Wednesday, March 19, 2008
Vacation souvenir: A low hospital bill
By Danielle Dellorto
Associate Medical Producer


I recently returned from a wonderful vacation in Paris with an interesting story to share. Yes, we visited the usual hot-spots: Notre Dame, the Eiffel Tower, the Louvre. But I unexpectedly experienced France's health care system, too.

My husband woke up around 4 a.m. on our last night in Paris very sick - throwing up, pale, severe stomach pain. Perhaps a bit naive, I figured it would pass. I was wrong.

Nearly 12 hours later he was still throwing up and was having a hard time breathing. His throat was starting to swell. At that point, I made the call to head to a hospital in Paris.

On the ride over, I started to think about the quality of care he was about to get. The cost also crossed my mind. Emergency room visits are never cheap and we would have to pay the bill up front and submit to our insurance company in the U.S. upon our return. I made sure my credit card was handy, expecting the bill to be a few thousand dollars.

Within five minutes of our arrival, my husband was checked in and getting settled into a hospital room. Ten minutes later, he had an IV in his arm and blood was being drawn. The doctor conducted his evaluation, took a throat culture, and administered several medications all within 45 minutes.

Two IV bags, a cortisone shot and five hours later, we were heading to the billing department.

"Oh no," I told my husband. "I can just imagine how much this bill is going to be."

To my surprise, the total bill was 275 Euro, or roughly $450. For five hours of high-quality treatment. And this amount is not my co-payment or "my portion" of the bill. It is the total cost of care for the day.

To put that in perspective, according to Blue Cross Blue Shield of Georgia, the average cost of a day spent in a hospital in the U.S. is $4,700.

Interesting to note, if I were a French citizen, I would have paid, out of pocket, 1 Euro for the visit.

But before you start thinking health care is "free" in France, let me point out the taxes they pay. Approximately 21 percent of a French salary goes to France's version of Social Security, which includes mandatory health insurance, supplemental health insurance and retirement benefits.

So what do you make of it? Do you think we overpay for health care in the U.S.? Would you favor higher taxes if it meant our health care would be a few dollars a visit?

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I recently went to a hospital in Indiana for 4 stitches in my finger. The doctors injected a numbing agent and appplied 4 sutures. Total cost? $793. Total physician's time? less than 30 minutes - with the remaining hours in the waiting room... I've always had a "get what you pay for" approach, but this article makes me think otherwise. We can apparently learn something from the French.
If I knew that every man, woman and child in this country could have cradle-to-grave medical care of the the highest quality...take 50% of my salary! It would be worth it!
Yes I think we are overpaying in the US. We spend more on health care (if you count gov't plus private) per capita than other industrialized countries AND something like 40 million people have no coverage at all. Something doesn't add up. I don't know if it's inflated drug prices or doctor's legal fees or what that is causing the enormous costs but I I hope this mess can get straightened out soon.

