Few things can blow a budget like unexpected medical bills. Even those who practice frugality and invest for the future can find their financial plans smashed to pieces by unexpected health problems. And for those who don’t have their financial house in order, a medical crisis can be devastating.
Five years ago, I had surgery to replace the ACL on my right knee. Though I am insured through Kris’ job, I found the experience frustrating. Nobody could tell me how much any part of the process would cost. MRI? Nobody knew. Surgery? Nobody knew. They didn’t know the total costs, and they didn’t know what my obligation would be. “Don’t you have insurance?” everyone wanted to know.
In the end, my portion of the procedure cost me a couple thousand dollars, and physical therapy cost me even more. (I don’t have exact records from that period.) Because I was already deep in debt, these expenses only added to my stress. I had to borrow money from a family member to pay for the operation.
In a recent article at Kiplinger’s, Elizabeth Ody writes that there are ways to mitigate unexpected medical costs. She offers the following suggestions:
- Read your bill. If you something seems wrong, ask questions. Nobody cares about your financial circumstances more than you do, so take charge of the situation. When I couldn’t understand the hospital bill, I called to find out what was going on. I asked for clarification.
- Know your insurance. From my experience, insurance clauses can be arcane. Before I had my surgery, I read through our insurance and then called to ask questions about the sections that puzzled me. More recently, I had to see a doctor about a running injury. Finding a preferred provider near me was a challenge. Before you see a doctor or ask for treatment, be sure you understand how your coverage.
- Shy away from plastic. Ody writes: “When you apply for credit, owing money on a medical debt isn’t viewed as negatively as, say, splurging on a Lexus…But once you transfer the debt to a credit card…you lose the benefit of the doubt.”
- Drive a hard bargain. According to the article, what you are billed bears no relationship to what the provider will accept as payment in full. It’s often possible to ask for a discount. (The article provides a couple of examples of how this works.)
- Find a hired gun. If your situation is complicated, it’s possible to hire a medical-billing advocate or claims specialist.
The full article contains further anecdotes and suggestions for slashing medical bills when they get out of control.
[Kiplinger's: Save thousands on your medical bills]
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J.D., Medical insurance drives me insane. Every provider tells me I have ‘excellent’ insurance. Yet, beyond the standard co-pay, no one can tell me how much anything will costs. It’s always a crapshoot on what my provider will bill me after they get done processing the insurance.
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check out http://www.jayparkinsonmd.com he’s doing amazing things w/ healthcare and his new model for franchise offices called hellohealth.com
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Or move to one of the many, many countries with universal healthcare, like Canada, France, Japan, …
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“Know your insurance” is so true. The first time I got sick while insured, it cost me over $12000 dollars. I was 25 years old at the time.
It turns out I was 40 miles to the closest hospital in my HMO plan, so the first ride to the local hospital wasn’t covered, nor was any of the treatment there. They only covered the ambulance ride between hospitals and treatment at the second hospital.
Needless to say, my current coverage at my present job covers the local hospital.
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One thing that can save you money is paying up front for outpatient services. My newborn son’s health insurance didn’t cover his circumcision, but our bill was $100 less because we paid at the time the procedure was done instead of having his doctor bill us later. Definitely ask if there’s a discount for this.
Also, if you’re low income and applying for a state funded insurance program, know that hassling them (AND CONTACTING YOUR STATE REPS/SENATORS) is worth it if you think you’ve been rejected unfairly. Take the hearing to contest state rejection. The judge can make a reasonable decision where a social worker is bound by policy. And your local elected officials can be amazingly responsive allies.
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Always ask for a discount. I knocked 40% off a $650+ ultrasound bill (didn’t dawn on me to check that the provider was “in network”) without really trying that hard.
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Good post, and very important. Nothing makes me as crazy as thinking about America’s screwed-up medical system. I live very frugally, save for the future, and take pretty good care of my body…but I know that a lifetime of savings can be wiped out in an instant by a simple (or not so simple) health care problem.
So far, I’ve been blessed with good insurance; but that’s just luck. And genetically, I haven’t been so lucky: I have a rare blood condition that requires maintenance medication and frequent blood tests. If I ever lose my group coverage, it’ll become a pre-existing condition and won’t be covered. And then I will probably go bankrupt…despite having been fiscally responsible my whole life. It makes me crazy to even think about it. Obviously, I’m voting Democratic in 2008….
