ObamaCare Icebergs: Burgeoning Medical Debt and the Wobbly Start-Up of the Federally-Run Exchanges

An article by doctors David U. Himmelstein and Steffie Woolhandle, published by the Boston Fed, gives a stark picture of the extent and severity of medical indebtedness in the US, and why Obamacare won’t remedy that problem. And we’ll discuss later that getting the machinery running looks likely to be another serious shortcoming with the program.

Himmelstein start by reviewing the scale of the medical bankruptcy problem. In 2001, medical bills contributed to 50% of bankruptcies. By 2007, they played a role in 62%. The medical debtors were typically middle class. And of the people who declared bankruptcy for medical-related reasons, 78% were had medical insurance.

As bad as that is, it masks the size of the overall medical debt problem. Consider:

53 million working age adults reported having trouble paying medical bills in 2010. 30 million were contacted by a debt collector. 44 million were paying off medical debts on an installment plan

In 2010, 20.9% of all Americans lived in a household that struggled to pay medical bills. And insurance didn’t make a dent, since it a virtually identical proportion, 20.2% of insured, non-elderly people lived in a household with medical expense problems

A 2011 survey determined that 51% of uninsured 19 to 29 year olds had trouble paying medical bills or debts. But so did 29% of people in that age group who did have insurance

Consumer Reports found that the biggest financial problem for American households is paying for medical care

The article also stresses that Romneycare has not put a dent in medical bankruptcies in Massachusetts, that the 59% of bankruptcies before the program that had medical expenses as a trigger is “statistically indistinguishable” from the 53% afterwards. And if you look under the hood, you can see why. It’s crappy insurance. The authors write:

Consider that the cheapest coverage available through the state’s health insurance exchange to a single 56-year-old Bostonian who is not eligible for subsidies (in other words, one who has an income above 300 percent of poverty) costs $4,744 and comes with numerous restrictions on which doctors’ and hospitals’ bills it will pay. If the policyholder is sick, the policy doesn’t start paying bills until after the policyholder has taken care of the $2,000 deductible. The patient also is responsible for about 20 percent of the next $15,000 in medical expenses.

Obamacare also leaves individuals shouldering a large proportion of medical costs:

Nationally, the Kaiser Foundation estimates that in high-cost regions like New England, the unsubsidized premium in 2014 under the ACA will run $10,585 with additional out-of-pocket costs adding up to $6,250. Such costs will predictably leave tens of millions with large medical debts and drive more than a million into medical bankruptcy every year.

And not only is the ACA looking oversold in terms of outcomes, it looks also to be oversold in terms of when it will be operational, at least in any reliable manner, if you happen to be living in a state where the Federal government is responsible for the exchanges.

While some of the states are making good progress in building their infrastructure (see Maryland as an example), the Wall Street Journal tells us tonight that the Obama administration is insisting that all systems will be go, a GAO report casts doubts. Remember that there are two key deadlines: October 1, for the websites (the famed exchanges) for insurance shopping and enrollment and January 1, when hospitals and doctors need to be able to exchange billing and eligibility information with the insurers. To make matters more complicated, there are actually two types of exchanges, one for individuals (expected to serve seven million people) and another for small businesses (which will provide insurance for two million individuals). The small business exchanges are in the most trouble. From the Journal:

Government officials have missed several deadlines in setting up new health-insurance exchanges for small businesses and consumers—a key part of the federal health overhaul—and there is a risk they won’t be ready to open on time in October, Congress’s watchdog arm said…..

The GAO report on the small-business exchanges said officials still have big tasks to complete including reviewing plans that will be sold and training and certifying consumer aides who can help companies and individuals find plans.

It said that the 17 states running their own exchanges were late on an average of 44% of key activities that were originally scheduled to be completed by the end of March. “While interim deadlines missed thus far may not impact the establishment of exchanges, any additional missed deadlines closer to the start of enrollment could do so,” the report said.