Tim
I wouldn't mind paying more taxes if I knew it was improving my health care, and saw that it was working. I'm not someone that has been to the hospital or doctor very much, but as I get older I know I may not have a choice. It would be nice to be able to afford it since I currently cannot.
I would not pay more taxes for healthcare. We are already paying an exorbitant price as is. It's the greed of the insurance and pharmaceutical companies that have turned our healthcare system into what it is now - a business. My friends drive into Mexico to pick up medicine because it's at least 50% if not more cheaper then it is here. Why is the same drug cheaper in Mexico then it is here in the U.S.?
True story: A couple of years ago I took my mom to the emergecy room with a severe earache plus severe pain in the same side of the head. We were there for many many hours, she was never helped (they only got her personal information), so we decided to go back home. Guess what? Some time later we received a huge bill. I had to call and ask if they were now charging for sitting in their waiting room and breathing their air!!! They canceled the bill.
Shame on our medical system!
wow thats actually amazing. Still if i paid tax and received proper care then i wouldn't mind. If you have an emergency and end up in the hospital the bill would be high depending on the time spent there but come on only a couple of hundreds wow.
First off, I would like to respond to a few comments. To the person who stated that he wouldn't mind paying taxes for 50% of his salary.....first off, it has been shown that European care is not the highest quality, just the cheapest. Doctors checkups are scheduled months in advance, as everyone has the same government mandated insurance that tells them to go the same doctor. As for the person whose mother with an earache had to wait "hours..." It is an EMERGENCY ROOM, not a convenience room. If she has a bad earache and head pain, probably everyone with chest pain will be seen, then people vomiting/dehydrated, then people bleeding, and so on down the line. There are signs that say you are seen in order of severity, not time of arrival. As for the medical bill, it seems like a terrible mistake, but the hospital corrected it. Those of you who say that this is the fix-all need to realize that we live in a capitalist nation, and all of our ideals and principals are based on that notion.
Think of a custodian at a hospital who is earning $12 an hour. Now, since the hospital will have to have government mandated pricing, they will now have to cut their salary to $10 a hour, as they can no longer afford their previous rate. Then, after already having their salaray reduced per hour, they now pay %50 more in taxes. Does this really make sense? Do you not see why the economy in France is not the best and why it is in fact not doing well ( the fact that the Euro is doing better is because our economy is doing poorly, but that is for a different blog altogether ).
Those who want a socialistic healthcare system will come to realize that it will not "mesh" with our current government, policies, and personal lifestyles, and after 4 straight months of having "50%" less money, you will feel hardships, but feel better knowing that people will have free emergency care to treat their earaches.
I think you can blame alot of the high cost of US health care on frivlious law suits, greedy lawyers which in turn causes high insurance premiums. In the end this cost is passed on to the comsumer. Between the lawyers and the insurance companys I don't know which one is worse. The system sure needs an overhaul.
We're already paying for healthcare for people who don't have insurance. My DH has a nephew who received a $5,000 tax refund this year. He has no ins. Did he run out and buy ins. with that $5,000? No. Did he pay the hospital bills for the 3 ER visits his family made last year? No. He blew the money on crap he didn't need. That's why it cost $800 to put in 4 stitches. That guy sitting next to you with the 5yo girl with a broken arm? You paid for him too.
Okay, everyone,
Some of the comments on this blog show how unfamiliar many people are with the medical system. Commenting on the doctors making all the money: sorry, you're not looking as far up the food chain as you need to. Doctors, nurses, and even many of the hospitals are at the bottom of the care provider chain. They are not what really drive the health care industry. It is the investors, drug companies and the insurance companies who really set the prices and the standard of care.

As far as the quality of care; nope, the US DOES NOT have the best quality of care. It is excellent for the rich who can afford to pay for the top notch insurance policies, or for people who are very healthy prior to their illness. This is because, well, money talks: you have it, you get what you want and need. Also, if you are healthy prior to whatever treatment you need, the insurance company did not have a chance to "screen you out" as a potential user of high cost treatment. Chronic users of the system, meaning the chronically ill or injured, are typically "screened out" by insurance companies or care providers by using preexisting condition clauses, or caps on benefits for certain conditions, as the “reason” for not providing necessary medical services or treatment.

And to answer the blogger talking about our medical system working best as a "capitalist system": Sorry there, that's what got us into this mess in the first place. The basic principle of capitalism states it leaves supply and demand to balance itself through the process of providing and needing goods and services. Trouble is, it incorrectly assumes medical care is best served through this system when services can be provided for a profit. The problem here is when the demand for the services IS NOT DETERMINED BY CHOICE. I can choose what I will pay for my shirts and shoes, but I cannot choose to pay, or not to pay, for the meds I need to stay alive. Not every necessary medication has a cheap generic, and medical innovation is a horribly expensive process. This would be as if I'm expected to buy all my shoes at Prada, but I'm only qualified to work at the local Seven-Eleven. This isn't capitalism: it is cruelty.

The best comparison I could give would be the educational system: provided free, for all the people. There are still some countries in this world where people have to pay for their education. They are also countries where the poor stay poor, and bettering oneself remains tough to unlikely without money. We in the US would not hear of such a system because we value an educated population as the source of what makes this country great. The inability of our country to recognize how a healthy life, and guaranteed health care, is the key to keeping our country's population functioning as well as possible.

