by Aaron » Sat 29 Aug 2009, 09:19:18
$this->bbcode_second_pass_quote('Auntie_Cipation', '')$this->bbcode_second_pass_quote('Aaron', '')$this->bbcode_second_pass_quote('', 'I') guarantee you that the doctors who were working on you knew that you would be required to file bankruptcy and they were okay with it (if they weren't they wouldn't have done the procedure).
I considered this a given.
Don't forget the option I described telling my dad's story. He's self-employed without insurance, and had a heart valve replacement due to a murmur. He made a payment agreement with the hospital -- something extremely reasonable like $100/month. As long as he makes those payments consistently, the hospital has to (as I understand it) accept that.
He knows he's unlikely to pay it all off even if he lives to 95, but he does what he can in the meantime, it doesn't hurt TOO much financially, and they don't pester him for more, nor did he need to file for bankruptcy.
Once he's gone, I suppose his estate (essentially his house as he doesn't have many other assets) will owe the balance, but hopefully it will be pretty low by then. I think it's being paid off at zero interest if I'm correct.
PS this was a mainstream large hospital in San Jose, California, not some funky hidden away place.
Oh I do... but it's not just this hospital. Try 3 separate hospitals in 3 different states. In addition I pay various labs for reading diagnostic results from tests which I'm still paying for, separate Cardiologists who ordered these tests, 3 different surgeons who operated on me for angioplasty and now another one who did my bypass surgery, plus all the tests etc with that..
Oh yeah... this is my only debt... I don't borrow money... no unpaid CC balances, student loans, not even car notes. All paid up-front. (Except the mortgage of course) Open heart is 1/2 million bucks alone though. Stint lab around $150,000 + or so... each time. So poof... 1 million in debt.
This condition runs in my family on mom's side if you were wondering... only for the men though... girls are exempt and live very long lives.
$this->bbcode_second_pass_quote('', 'N')ope. You can't write off services given charitably. You have to give away money to get a deduction.
The problem is, of course, that not only is economics bankrupt, but it has always been nothing more than politics in disguise... economics is a form of brain damage.
Hazel Henderson
by smallpoxgirl » Sat 29 Aug 2009, 12:16:55
$this->bbcode_second_pass_quote('Sixstrings', 'I') think this should be a stop-and-think moment for everyone who's anti universal healthcare.
No one is anti-universal healthcare. No one wants to see people going bankrupt over medical bills. The problem is how that's gonna happen. The US currently spends around $2 trillion per year on healthcare-half from the government and half from other sources. The government funding piece comes to about $3000 per US citizen. Compare that with around $2000 per UK citizen for the NHS.
Call me crazy, but it seems to me that if you're going to decide how to improve a situation, you look at it and see what's working. Government funded healthcare in the US is not working. Medicare and medicaid are a screwed up dysfunctional mess. If they were providing quality, efficient care at a low cost, I'd be the first one ready to jump on the bandwagon. Medicare and medicaid are the worst part of the American medical system right now. Medicare's funding formula has just about destroyed primary care. It is outrageously expensive dealing with all of their rules and regulations. The require massive amounts of paperwork, lose about half of it. If you call them on the phone, you will probably get the wrong answer and if you want to talk to the person that has the right answer, you're gonna have to wait a week for him to call you back. Just because our healthcare system is a mess, that does NOT imply that it's not possible to make it worse. It is dangerously short sighted to assume that Obamaclaus and Tiny-Tim Gietner can just put a heart bypass in everyone's stocking for Christmas and the problem will be solved.
"We were standing on the edges
Of a thousand burning bridges
Sifting through the ashes every day
What we thought would never end
Now is nothing more than a memory
The way things were before
I lost my way" - OCMS
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by Sixstrings » Sun 30 Aug 2009, 01:13:15
$this->bbcode_second_pass_quote('smallpoxgirl', '')$this->bbcode_second_pass_quote('Sixstrings', 'I') think this should be a stop-and-think moment for everyone who's anti universal healthcare.
No one is anti-universal healthcare. No one wants to see people going bankrupt over medical bills. The problem is how that's gonna happen. The US currently spends around $2 trillion per year on healthcare-half from the government and half from other sources. The government funding piece comes to about $3000 per US citizen. Compare that with around $2000 per UK citizen for the NHS.
