Re: Pearls Before Swine: Uncle Is Not Good With Money

On 27 Jan 2025 22:24:11 -0000, kludge@panix.com (Scott Dorsey) wrote:

D  <nospam@example.net> wrote:

How much was the cost of the surgery? I frequently hear horror stories
from democrats saying it costs millions of dollars and that you cannot
live in the US due to the high cost of operations like that.

>
Nobody really knows what surgery costs in the US.  You can ask the
hospital for a list price but what they actually charge is much less
than that because the insurance companies negotiate it down.  You can
think of the system as being run by the insurance companies, who decide
what you pay, who help decide what the hospital gets paid, and who decide
if you're eligible for a given procedure.
>
Two people may have the same procedure at the same hospital and get charged
completely differently because they have different insurance, but neither
one is likely to get a real accounting of what things cost.

It's been quite a while, but /all/ of my statements from medical
insurance showed what the hospital charged in one column, what the
insurance allowed them to get in another, how much they paid (or would
have paid if the deductible had been satisfied), and how much I was
responsible for. So I /know/ how much I saved, and, especially for the
cataract surgeries, it was impressive.

But as far as someone trying to choose a plan under the ACA goes you
are spot-on: there is simply no way to tell how much you will pay on
any given plan for a given procedure, in large part because it varies
by provider. There are /far/ too many variables.

If you don't have insurance, then yes, things can cost millions of dollars
in part because you don't have anyont to negotiate for you.  Go to a
for-profit hospital without insurance and you can find yourself with a
lifetime of debt.  But it can also be completely free to have the same
procedure, especially if you are on an insurance program run by the
same company as the hospital (what is called a Health Maintenance
Organization plan here).   Careful planning pays.

Older folks generally have Medicare. Comes right out of their Social
Security.

Retired Federal Employees have (or should have) their FEHBA plan.
Unless something has changed, for anything Social Security covers,
/all/ costs left to the patient are paid by the FEHBA plan. Including
the SSA deductible. And no FEHBA deductible or copay or coinsurance
either. For items not covered by Social Security, however, the usual
health insurance nonsense applies, including a deductible. These plans
also satisfy the Part D requirements, AFAIK.

Pretty much all Federal Employees have one or another of the FEHBA
plans, which means a lot of young, healthy people to help keep the
premiums down.
--
"Here lies the Tuscan poet Aretino,
Who evil spoke of everyone but God,
Giving as his excuse, 'I never knew him.'"