneous hospital costs. Which evidently doesn’t include a 1000% mark up on something like an aspirin, which was %7.00 a pill twenty years ago.

    Yet, who does the public despise for high drug prices? The pharmaceutical companies of course, which is quite a cool case of misdirection, as it is hospital and physician fees which consume >80% of every health care dollar in the U.S.

    At least you got to see your individual hospital charges, Jerry. A lot – if not most – folks never get the breakout, they just get the insurance company ledger which shows them their out-of-pocket arrears.

    So… why is American health care the most expensive in the world again??

    1. Hospitals are forced to overcharge to recoup their losses from the uninsured who show up at the ER for routine care.

    2. They are also forced to overcharge to cover the insured… when the insurance companies fight every procedure tooth and nail. They are forced to overcharge to cover staff costs for those staff that have to fight the insurance claims adjusters.

      So hospitals “pad” the bill. To pay the direct and indirect costs associated with the insurance go-betweens. And then there’s malpractice insurance… come to think of it, it seems as if your premise is misguided. It’s not going to pharmaceutical companies, but insurance companies, overwhelmingly.

      It’s also the reason why people paying cash out of pocket CAN talk the bill down. The hospital knows there will be less associated overhead just getting the transaction done. So they just subtract the stuff that was put on there to give them headroom against the claims adjusters.

      1. sasquatch said:

        “…They are forced to overcharge to cover staff costs for those staff that have to fight the insurance claims adjusters…”

        Yes. And every doctor in the U.S. also has at least one half-time staff member doing the same thing – trying to recover physician fees, and they also have another part-time equivalent trying to recover physician fees from patients, and they have another part-time equivalent acting as a patient advocate against the insurance companies.

        Meanwhile, the insurance companies, as you said, have a gigantic staff dedicated to illegally denying payouts to patients, institutions, and doctors. All of which is needed to cover the titanically-huge remuneration of top executives, who each average $10 million per year. Additionally, a single long-term incentive payout can be… ten times that amount.

        Remember that the next time you read how a particular test or procedure is too expensive to be justified.

  18. The ketamine was $1400 because they bought it from a pharmaceutical company.

    Cocaine at 76-bucks is street price in the hospital parking lot.

    1. actually, I think the ketamine looks so high because they lumped in the costs of the anesthesiologist.

      IIRC, proper use of ketamine in that setting would require the assistance of a trained anesthesiologist.

      I know ketamine itself isn’t that expensive.

    1. When I went to grad school, I would have thought that funny.

      Now that i see what the current students have to pay?

      I don’t think I would, sadly.

      last I checked even REGULAR tuition at the UC’s would make me choke on the costs.



      for UCSF, the average tuition and fees for ONE YEAR of medical school is…


      man, the 4 years I spent as a grad student at Berkeley *only* set me back about 30 grand, total.

      for a 4 year med program at UCSF, you’re talking, in JUST FEES, 220 grand!!

      add a couple grand per month for food and rent, and another 200 or so for misc….

      you’re basically talking TEN TIMES the cost of what I paid for my grad degree at Berkeley in 1991.


      1. oops, read that slightly wrong.

        55K is the average TOTAL estimated cost per year, including fees and living expenses.

        the fees are *only* 35K of that.

  19. The shameful part is that the hospital bill is what someone without insurance would have to pay. The insurance company will only pay the “negotiated” price which can be as little as a third of the hospital bill. I had 2 carpal tunnel surgeries that were each billed at over $21000 but the insurance company paid around $8000.

    1. The shameful part is that the hospital bill is what someone without insurance would have to pay.

      Not usually. Normally, the hospital sucks it up (people that don’t have insurance usually also do not have the wherewithal to pay the bills) and passes it along to the rest of us in increased premiums.

      The real badness is that people don’t get basic medical care, wait until it’s an emergency, and then get treated at an ER, at hugely increased cost that we all pay.

      It’s just stupid.

      It’s a system designed to enrich insurance companies.

  20. Thanks for posting that Jerry. It was certainly an eye-opener for me being someone who has only known public healthcare (I’m Canadian…) – cheers.

  21. It would be very difficult to know for sure what the real cost of Jerry’s surgery was. That bill is an inflated account sent to the insurance company, and paid at some unknown percentage known only to the hospital and the insurance company. The usual inflations in these situations are two to three hundred percent, sometimes more. It’s all a dance, done for mutual advantage. Everything in the equipment line is disposable, ev

    1. (premature posting!!) – carrying on – even though third-world countries would find ways of re-using most of the hardware several times and perfectly safely. A reasonable estimate of the real cost for what Jerry had done, including surgical fees, would be 30 to 50% of what is listed. Even that is too much. A friend of mine came down from Canada to have me remove a lumbar disc (too long a waiting list at home). Her total cost for the procedure – one hour of OR time, done as In and Out _ under general anesthesia, and including a pre-op MRI, was less than $8000, including surgical fee at Medicare rates. So, real costs are one thing; what Jerry’s bill states is a fiction that defies reality.

      1. even though third-world countries would find ways of re-using most of the hardware several times and perfectly safely

        Ah, perfectly safely?

        Perhaps not. I guarantee that they have higher failure rates, more infection, and more adverse outcomes.

        Ever do a sterilization assessment on a medical device? Or a reliability test? It sure looks easy if you’ve never had to face a regulator (e.g. BSI or FDA) and provide proof (more accurately: data) that a device is “safe and effective.”

        Sterilization cycles damage polymer materials (which are included in virtually every implantable/invasive medical device). It’s not like autoclaving steel instruments.

        If a device is designed for single use, it’s very likely that it will fail during repeated uses. It’s hard enough to define health outcomes (in various patient physiologies, in various OR environments, with large user variation with the surgeons) without trying to assess health outcomes when (undefined, uncontrolled) failures are included.

