sob

This is DEFINITELY a topic that begs for discussion.

There have been several good answers posted, but I haven't seen a few things mentioned. I'm going take a big risk and use lots of quotes. If I get a lot of negative feedback about it, I will promise never to do it again.


An employer-sponsored health plan is the result of negotiations between the employer and the insurance company. It works like this:

Employer: I've got $100/ per month to spend per employee. What can I get for that? (Note: This is why so many companies prefer to pay overtime, rather than hiring another employee and paying medical, dental, and vision insurance, vacation, sick time, maternity leave, family leave, holidays, workmen's comp, unemployment insurance, 401K/retirement, continuing education, etc.)

Insurance rep: You can have a choice of the doctors on our plan, a $20 drug deductible, but no liver transplants or Viagra.

Employer: What if I guarantee you $1000 employees on the plan you mentioned? Can I also get your enhanced benefit plan at a discount? So that I can get Viagra?

(This kind of bargaining can go on for days).

Anyway, an agreement is eventually signed. You can take it to the bank that the more doctors are on your plan, the more the company is paying the insurance company, and thus, the more the company is paying the doctors it contracts with. By the way, I know of no doctor whose annual compensation package approaches what the head of Traveler's Insurance made awhile back. His total compensation? $52 million. For one year.

I'll talk about this more later, but here's the crux of what you're asking:

The reason that prices vary is that hospitals contract with insurance companies, too. Under the terms that have been negotiated, the hospital may have agreed that setting a broken arm costs $175 with Blue Cross, but $200 with Aetna. Depends on how the negotiations went. It's important to note that the hospital has signed a contract saying that they will limit their charge to a specific amount for any patient covered by a particular insurance company.

However, if you stroll in without insurance, it's open season! They can charge whatever the hell they want, and they do! Remember that an emergency room is required by law to accept everybody, and not to inquire about their citizenship. Emergency rooms, therefore, have become the de facto family doctor for illegals. The last time I was in one, with a broken arm, I was waiting for the doctor to finish with (I'm guessing, from what I overheard) two illegal kids with head colds, and one bum with gonorrhea.

Basically, when they see you coming, they plan to make up for all the free medical care they're required to give away. I've often thought that if I didn't have insurance, I'd go to an emergency room and pretend to be from another country, so they'd have to treat me for free.

There is actually a cottage industry in which you can submit your bill to a company rep, and they will review it. Their fee is a percentage of the overcharges they find. How's that for confidence on their part?

I would advise you to look over your bill VERY carefully. Also, try to make sure that everything that was charged for was actually done, or dispensed. Billing for drugs that were not dispensed is extremely common.


You'll have to ask the trial lawyers that one. You know, the group that's the largest contributor to the Democratic party. Or maybe the union bosses. Ditto.


Of course they can! Insurance these days is the equivalent of whipping a piece of paper out of your pocket and saying, "Wait! I have a discount coupon!"

You won't see that while the insurance companies have lobbyists. And all that money.


I'd love to see the reasons you feel the two are similar. Price-fixing (for doctors) is illegal, but wage fixing seems to be very popular, at least to the people who post on TFP.

It's not. Canada, for example, establishes an amount that they will pay for the year. Although it's been a few years since I checked, the orthopedists used to max out around August, and they'd come to the US for the rest of the year, rather than working for free. So if you wanted to break a bone in Canada, you'd better do it prior to August. Also, a mammogram had about a year-long waiting list. Canada doesn't publicize how many of its citizens pay their own way, rather than waiting a year to find out if they've got breast cancer.

Then there's Russia. If you're in a hospital there, and you want clean sheets, you'd better grease the sheets guy. Same applies to a lot of other aspects of the hospitals.

You don't want to hear about the re-use of gloves, needles, and the like. And the non-sterile equipment that doesn't work.

Because they're paying for the people who pay nothing. I agree with you--paying for the free rides of others isn't any fun at all.

The issue of accurate record-keeping has already been discussed, so I'll just say that Cuba is a country that can't even get parts for cars, so I'd be leery of trusting that their hospital equipment is functional, or sterile.