And, this person appeared to be a working, middle class type, wearing a uniform of some sort like they worked in a healthcare environment. It made me sad. I wish there was an option for the pharmacist to say, call this number and they can help.

How about the knee brace my doctor just billed my insurance carrier $1260 for, which retails on the net for $178?

Insurance wrote off $300. Bless their heart. Medicare "allows" $869 for this device, which the doctor and the insurance company use to base (collude) such an exorbitant rate for a private insurance policy.

Insurance paid my doctor over $400. Bless his heart.

We are both self-employed, and pay over $600 a month in premiums, with $2500 deductibles on each of 3 family members.

My out of pocket for this $178 brace? $521.

And no, I wan't given an option to shop elsewhere. The doc slapped the brace on my knee before I could even ask. I shouldn't have trusted him. I won't again.

Not all doctors are like that. When I broke my toe, the podiatrist only charged me for the cost of the x-ray. He LOST money treating me. We have a GP who we see only if we absolutely have to or I do something ignorant like getting bit by a wild animal ("Look, it's letting me pet it."). The Dr gives us samples from his drug reps whenever possible and doesn't order tests just for the sake of tests. He did make me get a tetanus shot. :)

I can certainly understand the sympathy. But, what do you really know about this person and the reasons for the problem? Seems to me you're taking one incident you know very little about and turning it into how America has failed as a country.

I won't get into a long debate, but not many doctors are struggling to get by. Doctor's fees are but one cost which has simply spiraled out of control. As for me, it all starts with the 'black hole' of insurance. When the bill stopped going to a person to pay and simply went to a company which was spending other people's pooled money, we started the downhill slide. It didn't take long for doctors, pharm companies and seemingly everyone else associated with the medical profession to figure out they had no incentive to control costs or limit their bills. I mean, they just bill 'insurance', right? They forgot that insurance money doesn't just appear. Someone has to pay it. What other profession operates this way?

I have not been in favor of government controlled health care. I don't believe the government makes it better. But, the greed of doctors and other medical related professionals and companies are pushing us ever closer to a place they really don't want to be. When doctors have government price controls or are employed by the US Gov't. they will lament for the good old days. Don't get me too wrong. Doctors provide a necessary service and are often compassionate, caring folks. They deserve to be paid handsomely. But, I don't think you'll find too many folks who don't think it's gotten out of control.

It always depresses the shit out of me.

Still, I'm thankful we don't have some sort of government-funded health care system in this country. We would risk spending less money per capita and a smaller percentage of our GDP on health care, while achieving a higher level of overall health.

/shudder/

From the World Health Organization:

The U. S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. The United Kingdom, which spends just six percent of gross domestic product (GDP) on health services, ranks 18th .

...

The impact of failures in health systems is most severe on the poor everywhere, who are driven deeper into poverty by lack of financial protection against ill- health, the report says.

Our current system thankfully keeps the poor and ill desperate, fearful, and primed for exploitation by the GOP's fear-mongering and war-machining.

Like the bumper sticker says: God Bless America.

Yes...it's really getting ridiculous how medical care costs have gotten out of control.

I am fortunate that the company I work for has excellent benefits, in fact, it is ranked in the top 15 of Fortune 100 companies for health care coverage and other employee benefits. I pay $80 a month for coverage for a single guy.

I recently had a bout with kidney stones...oh and..btw...I don't recommend them to anyone...it really is true about how painful they are! Anyway..on the first trip to the emergency room I basically got a hefty dose of morphine, a 5 second visit with the ER doctor, an MRI, and the recommendation to go home and pass it.

The 2nd trip to the emergency room a week later after being rolled into the ER in a wheelchair because I was in to much pain to walk, I was basically given the same procedure as the first time except this time I was told to call a urologist.

After a visit to the urologist, and a 3rd trip to the emergency room for an emergency stone removal (I was blocked) and a Lipotripsy (a procedure that uses sonic waves to blast out stones in the kidney that have not come out yet) my total bill so far has racked up to about $42,000. My responsibility is going to be about $1300 plus my co-pays on prescriptions which has been about $100.