I know if I did not have to pay thousands per year out of pocket for my health care, I would be consuming more goods, actually taking vacations, purchasing a home; the list goes on. Instead, I have to struggle to pay my bills, and try to live as best I can with my doctor's assertion that I am running out of time unless I can pay more money for more treatment.
Yes, it is possible for a government program to work, if it is focused on the people. If there were not insurance companies or investors making huge amounts of money off the misery of people like myself, we really could afford health care that works for everyone. If everyone was guaranteed health care, how many malpractice lawsuits, or court cases for failure of insurance companies to pay, do you think would really enter the court system if medical services were provided at low to no cost? Capitalism is not the answer to everything. A compassionate country, and its people, would recognize this.
C. Anne Dover, NH
I notice the person who responded to mine is using extremes and mass media hyperbole.
"Yes, it is possible for a government program to work, if it is focused on the people." What a nice campaign slogan. But like most campaign slogans, they sound nice, but rarely have a backup plan becuase they are simply what people want to hear, rather than fact. Where will the money come from for this plan? The taxpayers? I pay enough out of pocket for other people's insurance re: medi-cal, medicare, etc, and yet I am surviving. I pay for my own private insurance, and that is a nice chunk of my paycheck, but I have made sacrifices. Since you used a personal example for a debate subject, I can use one as well.
Again, if you want to create a communistic/tyrannical socitey where you limit how much the "evil" drug companies and hospitals and insurance companies can charge, then where do you stop, and again, with what do you stop. I need food to live....so, now, the government should say to Safeway that all my food is free. Hope the clerk earning $7/hr doesn't mind that some days he will be earning $3/hr. This is response to capitalism is evil, not compassionate, etc. That is the same logic of saying "we need it, so the government should pay." If we were compassionate and made healthcare free, again, then how much money of taxes would be taken out. Secondly, are you willing to have the government tell Harvard that they can only charge $300 a semester, so that future doctors will not have to charge high medical bills to pay off their student loans. Or, the other example of government controlling everything......How about "you don't have insurance and received a $6000 tax refund." Make it a law that anyone who uses excess money on crap we don't need, like tvs, stereos, etc instead of healthcare then does not get a refund the next year. It was funny ( I work as a much lower level rung on the hospital, so don't think I am an executive type, I just use logic, not emotion ) to see someone without his insurance and his wife come in to my hospital with starbucks. We can't afford insurance, but we'll spend $9+ on two cups of "gourmet" coffee that could cost us about 30 cents for two cups at home. How many starbucks do they buy in a week? If they thought this over and made other lifestyle changes as well, could they maybe afford a cheap insurance plan?
I realize I am going on tageants, but it is so tiring to hear about how evil all healthcare workers, drug companies, hospitals, doctors, etc, are being.
By the way, I took my mom to the Emergency room because she had a SEVERE earache and SEVERE headache out of nowhere, in the middle of the night. Plus, I am very aware of her medical history, and, yes, that qualified as an EMERGENCY. I more than understand that there are priorities in an Emergency room but to be waiting for hours with excruciating pain and not be seen by even a nurse...c'mom!! Don't tell me there is nothing wrong with it. I also think it's an unfortunate misconception ,and one that is used to kind of make us feel better about the fact that we pay exorbitant amount of money for our medical care, to think that we have the best medical care in the world and that everywhere else medical care just suck! I have family and friends in Europe and that's NOT what I hear from them. Sure, we have many things to be grateful for, some even to be proud of, but when a hard working father, that pays insurance, mind you, has to sell his car, home, even go into bankruptcy to pay for the medical care of a chronically ill child, or a single mother cannot afford medical insurance for her family, in a first world country, there must be something VERY WRONG with our system. Let's stop making lame excuses. Let's not turn a blind eye. There must be a solution.
Ok my two cents:

First of all...we still have high taxes in this country and still pay out the wazoo for healthcare... if you are single and make over $32,000 a year you pay 25% income tax, married and over $42000 combined income is also 25%. So are French taxes really higher than US? I think in the end it probably evens out. But the french system of national healthcare is different in that it doesn't punish people financially for being sick. Our system does. When you are sick, you already have enough to worry about.
Let's spread the financial burden of healthcare out and approve universal healthcare. It won't raise taxes or cost of insurance tremendously because a lot of the expenses we pay now are to cover the costs of people who don't have any insurance and can't pay their hospital bills. And it will encourage people to seek care for their health problems earlier because they won't be as worried about the costs, which will lead to finding problems sooner and curing them with less expensive means. This is the way to go people.
Oh and to the person that said we will have 50% less money- first, having 50% more taxes does not mean 50% less money. If you get $10 and had to pay $1 in taxes before, and now you have to pay $1.50 (a 50% increase) you still have $8.50 instead of $9. Thats not having half as much as you did before. And universal healthcare will NOT raise taxes by 50% anyway.
JPN, MD
YES! I would absolutely pay higher taxes to get decent health care benefits. How lucky were you to get sick in France and not the U.S.
I would happily pay 21% of my salary for high quality healthcare. As it is I'm paying 28% of my salary and that doesn't include the portion my employer is covering. It about time this country got back to taking care of domestic problems including but not limited to healthcare.
It goes beyond the "cost" of the health care. My concern with the proposed universal health care plans are not necessarily the increase in taxes and/or the other associated costs. It is the quality of health care we would receive. Despite popular belief, the USA is not on the leading edge of health care technology. Without getting in the "who is to blame" arguements, the bottom line is procedures and medications that are available in Europe are not available in the USA. I have had conversations with more than one physical therapist who told me that inspite of their years of education, they would not be able to work in France for instance because their training is not as up to date as what is being currently practiced there.
Hmm,
It seems "anonymous" responded to my "hyperbole" with a little more of the same. But it is encouraging to see almost everyone else has been feeling some of the same pressures I've experienced with the inequities and wastefulness of the medical system in the US.
Yes, I agree: it's frustrating to see people complain of high costs while toting a Starbucks coffee container. Six years of working with substance addicts and the homeless has shown me that side of people, too. But as a single female struggling to support myself, being forced to pay almost 20% of my take-home pay on my cost of my insurance, then another $200 to $400 per month to cover the costs of meds, medical equipment and screenings my doctor says I need, but my insurance company won't cover, makes it tough for the day to day stuff of living. And, no, not Starbucks: I'd like to not worry about transportation because my car is 10 year old, with 220,000 miles on it, but I cannot finance a new one due to "excessive medical expenses." Stuff like stereos or other equipment is not even in the picture, nor take out food, nor shopping for anything other than food. As far as tax returns: I didn't get one last year, and this year's is less than $150. This isn't listed because I'm out for sympathy: it is because I hear of situations like mine every day, from hard-working middle class people as well as the ones living in homeless shelters. Even if there is a system with a basic set of standards of care, provided for free, with the option of purchasing insurance or other provider care as a supplement to the free care. As it is, so much of the expenses of the folks who need to use the ED for routine care end up being absorbed by the hospital itself. That wouldn't need to happen if another system to cover that cost was in place.