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The shame of it all is those without insurance get slammed the hardest. They are billed the [inflated] total amount, whereas every insurance company has a “negotiated” amount which slashes a huge amount off the bill before it even gets processed. The entire system has become so crazy. HMOs stink largely because of the kind of problem Edmond speaks of. HMOs also have added tremendous overhead to every medical provider, because of the massive and competitive bureaucracies, AND delayed care in numerous instances. A single bureaucracy, though annoying, would be simpler and less expensive.
Enough ranting!
In the current state of insurance, with complicated cases, I think your suggestion to hire an advocate is excellent.
On a side note, I can’t praise Flexible Spending Accounts (FSAs) enough. Ours has saved us a tremendous amount of money over the last 3 years.
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As an insurance specialist at a large hospital, I absolutely endorse the idea of knowing your coverage. It pays to have a basic understanding of how your plan works in case of an emergency situation – arming yourself with that knowledge will at least give you some peace of mind on that front. For procedures or visits that are scheduled ahead of time, it’s good to call your insurance and have them run through your coverage as it pertains to that particular procedure. Is a prior authorization required? Is it in place? Are you seeing a contracted doctor or having your procedure done at a facility that participates in your plan’s network? What are you looking at for out of pocket costs – does your plan have a maximum that it expects you to pay before they start covering in full? What is your deductible and coinsurance (the percentage that you are expected to pay yourself)?
One reason why it is so hard to get a concrete answer on how much a procedure will cost is because those costs tend to vary from patient to patient. You may be coming in for something in particular, but your doc may find something he needs to check out during the course of the procedure, which in turns raises the total price. It may seem obvious that more procedures/medication/etc = a higher price than originally quoted, but providers want to avoid situations like a patient saying, “Well, you told me it would cost X, and that’s that.” What a provider can and should do is provide an estimate. At my hospital, we figure out what the average cost was for a particular procedure based on admissions over, say, the last year, and make it clear to the patient that it is an estimate based on previous cases. If something unexpected happens during the procedure, then that will affect the total balance.
Also, some places offer discounts, others don’t. Those who do will have varying guidelines. Never be afraid to ask, even if you are insured. You may qualify for assistance on your share of the costs if you meet the criteria for that particular provider. Just don’t expect that simply asking for a discount will get you one because, again, that varies. Some providers are better equipped, financially, than others to provide financial assistance.
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Oh do I know this subject well!!
My husband had a 2 day stint in ICU a few years ago to the tune of over $12,000.- and we had no insurance due to a shady job loss and just starting a new job. The hospital was a non-profit and after informing them of our insurance situation, or lack thereof, they knocked off 42% of the final bill. Plus help from the state brought down our out of pocket to 1/4 of the bill.
At first I felt guilty for the state help but we all pay into that via taxes and that is what the money is supposed to be for – emergencies/hardships. I am grateful it was there and happily pay taxes knowing that someone else may run into trouble and that will be available to them as well.
What still perplexes me is that the hospital had no problem knocking off that much from the bill due to us having no insurance. How can that be done even if it is a non-profit?
I to will be voting Democratic this fall.
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vje – there are hospitals that have funds set up for financial assistance. The funds available for such programs may vary from budget year to budget year, but they are set aside in order to help the uninsured or underinsured (as in, you have insurance, but doesn’t cover very much).
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I too also worked in claims for a Hospital in calif.
A lot of people don’t read the fine print in their plans. For example if you go to the ER and are then admitted you don’t owe an ER copay or ER charges since they combine them into your hospital stay. (which will be cheaper anyways)
I’ve seen so many people with bills where the insurance denied it and the patient was billed in full as a result of billing the secondary as the primary insurance or billing the wrong ins.
I would also suggest if there is a negotiation for a reduced rate that you get something in writing that the balance was paid in full. Sometimes people get billed or sent to collections in error 2 years later and without proof especially if they paid cash they might be billed for the balance in error. In those cases I would suggest that you go back to the collections department and ask for them to provide proof that the services are still owed., If they can’t provide that proof w/in 30 days they have to write off the debt as non collectible and it can’t go on your credit report.