Notice that the GAO report ONLY covers how a sample of states are faring. The Obama Administration continues to pull a veil of secrecy over how the Federal efforts are going. As Bob Laszewski of the Health Care Policy and Marketplace Review blog writes (hat tip Lambert):

…. apparently the Federal Data Hub is up and running. While that is what the Obama administration has been telling us, it has been hard to find anyone who has actually seen it or used it…

I continue to be puzzled by the way the Obama administration is developing the federally run exchanges in the 35 [sic, 34] states in which they will have to run them.

We don’t know any details on just where they are and if they are on track. They continue to tell us they will be ready on October 1 to begin enrollment and on January 1 to exchange billing and eligibility information with the health plans––by far the toughest challenge.

But why all of the secrecy? Why aren’t we getting the same reports from the Obama administration we are getting from Maryland? Why isn’t the GAO doing a report on just where the administration is in the 35 states’ exchanges they will now manage?

Even more, all of the health plans intending to do business on the new federal health insurance exchanges had to submit their plan and rate data to the Obama administration weeks ago.

Will we have rate shock in the federal exchanges? The Obama administration has all of the rate data. They know if we will or won’t. True, all the rates are preliminary but they are preliminary in California and Ohio and all of the other states that have released that data.

Why won’t the Obama administration release the detailed information on which health plans are participating in which states and what they are charging?….

It’s notable that more is now known about that national security enterprise than exactly where HHS is on “ObamaCare” implementation!

Why is the implementation of “ObamaCare” by the Obama administration a top-secret enterprise?

The answer to Obama’s insistence on “all secrecy all the time” is becoming more and more obvious. As we said back in 2010, Obama thinks any problem can be solved by better propaganda. Having reality be less observable makes it easier to pull off a snow job.

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  1. jake chase

    The ideal solution to the health care problem is don’t get sick (or injured) until you are old. Eat moderately, drive slow, walk everywhere, avoid toxic substances (generally found in prepared food and beverages other than water). Stay away from doctors and hospitals and drug stores. Avoid supplements. Find work which offers good ventillation, or even better, work outside. With good genes you ought to make it to 65. Prayer may help too. Who knows? Medical care is oversold, but it takes guts to ignore it.

    I guess now you’ll also have to pay the penalty for going uninsured. Bummer.

  2. LAS

    It’s interesting that several Republican states (AZ and OH) are turning to embrace the expansion of Medicaid as offered by the ACA after initially balking (as reported by PBS News Hour recently). Analysts say the reason is that hospitals are explaining to state executives and legislators that they will go bankrupt without it. I wonder if the ACA law hasn’t been written to help the hospitals and doctors stay out of bankruptcy if not specifically the consumers or patients.

    1. Banger

      Excellent insight. Yes, that was part of the motivation. The idea behind the ACA is to create a situation where the HC industry can flourish as a system not just the insurance companies–that’s why the insurance companies were not that happy with the ACA. The ACA can be viewed as a way to insure stability and continuity giving government a stronger role in regulating the industry FOR THE BENEFIT OF THE INDUSTRY.

    2. Kmurp

      Hospitals are getting their charity care funds from the Feds reduced. As compensation they are supposed to see more uninsured people falling into Medicaid. If the state refuses this increase in Medicaid enrollment , it would make it tougher on the hospitals in those states.

  3. dearieme

    I can remember when anyone who pointed to the flaws in Obamacare was in danger of being called some sort of fascist who wanted the poor all to die. Ah well.

    I repeat my sole advice to Americans on this subject: whatever you do, do not copy the NHS. By all means copy the Canadians, Icelanders, French, Singaporeans … : your shout.

  4. mad as hell.

    Hospitals have charity boards that will forgive any costs incurred IF you are under a certain income level and have insurance. If you don’t have insurance I don’t know of the willingness of them to grant forgiveness as easily. Although they do waive costs for people without insurance. I’m not talking about just emergency room admissions.