        Try to “sell” the difference in infection rates (just that, forget about failure rates) to the FDA or BSI. Lots of luck!

        1. You have a point. I should have been more restrictive. However … I have worked in third-world OR’s, using re-sterilized ‘single-use’ devices, without incident. I even took along and used ‘past-date’ packaged equipment, again without problem. Some stuff can be re-used safely (I agree not here, because of liability issues.) And I know, from living in ORs for 40 years, how much waste occurs therein. The amount of garbage generated daily in our ORs in the form of single use sheets alone exceeds several thousand tons, to say nothing of discarded equipment opened prematurely or carelessly. Wound-closure staplers are totally disposable, rather than just the staple cartridges. Just for safety? Nonsense.

          1. You have some good points. (I’m all in favor of: R/R/R (reduce/reuse/recycle)).

            Past date stuff is usually just covering the sterlization date (and that’s just when it passes the date that’s been valdiated — doesn’t mena it’s not sterile anymore) or (for active devices) it indicates whether the power source will meet life expectations. Should be perfectly safe to use. The use-by date is QA for customer acceptance most of the time.

  22. Yeah, people in the UK often criticise the NHS, but they would be horrified to face the health care “system” in the US.

    That’s why I keep my travel insurance in place whenever I visit the US. (As I must tomorrow for a family emergency.)

    But having national healthcare drives down healthcare cost for everyone. My wife had a fairly major operation a few years ago, and the fees for 3 nights in the hospital, plus the surgery and a lot of follow-up care, were about half what you’re being charged for an outpatient procedure. And our private insurance paid nearly everything — we were out maybe £100 or so, total.

    1. OK — let me sound off a bit. My sister is lying in a US hospital, dying/dead right now, in large part because 1) she doesn’t have medical insurance, 2) has limited income and 3) put off going for treatment until she collapsed with what seems to be kidney failure.

      Yes, there is a state-funed “charity” hospital nearby (thank the FSM, or rather the government!), if you’re willing to wait 10 hours of so to see someone. Or you can go to work anyway, wait until you’ve collapsed, and it’s too late to do much.

      1. I am very sorry to hear about your sister. I certainly hope she is a statistical anomaly and recovers. That was almost me.

        1. Thanks, guys. I’m feeling angry about what led up to the situation.

          She could have done better to take care of herself, but her limited access to health care did not help. Here in the UK, if you don’t feel well, you just go to the doctor (or hospital if it’s urgent).

          1. If you’re poor and without insurance, it’s unlikely that you will seek a doctor until it’s too late. Preventative care, anyone? Very sorry, Ray.

        2. Update, since I raised my personal issue here: my sister is stable but critical. Prognosis completely uncertain, but there’s some hope that she’ll recover. We’ll know a lot more in the next 2 days.

          Thanks for your notes of concern and good wishes.

  23. I work in the medical device industry (design engineer). The cost of the material includes all the R&D, design, process development, validation, and regulatory work required to bring a device to market. And you wouldn’t want it any other way. (And the manufacturer expects to make a profit.)

    I note that the active devices and delivery devices cost a total of $7191 out of a total bill (JC’s estimate of) $40K or 18%. The lion’s share of the bill was for the surgeon/OR ($15,304 or 38%). The anaesthesiologist cost over $4000.

    As I always say: I want my airline pilot and surgeon (and anaesthesiologist) to be happy and well-paid. Think about it.

    All this said: I am in fover of a single-payer system on the lines of Canada or France or Germany. To me, this is the only sane and moral way to provide health care.

    As I ask my fellow Americans:
    1. The EU/CA/AU systems cover everyone
    2. The EU/CA/AU systems have better health outcomes than we do
    3. The people who use EU/CA/AU systems live longer than we do
    4. The EU/CA/AU systems even cover strangers (like me, personally) when they are in their countries
    5. The EU/CA/AU systems spend one-half to one-third of what we do on health care, nationally (Germany and France)
    6. When a person in Europe or Canada (or any other developed country except the US) loses their job, they still have health insurance.
    7. The leading cause of bankruptcy in the US is health care costs: This (bankruptcy due to health care expenses) basically does not exist in Europe or Canada
    8. My personal experiences, having actually received care in Europe, New Zealand, and Australia, have been as good as anything I’ve ever had in the US (and better than most).)

    Now tell me: Exactly how is the US system superior?

    1. We have lower taxes? That is pretty much the conservative argument, once you get past the blind denials of what you listed.

      BTW, I have a friend that works for an insurance company. He is fairly high up in management. They are working on a system where, if you need care, you shop around and get a quote, they cut you a check, and you go wherever you want. The intent is so that you can fly to India or wherever, have the surgery and fly back for cheaper than a stay in a US hospital.

      1. We have lower taxes and much much much much higher insurance/out of pocket medical costs – except people in the highest brackets, who would pay more in taxes if we had a National Health. It works for no one but the super-rich.

  24. To me, it’s the actual medical costs that seem insane, but there is a lot of R&D that goes behind the modern medical advances.

    Questionable. Medicine isn’t very scientific. It is comparable to biology as an Auto Mechanic’s craft is to Mechanical engineering or Engineering is to Physics.

    Medical device technology is warmed over industrial applications technology that has been expensed fully most of the time. We live in a high cost economy with rapacious rent seeking middlemen – the insurance companies. The same operation paid out pocket at one of the many fine hospitals in India, Sri Lanka or Thailand, I have found would cost the equivalent of $5,000. Already the scale and quality of several surgical procedures in India far exceeds that in any other part of the world. Dr. Girinath India’s leading cardiac surgeon has personally supervised 38,000 surgeries, including surgery for the world’s oldest heart transplant recipient to date, who incidentally is an American! Over half his cases have been performed for no fee! There is a serious case for the US learning from other countries such as Cuba (similar outcomes as ours for 1/10th per capita healthcare expenditure), Canada, EU, Japan ANZ etc.

