I'm not sure what's behind the grossed-up charges we all see for equipment and hospital charges but I do know they can be completely ignored. Completely. The numbers you cite are typical - Medicare reimbursements are lower than group insurance rates and so Medicare (as primary insurer) pays its lower share and your secondary insurance pays the difference, to its negotiated (higher) rate.

The form of insurance, whether private or public, has nothing to do with what's covered. As an example, let's say I have have Blue Cross insurance and you do too. If we're in different groups, what Blue Cross covers and how much the patient share is for each of us may be completely different. The coverage is what's requested and then negotiated between the group sponsor (or payer) and the insurance company.

Medicare is a single payer system and for a lot of people it works just fine. Similarly, it covers what it wants to cover and pays negotiated fees. It could add or subtract items as it wishes, what's affected is cost. If you got medical care that Tricare covers but Medicare doesn't, then Tricare would pay for it consistent with the policy terms and there would be no slice of it paid by Medicare.

As far as Brits in US clinics, I say, eh. The private (non-NHS) system in the UK has high standards and a good reputation, as is the case generally in other European countries and other places like Australia. Very few people with private insurance leave home, from the UK or elsewhere in its neighborhood, for medical care.

Edit for PS - I hope you are feeling better.

For instance, in my case. My dentist didn't take my dental insurance, but DH only wanted to see her. So I said sure, for cleanings only. She charges $297. But now we have a different insurance company, we both go to her & she accepts our new insurance. It pays $69 twice a year each, for cleanings and WE PAY NOTHING. But before.....we DID pay the $297!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

We have medical insurance just for this purpose. The small routine things we pay a deductible, like Urgent care...$100 ded. Any prescriptions are less as well until we meet our annual deductible of $2500 each. A Dr's visit is full price, but with a lowered price because of the insurance.....

I agree about the Dental insurance. But, if I don't have it, I pay more for what I still have to pay for with the Dental insurance. Makes sense, right? NOT!

One of the greatest things my late husband did for me was stay in the Navy Reserve after we married. He put in his 20 (6 active, 14 reserve), and due to that I have TriCare for Life. I pay nothing for it and if my med is on the Ft Knox formulary, I get that prescription at no charge. Some are not carried but are still no charge through ExpressScripts, but the ones that are not on the formulary are about $50 co-pay for 3 months supply - pricey but FAR less pricey than the drug. Having to take about 10 different meds, this is a HUGE savings for me.

I pay $480 a year for 2 of us(Delta Dental), for dental insurance and get a total of 4 FREE cleanings. Instead of paying $1200 out of pocket for 4 cleanings without dental insurance. Then the insurance limits the amount a dentist can bill us for other things....it's a win win for us!

The medical insurance works the same way until we meet the deductible and then it's free...dental only pays $1000 a year, but limits what they can charge us. Medical: If a person has an $8500 deductible then they would pay $8500 and the rest is free....so billing $31K...well...there "are" people paying it. :0)

I honestly don't see a problem with this,,,,?

Most dental insurance is much more like prepaid service contracts that offer discounted rates for non-covered services than actuarially managed risk sharing in pools as with medical insurance.

I fundamentally do not understand how health insurance works. When I think of insurance I think of risk being spread. Not everyone is going to have a car accident or suffer through a flood. Everyone is going to have medical issues. If they are routine, everyone has the same ones on the same schedule. The only question over your lifetime, how sick will you become. Even routine care become exponentially more expensive as technology and drugs have become more and more advanced. One could imagine paying for medical care out of pocket at some point in the past. Today, I think you would have to be quite well off to do that.

Doctors are certainly not the ones making all the money. For example almost 20 years ago I had an unusual problem with my knee. I was very unhappy with the orthopedic surgeon I saw at my regular clinic and chose to see someone out of network instead. He told me he would be happy to take care of me and could tell me what his fee would be for the exploratory surgery but he said there was no way we could go that route because he had no earthly idea of what the surgical facility would charge. He said when he heard what people were billed he could make no sense of the charges. So since we were not in a position to be able to afford an open ended possibility like that, I went back to my usual network and managed to resolve the issue.