    So if you have a high deductible on your insurance the hospital can waive that fee if you meet certain income criteria.

      1. Linden

        Oops, little too quick on the trigger finger. I mean to say, hospitals don’t write off much in terms of charity care. And how can they, when they are for-profit businesses? Even the non-profits do little more.

        1. Code Name D

          Very true. Charity care is one of the symptems of our deseased care system. You can argue if they are to make profits or not. But unless we are going to give them the ability to print their own money (as the too-big-to-fail banking sector does) the money has to come from some where.

  5. Noni Mausa

    Last summer, visiting Minnesota from Canada, I chatted with an RN in my mother’s care home about the US system. She told me she and her husband had been lucky to keep their home after her husband was diagnosed with cancer. He had insurance through work, she did also, but you know what saved their home? They had won a $15,000 state lottery a few weeks before the diagnosis.

    Our system has its faults, but I don’t personally know anyone in Canada who has gone bankrupt for medical reasons (though there are some.) but I know literally dozens who would have, in the the US system.

    The rest of the world watches your system as a tragedy made policy — with all the pity and fear, but sadly none of the catharsis that dramatic tragedy is supposed to invoke.


    1. Banger

      The sad part is, Noni, that “progressives” supported the ACA which is designed to maintain not reform the system. Part of the reason is that most Americans have no idea what the system costs or the human tragedies involved because the U.S. propaganda organs, i.e., mainstream media generally does not report reality that isn’t approved of by the virtual Ministry of Truth. Also the Democratic Party is very connected with the Medical Industry that is 17.4% or more of the GDP of this country–virtually no one in the U.S. knows that or what other countries pay as percentage of GDP.

  6. Chromex

    ALL hospitals have “charity boards” that MANDATE such cost forgiveness?
    Not in my experience
    Also I pointed to the flaws in Obamacare yesterday and got told that same thing. I told them what I always say; insurance is NOT care

    1. Code Name D

      My brother in law is an EMT. When they are carrying a patient without insurance, all of the emergency rooms suddenly end up closing. He has lost patents in transit, simply because they are racing all over the city in a futile effort to find an open emergency room.

      But the morgue will always take them.

  7. TomDor

    What do ya expect when the vested interests in health care lobby the sense out of common sense in order to profit maximize their private insurance regime.
    Step on up to the new privatization plan, better than the old plan – just don’t open your eyes if you don’t like the new heights of stupidity we have achieved.

    1. splashoil

      If you are over 55 and unemployed, Obamacare rolls you into Medicaid where the states handle the nasty job of starting a tab of all costs including monthly fees and expenses which will be recovered from your estate. No shopping at the Exchange and hoping for a subsidy. And many of the same players in the foreclosure racket will be handling the clawback on contingency. What could possibly go wrong?

      1. TomDor

        Well of course: Being born today means you owe a debt that needs to be payed back to those who lent you money to live – Financialization means you no longer have a right to life.

  8. mk

    “…Obama thinks any problem can be solved by better propaganda.”
    ~~~~~~~~~~~~~~~~~yeah, like his entire 2008 presidential campaign.

    1. Banger

      Which won advertiser of the year, I believe. I remember when I first realized Obama was a fraud. I listened to a Charley Rose interview with him that, if you listened carefully, was one piece of BS after another. The conclusion I came with after the interview was that he said nothing about as well as anyone I’ve ever heard. He’s clearly brilliant intellectually to be able to do that so I was impressed.

  9. Banger

    The ACA was a result of the weaselification of the left part of the Democratic Party. If the left had stayed on focus and insisted on real reform I believe we would have been closer to that reform now than back then and now real reform is next to impossible and the sort of results indicated in this post will accrue.

    Again, as I often rant–the thing we are facing here is not health-care so much as Washington politics and how it works as a system to deliver bad policy. It is now to the point where we are better off shrinking and starving the federal government and decentralize authority so that localities, communities and states can experiment with their own systems. I was a social-democrat but after the fact that social-democrats supported, mainly, the ACA–I’m done. I will probably vote Libertarian in the future–and yes, I know libertarian philosophy is weak etc. but at least it is an opposition movement.