    1. “Medicine isn’t very scientific.”

      Maybe not, but developing medical devices (what was used in JC’s procedure) is.

      1. There is a great deal of engineering that goes into medical devices. But the science is often lacking. I don’t care how well the device is engineered, I care how well it performs. And that takes time, money and skill to study. Devices often become mainstream before their worth is proven. That is the combined fault of everyone involved including the manufacturers, FDA, doctors and patients.

    2. “Medical device technology is warmed over industrial applications technology that has been expensed fully most of the time.”

      You clearly don’t work in medical device design (which I do.)

  25. I see universal health insurance as a public health issue, not as a right. Calling it a right is what kills the argument among conservatives. They are often not moved by “rights” arguments if it is something new. But that is a tactical decision.

    So, I have had cancer. When I had cancer, due to recurrence of the tumor after chemotherapy, I had to have high-dose chemotherapy with stem-cell rescue which is basically a bone-marrow transplant [BMT] (except I was my own donor). I had no insurance, and I was still in the exclusion period for disability and hence medicare (I may have some of the details wrong, as insurance can be complicated and I was sick at the time, plus it was a few years back). The hospital told me I could not have my medically-necessary and life-saving BMT without insurance, of a $50,000 down payment
    Luckily, UC Davis is a teaching hospital and they were able, certainly after a lot of arguing and such, to put it in the teaching budget as long as I allowed medical students to examine me. I said they could put their balls on my forehead and take pictures if it would get me my BMT.
    Also, before I could have the BMT, they needed to give me chemo to make sure the tumor was still responsive, however, no insurance. For the chemo I was to get, I needed to be checked into the hospital (not outpatient), but I couldn’t be checked into the hospital because I had no insurance. The doctor told me to show up on a certain Saturday morning at the emergency room and to complain of shortness of breath. She conspired with another doctor there who was familiar with my case and who would “decide” that a round of chemo was the proper treatment for a shortness of breath. In the US, you cannot deny someone treatment because they cannot pay when they come to the emergency room. They had no choice but to check me in.
    The doctors moved heaven and earth to get me my treatment, for which I will always be grateful. The problem is the insurance system.
    Now here is the kicker. Essentially, the reason I had no insurance was because I was so sick from the chemotherapy that I could not keep my job*. The disease took away the insurance and that I needed to beat the disease.

    *The actual story is a bit longer. I had insurance through my wife’s job, which she had only had for a short time. My employer did not offer benefits. Her boss fired her shortly after my wife let it slip that I had cancer. Thus we were both out of work. In the US you can continue to pay for your employer-provided insurance after you lose your job through a program called COBRA, but you have to pay the portion that your employer used to pay which means the cost can more than double. This all happens right at the time you are unemployed and have little income. So effectively, I lost my job due to illness, my wife lost her job because her boss was a raving bitch, and our insurance premiums tripled (~$700 per month) while I had cancer, and we could not pay the bill.

  26. I think you are framing this incorrectly. Medical insurance isn’t needed because the ‘poor’ need it. We all (except the super rich) need the security that universal healthcare provides. You don’t have to be poor for a $32k bill for ruin your plans.

    As an actuary who grew up in Canada (now living in the US) I find few people understand how either a single payer system or insurance actually works. This is especially true of those who oppose it.

  27. The cost of dying isn’t much better. The accumulated bills from my late wife’s funeral would not have been manageable without a life insurance payoff – and that was with cutting corners as much as possible. As I found out much later, it cost as much for to have my cat, Freti, cremated, as it did to have my wife cremated.


    The Republicans argued that what we need is “a uniquely American health care system.”

    This means that any successful European or other system can be just stuck up the ***. Cause they’re not going to consider adopting someone else’s ideas.


    So, of course this is the reason for a TAX INCENTIVE based system, with tax credits (rather than real money being paid out of the treasury…. just don’t take it in.
    The tax incentive business is UNIQUELY AMERICAN.

    Then too, we had a sort of uniquely American system at one time, based upon employment based insurance. Employers paid all or most all of the costs.

    The government helped by declaring that the free medical care was not a taxable fringe benefit, and allowed full deduction to the employer.

    When medical care became more expensive, different factors came into play such as the business-like belief that “Bigger is Better” and gigantic HMO (Health Maintenance Organizations) were going to be the salvation. American Business thinking would triumph.

    Also, the employers discovered tricks such as PART TIME EMPLOYEES with NO HEALTH BENEFITS.

    Then too there were employers who just cut them out altogether, saying it was just too expensive for the employer to pay and have to raise prices.

    The last “American Solution to Healthcare” didn’t work out as a long term possibility with “fairness to all”.

    Whatever the Republicans come up with as a “New Truly American Healthcare Policy” will suffer from failure to have learned from the best and brightest in the world, and the homage paid to TAX BASED manipulations of the economy.

    1. Just a few years ago it was widely held that health care costs were what was driving large US corporations such as General Motors into dire financial straits. It looked as if a very odd partnership of progressive voters & corporate America were going to finally find common ground and bring change at last. Something happened to that scenario…

      I would REALLY like a congressional investigation into the no-full-time, “independent-operator,” “adjunct professor,” etc., type schemes that have been metastasizing of late so as to rid employers of health care responsibility. All these trends keep destroying us and it’s as if no one notices…

  29. Ketamine and cocaine?
    Who’s a rockstar of science now!
    Mind you, it would take a lot more than $1400 of Ketamine to make me nominate Layla as the best rock song ever!

