have more complicated pricing than medical services. At least you know what you're paying BEFORE you get on that aircraft.

This is what would happen:

1. You would be given a form in which you were instructed it was a "standard consent form", which was physically designed to be as unreadable as possible, whose major purpose is to legally bind you to be financially obligated for unspecified services at unspecified prices.

2. You would then have various people, many never seen by you, decide what to purchase on your behalf. Some of these purchases would be from the airline you thought you were doing business with, and some would be from totally different business entities you had never heard of.

3. At any point, if you tried to inquire about the nature of the services you were being sold, you might be told that this was a decision that only travel professionals were qualified to make, and treated as if you were being a "difficult traveler" who was imposing on the time of the busy travel professional.

4. If, at any point, you were so presumptuous as to inquire as to the price, or the number, of the services you were being sold, you would be unable to get this information. In many cases everyone you had contact with would be unable to provide the pricing information even if they wanted to, often because they themselves have no way to access that information themselves.

5. After you had then been sent on the airline to multiple destinations (which you had limited or perhaps no input in making the decisions), you would receive a bill for which you, or your estate, would be held responsible. This bill would be as unintelligible as possible, but in many cases would have prices 250 - 400%, and in some cases 600% higher than (still highly profitable) prices
charged to "travel insurance companies".

6. If you had the audacity to complain, you would be falsely told that all pricing and policies was caused by "the government".

You hit the nail on the head, and hammered it home.

Its called the NHS. With regard to an appendectomy - my own appendix decide it didn't love me anymore one Friday night April 2001, wandered off to the hospital Saturday afternoon, was taken out on the Sunday morning, checked myself out on the Monday night and camped in the living room for a week or so. Cost - sfa.

I would say a brain op is more complicated than an appendectomy. My wife's first brain op Oct. '88 was carried out by the NHS due to fuck up - she was insured privately but they'd failed to notice. Her second op Oct '89 was charged privately - c. £2000. Even with time adjustment I know that dwarfs US charges.

i hope your wife is doing well.

is that expenditure / prices are dictated by the government at acceptable levels. Generally speaking our consultant surgeons through to local doctors/general practitioners etc don't work for the government : they do work on behalf of the NHS and invoice accordingly.

Even when work is done on behalf of a private insurance companies here the price structure has been pre-agreed - there's no piss taking.

btw - your expression "single payer" baffled me completely at first because to me it conveys the payer of the insurance tax and not the government in receipt of such payment from the population and their employers. It defeats me that you didn't get anyway - you may have no idea the affect it would've had on employment in the US. If you scale this up you'll see what I mean http://en.wikipedia.org/wiki/List_of_largest_employers

If the expression "baffles" you, then you're not familiar with the debate surrounding ACA as it has developed over the last three years.

and didn't mean you personally when I said "your".

The whole world refers to it as socialised healthcare - just not the USA.

I have a New Year special going on; yes INDEED

.... is a byzantine mystery shrouded in secrecy. It's completely broken and needs to be fixed with LEGISLATION, the only thing short of single-payer that will work.

Most of the care hospitals provide is done under an insurance contract. Each insurance company (payer) contracts with each hospital (provider, usually at the "chain" level) exactly what the reimbursement will be for each procedure.

These reimbursements are often based somewhat on "charges", a fictional sum that nobody except poor saps with no insurance actually pays, or gets billed at least. The actual reimbursement is typically a small fraction of the "charges" number, something like 15 or 20 percent.

The net effect of this scheme is that if you have insurance, your insurance company gets billed something like a reasonable amount for your procedures and services. If you do NOT, you get billed the "non-contractual" rate which is an inflated beyond belief fictional number pulled out of thin air.

The LAW I want to see passed would set the amount billed to a non-insured patient at either the minimum that the hospital gets from any insurance company for the procedure/service, or at worst the average reimbursement for the procedure/service.

Then at least someone who has the misfortune of having to go to the hospital without insurance would have a fighting chance of getting a bill that has some basis in reality.

thousands of dollars.

Problem solved?

For Realz.

it was a big fucking deal! The Vice President said so!

Besides, if something catastrophic happens, maybe your friends will throw you a bake sale to pay your bills. Or you can put collection jars (with a sad picture of you taped to the front) on the counter at your local stores to collect peoples pennies.

Problem solved. USA!USA!USA!

Those horrific deductibles are less than this bill.

And it would mean his treatment would be billed at the contracted rate instead of the "uninsured" rate, likely saving him even more money.

Yes, single-payer is better. We'll get there. The ACA moves the battle from the Federal level, where Republicans have an advantage, to the state level. Democrats have a large advantage in "Blue" states. "Public options" and outright single-payer will be very successful in those blue states, leading to similar programs appearing in "purple" states. After most of the country is under de-facto single-payer, the federal battle will be rejoined, and we will get national single-payer.

Alternatively, you could try to come up with a national single-payer program that Lieberman would vote for. I somehow don't think "the senator from Aetna" could be brought along, but you're welcome to propose how you'd get his vote.

But yeah, this is exactly why we need single payer. Having one insurer will help standardize these costs.

...is my best guess. I never saw all of the costs in one simple bill all at once. The bills I did see (I'm not even sure all were sent to me) weren't always easy to interpret. I paid about $3000 of all of it out-of-pocket.

Clearly something is very badly broken when a routine procedure like this costs what amounts to more than a full year's wages for many people.

I saw all the bills for the first one. Total cost was about $55k. My out-of-pocket was the insurance's annual maximum. (We enjoyed calculating that our daughter cost $6,000 per pound.)

The second one, I didn't get the bills. The hospital just billed me for the insurance's annual maximum. (We moved, so different insurance, different city, different hospital). A far smarter move on the hospital's part - With no idea what it actually cost, it's hard to ramp up much outrage.

I am a nurse and at that time we started a program for children and put together a little kit for them to take home when they were discharged. It contained a comb, toothbrush and other hygiene products and a little stuffed toy. I was aghast when I saw what they wanted to charge for it. It was worth under $10 but they wanted to charge $40. I objected and did get them to lower it to $25.
And the sad thing is they were given this kit like it was a gift and the charge was hidden in the bill.

apparently "ordered" similar hygiene products in the hospital. The most expensive item in the collection was a small baby powder. The charge on the bill was 50 bucks.

Find out which hospitals in your area are for profit, catholic charity, teaching, etc. I realize that you can't pick and choose when you're sick, but if you know ahead of time which one will serve you best, you can pay a lot less than if you randomly go to a for profit hospital.

I knew that two of our nearby hospitals were catholic charity based, so when I had to go, I went to one of those instead of the profit ran mega hospital.

same appendectomy, cost $68K here in sunny west coast of Florida. Plus I got the additional pleasure of being billed two months later by a doctor that looked at me for maybe 5 minutes prior to being released. His pound of flesh was $1800.00.

New story about my left knee meniscus tear, Two months after surgery I get a bill for $1280.00 from the anesthesiologist that was out of network and wasn't paid by insurance. I called to complain and got the riot act read to me for not being aware that anesthesiologists don't just hang around hospitals waiting to be called by certain insurance companies for each operation. BTW, semi total on that bill was $11K for about 45 minutes work.

Called United Healthcare to inquire as to when my yearly defucktable would be met and the guy on the other end said, "well you've met your personal defucktable, but you still have to meet your family defucktable" then he laughed and hung up.

Last story. My first son was born in 1970 in Reading PA, no complications, 2 day stay in hospital. Total out the door cost: $1200.00.

Prick Scott defrauds Medicare for billions and gets elected governor of Florida. I wonder what his deductibles are.