Great Article
Aloha
Dawn
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After 21 years in the Insurance business (homeowners claims), I have to say that not only does it seem that the insurance business is staffed with know-nothing, careless and uncaring people these days, but the policies are slanted in such a manner as to deny coverage for any reason, and the policies are not only impossible for a normal human-being to interpret, but in my experience, hard to interpret on the staff side as well.
This issue seems to be heightened when it comes to health care.
Been a Republican for my whole life, but will be voting Democrat for the 2nd time this election. Not that I expect anything different from the Democrats either.
Thx jegan ;-/
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I remember being single and having free insurance, no copays, minimal deductibles, and my choice which doctor I wanted to see. Now I have to bargain hunt.
The most important point is… know your plan. Ask questions. We saved several hundred dollars & an office visit copay because we asked questions, and discovered we could have the same doctor do the same procedure in a different setting than was originally planned. All we did was inquire.
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I second what 42 said about asking for a discount. I have great health insurance and had two outpatient procedures at a very good hospital. I tried to get an estimate in advance of all the fees that would be associated with my surgery. Of course, as has been the experience of many others, it was impossible to get an estimate. When the bill came I was shocked by the difference between it and what I had been “quoted.” I then made it my job to find out what every little itemized item was. When it was explained to my satisfaction, I simply said to the woman I spoke with that it was so much more than what was quoted to me. She immediately offered me a 30% discount, and asked if that would help. Why, yes it would!
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first things first, you NEED to know the ins and outs of your insurance coverage. no exceptions. i went through the insurance maze for the first time at age 17 so i knew what we were in for after my husband’s injury.
i strongly suggest standing up for yourself. we spent a couple thousand going to an orthopedist who kept running into dead ends in treatment. at one appointment, i asked about a procedure i read on an association website as the next step when the earlier routes failed. we were told that my husband did not want to do that because “it was painful and expensive and it probably would not tell us anything.”
well, more thousands later, weeks off work, 5 or 6 (lost track) more doctors shaking their heads saying they couldn’t help and we landed in a pain clinic. the specialist’s first procedure? the one we asked for a year earlier. ARGH! that one procedure revealed the problem that 6 or 7 doctors could not figure out and we were able to initiate EFFECTIVE treatment.
we are currently facing a 4.5k bill from another clinic we used regularly. they changed contracts from in-network to out-of-network before husband’s last appointment and conveniently forgot to mention that when he handed them the insurance card. they screwed up what they were supposed to do anyway, and we enlisted his primary doctor (the one that ordered the procedure) to help us. she is going to write them a letter on our behalf saying that they screwed up and should reverse the charges.
we have been through this once before with a screw-up at the local MAJOR UNIVERSITY HOSPITAL. it took 3 letters from the ordering physician and biweekly phone calls for 8 months, but they did clear our bill.
i have also called up doctors explaining our hardship situation and asking if we could get a break on our portion of the bill. some are understanding, some can’t spare the money. understandable. it’s nice when they can.
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If you are paying out-of-pocket for something non-emergent, talk to either the Chargemaster or Resource Utilization to get an idea of what you can expect to pay.
There is variety in the cost but they will be able to get you a decent ballpark figure.
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@vje: I’m interested in the state assisting with a medical bill. How/under what situations can someone apply for that?
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At the local hospital, they will give you a 20% discount if you pay everything at once.
Also it can be very beneficial to have some type of insurance–even if you have an insanely high deductible. You will still get the discounted rates negotiated by the insurance company which is often 60% to 80% of what you would pay without the negotiated rates.
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If not move to a country with universal coverage, then just visit a country with cheap medical care. This is my personal contingency if I get sick and don’t have insurance.
I have personally had dental work done in Mexico before I saved a bundle (like 90% off). Places like India, Thailand, Costa Rica, are all huge medical tourism destinations which attract Americans for procedures which are very expensive here (heart bypass, etc.). Also for elective procedures (lipo, etc.) they and many other countries are huge. You can realistically get some procedure done and be able to travel and take a vacation for way less than staying in America.
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If you are wondering how hospitals can afford to offer 20-40% discounts on services, think of the patients we treat who pay nothing at all. I am an emergency department physician and every week I order CT scans of homeless alcoholics’ heads who fall down and come in unconscious. We will never see payment from these patients but we strive to treat them exactly the same as any other patient who comes through our doors. I love working in an emergency department because I can order whatever I want for my patients and never have to justify it to an insurance company who wants to deny payment just because the patient has a bad insurance.