  30. OMG. Did you see how much your microbiology testing cost? You were charged $148 for an aerobic (bacterial) culture, $92 for a fungal smear, and $73 for a bloody Gram stain! I have a contract lab that would do all of those tests for <$50! That's just criminal.

  31. I’m from Canada, and so the horror stories that I hear from about the U.S. health care system are mindblowing to me. I can’t understand why anyone would argue against universal health care considering all the bonuses to society. The difference in taxes/cost between just the rich being able to afford good health care, and providing good universal health care is trivial.

    Since Palin has already been mentioned, I thought I’d remind people that (a) she is against health care reforms, and (b) has publicly commented on going over the border to Canada to take advantage of our health care system/cheaper medication. Hypocrite.

    However there are negatives to universal health care. When everything is paid for, hospitals and doctors aren’t as motivated to stay within budget. (My neighbour was an accountant, who independently audited a hospital and discovered some inappropriate activities) In view of this, and the baby-boomers retiring, the health care portion of the federal budget is going to cause some significant problems in the next couple of decades. In other words, Canada probably won’t be able to afford the same kind of health care it currently has. However, I imagine this will mean a (temporary?) modification, such as some added fees or an increase in our insurance premiums.

  32. Incredible! This is such an important point, “It’s the people with some money, but who can’t afford insurance (or don’t have it provided by their job) who get screwed.” I don’t think enough people in this country get it. You should consider sending some version of this to a newspaper, especially considering the health care debate is about to heat up again.

  33. Several people have said the bill is inflated by 30 to 50%. Jerry said he has to pay 5%. So Jerry has to pay 5% of a grossly inflated bill while his insurance gets to pay for the deflated version?

    That’s a scam right there.

    1. The cost of the Ketamine is inflated even more than that.

      The cost to the NHS is under £9. If we call it £10, and convert the $1400 to £900, we get markup of 9000%.

      That is just obscene.

  34. Good lord, Jerry – that’s a hell of a bill! Now I’m going to ask for an itemized bill for my angioplasty and stent that was done in early December during my heart attack. I’m betting we got some of the same drugs.

    Thank christ I’ve got good health insurance, as I’m sure my bill is close to yours. If I had to pay that, even over time, I’d probably lose my home.

    Here in Vermont, there’s a movement afoot to enact single-payer. Looks like I better get on board helping.

  35. I just checked and the cost in the NHS for 10ml of Ketamine is under £9.

    Of course the patient does not pay that cost, it is what the supplier charges the NHS.

    1. If it’s on a prescription (of course, this particular drug wouldn’t be), the patient co-pay would be £7. Unless he/she were retired or unemployed, in which case the co-pay is zero.

      1. Or lives in Wales, when there would be no charge regardless of income, or in Scotland, where the cost would be less, and in time will also be zero.

    2. Well I suppose it could still be the same price – they don’t exactly specify how many mls of 10 mg/ml were injected into Jerry.
      If it’s the NHS price I calculate it at about a liter!
      No wonder he thinks Layla is the best rock song!

      1. The bill states 1 unit, so I am supposing he was charged for the vial, regardless of how much was used.

        Ketamine is not normally a drug that is used repeatedly except in end of life care.

  36. I am a cancer survivor (3+ years since diagnosis) and I had to have two bone marrow transplants, a pair of surgeries, lots of chemo, more CT scans than I can count, and lots of other procedures. The hospital fees for just one marrow transplant are $200,000. That doesn’t include doctor’s fees, and I had to have two of them. Fortunately, I was completely destitute–no job, no property, no savings–so I was able to qualify for Medicaid.

      1. No it’s true though – in the US “system” destitution is the only way to go. If you’re not destitute you have to pay full price until you are destitute, which is usually in about 15 minutes.

        1. This reminds me of Rueben Bolling’s cartoon “Tom the Dancing Bug” which has a couple characters, Hollingsworth Hound who is a super-wealthy business man/dog and Lucky Ducky who is a poor, downtrodden person/duck. They generally have Hollingsworth getting valuable concessions from the government, oblivious to the opulence surrounding him all the while cursing the occasional scraps handed to Lucky Ducky. So in a weird way it’s true that if you are destitute you get some assistance to stop you from dying quite so quickly but it takes a kind of blindness to see these “perks” as somehow making poverty seem attractive. In a further bitter irony, there really do seem to be people who see these programs as somehow encouraging people to be homeless so they keep looking for ways to make the lives of the poor even more miserable.

          Anyway, if you haven’t seen these comics yet, here are a few. On health care:

          And for OB, the double-standards in prostitution:

          And on Obama hurting the rich:

          (Lots more but I don’t want to get flagged as spam 🙂 )

        2. It just annoys me that our current system encourages abject poverty for the truly sick. One of the most immoral things in America.

        3. I am on full disability, which is a form of Social Security. THat also puts me in Medicare, but my SSDI income is too high to qualify me for Medicaid. This means two things: no possibility of dental care – I haven’t been in a dentist’s chair for over ten years. The other is that there is an annual deductible involved – the first couple thousand dollars of expenses each year have to be paid out of pocket before the Medicare starts paying. The big thing is that, after paying my life-sustaining bills (rent, utilities, food), I don’t even have enough to pay for the deductable incurred by even a single routine checkup. As a result I am reluctant to get care because, even with Medicare, I still can’t afford it.

  37. We are so fortunate to have the wonderful NHS in the UK. Why do so many Americans believe the lies that Republicans tell about it? And why do so many Americans who would benefit from free healthcare persist in voting against it?

  38. eheffa
    Posted January 14, 2011 at 11:18 am | Permalink

    As an Anesthesiologist practicing in Canada, I can tell you that the charges levied for the drugs you received are anywhere from 5-10+ times the wholesale cost (the cost of what our hospital would pay) for these agents. This degree of profit margin would make a used car salesman or a mob loan shark blush.