Call me crazy, but it seems to me that if you're going to decide how to improve a situation, you look at it and see what's working. Government funded healthcare in the US is not working. Medicare and medicaid are a screwed up dysfunctional mess. If they were providing quality, efficient care at a low cost, I'd be the first one ready to jump on the bandwagon. Medicare and medicaid are the worst part of the American medical system right now. Medicare's funding formula has just about destroyed primary care. It is outrageously expensive dealing with all of their rules and regulations. The require massive amounts of paperwork, lose about half of it. If you call them on the phone, you will probably get the wrong answer and if you want to talk to the person that has the right answer, you're gonna have to wait a week for him to call you back. Just because our healthcare system is a mess, that does NOT imply that it's not possible to make it worse. It is dangerously short sighted to assume that Obamaclaus and Tiny-Tim Gietner can just put a heart bypass in everyone's stocking for Christmas and the problem will be solved.
I read somewhere that medicare costs are increasing at a lower rate than private insurance costs.. which makes sense, since private insurance has massive PROFITS built into it. So how can you say medicare is a "failure"? Lots of old folks seem to like their medicare.. think they could just waltz into the insurance market at 70, 80 years old and pick up affordable health insurance?
I'm not surprised the UK cost is 1/3 less than ours.. their healthcare workers makes less money, and there's no massive corporate / investor profit built in. The question here really is, how MUCH does a physician really need to earn? Airline pilots in this country earn at the top end around 180k. If we can put our lives in the hands of someone making that amount of money, why is it so crazy to expect a doctor to sacrifice life as a millionaire so that we can have universal coverage?
And I'll tell you something about American physicians, albeit purely anecdotal. Some Americans point critically to the high number of foreign physicians in the Canadian and British systems.. well news flash, the numbers of immigrant physicians are swelling in this country too. And I have to say, from my personal experience, I've found them to BETTER. I've found the foreign doctors to be more communicative, more thorough, and above all they don't have that "I'm late for my golf game" attitude.
by smallpoxgirl » Sun 30 Aug 2009, 10:19:19
$this->bbcode_second_pass_quote('Sixstrings', 'I') read somewhere that medicare costs are increasing at a lower rate than private insurance costs.. which makes sense, since private insurance has massive PROFITS built into it. So how can you say medicare is a "failure"?
Well, if you'd link the article, maybe we could discuss it. I find it pretty unlikely, because Medicare very definitely promotes, through their warped funding schema, the most expensive and ineffective types of medical care. They flat out refuse to pay for are preventative care or alternative care. Their RBRVS funding system radically undervalues primary care. Between that, the costs of complying with their regulatory burden, and the expense of trying to fight with them over all their bureacratic screw ups, they are quite effectively driving private doctors out of practice. Meanwhile they're happy to fund all the multi-million dollar Mr. Wizzard care at the factory hospitals.
I personally don't think that pushing primary care doc into an assembly line where they're trying to see 30-40 patients a day is good for anyone. It makes the docs stressed out and uncompasionate. It leads to them ordering tests or specialist referrals on things they could figure out and fix themselves if they took a bit more time. It makes the patients pissed off because they wait 45 minutes for a ten minute visit and don't really get to tell their story. Medicare has gutted primary care in this country.
$this->bbcode_second_pass_quote('', 'I')'m not surprised the UK cost is 1/3 less than ours
Negative. Not 1/3 less. 1/3 as much. $6000ish per person vs. $2000ish per person.
$this->bbcode_second_pass_quote('', 'T')he question here really is, how MUCH does a physician really need to earn? Airline pilots in this country earn at the top end around 180k.
Median salary for a Family Practice doctor in the US is around $120,000. Surgeons and such make a lot more because of the RBRVS system from Medicare. I will happily assure you that medical school costs a heck of a lot more than flight school.
by Pretorian » Sun 30 Aug 2009, 10:24:27
$this->bbcode_second_pass_quote('smallpoxgirl', '')$this->bbcode_second_pass_quote('Pretorian', 'S')o what do they get of it, a tax write-off?
Nope. You can't write off services given charitably. You have to give away money to get a deduction.
But, if Aaron's surgery expenses were charity there would be no bill. If there is a bill, there are no charity.
His hospital ran into a number of certain expenses, both real and imaginary, on which they planned or hoped to collect. It is a business effort. If you are a restaurant owner and your diner runs away without paying, can't you deduct the costs of food, labour and maintenance from your tax declaration? What if all of them will run away?
by smallpoxgirl » Sun 30 Aug 2009, 11:27:30
$this->bbcode_second_pass_quote('Pretorian', 'B')ut, if Aaron's surgery expenses were charity there would be no bill. If there is a bill, there are no charity.
His hospital ran into a number of certain expenses, both real and imaginary, on which they planned or hoped to collect. It is a business effort. If you are a restaurant owner and your diner runs away without paying, can't you deduct the costs of food, labour and maintenance from your tax declaration? What if all of them will run away?