So the point being...in my opinion...$42,000 for kidney stones is highway robbery, and I'm sure my story is not unique. Did the hospital charge more because I had good insurance? I was really shocked when the bills started coming in...I figured it would be somewhere around $10,000...but $42,000?...I would have never imagined. How can anybody without insurance...or even good insurance for that matter afford to get sick? I probably spent a grand total of 9 or 10 hours actually being treated by someone, the rest of the time I was at home suffering or sitting in a waiting room.

After this experience I honestly believe medical care today is a profiteering scam between the providers and the insurance companies...which leaves anybody without good insurance screwed.

What do you really need to know beyond what Randy posted?

A lot.

Your diatribe sounds like something out of Rush Limbaughs wet dream about the evils of government managed health care...just another rich white guy that doesn't give a shit about people who cant afford private health care.

From someone who knows virtually nothing about me. Bravo. You even worked in a Rush reference. Give Justin 5 more points.

Most of my 'diatribe' was the spiraling cost of the private health care system. I don't think that will be on Rush's talking points.

She has postponed as we are unable to pay right now. As soon as we are finished paying the couple of thousand for the original test we'll be able to schedule the follow up.

I take it you do not have private health insurance. Correct? Are you or your wife employed? Does your employer offer health insurance? If not, are you eligible for Tenncare? If not, have you applied and why were you turned down? Given the cost of an individual health policy might be less than the tests your wife needs, did you look at an individual policy? BTW, I would not ordinarily ask personal questions, but you brought it up and you do post anonymously.

Doctors and other medical professionals should remember the old adage...pigs get fat and hogs get slaughtered. Who are the hogs in the health care field?

You probabaly know about these, but:

CoverKids

CoverTN

These are "in between" TennCare and private insurance...

Why should it matter if we are employed?

It has to do with eligibilty and income for insurance...not 'humanity' or 'value'.

When we fret over the ability to afford certain things in life, while typing on our high-speed computers, watching one of a hundred TV channels, running around town in comfort controlled cars or chatting it up on our cell phones, take a look at the story in today's News Sentinel about Haitians eating mud cookies...and count your blessings, count them one by one.

Nice to meet you Sam.

One problem is that there's no law in Tennessee that requires insurers to write an individual policy. If there were, there might be more competition and more people participating in the insurance pool statewide, and it might bring down premiums. You know, the market based solution everyone talks about.

Of course, if you're young and in perfect health and immortal, they'll probably be glad to write you a policy because they know it's very unlikely they will have to pay any claims.

I need a scorecard to keep track of who everyone is and where they stand on things. My husband is self employed. We have applied for private insurance and they won't touch our family. The adults have no coverage. The children have TennCare insurance, but we don't apply for food stamps or whatever else is out there. When my oldest child turns 18 this August, he will be uninsured and uninsurable. No insurance will touch him, but the TennCare cuts have made him ineligible. He has zero physical health problems. He is a cooperative patient who follows doctors' orders completely, while my fully insured father is the most uncooperative, difficult patient ever. My husband and I almost never go to the doctor. When we take the children, we are the last people called back to an exam room and once there, we wait and wait and wait while other patients are seen immediately. I do not use the emergency room as a primary care provider as mythology claims. Last year, we had a script for antibiotics for the children ONCE. I know people who have one of their children on antibiotics at all times. Make your own conclusions and live your own reality. Do not for even one second think that people who are uninsured get any semblance of good medical care. The uninsured are real live people and not nameless, faceless burdens on society who don't deserve to live. The insurance system is broken and it won't fix itself.

It sounds like you are saying, if a person doesn't have health insurance they must be spending all of their money on unnecessary "blessings".

It may sound that way to you, but that's not what I said. My guess is you heard a 'Republican accent' and responded based on that prejudice. But, you raise an interesting question.