    Is anyone surprised that there are very well organized and very well funded efforts underway to thwart the recent health care reforms in the USA? These people have the resources & the motivation to fight hard for their golden goose. As we can see, distortions, lies and fear-mongering are seemingly quite effective strategies. What is truly mind-boggling though, is how the US Health care industry has managed to convince the most vulnerable and under-served members of the electorate that their interests are well served by this corrupt system. Americans spend significantly more per capita on their health care than any other nation on earth & yet score near the bottom of the heap on surrogate measures of public wellness(perinatal mortality, life expectancy etc.) when compared with other developed countries. The time is long overdue for real reform but the forces allied against this notion won’t go without a bitter fight.

    Good luck to you.


  39. Perhaps that coke habit is what was causing you sinus difficulties (only kidding!)

    Simply can’t believe the price of your operation. If the NHS were being charged that amount for relatively routine and easy treatments (though I appreciate that might not be how it felt to you, Jerry) we simply couldn’t afford it. But it’s not so we can. In Northern Ireland, the cost to the customer of nearly all prescription drugs is £0. But we’re all communists, you know?

    Anyone who stands in the way of health care reform and privitisation on grounds of “efficiency” is clearly being misled. On that point, I feel that the reform didn’t go far enough.

    Keep smilin’

  40. i well bet you didn’t recieve all those drugs. if they give you one pill, one teaspoon, one injection, you are charged for the whole bottle or vial. and that’s
    not even the stuff they charge you with that you may or may not take home with you. think if you don’t have a med plan,
    then you are charged with subscription at the store. now you have to go back to the hospital after seeing your bill.

  41. The Mayo clinic has a “room charge”. This is not for the OR or a hospital bed. It’s a fee for escorting you to the doctor’s exam room. Unbelievable.

    I had a malignant melanoma removed from my leg. Wide excision, local anesthetic, sutures: total $5000. No insurance so I was making monthly payments of an amount agreed-upon with Mayo. After several months, they sent my account to a bill-collector. I fought back. Eventually, the balance was paid off out of a charity fund run by Mayo. Because of that, I cannot make an appointment with Mayo without paying several hundred dollars up front.

    Why don’t I or anyone else have the right to live and be healthy?

  42. I’m from South Spain. My brother spent 2 weeks in a certain hospital in Madrid to have a brain tumor removed because we were told that one of the best neurosurgeons for his particular type of tumor was working there. Not only there was no bill, but our national security also paid the plain tickets for him and my father so they could go to that hospital.

    It’s not a charity. The government needs us healthy so we can work and maintain the economy; and 4% of my monthly paycheck goes directly to our social security.

    We have an awful lot of backwards things over here, but I think we got the general idea of healthcare pretty much figured out.

    1. 4%? Here it is 1.45% and the employer pays the same amount as well, but you cannot actually use it (Medicare) unless you are old or disabled or poor.

      1. I think you are off by a factor of around ten, D.I. Most people pay more in Social Security/Medicare tax than they do for income tax.

        And 4% of a paycheck to cover national health care is way, way, way less than we pay here, even after our employers pick up the lion’s share.

        1. Actually, I am exactly correct.
          The medicare tax rate is set at 1.45%. Flat. Social Security is 6.2% (except this year it is 4.2% because of a tax break deal). Flat.
          Together they are 7.65%. Your employer matches that. If you are self-employed, you pay both halves, 15.3%
          I know. I am an accountant by trade.

          I never said anything about health insurance premiums, that is extra. If you are not old, disabled, or poor, you have to pay for your own health care, and that amount is a lot more. I pay $251 per month, and that is for a HSA plan, which are about the least expensive,a and the plan only covers me.
          We are talking about two different things.

  43. As several others have mentioned, much of the mark-up/cost inflation as evidenced by this bill is largely a result of two factors: One, hospitals are indeed “forced” to pass along the revenue lost in providing treatment to the uninsured (and, as pointed out, the underinsured) to paying, uh, “customers” (i.e., the well-insured). Two, since hospitals (and physician groups, etc.) routinely negotiate a variety of reimbursement schemes with various insurers, the charges for drugs, treatments, and services vary widely. A given hospital or physician almost certainly receives different compensation from different insurers for the same service. There is no law stipulating that goods or services must be provided at the same price to all buyers: Wal-Mart, for example, could charge one customer a dollar for, say, a pair of socks, but charge someone else two dollars, even in the same store. Of course, they don’t, not least because it would be completely absurd to do so for a variety of (obvious) reasons. What’s more, Wal-Mart clearly posts the prices for the products it sells, in part as a means of advertising their prices in an effort to gain a competitive advantage. Good luck, however, trying to clearly determine the costs of medical treatment in advance. This is one of the reasons that the “market-force” argument against nationalized health-care, or a hybrid system, or even tighter governmental regulation of health-care costs has always seemed so specious to me. The current “free-market” system is anything but; the end-user, as it were, really has no choice apart from paying for treatment or insurance wholly out-of-pocket. The relative cost of a sinus surgery, to use Dr. Coyne’s example, for anyone who could afford that would probably be roughly the equivalent of dinner and a movie for the rest of us.
    ‘Course, anymore dinner and a movie are luxuries for the rest of us, especially if we’ve done something foolishly irresponsible like fall on the ice, had a baby, bought a house, or put our 401k’s into the stock market.
    Don’t worry, though: The market will straighten it all out…

  44. Seeing this bill makes me realise how lucky we are in the UK with our National Health Service. I can never understand the opposition in the US to such a service.

  45. $1400 for 10 ccs of Ketamine?!!1?11?

    I used to work for a vet and even though we never used that much (not even on the tiger), clients probably would have abandoned their animals if that showed up on their bill.