    1. lambert strether

      The narrative that had the Democrats could have “stayed on focus and insisted on real reform” is wrong for two reasons:

      First, the so-called “left” in the Democratic Party had only and exactly one “focus”: Running interference for Obama, some because they bought the con job, others because they were funded to do that. (Jason Rosenbaum’s health care “news” column at FDL, for example, censored single payer stories completely from its disingenous beginning to its ignominious end; I can’t recall one single payer story printed in it, not even when Dr. Margaret Flowers got herself arrested in Max Baucus’s hearing room because he had no single payer experts on his panel.)

      Second, if the Democrats had been interested in “real reform,” they and their operatives and shills would have acted in good faith, and allowed real reform to be part of the discourse. This they did not do, and actively silenced and suppressed single payer advocates. They’re still doing it.

      1. Banger

        Ok, fair enough. I remember all that–but what you are saying is that there was no left in the Democratic Party and that is true now as it was then. Operatives trolled the blogs to insure conformity, to be sure but there was a lot of support for single-payer in the population at large. what happened was that the activist left did not believe in their own principles and, worse, did Minot understand politics. As I kept insisting at the time, politics is not about competing sermons but the application of power. First strengthen the coalition around solid principles in the initial phase of organization so that the zeal it’s are 100 % committed fight like hell then allow your story to seep into the mainstream then, at a certain point, you can sit down and negotiate from a position of power. Instead the activist left, in its cowardice, elected to just follow rather than lead Obama.

        After Bush was elected several Democratic operatives were hired at vey nice salaries by plants of the HC industry–activists should have known this.

        1. Yves Smith Post author

          No, Obama set out systematically to destroy the bona fide left wing of the Democratic party. Google “Jane Hamsher” and “veal pen” for details.

          1. John F. Opie

            He had to. They’re the only ones who might have called him out on what he was doing. What’s the saying? Keep your enemies close, but your friends even closer?

            It’s the Chicago way.

  10. washunate

    Yep, just like we knew four to five years ago, nothing meaningful has changed with the BFD. We still have the same basic problem that healthcare is too expensive given median wage levels.

  11. serf out of control

    I am familiar with both bankruptcy and health care and medical billing.

    My impression is that medical billing industry is a mess. There are so many examples, but I’ll give a few.

    For example, a party gets into a car accident and blames the other driver. The patient goes to the hospital and tells the hopsital that they don’t have insurance because they (incorrectly) believe that the other party should pay the bill. That’s not how things work.

    Another example is that not everybody carries around their health insurance card. SO when they go the hospital, they’re considered uninsured, or they don’t follow up with their health insurance company, and get a bill a few weeks later – and wonder why the health insuarnce company won’t pay the bill.

    Third, patients, especially lower income patients, hate co-pays. The medicaid system in my state forbids co-pays and medicaid is considered the gold standard among the lower and middle classes pricesly because it’s ‘free’. Nevermind that it’s not accepted everywhere, because the gold standard is ‘free’. I’ve seen first hand people turn down health insurance so they can stay on medicaid precisely because they don’t want co-pays or deductibles.

    Fourth, many insurance companies deny payment to hospitals until the patient completes a subrogation form – so the insurance company can recover money from the 3rd party if there is a lawsuit. A lot of patients can’t be bothered to read their mail and check a few boxes so their claim is denied, and 5 months later they’re like “why do I have $8,000 in medical bills” when all they needed to do was check a few boxes on the subrogation form.

    Fifth, the hospital billing departments don’t properly train their employees to ‘find the money’. I can’t tell you how many times I’ve seen hospitals bill auto carrier for med pay when there is no med pay at all. Then no one follows up on it and months later there’s a huge medical bill directly to the patient.