It was a discussion on the working uninsured that brought me out of lurkdom and into participation on knoxviews.

I was downsized at a private high school in 2003. I did some intense freelance work for about a year (wrote a book, was part of a team that developed curriculum for k-12, both on the Japanese American concentration camps in WWII) and was on a cobra. It expired after 18 months.

I have a serious pre-existing condition that is managable, but it's expensive to do. With medical management I'm a well-functioning productive member of society. Without management I'm not.

Since returning to Tennessee in 2004, I have thus far been unable to get a full-time job that includes benefits. I have instead worked as an adjunct teacher at a community college and done and great deal of freelance editing and writing. I like the freelance work, but for the sake of insurance am always looking for full-time work.

I haven't checked out Cover TN because I am a patient at Interfaith Health Clinic, which provides me with good primary care and access to specialists, although the specialists co-pay can be expensive (10 percent of the total charge). My co-pay for doc and labs is reasonable. My drug co-pay is astoundingly low ($5), but it sometimes means not getting the drug that both me and the doc would prefer because it depends on a combination of medical assistance donations from the drug companies and what they carry at the Health Department combined with the $5 generic at Target.

When I first got here, I applied for Tenn Care and they wanted me to divest my retirement. Yep, that's right, I didn't qualify because I had retirement that I can't touch for another however many years.

I take seven different prescription meds each day. Three for my chronic condition. One for high blood pressure, which was apparently caused by one of the medications I previously took. Two for allergies. One for a calcified knee that will eventually have to be replaced and is periodically, based on what I can afford and when, injected by a very nice PA at KOC. Given what I have been told my medications would cost if I had to pay out of pocket, it would be impossible for me to take them all without Interfaith assistance.

So, my guess is that the person that rneal's Mrs. saw at the pharmacy was very real, and very much a part of many people's lives. And it is a real shame that this is what's come of America.

pgs

Pam Strickland

"We are what we pretend to be, so we must be careful about what we pretend to be." ~Kurt Vonnegut

My husband and I are self-employed and were lucky enough to obtain private insurance a few years ago (in our twenties and not a huge risk), but all three kids were denied due to pre-existing conditions (one has had neurosurgery and suffered temporarily from seizures and the other two have allergies and asthma). They lost their TennCare recently and we applied for CoverKids. CoverKids lost our first two applications. All five family member's social security numbers were on the applications. The third application was finally received and approved, after having the kids go bare for three months. So far, it's better coverage than TennCare (except no dental has been added yet, and visual was just added in Jan. 08). It's a fairly easy application process (except for losing mine twice) and I suggest giving it a try. We have no premium for the kids and a $5 co-pay. Not bad.

We are willing and able to pay for a private family plan. We tried and were denied. Our two individual policies also cost us more monthly than the family plan would have.

(link...)

It's not just the uninsured. It's 12pm. Do you know where your "limit" is?

While, no doubt, there's an insurance crisis in this country, and some would argue, a healthcare crisis, there is also, perhaps more importantly, a developing health crisis in this country that must also be addressed.

I don't have a problem with providing people with a basic level of healthcare, but I do have a problem providing care for those people who, for whatever reasons, have developed Type II diabetes and heart disease, because of their lack of concern for their own health.

Pills, pills, and pills, don't make you healthy; healthy habits do.

With increasing rates of child obesity, and as a result, alarmingly increasing rates of Type II diabetes and heart disease among children, whatever governmental intervention there is may be quickly doomed if too many people continually fail to take care of themselves.

Somehow I am just not perfect enough myself to sit in self-righteous judgement about fat people, smokers, meat eaters or children who haven't been taught that juice is tastier than Coke. Maybe someday I will be perfect like you and will not care if I see a fat drunk on the street dying.

The lack of compassion in your post was really chilling.

Your support of the poor, and your belief that they are mindless cattle who must be herded everywhere by the government is chilling.

I have Type I diabetes, an autoimmune disease brought on by a virus. Type I is more serious than Type II, yet Type II is the more serious numbers wise because of the rapidly increasing incidence of adult obesity and childhood obesity.