I never have to provide subpar care to patients because they are poor or homeless. Unfortunately, those who have limited funds but are conscientious about trying to pay their bills are also subject to the major expenses that an American level of medical care results in.
I have had patients ask me what I want to do for them and then try to pick and choose from the options as if I had provided them a menu (usually based on what they think will be most expensive). That doesn’t go over well. This isn’t Burger King. I don’t order it unless I think you need it. The internet doesn’t know what you need, because it doesn’t know you. The internet offers catchall advice for patients and can be a helpful tool, but your doctor is using that information in the specific context of you and what is right for you. Opinions may vary on that across different providers, that’s human nature.
Your best bet is to, when you have a choice in the matter, try to find a doctor who you trust to practice evidence-based medicine and not cover your ass medicine. A doctor providing evidence based medical care will not order unnecessary testing just because they are afraid you are going to sue them later. They will order the testing that you need.
You better believe we don’t have a clue what most things cost. As pointed out, that’s determined by what price your insurance has negotiated, and if you don’t have insurance, it’s completely different. We order hundreds of different types of tests, it’s impossible to know all these prices. And that’s good in a way. We have to make sure that we are doing what’s best for you, not what costs least for you. I’ve seen doctors skimping on medications/tests for patients because they knew we weren’t going to be reimbursed for our costs (the damning words ‘self pay’ on your chart), and it made me feel dirty. Luckily, very few doctors operate that way, at least at the academic/nonprofit hospitals where I work.
At the same time, I do encourage anyone to ask questions about their medical care, though preferably not in an angry/confrontational way, such as “why do you want this test? what information will this give us? If it were your family member, would you recommend this?” Get second opinions (from doctors!). Unnecessary tests happen, and most doctors are happy to explain because we want our patients to understand what’s going on with their health.
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We didn’t have maternity coverage when we found out I was pregnant with our second daughter. So I did major negotiating and managed to save 40% off what it would have cost us. The key is to be upfront and ask for the self pay rate and then negotiate from there. A good resource for learning what medical procedures cost is on the AMA website. I have more info regarding saving with and without health insurance on my website: http://www.theshoppingqueen.com/show_shopping_guide.php?display=all
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@ #11: JenH – Thanks for the info – that makes sense.
@ #18: Noah – When my husband was in the hospital a social worker got us together with a case worker associated with the state employment and economic developement dept.. I am not sure how one would go about applying or asking for assistance since it was all done via these people. I assume it had something to do with the fact that he was ‘let go’ from one job and the new employer subsequently ‘let him go’ over the phone while still in the hospital. Also assuming he did this because he felt my husband was a medial liability and he was a small business owner. Just speculating.
Hope that helps!
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I’m surprised things like this also happen in US.
I live in the Philippines where universal healthcare is non-existent. If something happens to me (heart operation, cancer etc) my health insurance will not be able to handle it and the money I saved for many years will be gone in a few days of hospital stay. Migrating to another country with universal healthcare seems to be an option available to most of us.
I just hope nothing so bad will happen to us,….
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If you have insurance make sure everything runs through them. Some places don’t understand this. I’ve got a collection agency after me for a $400 bill (only outstanding debt!!!) that I refuse to pay until my insurance tells me they won’t cover any of it. The provider simply refuses to send the bill to my provider (pretty shady little emergency treatment station).
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For people with kids, who get annual physicals, make sure the date of the physical is at least one year to the date from your last one. It’s so worth it to double check this. I was two days under with our firstborn and the insurance wouldn’t pay for his well baby or his vaccinations. I appealed but to no avail. We were out a few hundred dollars.
Lessons learned. Now I call to check on everything from regular exams to lab work…
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The patient advocate is a great idea. I’ve read about that in the past from Money magazine.
The healthcare industry is a confusing maze of regulations and undocumented costs. My opinion is the industry needs to “grow up” much like the financial industry. Document fees, make it easy to make a decision. Of course I’m guessing those changes will be slow to come.
Didn’t you link to a site once that would let you compare your medical bill to the average for that procedure and throw up a red flag if something was way out of line?
