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September 14, 2014

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Yes, our health system is broken - and it all comes down to the whole third-party pay system:

The insurance companies have massive clout, as they tend to control a significant part of any hospital's potential patients. This lets them negotiate prices down (which is supposedly a good thing). The hospitals, in order to stay in business, then start negotiations with ridiculous charges from which they will negotiate down. This is particularly problematic for patients without insurance - they get the fantasy bills (hospitals cannot bill them for less without ruining the negotiations), and think that they are real, and try to pay them.

Medicare and Medicaid play this game, too, often paying less than the cost of providing services.

The free market system assumes that people pay for their own benefit, that they know the actual prices for things, and can shop around. We haven't had anything close to a free market in health care in decades (remember "Major Medical"?)

Binge watching is as weird as it's cool -- and yes B99 is really terrific, great ensemble acting

Another similar -- 'Psych' even for this one, repeat-binge. One of the best-sweet-hearted TV shows ever.

When my wife was treated for breast cancer 13 years ago, the stack of EOBS was 2 3/8" tall, comprising over $150,000 in treatment costs (Surgery, Chemo and radiation). We paid about $4500 in deductibles.

If she were to have the same treatment today, as far as I can get the numbers from the facilities, her treatment would be billed at approx $575,000, and we would have to pay $10,000 minimum out of pocket, plus everything that the facilities could bill us for out-of-network usage, probably another $15K.

Does *anyone* really pay full list price?

Oh, yes. If you're uninsured but solvent, you'll end up paying full price. If you're insured, but you go out-of-network to get a specialist, and your insurance says "we don't cover that guy's services", you'll end up paying full price.

I'm looking at a series of treatment plans for my daughter's uninsured oral surgery: reconstruction of the maxilla and implanted titanium screws. $25 k for the surgeries and anaesthesiologist, payable before the surgery or it doesn't happen. Worth every dime, but ouch.

Then there's the dental prostheses that go on the implanted screws. I figure another $25 k before it's all over. All cash out of pocket.

Does anybody pay list price? Sure. If you are one of those who doesn't have insurance (I've been there), you have no negotiating leverage. So you pay list price. All of it.

And note that, if you don't have insurance at all, it's probably because you can't afford it . . . and are therefore even less likely to be able to afford the huge medical bills. Which is why so many people without insurance avoid going to the doctor as long as possible, let alone for preventitive care.

binge-watching

Every year, in the week before the new Game Of Thrones season premiere, we binge-watch the entirety of the preceding seasons.

I don't have HBO, so I binge-watch the Game of Thrones while cat-sitting for neighbors when they're on vacation.

GOT provides a natural segue to our Middle East policy, since there's another case of wars with multiple sides and shifting alliances and near universal savagery. How about our policy towards ISIS? I supported saving people in danger of imminent slaughter, but arming "moderate" Syrian rebels seems like a great way to funnel weapons to the people we're bombing.

@DJ: arming "moderate" Syrian rebels seems like a great way to funnel weapons to the people we're bombing.

The US military-industrial-complex needs to step up and develop some armaments with planned obsolescence. At some random point, one year after they're handed over to "moderate Syrian rebels", they misfire, killing their operator.

More bux for the MIC; it's a puzzle why they're not already doing this.

I remember "major medical," very fondly. An almost sensible way to do things, and it allowed for both insurance and real-life pricing.

I think I must have had one of the very last major medical plans. Toward the end, I was saying to the doctors' office people "Bill me." and they were saying "Really?" because there were already people working at doctors' offices who hadn't heard of paying one's own bill.

But that plan died, and for decades now, I've been like everyone else; looking at bills for $lotsandlots, and the deductions and the negotiated savings and etc etc, and finally paying $smallnumber. And saying, "Why can't they just bill me for $smallnumber in the first place?"

"More bux for the MIC; it's a puzzle why they're not already doing this."

Good point. Still, though, one could argue that by bombing the side that we indirectly arm, there's a kind of win/win.

The US military-industrial-complex needs to step up and develop some armaments with planned obsolescence. At some random point, one year after they're handed over to "moderate Syrian rebels", they misfire, killing their operator.

Most of the stuff is consumables (ammo) or will be used up (destroyed) in rather short time in any case. And those items that are not (rifles) usually can be taken apart to get rid of the self-destructive devices or to replace the intended-fail parts. More complex ones would not get handed out to non-state actors.

Knee replacement: $19,400

Surgery Center of Oklahoma

I got the unadulterated bill for my cardiac ablation. Which I've had done three times.

180K. The biggest part went to the anesthesiologist. I pad a $40 office visit copay.

I'm on a pacemaker, of which I didn't get to see the unadulterated bill for, but it had to be just as much, if not more. I wasn't, and never am, an easy case. Waking up to having them pulling the arterial monitor out of my arm wasn't exactly pleasant. And now, I have regular trips to the hospital scheduled every few years for the rest of my life, since the batteries run out.

at least one character's voice in your head. Is the fact that it's Andre Braugher as Capt. Ray Holt surprising, or is it pretty much inevitable?

Not entirely. The incredibly irritating Jake Peralta character has a similar effect, but not in a good way.

The presence of Andy Samberg is the main thing keeping me from trying that show. I used to be a fan but the man just can't act. For a really bad example of Samberg, check out his performance from the James Franco roast.

Binge watching Friday Night Lights (having exhausted other series for the moment), I am torn between appreciation of an excellently written and consistently amusing drama, and cringing at the spectacle of kids playing a game which carries the inevitability of long term brain damage for many of its participants.
(Cue apropos link to TNC's latest article:
http://www.theatlantic.com/entertainment/archive/2014/09/boycotting-the-nfl-pro-football-and-the-sanctity-of-the-body/380275/ )

My kids, who have no interest in the game, and regard it in any event as absurd, thoroughly enjoy the series.

One point of note, teenage characters on US TV seem to be played by actors in their mid 20s more regularly than is the case in the UK...

In the US, there are tight restrictions on the hours an under-age actor can work. (Especially on school days.) Perhaps the UK has different regulations?

But that is why shows which include one or two kids typically only have them in a few scenes each episode. And shows which are all about teenage characters (set in a high school, for example) routinely have the teenages played by actors in their 20s. It's just way too hard for most producers and directors to schedule everything and get the show done otherwise.

I've burned out on English language TV series. I now binge watch Asian drama series. :)

CharlesWT, do you understand the language? Subtitles for Asian stuff can be grotesquely off (esp. when US made but German ones can be too).

I don't understand the languages aside from some words and phrases I've picked up. I find many of the dramas very entertaining in spite of the uneven quality and outright, as you say, grotesque English closed captioning. Although, some of it can be entertaining in its own right.

I think some of the mistakes may be deliberate so the content providers can detect who is pirating their cc.

My impression is that cc is getting better. Still, how a script is translated seems to vary as widely as the number of translators.

Have you gotten to the B99 where they go to the Captain's house for the party? Melissa Fumero is hilarious in that episode. "Hello Raymond! Those slacks are a knockout!...[to herself: 'come on Amy']."

I'd agree Samberg isn't a great actor, but he's a good enough comedian that I find his "perplexed face" to be funny.

Friday Night Lights...

Second series has major deficiencies.
Writer's strike ?

wj: "And shows which are all about teenage characters (set in a high school, for example) routinely have the teenages played by actors in their 20s."

This also seems to be generally the case in Korean dramas. Although, in the TV drama series, Hi! School-Love On (High School-Love On on Hulu), the 18 year lead character is played by 14 year old actress, Kim Sae-ron. Her two co-stars are close to ten years older than she is.

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