Obamacare is the law of the land



the problem with all this Urgent Care / ER stuff is that’s fine if you’re in an area you’re semi-familiar with. I was at a Scout Camp last summer and my Son sliced his finger deep. Needed stitches. I cell service sucked, even if it was better I doubt I would have spent 30min or so looking for where the closest Urgent Care center was vs. the ER that the camp told me to go to. on the EoB — Cost of ER stitches (4 of them) was around $1k, Agreed price from BCBS $600, I paid my $150 copay, the Insurance paid the other $450.

If I had my previous high deductible shit plan (which is what the GOP want people on) I doubt United Health Care would have a lower agreed upon price like that… those shit High deductible plans, are purely for critical emergency care only.


High Deductible plans still get the negotiated rates. In the industry it’s the contracted rate or also known as anything above the allowable you don’t pass on to the patient, aka patient responsibility.

So in this case you would pay the 600, the contracted price, and not the 1k. The problem is, it takes a lot of money to reach your deductible in a high deductible scenario, and even when you do it’s usually a worse split when the insurance company does begin to pay like 60/40 instead of 80/20 or 85/15. The nice thing about ACA though is that is not the case for preventable services so your annual exam, for example, should still be nothing out of pocket, 100% covered.


That was seriously weird.

AND he put sugar in it.

I am pretty serious about my tea and I follow the Alton Brown good eats instructions pretty much. Season 4 episode 4.


I know that’s the way It’s suppose to work… but the cost for paying through the insurance is ALWAYS a LOT more than the cost if you simply paid cash( aka out of pocket)

At least with the plans that I’ve had… those contracted rates were often pretty much shit…


I think you will find if you become very sick, those annual maximum out of pockets suddenly come in handy. Most people think about CT and XRAYs when they talk about cash prices, not almost 2 years fighting for your life in a hospital bed. ACA gave the maximums. And then there are the drugs, 50-60k per dose went to 15k generic, that’s the cost not the mark-up. I believe that was a chemo drug Mark-up can be a few percentage points. Let me tell you anti-venom isn’t cheap either.

I’m certainly not going to convert anyone, but using a machine that has been paid off for years is going to be cheaper than the one they bought yesterday and now need to pay for.


Brian, I love you man, but your taste buds are frickin nuts. Krispy Kreme is far superior to Dunkin, and In 'n Out is vastly overrated.

Culver’s though, that’s my sandwich of choice.


What sort of examples are you talking about here and what sort of plans? Because what you describe is the exact opposite of the normal way things are in the US, where the contracted rate is between 65% and 85% less than the “list price” and the “cash price” is often 15% to 35% less than the “list price”. Or to put it another way, the typical health care provider pretends to charge about 4X what they will actually accept from insurance, and then when faced with a cash patient, accepts about 3X what they accept from insurance.

I could see that you might get a good deal in cash terms for something fairly focused like an MRI, etc. but if you are talking big ticket items like surgery and hospitalization, then yeah, insurance is going to be much cheaper.

I gather from your post that you think the ACA is pouring money down rat holes and that there is another method? Perhaps some “skin in the game” or somesuch? Please discuss how that is going to work, taking into account the inelasticity of demand. To make it simple think of this: if you don’t get the exact model of cell phone you want this year, it’s not going to kill you. But if you don’t get the exact type of health care you need, it can damage your health permanent and in some cases, kill you. Since the health care market is fundamentally different from typical markets, how is introducing more typical market elements going to help?


Your assessment is spot on. I’m coming from fairly mundane examples. Sick child visits, specialist vists, that sort of thing. Those cash prices were always significantly lower than the contracted insurance rate with the plan. Something like… Sick child visit $265-$350 through insurance (depending on how they decide to code it) , $145-$190 cash (not through insurance)

So, yes, not big ticket items, which I’m sure it’s insane to try to even tackle that sort of thing with out insurance. But these little things it’s just crazy. Facilities train Dr.s and LPNs to take as many assessments to insure that they are meeting the criteria for the higher CPT billing code time and time again. Not all Dr may act this way…

Many of the “good ones” often feel as if they are doing a service drawing out a sick child visit, but honestly to have Dr constantly code for a 99214 for a sick child visit, which is just 1 step away from pretty much heading to the ER / Urgent Care facility seems completely nuts.

In the grand scheme of things, my experience in the high deductible world is certainly limited and primarily focused in the out patient world. But it’s a pretty shitty world there.



Dunkin doughnuts has the best breakfast sandwiches in all of fast food though.


I can’t even.


He’s just a stupid, childish, asshole. The country will not be able to withstand 4 years.


It is pretty hard to generalize about these things although I do agree that list price appears to be typically 4-5x what they actually get from an insurance company/government. I have heard of doctors, especially but not exclusively concierge practice, which offers a modest cash discount. Saves them labor cost versus dealing with insurance.

And of course, medical tourism does include pretty major procedure done entirely on a cash basis.

I get 5% discount from my dentist for cash, and the prices were the same as when I had dental insurance. I’ve also gotten a discount from auto body places less than their negotiated prices for insurance companies. (Although this was probably due to tax avoidance)

One of the incredibly frustrating things with trying to do any type healthcare reform is the complete lack of transparency on price. I’ve used the $10K or $10.3K figure on the average cost of medical care a lot but, I have no clue how this figure was arrived at much less the accuracy.


The 17 states (plus DC) suing over the CSR cutoff: California, Kentucky, Massachusetts, Connecticut, Delaware, Maryland, Oregon, North Carolina, Illinois, New York, Vermont, Pennsylvania, Rhode Island, Virginia, Minnesota, New Mexico, Washington, Iowa, and the District of Columbia.


Thanks for your support, Governor Shithead.


Stop posting pictures of Skeletor!


I thought it was Matt Frewer as Trashcan Man from The Stand.


With the nukes about to fly, he’ll look even more appropriate soon.


Honestly never would have called that one.