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J.D. I also find it frustrating that nobody in the medical community knows what things cost. 90% of my hospital visits are non-emergency, and I have plenty of time to shop around for the best value (value = quality/cost) that meets my needs. Quality can be subjective, but I can find out information on doctors/hospitals. Unfortunatly it is nearly impossible for me find any cost information.
And to those referring to the “screwed-up” health care system in America – we don’t have a “health care system”. Just as we don’t have a used automobile system. We have a health care market, which happens to be under HEAVY regulation (see Medicare, and the many state regulations). Because of the regulation and tax structure surrounding this market it has led to a very price-insensitive market where you can’t even find out what a procedure costs if you ask. It also has led to a very insurance laden market which, from reading above, no one seems to enjoy.
You can vote Democrat if you want in 2008, but don’t expect it to lead to a health-care utopia. Best bet is to free this market from the regulations, and allow price-sensitivity back in.
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Re Alison @21, maybe doctors in the emergency room don’t think about costs/insurance, but that may not be true elsewere. When I was getting chemotherapy in 2005, I had GREAT insurance (moderately high deductable, but that got spent immediately and after a certain amount I ws 100% covered…) and was freely prescribed very expensive blood support medications and a lot of different nausea preventers etc; other patients also getting chemotherapy were beimg treated differntly, for example, they weren’t given the anti-nausea medications routinely, but were told, “Let me know if you have a lot of nausea and we can discuss some pills you could try” and they did tell patients what the cost of those pills would be…
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Finding out the cost of procedures…
The trick is to quit asking the doctors and nurses and go straight to the billing specialist of that Hospital/clinic/office. Since being forced to a High Deductable plan a few years ago, I’ve managed to figure out ways to get the cost of my care and even cost comparisions when time permits.
Office visit quotes are generally pretty easy to get. Generally any treatments administered on the fly during an office visit or ER are the most difficult. Suregeries tend come in the form of estimates, but I ensure PT and common procedures are exact figures.
I’m pretty much on a very friendly, first name bases with the billing specialist at all the Dr. offices we routinely use.
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It is crazy how there is no way for medical profession to tell you in advance how much something is going to cost. About 7 years ago I had a birthmark removed in an outpatient procedure. My insurance paid for 90% of it. Guess how much it costs to have a birthmark removed? All told the bills were close to 6000 dollars (I paid 600 out of pocket, not an insignificant sum). I was shocked at the cost, and can’t imagine what people who do not have insurance, or have more expensive procedures do.
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I have had the same issues but am determined to learn about my insurance coverage. I think people in the comments section are ticked off about the wrong problem. Most express a disappointment with insurance companies but I am ticked off that my 7 1/2 hour stay for a heart cath cost $14,000!!!!!! A bill of $1866/hr is nothing but absolute ROBBERY!!! I would much like to see doctors and hospitals be forced to provide an up front fee for their services. Once patients know up front what the costs will be then the outrage will bring prices down.
I will not be voting Democratic (not sure about Republican) this fall as we will have a huge increase in taxes for basic health care coverage. In other words, if you think that you will be able to drop your insurance for tax payer funded health care then you are engaging in self-delusion. The end result will be higher taxes, minimum health care coverage, and an insurance premium for “universal” health care.
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4 Weeks ago, I spent 5 hours in a private hospital’s ER because I had broken my clavicle in an auto accident. The hospital and my insurance plan are owned by the same company; so coverage was not an issue. I will end up paying nothing out of pocket because I was a passenger in the accident.
The issue I had is simple: I spent FIVE HOURS in the ER with a BROKEN BONE! When I finally saw an RN, I was seen at the same time as a fine gentlemen that reeked of alcohol and had an ingrown toenail. You see, the toenail was really painful and he needed “help.”
Needless to say, I was not happy to see that the ER’s triage system treated me the same as this guy.
I’m also the CFO of a small business that purchases health insurance (HMO) as a benefit to our employees. HMO costs are ridiculous!
All of that being said, universal healthcare will accomplish just one thing: longer waits in the ER. I wasn’t at a public ER and I still had to wait for 5 hours. I couldn’t imagine what the wait would have been if I went in on a Friday night or if we had universal health insurance. Be careful what you wish for.
FYI- I had no choice but to go to the ER. The paramedic didn’t know how severe my injury was and he wasn’t taking any chances.
