Posted by: distributorcap | July 24, 2008

Cash In Advance

While the candidates, the Congress and (of course we cannot forget) the lobbyists all “discuss” reforming one of the world’s most complicated, unfair and skewed health care systems (a-hem, ours), the process of taking care of the American populace continues to evolve into an unwieldy and convoluted structure. This of course means as time goes on, it will become more and more difficult to implement any potential change to one of the world’s most poorly organized medical systems.

One such insidious policy that is growing in attractiveness is “payment upfront” for treatment. What this basically means is that hospitals and physicians are more and more requiring patients to make partial or even full payments for health care services before any services are rendered. While Federal law requires medical facilities to treat “medical emergencies” (defined as immediately life threatening) regardless of the ability to pay, there is no law that forces a hospital or physician to treat someone with terminal cancer or severe diabetes. In other words, if you do not have the $30,000 ahead of time for that chemo-treatment, you are shown the door. Remember what President Irrelevant said what we should do during wartime – “go shopping” – well now it appears we need to hit the mall for a health care institution that will treat you, even if you cannot afford the sticker price.

Doctors have often required payment-in-full and it becomes the responsibility of the patient to collect from the insurance company. If you have a good relationship with your physician, sometimes they will take a partial payment as long as you have the insurance company send the payment directly to the doctor. Practitioners in HMOs take a co-payment and then collect from the insurance provider. But hospitals have been different – they traditionally bill after services rendered.

Not any more.

Even people who have full health insurance coverage are being asked to pay for surgeries and test upfront. Then the onus of collecting from the insurer falls on the patient – not the hospital. Not only does it improve the upfront cash flow to the facility, it avoids the costly issue of chasing non-payers or fighting with insurance companies. It shifts the onus of all financial dealings to the patient. The patient might as well be shopping in Bloomingdale’s. (Yes credit cards transfers the risk to the credit card companies – but ultimately all fiduciary burdens will still fall on the consumer, not the hospital). No wonder more and more people are going broke staying healthy.

The implications of this type of practice are colossal and scary. We all know what even basic health care costs these days. Just walking into a doctor’s office is a minimum of $200, not counting any tests, medicines or procedures. Treatment for chronic or long-term illnesses like cancer, hypertension or Parkinson’s can easily run into the tens of thousands of dollars in a very short time. None of these (no not even cancer) are considered emergencies. But procedures and treatments in hospitals are even more expensive. And how many people use hospitals and emergency rooms as their primary care physicians because NO doctor will take them on as a patient because they have no health insurance. Can you imagine having treatment withheld until you hand over a check (and probably a certified one)?

What a vicious cycle.

And compound this mess with the fact that insurance companies are limiting payouts and quantity of treatments more frequently today. What if you need 10 radiation treatments for your thyroid cancer, but your insurer will only pay for 5. You are on your own for number 6 or get your own radiation machine. The hospital or oncologist might require you to pay for all 10 ahead of time. That stent or pacemaker you need — well that is just going to have to wait until you have the $50,000 (or more). Saving for medical care is on par with saving for that Caribbean vacation – a luxury.

Hospitals are implementing this policy because they claim they are being hit with smaller insurance payouts and an increase in deadbeat patients. After all there are stockholders to keep happy, regardless if families suffer.

But the Republican Party (and some Democrats) continues to push for market solutions to health care. The market will handle it and fix it. And with incredible lobbying pressure from insurance companies and HMOs – the impetus to change has been non-existent.

So for all of you that have chronic diseases like diabetes or emphysema – start saving those nickels. Don’t expect the Hippocratic oath to get in the way of the current quarters’ P&L statement. After all America is about business — where the bottom line is more important than preventing a flat line.

What can you do?