Whether or not it can be accomplished at this time, with the system the way it is, is not certain. But a market system only works when there is a choice. Having basic care provided would give people the resources to take care of the rest.
Yeah, I know: we can't compare our system to the one in Europe or Canada. But folks there are not being financially wiped out, or dying, or unable to provide the basics because of it. The US is better than what it has now. It needs to be thinking about its own.
C. Anne Dover, NH
I like that we are able to discuss this, but again, I have yet to hear a plausible solution. In every system, there is someone that goes unnoticed and has the system screw it. And yes, this happens in Europe as well. Is it right? Of course not. But, to continually say "we are better than this, it is pathetic, etc" are not offering viable solutions. It is "honorable" for that one person saying he doesn't mind an extra 21% of his salary going to taxes. Good for him....but, as judged by previous bills not passing, I can guarantee the majority of people do not want an extra 21% taken out ( A little aside....I stated 50% because that was an example of someone trying to sound altruistic, so I gave my example of a day in the life of a custodian working at a hospital ). As for the earache person....adding "cmon" does not negate the point, that, as painful as it was, an earache can be put on hold (usually) in a busy ER, and the beds will go to more serious patients. Your whole point in this discussion was to vent your frustration about an ER visit that has nothing to do with the discussion on universal healthcare. If anything (again, in theory) with universal healthcare it would take forever to get appointments with government approved physicians ( this does happen in Europe also, people commenting are continously leaving out the bad parts of european universal healthcare ) and that would fill up our ERs with even more non-emergencies. As for my main "combatant" =), I am sorry about your personal situation, but unfortunately, that is not my problem. I am saying this in an a matter-of-fact tone, not a "nyah-nyah-nyah playground I think I'm better than you" tone. It may sound selfish, but that's my perogative. I am for government medical assistant/insurance for disabled, retired, and military families. I am not for people getting free insurance because they are unemployed but come in with starbucks. And, in case I misunderstood you ( and if I did, call me out, it's cool ), I cannot believe how ludicrous it is to compare that with your expeirence working with people with drug addiction. If you are addicted to caffeine, by store brand coffee and brew it at home for 30 cents a cup. I personally think with less government programs, people will rally around you MORE in terms of charity, grants, donations, etc, then with the already poorly designed medicaid programs offered. I realize this has been random tangeants and all over the place, but I genuinely have a headache due to lack of sleep (up too late for weekend). I want people to tell me, nay convince me, universal healthcare can work. I use logic, not emotion, so personal stories of hardship won't do. Evidence that it won't kill my wallet and the nation's economy will convince me to be for universal healthcare. So, everyone....convince me. Who knows, you may come up with something the candidates like and hadn't thought of. Have a good day, "C." - Your friendly neighborhood anonymous
Why are our bills inflated by orders of magnitude of the actual reasonable cost?