The OP, IIRC, was asking about the surgeon's fees. The surgeon did the work and didn't get paid. If you spend an afternoon volunteering at a homeless shelter, you wouldn't generate any tax deduction there and neither does a surgeon who doesn't get paid. The hospital certainly can deduct the cost of nurse salaries, building up-keep, supplies, etc whether he pays his bill or not. The hospital though, is almost certainly a nominal non-profit anyway. If he'd paid his bill, they would have had to find something else to spend the money on anyway to avoid turning a profit.
"We were standing on the edges
Of a thousand burning bridges
Sifting through the ashes every day
What we thought would never end
Now is nothing more than a memory
The way things were before
I lost my way" - OCMS
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by Aaron » Sun 30 Aug 2009, 12:30:21
$this->bbcode_second_pass_quote('smallpoxgirl', '')$this->bbcode_second_pass_quote('Pretorian', 'B')ut, if Aaron's surgery expenses were charity there would be no bill. If there is a bill, there are no charity.
His hospital ran into a number of certain expenses, both real and imaginary, on which they planned or hoped to collect. It is a business effort. If you are a restaurant owner and your diner runs away without paying, can't you deduct the costs of food, labour and maintenance from your tax declaration? What if all of them will run away?
The OP, IIRC, was asking about the surgeon's fees. The surgeon did the work and didn't get paid. If you spend an afternoon volunteering at a homeless shelter, you wouldn't generate any tax deduction there and neither does a surgeon who doesn't get paid. The hospital certainly can deduct the cost of nurse salaries, building up-keep, supplies, etc whether he pays his bill or not. The hospital though, is almost certainly a nominal non-profit anyway. If he'd paid his bill, they would have had to find something else to spend the money on anyway to avoid turning a profit.
All accurate to my knowledge.
The hospital is quite profitable though... not a hospital which can't refuse patients because they are state or federally funded anyway. I came in as an emergency patient... they treated me... I owe the bill in full.
The problem is, of course, that not only is economics bankrupt, but it has always been nothing more than politics in disguise... economics is a form of brain damage.
Hazel Henderson
by Sixstrings » Sun 30 Aug 2009, 18:04:35
$this->bbcode_second_pass_quote('smallpoxgirl', ' ')Well, if you'd link the article, maybe we could discuss it.
I personally don't think that pushing primary care doc into an assembly line where they're trying to see 30-40 patients a day is good for anyone.
Here ya go:
$this->bbcode_second_pass_quote('', 'H')ere’s the raw fact, from the National Health Expenditure data: since 1970 Medicare costs per beneficiary have risen at an annual rate of 8.8% — but insurance premiums have risen at an annual rate of 9.9%.
http://krugman.blogs.nytimes.com/2009/07/29/medicare-versus-insurers/So, how can you label medicare a failure when cost-wise it is in fact more successful than private insurance? Not only that, but private insurance insurers mostly healthy people.. medicare is stuck with elderly and disabled who use a lot of healthcare -- and yet, medicare's cost increase still beats private insurance.
As for seeing lots of patients.. they already do that! For one, they want to make as much money as possible (profit incentive is such that seeing more patients is rewarded, whereas giving more time to each patient is not). And I don't have a link, but I remember reading something one time about how HMO's work, where docs are paid some kind of bonus for accepting a large pool of potential patients. Don't they also get bonuses for lovely things like not giving diagnostic tests, etc.?
And while I'm on about healthcare.. WE HAVE TOO MANY SPECIALISTS! It ain't necessary! Every doctor wants to be a specialist so that they can bill more, and fewer and fewer want the lowest paying gig of all -- general practice. But let me tell ya something, it doesn't take a rocket scientist to prescribe prednisone for rheumatoid arthritis.
So what I'd like to see is a return to qualified gp's and stop sending people to specialists unless they really need it. One trend I really don't like though is nurse-practitioners treating patients.. yes, it's cheap, but I'd rather cut down on specialist use and have more good gp's. General practice is now so underrated that patients are herded into a nurse's office now (not even a doctor).
by smallpoxgirl » Sun 30 Aug 2009, 18:55:57
$this->bbcode_second_pass_quote('Sixstrings', 'S')o, how can you label medicare a failure when cost-wise it is in fact more successful than private insurance?
Medicare's RBRVS funding scheme is used by almost all insurances. It badly missallocates payments to the most expensive and least useful treatments. They may not be pulling their end of the wagon, but Medicare drives all the allocation of health funds in the US. If the insurance companies deserve blame for anything it's their decision to also use the RBRVS schema.