  46. This reminds me of the time my wife cut her finger. For a mere $2000, not covered by insurance, they put a dab of Super Glue on it.

  47. As an Australian, who has access to magnificent universal health care, I simply cannot understand the objection by so many Americans to a national health care system. It must be particularly galling that the people who would most benefit from it are among those most vociferously opposing it. Is it so hard for them to see that they’re being manipulated by vested interests?

    1. I concur. In Australia we have had a history of dual government and business versions of entities, which have kept the cost down. Whilst the business interests scream from time to time, we have a higher trust in the government and science and a better notion of interdependence than the myth of independence which reigns in the US. This has also helped us to trust the police to carry our guns for us, leaving us with a much lower gun fatality as well. I’m shocked by the price of the medical service that you quote. Methinks it would have been a quarter of that here.

    2. Yanks have been bizarrely brainwashed to support the obscenely rich elite minority, no matter what the personal cost, either in the short-term, or long-term.
      By both mass-media propaganda frauds, and church lies, supported by deliberately poorly-run state-run policies of ‘education’.

  48. Anyone care to sing a few bars of O Canada with me? Of course, we do not have any carrier groups, or a nuclear deterrent…

  49. But… But… But…

    I keep seeing and hearing how most of the 45 million Americans who don’t have Insurance can afford it, but choose not to.

    Just out of interest, how much would a family of 4 have to pay to get comprehensive health coverage?

    1. In 2006, I quit my job in upstate New York and was able to continue comprehensive health insurance for my family of 4 through COBRA. The cost was about $1200 per month.

      Medical expenses – including insurance costs – that exceed 7.5% of income are deductible for Federal income tax.

      Median household income in the USA is about $50k p.a.

  50. “Obama’s on the right track”

    Jerry, I respectfully disagree with you on this point. All Obama did was re-package bad a bad Republican idea (first proposed by Bob Dole I believe and then implemented by Mitt Romney in Massachusetts where it’s had many predictable problems) and sold it as some triumph of progressive policy making.

    Furthermore, Obama would not even allow single-payer (which I think is the best solution) to be considered. He didn’t even try to use it as a bargaining chip to get the public option (which I viewed as an acceptable compromise). Instead, he used the public option as a bargaining chip with progressives to get their buy in and then sold it out in a sleazy back-room deal with the medical and drug industries in exchange for a “non-aggression” pledge (which these industries have already failed to live up to).

    Obama and the Democrats could have implemented the public option and/or Medicare buy in for unemployed folks over 50 via the reconciliation process (needs only a simple majority and can’t be filibustered) but chose not to do so. You can’t blame the Republicans for that – the fault is entirely with Barack Obama’s corporatist, neo-liberal agenda which has been wholly embraced by the Democratic Party.

    1. It’s not even remotely fair to lay this much blame at President Obama’s feet, and yes, the Republicans are largely (if not wholly) to blame. For starters, the notion that a single-payer option could be used as leverage against Republican obstructionism is a stretch, to say the least, especially given that the new Republican majority in the House has not only made it clear that their first item of business is a repeal of the new health-care laws, but have also exempted such a repeal from their new “rules” requiring all legislation to be tied to spending cuts or deficit-reduction measures (exempting the new health-care laws, which are paid for and stand to reduce the deficit, doesn’t seem to conflict with the fiscal responsibility that they wholly abdicated during the Bush Administration).
      Obama hasn’t turned out to be quite as progressive as many of us had hoped for, but given the impatience of an American electorate (that stood idly by and let Bush, et al., make a catastrophic mess of nearly everything they laid their hands to then expected Obama to fix in less than two years), the ridiculous “birther” nonsense, and the obstructionism across the aisle, he can hardly be condemned as “corporatist” and “neo-liberal” (whatever that means).
      I don’t mean to take this so far off-topic, but if anyone’s feet are to be held to the fire regarding the continuing absurdities of our health-care system, it should be folks like Palin, Boehner, Beck, and Limbaugh (among many others), who have no qualms about spreading outright lies (“death panels?”) and hamstringing so many of Obama’s initiatives.

      1. This is a typical Obama-bot dodge. No one is blaming Obama for not fixing all of the problems caused by either the Bush administration or the past 30 years of conservative and neo-liberal rule.

        What pisses me (and a lot of other folks) off is that Obama has, in both domestic and foreign policy, shown his allegiance to the same economic and political ideologies that Reagan, Bush I and Bush II embraced. Trickle-down economics, the Afghanistan surge(s), the kid-glove handling of Wall St and the big banks, the deference to BP in the oil spill and on and on. It’s the direction and the philosophy that I object to not the lack of results.

        Obama’s corporatist credentials are exemplified by his so-called health-care reform bill that is nothing more than Medicare Part D writ large. Just like his continuation and extension of the Bush/Cheney assault on civil liberties, Obama has gone George W Bush one better in the area of health-car policy.

        Your “point” about single-payer is ridiculous. The “current Republican majority in the House” wasn’t there 2 years ago. There was a solid Democratic majority that passed a far more progressive version of HCR only to have it steamrolled by the corporate-friendly bill backed by Obama and his Blue Dog buddies in the Senate.

        Obama never even made a pretense about fighting for a more progressive bill. He spent most of his time and effort in Quixotic effort to gain un-needed support from Olympia Snowe. And you can’t blame John Boehner, Glenn Beck, Sarah Palin or Rush Limbaugh for the deliberate exclusion of single-payer advocates like Physicians for a National Health Plan from the initial discussions on HCR – that was Obama – or for having single-payer advocates arrested at the Senate hearings – that was Max Baucus.

        Keep drinking the Kool-Aid pal.