  1. Read your policy CAREFULLY (assuming you have health insurance) – know what is covered, how much is covered and what is considered experimental.
  2. Challenge decisions and costs
  3. Seek organizations that might be able to help or advise (like the National Cancer Information Center).
  4. Vote for people that really believe in reforming this mess of a health care system
  5. and…… adhere to what is really the mantra America’s health care system

Do not get sick

America doesn’t have a health care system – it has an insurance profit center. As long as the health of this nation is treated as just another aspect of capitalism – a consumer product for those who can afford it – as opposed to a basic human right, hospitals and providers will make decisions and policies based on maximizing return on investment (ROI) instead of return on health.

After all, Health Care Administrators need a Mercedes and condos in Boca too.


  1. I hope to following rule #6 and not get sick. Just heard from a friend that her nephew (husband’s brother’s kid) was diagnosed with brain cancer. He’s only 15. His dad is a self-employed lawyer and she is worried about whether he has a good insurance policy (he’s not a gazillionaire lawyer), but she would rather not bring that up right now. Could you imagine having to deal with a devastating diagnosis and then having your insurance company dick around with you? I hope the insurance company honors its commitment (because the dad is a lawyer, after all), but it disgusts me that people with less resources or knowledge of these matters get royally fucked.

  2. I read about a policy about 15 or so years ago that was rather radical but it has been kicking around in my head forever. It basically works on the premise that health care what’s you sick not healthy. Afterall, there is no money in healthy people.So here’s the idea. You pay your doctors premiums every month instead of your insurance company. When your sick you don’t have to pay until your healthy. I know it’s only a theory and needs some work but think about. Now doctors would have a reason to make sure you were healthy. Something that I think is a plague on our medical system but for another time. Imagine you doctor making you eat right and exercise instead of just giving you a pill because your overweight and have high blood pressure.Just a thougth. Not mine by any means but I think it is something that should be explored. We have become dependant on drugs instead of taking the steps necessary to prevent a lot of health problems that plague this nation.(climbing down off of my soap box)

  3. MattThat is exactly the way medicine was practiced in Asia until just recently. You paid your doctor to stay healthy. If you got sick he got nothing. That was Chinese natural medicine I believe.

  4. Universal healthcare.This must be the goal of the next administration and with the Dems in charge of the both Houses of the Congress and Obama all but certain to be elected president, there is no excuse for this goal not to be realized.

  5. For a society that so often clamors around the politicized messages of “culture of life” – read against abortion and for prolonging of life, we sure are pretty fucking interested in death, aren’t we?I am about to end my insurance with my former employer, I have been on COBRA. Now I migrate to my husband’s policy which is very crappy.But better than nothing I suppose… Maybe.

  6. Hi Cap;Well. there is a solution, but no one wants to implement it. When I lived in Mexico, the doctors there are available and more than affordable. Took my wife to see a physician at 11 PM and it cost me $40 for the visit. He opened up the office for us.I had surgery in Tijuana, a procedure that included an overnight stay in a private hospital room with television and very caring service and attention.Ten years ago the price was $2,500 and I paid before walking out the door the next day.Outlaw the insurance companies and let the free market work. We are no longer patients, we are customers and as such, we should use our money to advantage and not pay premiums and pay the doctor directly.

  7. Interesting note, the Texas Medical Association (which usually votes and endorses a straight Republican ticket) recently pulled their endorsement of incumbent Sen. John Cornyn.That’s pretty rare, and quite delicious.

  8. Excellent. Spot on, every word. Welcome back.

  9. DCap – You said it man. As I was reading through this, my thoughts were the same as your statement “Do not get sick.”

  10. Whew! I’m glad I still have my constitutional right to not get sick.dcap, your blog can be so depressing sometimes. 😉

  11. And if we have any kind of universal plan, it must improve upon the limitations of Medicaid or Medicare, which run deficits frequently and are constantly underfunded.

  12. As someone who has had pretty good insurance through my work for over a decade I’ve also found as of late that medical professionals are much less willing to eat the difference in what the insurance company will allow for a minor procedure and what they charge.The result is you either pay these stupid bills for 10-20 bucks or waste your valuable time arguing with some insurance company hack or some knucklehead in the finance department of the doctor’s office.My main focus of ire is on the doctor’s office in these cases. What the hell is the co-pay for? It’s like the whole concept of insurance has transformed over the years.