$this->bbcode_second_pass_quote('', 'A')s for seeing lots of patients.. they already do that!
Exactly. Primary care in this country is on death's doorstep, precisely because of Medicare's choice to underfund it in preference for invasive, expensive, and ineffective treatments. Doctors are scheduling so many patients that they can't adequately address their patient's problems. They do this because it is necessary in order to meet Medicare's coding requirements and still bring in enough money to pay pay the army of back office people to fight with Medicare to try to get payment, pay for all the expenses of complying with Medicare rules, pay the malpractice insurance, and still have enough left over to pay the rent.
$this->bbcode_second_pass_quote('', 'W')E HAVE TOO MANY SPECIALISTS! It ain't necessary!
You aren't listening to what I'm saying. We have so many specialists because RBRVS pays a specialist maybe as much as 3-5 times what a primary care doc makes. It wasn't some stroke of unfortunate bad luck. Medicare wrote the rules that way.
$this->bbcode_second_pass_quote('', 'S')o what I'd like to see is a return to qualified gp's and stop sending people to specialists unless they really need it.
by Sixstrings » Mon 31 Aug 2009, 02:57:48
$this->bbcode_second_pass_quote('smallpoxgirl', '')$this->bbcode_second_pass_quote('Sixstrings', 'S')o, how can you label medicare a failure when cost-wise it is in fact more successful than private insurance?
Medicare's RBRVS funding scheme is used by almost all insurances. It badly missallocates payments to the most expensive and least useful treatments. They may not be pulling their end of the wagon, but Medicare drives all the allocation of health funds in the US. If the insurance companies deserve blame for anything it's their decision to also use the RBRVS schema.
$this->bbcode_second_pass_quote('', 'A')s for seeing lots of patients.. they already do that!
Exactly. Primary care in this country is on death's doorstep, precisely because of Medicare's choice to underfund it in preference for invasive, expensive, and ineffective treatments. Doctors are scheduling so many patients that they can't adequately address their patient's problems. They do this because it is necessary in order to meet Medicare's coding requirements and still bring in enough money to pay pay the army of back office people to fight with Medicare to try to get payment, pay for all the expenses of complying with Medicare rules, pay the malpractice insurance, and still have enough left over to pay the rent.
$this->bbcode_second_pass_quote('', 'W')E HAVE TOO MANY SPECIALISTS! It ain't necessary!
You aren't listening to what I'm saying. We have so many specialists because RBRVS pays a specialist maybe as much as 3-5 times what a primary care doc makes. It wasn't some stroke of unfortunate bad luck. Medicare wrote the rules that way.
$this->bbcode_second_pass_quote('', 'S')o what I'd like to see is a return to qualified gp's and stop sending people to specialists unless they really need it.
by smallpoxgirl » Mon 31 Aug 2009, 08:09:06
$this->bbcode_second_pass_quote('Pretorian', 'e')xcept that i didn't know that they can skip on surgeon's salary
Generally the doctors that work in a hospital aren't employees of the hospital. When a doctors opens their practice they apply for privileges at one or more hospitals. The doctor then has the "privilege" of admit his/her patients to that hospital. The hospital bills for any facility based charges (medications, the room, nursing services, etc.). The doctor bills separately for seeing the patient and any procedures they do. In the case of a surgery, there's also an anesthesiologist who is also a doctor and bills separately. That's how it used to be anyway. Things are changing though in a few ways. 1. Most anesthesia these days is done by nurse anesthetists. You might have one anesthesiologist supervising 5 nurse anesthetists. The nurse anesthetists though are part of the anesthesiology group and still bill separately. 2. Like I said, billing and regulatory compliance are becoming much more time difficult and expensive for small private practices. Meanwhile hospital based "non-profits" have money that they need to put into capitalization to avoid having a paper profit, so they are buying up medical practices left and right. Doctors are turning into tenant farmers. 3. Because of the way that the coding and billing guidelines are structured, the typical approach to keep a primary care in the black these days is to load up the day with short appointment slots. It's not unusual for a primary care doctor to try to see 40 patients in a day. When you do that, it's impossible to even give those patients the attention they need. Having several patients in the hospital who you're trying to take care of at the same time is just madness, so a new breed of doctor called a hospitalist has popped up. Hospitalists are hospital employees who are paid to take care of the patient while they're in the hospital and then they go back to their regular doc when they're discharged.
"We were standing on the edges
Of a thousand burning bridges
Sifting through the ashes every day
What we thought would never end
Now is nothing more than a memory
The way things were before
I lost my way" - OCMS
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