You can spit in my eyes, you can make me eat dirt, you can call me whatever names your "lovable" liberal mind can think up, but you can't argue with the facts. And the facts clearly indicate a large proportion of our society through poor diets, lack of activity, and other poor health habits, are intent on killing themselves, while looking for the next miracle cure that makes everything easy. I shouldn't have to pay for their suicidal self-, and over-, indulgences.

metulj,

I have a friend who is a low-income single working mother and is overweight. She pointed out something that adds to your comment. Trying to lose weight by eating a proper diet is expensive. Hot Pockets are much cheaper than proper food. And single working mothers sometimes have a problem finding the time to cook.

WalMart and Mickey D win again.

Wearybottom Associates

Just yesterday in the grocery store, there were two people (man and woman) talking about all of the weight each has lost. The man was an employee and the woman was a customer. They were talking about how hard it was to lose the weight and it was getting very hard to keep it off. They both agreed over eating, for them, was an addiction, just like drugs or cigarettes.

I had heard this addiction explanation once before from someone close to me. I didn't say anything but I found it hard to believe. Now I'm changing my opinion. Just because I don't have this particular problem doesn't mean it isn't a problem.

I guess I'm listening to too many side conversations.

Please provide data that supports your claim that poor diets, lack of activity and poor health habits are a result of individual choices.

Last time I went grocery shopping the consumers weren't being forced at gunpoint to fill their buggies. I realize that being an academic, an assumption I get from reading your previous posts, you apparently need numbers before you are able to believe anything, but for those of us who mainly operate on common sense, individuals make choices and we call them "individual choices."

Unless someone goes into the voting booth and votes for you, or is standing outside the polling place threatening you if you don't vote a certain way, then you will choose a candidate.

You're an individual, thus, we have an individual making a choice, tadah, an "individual choice."

But this is what the American Diabetes Association says:

Pre-diabetes is a serious medical condition that can be treated. The good news is that the recently completed Diabetes Prevention Program study conclusively showed that people with pre-diabetes can prevent the development of type 2 diabetes by making changes in their diet and increasing their level of physical activity.

Are you a teacher at the medical school or in the social sciences? I realize that if you're in the social sciences that you think you know more than anybody, including endocrinologists and researchers, but forgive me if I ignore what you say and give more credence to what they say. (link...)

(link...)

If that's too simple for you to understand, please stay in the classroom. As damaging as that is to future generations, I'd would rather have you there than in the real world.

I'm not making excuses for anyone, and goodness knows that I could eat more healthily, but I think a great deal of it has to do with how far awy we've gotten from the raw sources of our diet. We process and box everything up to the point of having more chemicals than nice fresh apples and green beans.

That and the lack of exercise and activity. I'm aware of a number of middle income males whose daily activities are computer or video games. My point is it's not just the lower income groups, but it does include the lower income groups, and all the counseling, group therapies, doctor-patient talks won't make people healthier, if they are unwilling to take care of themselves.

You are not an endocrinologists nor a researcher.

No, but I have Type I diabetes, first and incorrectly, diagnosed as Type II for two years. So I guarantee I know more about it than you do...oh, but wait I merely point you to my experience working at an AIDS in Africa NGO as fundamental to my thinking that there are structural causes to these things, blah, blah, blah.

That may sell in liberal academia, but unless you think that I, or others, believe that because you served in a nation that begins with an "A," and that makes you an authority on everything else, you are delusional.

Obesity is systematic.

And this means what? Can you prove it? Can you even explain what it means? I'm not one of your undergrads impressed by your use of words like "systematic," so you're going to have to work a little harder.

If you can't make an argument, don't start trolling with your little personal attacks, just move on to another post.

I AM METULJ HEAR ME ROAR

I'm hearing you...no wait, I'm hearing myself and others roar...with laughter.

I thought only Niner would show up at the OK Corral with just a butter knife.

Wearybottom Associates