    Finally, I file hundreds of bankruptices a year, and I’ve discussed this issue with dozens of bankruptcy attorneys, and all of us agree that it’s myth that medical bills ’cause’ bankruptcy. They contribute to it, sure, it’s part of a pattern of behavior not to pay debts, thats why debtors file banruptcy. The ‘contribution’ is usually co-pays or out of pockets. The $300 co-pay on the MRI is drawfed by the $2,000 Best Buy credit bill for the big screen TV.

    I’m not here trying to blame patients, the system is a mess, but it’s mostly a result of co-pays and deductibles that patients loathe to pay. So they don’t. ask any doctors office how hard it is to get people to pay the $20 co-pay for an office visit.

    The co-pay is there to discourage use of the medical system unless it’s necessary, it’s the same reason why there are $500 deductibles for car insurance. It’s not working making a claim for a little scartch that costs $100 to fix if there’s a $500 deductible. Same for medical. No sense in going to the doctors office for something totally minor unless if there is an out of pocket expenses. But people use it anyway and just don’t pay the co-pay.

    1. bondsofsteel

      RE: The co-pay is there to discourage use of the medical system unless it’s necessary, it’s the same reason why there are $500 deductibles for car insurance

      I keep hearing this, and can’t help think it’s a meme. The difference between using car insurance and health insurance is that using heath insurance is a horrible, horrible experience.

      Are people really seeking out unnecessary colonoscopies? It’s not the co-pay that keeps me from going to the Dr’s office… it’s the crappy waiting room full of sick people, that icky table with the paper, and the humiliation of the pelvic exam.

      1. serf out of control

        Medicaid patients without co-pays have free virtually unlimited amount of insurance and there is a contingent that overuses or maybe even abuses it and visits the ER or doctor for routine things that don’t require visits. That’s one of teh reason medicaid spending is out of control in most states, including Illinois where I live. If you give people for free an unlimited amount of a valuable service, they’re going to use it.

        Remember how cheap gas was for so long, and how cars got 8 miles to the gallons for many many years? Now that gas is no longer cheap, the trend is towards fuel economy and the days of teh 1950 all steel gas guzzling lincoln are long, long gone, and never returning.

        1. Yves Smith Post author

          Provide some substantiation.

          The people who go to the ER for care are overwhelmingly people who are uninsured, not Medicare. And of those, a teeny proportion are responsible for a huge amount of costs. See:


          This idea that there are medical system abusers who seek doctors for overtreatment is an urban legend. I occasionally hear claims yet I have yet to see anyone provide evidence that this happens. And there’s an obvious reason why. Doctors find it very hard to get paid in general by insurance, and a recidivist patient who isn’t really sick is gonna be very hard to get an insurance company to pay for. It’s hard enough to get insurers to pay for legit claims.

          The people I know who do see doctors a ton are ones with bona fide chronic conditions that Western medicine does not treat well OR people who have trouble getting a diagnosis. I know a wealthy guy in NYC, for instance, where despite having access to supposedly very good doctors, suffered from advanced Lyme disease for two years before someone figured it out. He was repeatedly being told it was in his head and he needed antidepressants.

        2. Ms G

          Personally, I’ve never met *anyone* who goes to a doctor or an ER for the heck of it, or having determined that their problem is “routine and ordinary” and therefore not requiring medical care.

          This is the central Straw(wo)man — i.e., Fake Character — of “health care reform” (as it was when HMO’s were introduced”: the person who “overuses” the health care system.

          Somehow this idiotic “actor” has been swallowed hook line and sinker. Sort of like the “rational economic actor” that anchors that branch of charlatanism known as “economics.”

        3. whatever

          An evil animal named serf out of control speaks:

          Another example is that not everybody carries around their health insurance card. SO when they go the hospital, they’re considered uninsured, or they don’t follow up with their health insurance company, and get a bill a few weeks later – and wonder why the health insuarnce company won’t pay the bill.

          I don’t wonder. Insurance companies like cheating people. Thanks for defending thieves.