I had some cardiology tests done at the local outpatient hospital clinic and the bill (paid by insurance) was around $4000. My father is a cardiologist and was appalled when he saw my bill, and said that he only charges a few hundred dollars for the same tests.

Also, all of my $4000 tests at the hospital clinic were done by technicians, a total of about 2 person-hours, whereas my father, a private practice cardiologist does the tests himself for a few hundred dollars. He has no idea why the clinic is charging absurd amounts. (I know the technicians are not being paid $2000/hr, so where is the money going?)

Has there been any study of where all of the money goes? Would CNN investigate such a thing?
This is a great discussion on universal care that is long overdue. Our country has largely ignored it, or considered managed care a great option, since Nixon sold us the idea.
However, there is one issue I urge everyone to consider when thinking about universal care.
For the person holding a different perspective than my own state; I urge you to reconsider one statement: “I am sorry about your personal situation, but unfortunately, that is not my problem:” I’m sorry, but this is everyone’s problem. No one exists on the planet in a vacuum, and everyone’s problems, concerns, behaviors and attitudes impacts everyone else. Doing the work I have for many years has given me a larger perspective of these issues, going way beyond my personal problems.
I’ve viewed first hand the sobering perspective of how society treats what it typically considers its “throw-away” segment of society; poor, underprivileged, uneducated, addicted or some combination of the four, and how foolish it is to ignore providing adequate medical care. I’ve worked on city committees putting together grants for federal funding to take care of working class poor who’ve slipped through the cracks, only to find treatment, for medical or mental health issues, as a huge portion of the financial need. I’ve worked within the state prison system, as well as the state and federal legal system, and discovered how overburdened these systems are, and how medical concerns are a large part of the problem. And I’ve worked with middle class families, including business owners, long time company employees and professionals, who were refused, or could not get, medical insurance, no matter how much money they were willing to pay for it, direcly impacting their ability to be productive, tax-paying citizens, able to contribute to the economy rather than burden it.
The US public can be quick to dismiss the criminal population on moral grounds, stating “if they just followed the rules, they wouldn’t be there,” or dismiss the concerns of two-parent income families, stating “they can work-they can take care of their own.” Very true. Unfortunately, as US taxpayers, we all are burdened by paying for any medical care provided to the public when the public cannot pay. Taxpayers pay for the legal system, clogged by addicts unable to get addiction treatment because facilities can no longer afford to stay open, who are incarcerated, then released, only to continue the behavior and additional medical costs. Some estimates state near to one third of the prison population struggles with a major medical or mental health issue that the prison must treat, courtesy of the taxpayers. Not to mention loss of production at work from ill workers, unable to cover their out of pocket expenses for medical care because their insurance is not good enough, then leaving the hospital with large unpaid bills, further spreading the high costs to others.
There is another article on this website discussing how doctors are now being trained to discuss cost of treatment as part of the treatment plan. This is something I have done personally for close to twenty years, and is long overdue in the medical profession. I would urge all doctors to consider this in an effort to keep overall costs down, even if it means shorter treatment options. I fully understand it is my misfortune to have a short life; I've delt with it, just like many others. It's part of the deal. But it doesn't mean the quality of life while we are here needs to suffer, as long as we are committed to sitting down to discuss options.
Whether we like it or not, we need to be working together to come up with a plan that works, and not sitting back and expecting someone to hand us something we think will be acceptable. Its not about convincing each other who has the right plan: its about keeping the dialogue going to make a good plan happen. Very few decisions on policies are strictly about the money or the facts. Where human lives are concerned, it won't be, at least not for the majority of the population. Waiting for that to happen is a set up for failure.
C. Anne, Dover NH
To the person who wrote " first off, it has been shown that European care is not the highest quality, just the cheapest." What constitutes "highest quality?" If you mean hospitals and doctor's offices that look "warm and fuzzy", you are right. But, if you mean the actual art of medicine affordable to the higher percentage of the population, you are very wrong. I live in Germany, which has a population of over 80 million. Only about 250,000 Germans are uninsured. That means that almost all Germans have access to affordable medical care. And that includes medical care which is not readily affordable in the United States. I am a lung transplant patient – and my insurance not only paid for over a year of hospitalization, they have now paid for all my immune suppressant for over five years.

You also wrote "Doctors checkups are scheduled months in advance, as everyone has the same government mandated insurance that tells them to go the same doctor." That is simply not true. Whatever gave you such a silly notion? In Germany almost all physicians are entitled to treat patients who are "publicly insured". Only a very small minority of doctors have limited their practice to privately insured patients. As far as the waiting for appointments is concerned – I have never encountered as many difficulties anywhere else in the world in getting a prompt appointment as I have had in the U.S. Which is surely a reason why E.R.s in the U.S. are so overloaded.

You concluded with " Those who want a socialistic healthcare system will come to realize that it will not "mesh" with our current government, policies, and personal lifestyles…" Do you think catastrophic diseases, which become fatal when they cannot be treated due to lack of money, "mesh" better?
STOP COMPLAINING AND PAY YOUR BILS.. If everyone paid atleast $5-$10 a pay period til it was paid of health care would be cheaper. STOP BLAMING THE GOVERNMENT AND LOOK IN THE MIRROR AT OURSELVES. How many of you have a past hospital bill on your credit. We live in a country where you can be jobless even homeless and get treated we are not allowed to turn away. So to reply to looking out for the people our government is.
For taxes if everyone thought about it. how much is taken out of your pay check every pay period for health care. If everyone had half that amount taken out of their paycheck every pay period for healthcare we would have cheaper health care.
So if we think about hospitals here are clean, we have new needles for every patient, we have good equipment, workers that keep the place clean and sanitized, we have medication, repairs, and supplies. come on people open your eyes and think how do these hospitals get their money. it's not all from the government or charities. It is hospital bills, and if 3 million out of 4million are not able to pay their bill and don't have health insurance but we all need clean place and supplies right? We then the people that do pay their bills get charged more to accomodate that.
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