At 8:50 AM -0700 10/30/97, Secret Squirrel wrote:
The really good way to protect your medical privacy is to self insure. Most people are happy with policies that tap out at $1 million. If you would be happy with such a policy, then all you need is $1 million to protect your privacy. It is likely that this $1 million will not ever be consumed by health care costs. (Probably much less likely than that a policy holder will hit that limit. People tend to spend their own money more responsibly than somebody else's.)
I used to think this was so, too. But there's a certain kind of market failure at work. (Actually, it's not a market failure at all....it's a manifestation of the market. Read on.) It turns out that if I have to go to the local hospital, the daily rate for a hotel room will be something like $2000 a day. Exclusive of whatever treatments I'm receiving, of course. Turns out that Blue Cross and Blue Shield have negotiated, through enormous buying power, daily rates of about $700 a day. (These numbers come from my memory of a "60 Minutes" report a few years ago. Details and current figures may vary.) Listed prices are the "sucker rates," kind of like the posted prices for out-of-towners, with locals getting a discount. And these pricing differences apply to the whole range of procedures. For example, an insurance company might have negotiated--over many years of intense negotiations--a fee of $100,000 for a liver transplant, but a "cash-paying customer" (a victim, a mark, a sucker) would pay the list price, e.g., $300,000. Could I negotiate a lower room rate, and lower fees for a spectrum of possibly needed treatments? Probably. I haven't had to try, fortunately. (Nor am I knowledgeable about procedures. Nor am I patient negotiator, no pun intended.) I'm not calling for market intervention, price regulation, government intervention, etc. Just noting that cash is not always king. Especially to any medium-sized or larger hospital, where filling out the forms correctly is more important than getting paid in cash. (My dentist's receptionist is befuddled by my paying in cash. She clearly prefers to just enter the number of an insurance company.) Walking in off the street, or arriving in an ambulance, without an insurance policy number is becoming a guarantee that one will pay the absolute maximum rate, the "sucker rate." If one is admitted at all, as many hospitals turn away anyone without a means of proving they can pay....and promises are not enough. And if one proves to the hospital that one has large resources, I fear for the consequences ("wallet extractions" being one risk). I have so far elected to self-insure, i.e., to just pay any medical bills I might have out of pocket. However, given this "sucker rate" and the increasing unwillingness of hospitals to take patients not in health care or insurance programs, I may have little choice but to sign up. --Tim May The Feds have shown their hand: they want a ban on domestic cryptography ---------:---------:---------:---------:---------:---------:---------:---- Timothy C. May | Crypto Anarchy: encryption, digital money, ComSec 3DES: 408-728-0152 | anonymous networks, digital pseudonyms, zero W.A.S.T.E.: Corralitos, CA | knowledge, reputations, information markets, Higher Power: 2^2,976,221 | black markets, collapse of governments. "National borders aren't even speed bumps on the information superhighway."