          An evil animal named serf out of control speaks:

          Fourth, many insurance companies deny payment to hospitals until the patient completes a subrogation form – so the insurance company can recover money from the 3rd party if there is a lawsuit. A lot of patients can’t be bothered to read their mail and check a few boxes so their claim is denied, and 5 months later they’re like “why do I have $8,000 in medical bills” when all they needed to do was check a few boxes on the subrogation form.

          To bad they can’t submit it later and check the boxes and the insurance company can then process the form and pay the money it is supposed to pay and perform the service it was (vastly overpaid) to provide. It’s sad. The poor insurance company was sadly forced to make up insane rules that let it cheat patients! And those ungrateful patients then break these rules forcing the Just And Good insurance companies to cheat them!

      2. jrs

        plus having to miss work to go to the doctor, as most dont’ work on weekends, but believe though missing work to go to the beach … um I mean the doctor, yea that’s it.

    2. Bruno Marr

      Well, you may find the blizzard of billing envelopes and form letters with checkboxes that arrive after a stint in the hospital as navigable, but first-timers do not!

      Hell, the hospitals will bill you for services that were never performed, and much of the billing codes are wholly undecipherable. I’m a lucid, experienced professional and my initial hospital billing experience was like working with Martians. (In fact, you need your own personal Billing Defence Doctor to protect you while you’re in the hospital.)

      1. Code Name D

        Hell, I am still getting bills from my hosbital stay from years ago. $10 dollars for this, $8 for this other thing. They don’t even bother telling me who they are, what the bill is for, or when the survice has been acrued. I bet you half of them are frudulent. But how can I know? I don’t dare not pay them, the cosiquences are just too dire – for $10 fucking dollars!

        It ain’t the big wallups that get you, its this death from a thousand cuts – AFTER the big wallup – which comes after the co-pays.

      2. Ms G

        “(In fact, you need your own personal Billing Defence Doctor to protect you while you’re in the hospital.)”

        Exactly. Same thing with insurance, if you’re lucky to have it — you need your own personal Secretary and Advocate to engage the relentless “not covered”, “we didn’t get the paperwork” nonsense (er, tactic). And that’s *with* insurance.

    3. aletheia33

      which costs society more? people going to the dr. when they don’t “need” to, or people not going to the dr. when they really need treatment because they can’t pay the bill?

      could you please give an example of an “abuse” of the healthcare system that a copay will prevent?

      1. Ms G

        Thank you Aletheia. That’s a good question and I’m sure there’s nothing but a Power Point (canned, ideological and counter-factual) answer to that one. The only honest answer is: no, I have no examples because that notion is a crock.

  12. serf out of control

    The system gets even crazier in areas where people have insurance vs. don’t have insurance. Newer hospitals in wealthier areas run up bills like you wouldn’t believe. MRI this, CT scan that, and a routine back strain car accident has $10,000 in ER bills plus a few thousand for physical therapy. I have that case on my shelf right now. Compare that with teh poor area hospitals, where most patients who come in don’t have insurance or are on medicaid. They keep bills low, very low, and a back pain results in a $990 ER bill, with maybe one x-ray and no physical therapy, and a discharge sheet that says “you’ll be OK in a cuple of days”: and they ususally are. Heck, if i were uninsured, i’d be happy to have only a $1000 ER bill from a local hospital, as opposed to a $10,000 bill from a rich neighborhood hospital

    But in my opinion, the quality of the care is pretty much the same.

  13. Kokuanani

    Typo: *** And of the people who declared bankruptcy for medical-related reasons, 78% were had medical insurance.”

    Unless you mean to say they were “had” by having medical insurance.

  14. lambert strether

    Fortunately, the Enroll American campaign is starting, so the ObamaCare rollout is already a proven success, by definition. The kayfabe around the draft CA rates — ably executed by Democrat players like Krugman, DeLong, et al. — was really only a warm-up in a “battleground state.” Be prepared.