  13. I think you summed it up really well'it has an insurance profit center.'The delivery of health care payment has been turned over to a third party which is fucking us and doctors….fellow I know, Ob-Gyn Doc, literally retired because of the insurance premiums he had to pay and the hazzle he was getting from insurance companies not paying up for patients. He got tired of the whole deal….insurance would not pay the bills for his patients…he couldn't collect from them…and the malpractice premiums were killing him. ('course he had made enough by 56 to RETIRE…. but the bigger point is that some honest providers are getting screwed, too.)He felt like he wasn't a doctor as much as an accounting firm.&Damn! it is good to read you again…..the trip sounds like it was great….looking forward to reading more about that, too!

  14. Welcome back, DC! Glad you’re home (o:

  15. I remember some years back when a friend of mine at work banged her head really badly. I volunteered to take her to the emergency room. As I drove her car to the hospital, I talked to her and discovered that she did not remember any of the previous 24 hours. I’m no doctor, but I knew that this was a sign of a pretty serious brain concussion.When we got to the hospital, it took awhile even to get to the point of signing her into the emergency room. There were a million questions, and about every fifth one was “How will you be paying for this.” I had worked as a clerk for a worker’s comp attorney and knew ultimately the restaurant would be responsible for the bill, and I kept telling them this. They kept asking her how she was going to pay for it, and I finally out of exasperation coldly told the woman, “Um, did you miss the ‘she banged her head really badly and has a memory loss?'”One of my closest friends just got laid off in the most recent round of cuts at the Hartford Courant and one of his biggest concerns is how he will be able to afford continuation of medical coverage.

  16. Sicko really opened my eyes as to how fucked up the healthcare “industry’ is. And to me, thats the problem..its a for-profit industry. It will never change as long as the lobbying arm of the industry keeps showering politicians with money, gifts and anything else they can get away with.Universal healthcare won’t happen unless and until we removed the profit aspect of it.

  17. Hey DCap,As usual – awesome post. It nails down exactly what the problem is and how we protect ourselves: “Do not get sick”.That said, for the first time since I’ve been trolling your blog here, I have to take issue with a term I see you’ve started using: President Irrelevant. Unfortunately, I don’t think it fits. The man is still our President until January 20 and is still pushing for war with Iran and getting his disastrous wishes fulfilled by Congress. Have we forgotten about the immunity for telecoms already? I much prefer the name used currently by Jon Stewart: Still President Bush.We do ourselves a great disservice by turning a blind eye to the Bush administration by giving them irrelevant and/or lame duck status. They are still moving full steam ahead at destroying our country, and although our media and many fellow bloggers like to pretend that Barack Obama is already the President-elect, we need to remember that is not true.There is still a lot more damage President Bush and his co-conspirators can do with the time they have left.(by the way, that comment that was deleted by the author was me. My boyfriend was still signed in and I commented accidentally under his name)

  18. thanks for all your comments. i dont think we really understand how truly broken our health care system is — or maybe we do. i know under mcsame NOTHING will be fixed and it will continue to deteriorate and inevitable fear is that no matter who wins, the insurance industry is so powerful as lobbyists, NOTHING will change (like most things in this country) and we will just move along like the govt wants us to do. as for Pres Irrelevant — you are right — the damage he can inflict in the next few months has the potential to be devastating — but my gut says he wont — the fucker in the white house is trying to do two things — dump as much of the mess on #44 and make whatever legacy he has seem better. i used to think he would go to war with iran — i dont think that anymore (but what to i know?) — i think even the dickwad in the white house cant wait to get out of there at this point.but that is just this humble man’s opinion

  19. this post hits home. what a fucking mess we have in this country. why can’t the masses get pissed off enough about this and begin to DEMAND solutions, much along the lines of what France has for example.

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