        1. “Keep drinking the Kool-Aid?” Really?
          In spite of being encouraged to drink Kool-Aid (a turn of phrase that is as obnoxious as it is condescending), you definitely make several good points.
          Believe me, I am no “Obama-bot,” and I am also disappointed by many of his unfulfilled pledges (including his DADT two-step and failure to close Gitmo, in addition to many of those you mentioned). Also, respectfully, I’ll grant that I can’t offer (nor am I particularly inclined to look for) any specific citations, but it seems pretty clear to me that generally many – if not most – Americans do in fact blame Obama for not magically fixing the damage done by the Bush Administration.
          I wholeheartedly share your objections to, as you said, Obama’s “direction and philosophy,” but my own objections are tempered somewhat by the bizarre hostility that has metastasized over the last couple of years (to wit, the absurd accusations that he is a foreign-born, secretly Muslim, kitten-eating Marxist, among others) and the fact that he has faced increasingly entrenched right-wing opposition. Granted, he had a Democratic-majority Congress for two years, but that majority was always tenuous (and ineffective, for that matter).
          In any event, I agree with much of your reply, and your points are well-taken. I don’t mean to start a debate over the minutiae, either, but I still think it’s unfair to lay all the blame at Obama’s feet, especially in view of the hysterics and duplicity swirling about right now. The “death panel” debacle is, I think, the perfect illustration of this: A minuscule component of a vast health-care reform act that was so deceitfully and deceptively bastardized by Obama’s political opponents into a meme which was in turn voraciously consumed by an American public that either could not, or, more likely, would not be bothered to see it for the lie that it so plainly was. Glen Beck, et al., shovel untold buckets of shit every day and America keeps gobbling it up.
          There’s plenty of Kool-Aid to go around.

  51. A couple years ago I went to the doctor because I was pretty sure I had bronchitis. No one could see me, so I had to go to the emergency room. Told them I had all the symptoms of bronchitis, and my boyfriend was diagnosed with bronchitis the week before. They refused to give me drugs until doing $2,000 worth of tests (which took 4 hours, three of which with me just sitting alone in a room wondering if anyone was ever going to come back, while I had a 103 fever), 700 of which I had to pay for. Now I just suffer through my illnesses, blargh.

  52. The reason we have such an inequitable and inefficient system is the financial might of the insurance and pharmaceutical companies who lobbied and donated to our representatives and helped write the bills. It’s hard to overcome the power of money. However I’m supporting Healthcare-Now ( a coalition of groups working for single payer.

  53. I tremble in my number 6 shoes to think of what would happen if we had to live in the States…in Japan, my son had eye surgery for a lazy eye (strabismus–ended up working on both eyes, actually) when he was three. Cost: Y 0.00 Children under elementary school age (before they start first grade) pay nothing. For anything–visits, x-rays, meds, surgery. And that’s just Kanagawa Prefecture–up in Tokyo the cutoff age is 12 or 13 (so you pay nothing through elementary school).

    My mother had a liver transplant almost 6 years ago. $250,000. A quarter of a million dollars. *And* she has to take expensive (a couple thousand a month) immuno-suppressors for the rest of her life.

    American health care is a disgrace.

  54. Frankly, going by your line of argumentation, I would have expected this blog to be “Why creationism is true”…

    Most notably, by using the medical charges as an argument for some form of public health care, you are effectively creating a strawman: The largest problem here is simply that the US health care industry over-charges in the extreme. Correspondingly, the first step in the solution must be to reduced prices to be in proportion to costs. After this has been done, the situation can be fairly re-evaluated and other options for financing than private insurance discussed.

    The fact that a large proportion of your compatriots cannot afford to do their everyday shopping at Neiman Marcus is irrelevant when they can afford to shop at Walmart.

  55. I know what my choices are– I reject treatment. I work for the city and have healthcare but I can’t always afford to pay for my share. There are some things that I have no choice about in order to function (migraine meds for instance) but if it is something that is bothering me but not keeping me from working, I won’t get it taken care of. I have also had small children and been without healthcare… the worst is when they have something as simple as pink eye. The medicine is cheap and you know exactly what is wrong with them but you can’t get medicine without a prescription. A doctor’s visit without insurance for just a little bottle of meds even then was ridiculous!

  56. Ketamine was $1400?!? At my hospital (also in chicago) they charge “only” $120. I can’t imagine why there is such a difference. Maybe it was extra powerful ketamine having been immeaurably strengthened by a 30C homeopathic dilution and then blessed by the pope. If so, then $1400 is a STEAL!

  57. OK, I’m a bit late to the party on this post, but Jesus H. Christ what sort of country has the U.S. become?!

    In August 2009 I had a heart attack at work (here in Auckland, New Zealand). Spent about 5 days in hospital; angioplasty/stent insertion performed by head of cardiology from Auckland Medical School (teaching hospital); fabulous hospital care; extensive post-event education, support and follow-up. I dont have insurance. Total cost: $0.00.

  58. I thought I would add my story even though I’m very late to this party.

    I am a self-employed U.S. citizen, and was lucky enough to get health insurance years ago… if I cannot pay even one payment, they will drop me. My monthly payments are $1009, and I have a $4,000 deductible. So, the insurance co. gets $16,000 from me each calendar year before I can start getting any benefits from them. And it starts all over each January 1st. AND the monthly rates increase every six months, so next year I will be paying more than the $1009 per month I pay right now.
    I needed a knee replacement and two hip replacements in the last 18 mos… I am glad I had insurance but I STILL got billed for some items on most recent surgery because the insurance co. only paid a portion!!!
    It has taken much of my time to sort it out and to try to get the remaining bills paid by the insurance co. OR “adjusted” by the healthcare provider.
    The U.S. health insurance industry is NOT interested in much, except to make money… people who are supporting it, and who won’t let the govt. try something else (i.e., Obama’s new healthcare law) just don’t understand how bad it is out there.
    By the way, before Obama’s new law, if my insurance co. dropped me for missing a payment, it will be nearly impossible to get insurance from anyone else due to my “pre-existing conditions.”