    * * *

    People need to remember IMNSHO that Enroll America is not like a political campaign; it is a campaign, and not just because EA is stuffed with former Obama campaign operatives, or because it’s partially funded with a slush fund run by Sibelius, or because the Navigator program is an obvious way to steer walking around money to Democratic-leaning non-profits, but because the 2014 midterms are at stake, and possibly the Presidency in 2016. And, oh yeah, branding: Obama’s name is on it. QED.

    So every single utterance on ObamaCare from the Administration, Obama supporters, the Democratic apparatus, and anyone funded by PPACA should be given all the credibility of a campaign promise. The entire discussion will be couched in terms of policy — perhaps even as a “conversation” about policy — but kayfabe is what it is and what it will be.

    * * *

    Remember: ObamaCare can never fail; it can only be failed!

    1. Ms G

      I’ll be sure to ask the good “folks” of Enroll America to guide me every step of the way and I am sure that they will help me make the very best choice, even if that choice involves not buying an ObamaCare Exchange Policy. Because they really, really care.

      Ha ha.

    2. jrs

      from the article:

      “The site also disclosed what a person gets for that low premium. The bronze plan comes with a $5,000 deductible for an individual ($10,000 for a family) and very high cost sharing for many services. For example, a person would have to pay 50 percent of the bill for a stay in the hospital, even to have a baby; 50 percent for emergency care, unless it resulted in an admission; 50 percent for diagnostic tests like CT scans and MRIs; and $120 for every urgent care visit. In other words, premiums may be low but that may be nothing to celebrate if you get sick or hurt”

      ok so the big question becomes: is there an out of pocket maximum or not? Because if not NOONE but the 1%, not even the lucky people who are mostly doing fairly well economically can afford *that*! One hospital visit could cost 100k, so you pay 50k? And what if you have to go to the hospital more than once?

  15. Westcoastliberal

    The way modern insurance is set up (unless you can afford the “gold-plated” policy, such as those in CON-gress have), your premiums are for “access” to their network, then your deductables and co-pays are what the actual procedure/test, etc. should cost. Search “Oklahoma surgery center” for their non-insurance prices on common procedures. It will shock you when compared with the prices you pay WITH insurance.
    Obamacare is just another giveaway to big business.

    1. Kmurp

      It’s easy to give a significant discount like that surgicenter does when all you are doing are cases that actually pay you. No Medicaid no Medicare no charity care etc.

      1. whatever

        It’s easy to give a significant discount like that surgicenter does when all you are doing are cases that actually pay you. No Medicaid no Medicare no charity care etc.

        Thanks for the story. After story time can we have milk and cookies?

        Why should I believe them or you without actual evidence from semi-trustworthy people? IE not you or them?

        1. Kmurp

          Why wouldn’t it seem self evident to you that when one does a limited menu of procedures with a known predictable cost and nothing else, one can do it cheaper than a hospital. The only thing these guys seem to be doing different is that they don’t accept insurance. It’s smart to give a pre payment discount in this era of high deductible plans. They won’t be seeing any poor people there and the rare complications go to the hospital.

          1. whatever

            Well, zippy, that’s not what I asked you to prove.

            I asked you to prove this statement:

            It’s easy to give a significant discount like that surgicenter does when all you are doing are cases that actually pay you. No Medicaid no Medicare no charity care etc.

            That the poor hospitals are beset by dead-beats that don’t pay them anything and suck them dry. And that is not self-evident when all the hospital has to say is “emergency room is closed” or “emergency room is full” or provide grossly inferior care for non-paying patients.

            It is not self-evident AT ALL that hospitals are being sucked dry by deadbeats. So present something approaching semi-believable proof.

      2. Yves Smith Post author

        Just not true or at least not true anywhere near as often as you suggest. I pay for a lot of my medical personally and then submit for reimbursement (so from the doctor’s perspective I’m not an insurance patient). I’ve never for the 20 years I’ve been doing this gotten a better rate on any service.

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