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Steve, Re your comment: “In other words, if you think that you will be able to drop your insurance for tax payer funded health care then you are engaging in self-delusion. The end result will be higher taxes, minimum health care coverage, and an insurance premium for “universal” health care.”
I doubt that anyone really expects any great product from either the Republicans or the Democrats. However, just a guarantee that you can **actually** buy insurance would be a benefit that we don’t have under the present administration. At least Hillary tried to develop something while acting First lady. Our market-driven present situation seems to be coming apart at the seams.Inn fact, your concern about the cost of your hospital stay is just one facet of the problem. I presently pay for three policies separately for myself and two kids. My son has a basic Blue Cross policy at $50 per month, which seems to deny every bill presented (in essence just minor office visits), my daughter cannot get insurance at 22 as she has tested positive for Herpes simplex virus-2.. Which can lead to uterine cancer. (Of course 30% of all young people test positive for it as well.. And it is not a guarantee of contracting cancer.)I can only insure her through the College while she is attending at a cost of $120 per month. And I pay $560 per month Cobra. When it runs out, I have been informed by Blue Shield that I will not be insurable through them due to a workers comp claim, which left a metal plate in my ankle (it is not structural – just left there as removing it would pose more risk than leaving it,) and my inherited cholesterol level, which is maintained through the use of generic simvastatin. (Thanks Dad!).. Anyway, none of us are in any way incapacitated, bed ridden etc… So personally, I intend to vote for whoever has the best handle on a problem that we all seem to face. And as a lifelong Republican… That will not be McCain.
Thx jegan
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A note to Brian who waited in the ED, from the ED doctor:
I’m unclear on how universal healthcare would increase the number of visits to the ED. Many people who visit the ED do so because they have no primary care doctor or no insurance, such as your acquaintance with the ingrown toenail. With universal healthcare, the idea is for everyone to get hooked up with primary care and to be covered by insurance. This way for ingrown toenails, they have a place to visit where they do not have to wait for hours to be seen, presumably driving them not to come to the ED for non-emergent complaints.
I cannot wait for universal healthcare, even though I will still have to deal with drunk people every night who don’t care that they have a primary care doctor or insurance, at least people who want to use primary care will be able to instead of coming to see me for a sore throat or a prescription refill. And at least we will get paid for the patients we see, because all of them will be covered.
Remember, the drunk guy might have gotten seen because the staff in the hospital know they will be able to boot him out the door in under 10 minutes to make room for actual sick patients, not because they think his complaint is just as important as yours.
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Recently I became suddenly and violently ill while visiting another city in my home state. I wound up at the local hospital emergency room and was there for six hours until I could stand up and walk out. It cost several thousand dollars for six hours. My husband wrote a check for few hundred while we were there, and then we were billed for the rest: four hundred dollars. Well, we couldn’t pay it all that immediately, so we told them we would send them $50 a month. That wasn’t good enough. The hospital wanted $90 a month, at least, or they would turn us over to a collection agency. At no time did anyone offer us a break. My husband has 20+ years with his company and has the best insurance offered. But of course, people like us PAY for the uninsured, because we were at least making an effort to pay. People like us pay for the rest who can’t –or WON’T pay their medical bills. We are dunned and harassed and threatened and turned over to collection agencies immediately if we don’t pony up and pay, but let us be deadbeats or uninsured and we are gods.
BTW, we STARVED during the greed-is-good, go-go 80s and we starved more during the dot.com boom and NOBODY gave a sh*t. If we screwed ourselves, people let us know it. So we put our heads down, ACCEPTED RESPONSIBILITY for our actions and paid off our debts saved our pennies and did without, while again, people around us bought the McMansions, the SUVS, had the kids, went on vacations and generally acted like smug, complacent idiots who believed they were better than we are because we were the (so unfashionable then, so hip now) working poor. Now, I’m supposed to feel sorry for them, boohoo, sob-sob. Go to hell. You reap what you sow.
Please. Please. Please. Unless you’ve spent your ENTIRE life doing the right thing and getting raped and screwed for it while the rest of the world gets a free ride, don’t assume that doing the right thing will in any way/shape/or form, matter, like there’s some sort of reward. Do the right thing because it’s the right thing to do and in your heart, you are honoring your own character and integrity. I voted Repub president for the first time in my life in 08. I’ve lived through much worse time than this with no rich daddy, no rich husband, no welfare system, no pity, and no victimization.
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