    Oh, and one more thing, for those who are interested: the knee was billed at about $40K, and each hip was billed at about $60K. As others here have stated, the insurance co. has a contract with the providers to pay less than that, but if I were uninsured I would have been billed the full amnt.

    1. A very welcome contribution–real numbers make it that much clearer; and so obvious that non-employer-provided insurance is so far beyond the pale for the working poor, whose employers (think Wal-Mart) have been careful to avoid having to provide any benefits for.

    2. That’s incredible! It’s far more than I had imagined.

      The people who are probably hardest hit would be those who are making enough to prevent them from getting medical aid but not enough to let them afford a medical plan (understandably – that’s more than I’m paying in rent & utilities). It sort of puts things into perspective when pundits say that some Americans don’t have insurance because they are risk-takers or have made some informed decision about the benefits. If these numbers are accurate, I can think of some other factors which might lead people to go without, even if they are afraid of the risks.

      1. Tyro you wrote, “that’s more than I’m paying in rent & utilities”

        I hear that a lot. Yes, the $16K per year is more than many people make in a year in my rural area.

        Imagine my being grateful (!) that the insurance co. did not drop me after the first joint replacement, which they could have. Obama’s new law now prevents that. (And, as I wrote above, they could still do so if I miss a monthly payment.)

        It’s a gamble, always… do I drop it, or do I continue paying? I still need one more knee done,if I want to be mobile (I’m in my early fifties), so I’ll pay as long as I can manage it.

        The U.S. history of health insurance (and the health insurance industry) is, strangely, tied to employment; I remember hearing a piece on NPR years ago that explained how that came about. It’s created a monster that will be hard to beat. That is why I support some sort of change in the law. SOMETHING must be attempted.

  59. Little late to the discussion but I thought to add my two pen’th worth.

    In the UK as most people know, we have a universal, free at the point of delivery health service. Similar schemes exist in most European countries and this allows the UK to have reciprical agreements with those countries. This means that I can travel across Europe and get emergency treatment in those countries.

    Most people still take out insurance for additional costs such as repatriation etc.

    This came in handy when my young son broke his collar-bone and needed X-rays etc in France. We received 1st class treatment from the French Hospital and had to pay around £50 – as is the case for all French treatment; the remainder being met by the UK govt automatically. I was able to claim the full £50 back from my travel insurance. No fuss, little paperwork and satisfied panicing parents in a foreign country with rudimentary understanding of the language.

    It is one reason travel insurance to Europe is next to nothing compared to travelling to the USA.

    The vast majority of people in Europe would revolt if any Gvt tried to remove their NHS. It’s not to say any system cannot be improved but the principal of “national” insurance seems to be a no brainer.

    Remember, people in the UK can take out additional private insurance if they wish to cover private rooms or get quicker treatment. The state offers basic, effective treatment to the same standard for everyone whether pauper or prince. The standard is set by what the country as a whole can afford, not by what individuals can afford for themselves thus arguments about “bankrupting the nation” are ultimately useless.

    It means also that whilst there may be little incentive for Dr’s to cut costs, (though there is by managers) there is also no incentive to over-prescribe or offer unnecessary treatments as there is to private Drs. There is also the ability to negotiate far better deals with suppliers because the NHS has a near monopoly (remember competition in demand leads to higher prices, if you wont pay £100 for my drug, someone else will)

    Travelling to the USA sometimes scares the hell out of me thinking about if I got ill. I cannot get travel insurance for pre-existing conditions without paying a very high premium and whilst my asthma is controlled (thank you NHS) I shudder to think what would happen if I had an attack over there.

    1. I have been thinking about this for a few days… about Sean’s statement that visiting the U.S. could turn into a very expensive thing should one get sick while here.
      It makes me wonder if the U.S. is losing any potential tourism because of this. It’s very interesting.

      1. Jesse,

        At least in Canada, health care is provided only to residents. Tourists are not covered. It’s a misconception that health care is ‘free’ in Canada. It isn’t. It’s paid for through a payroll tax and if you aren’t a resident you aren’t covered.

        1. Right. It is good to have this clarified.
          I was thinking that if the high billed costs of U.S. health care keeps people from visiting the U.S., this would be another talking point in the U.S. efforts to get affordable health care in the U.S.

  60. This post and some of the anecdotal comments following it have made me feel faint.

    I was hospitalised last summer with an intestinal blockage and, although I didn’t need surgery in the end, the cost to me had I done so would have been the same as the bill I did receive; £0.00.

    I cannot imagine how terrifying it must be to actually avoid going to hospital for a serious illness because you can’t afford treatment. Rock on, NHS, you beautiful and inefficient behemoth.

  61. Cocaine is a numbing agent. I’ve had it used medicinally on me when I had nasal problems (nowhere near as severe as yours).

    I agree, the costs are astounding and totally out of proportion to the “real” costs of providing that service.

    The problem, of course, is that the insured currently subsidize the uninsured, and the insurance companies don’t want to do that, so they do this little dance. The hospitals jack up the cost of everything, the insurance companies say “no way, Jose”, and then they come to a reasonable accommodation. But if you’re uninsured, the top cost is THE cost, no questions and no negotiation.

    It’s the most damnably counter-intuitive and anti-logical system I’ve ever seen. Where the people with the least ability to pay automatically and inflexibly are charged multiples of the highest rate those who have the ability to pay ultimately are charged.

  62. Insurance premiums are high because hospitals overcharge. Put a stop to the greedy overcharging and maybe people can afford it.

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