But how can costs be so opaque? If that were the case in any other realm we would call that thievery.

So, as Elmer said, Medicare is single payer. Tricare then acts as as supplemental insurance? And everything is covered reasonably. Can we not find a similar solution? Medicare for everyone as the Bernie folks want and then supplemental for those who want improvements? We would all pay into the Medicare system and having fewer uninsured people would drive costs down, no? This would certainly help businesses who are having to pay large health insurance premiums for their employees.

Or could we try the German system, which is similar to the ACA, but the insurance companies are regulated?

I bristle at the constraints on care in Canada (my native country, though I have not lived there for long- I do have some first hand experience with their system- and frankly, it was underwhelming, I am very sorry to report.)

So in all it seems like our medical system is a Ponzi scheme of sorts.

My apologies for rambling and not being well prepared for this discussion- my time was limited and I really wanted to participate.

Anglo, I am so glad you are able to get the best possible care. How awful for those who cannot. I hope you are feeling better.

That heinous practice is called "Balance Billing". Its a highly inflated amount and it would be the amount you'd be billed if you went there as a cash customer stating that you could pay the bill yourself. I see it as an awful gouge, however there are hospital employees who are brain washed to believe it is an appropriate charge and they may support the action.

The argument supporting this action goes something like this: The hospital takes in all manner of patients through its emergency care center. Gun shots, stabbings, heart attacks, robbery and accident victims, and in-family violence, are but a few of the trauma cases they see. Some of these do not have insurance nor can they pay, but the hospital feels, or is, obligated to try to save their life and stabilize the patient. The management looks elsewhere to find the cash to recoup their losses and Balance Billing is one of those tools.

If you go there as a cash paying patient, you will be hit with a balance bill; Get admitted through your health insurance and the billing will be the amount negotiated between the hospital and the insurance. Your charges will be any co-pay and amount (of the negotiated price) not covered by your insurance. The large fictitious amount you might see on the bill may be the Balance Bill or the starting point for negotiations. It is not the true charge.

Elmer & Jem explained it more eloquently. :0)

There are folks that gamble and don't buy medical insurance. If you listen to statistics, people claim bankruptcy ALL the time over medical expenses.

My only objection....I pay a penalty for having non-Obama plan medical insurance. I should be able to pay for ANY plan I like, or wish to participate in. The penalty is $2500. Obama insurance would have been $12K more than I currently pay.

Nicole, you pay a penalty for different insurance? My understanding is that the penalty is for people who choose no insurance. Many people are not on the ACA plans and have private employee sponsored insurance, myself included, and don't pay any penalties.

chi....non-Obama insurance carries a penalty. A lot of people don't understand why Trump is trying to amend the Obama care plan. It's VERY flawed! Yes, when I was employed by someone else it WAS Obama insurance. :0) One of the perks of Obama insurance is that preventative care is FREE. I don't have that. But....I can afford a Dr's visit(goes towards my $2500 ded).

ie: right now I have a cold/sniffles and I won't be going to the doctors, taking antibiotics, which I shouldn't be taking anyway.....lol

Insurance premiums can't be affordable without a big pool of people paying premiums.

Insurance companies can't negotiate with providers if they haven't enrolled a big block of customers for health services.

When did anyone's health insurance premiums ever go DOWN? This is a not some sudden result of the ACA. America is the only first world nation without negotiated pricing for health care. Price increases have even been slowed because of constraints under the ACA.

States insisted on controls when the ACA was set up. Then some states (mostly Red States) refused to fund-match federal dollars. Without state support, insurance companies couldn't offer affordable insurance. Instead of blaming their states, people blamed the act -- and Obama.

Trump and his (largely Red State) supporters want to stop federal funding of health insurance to all states to put an end to the ACA. This is a wonderful example of cutting off your nose to spite your face.

Without federal funds, many Red States will have no health plans. Should Blue States stop sending funds to Washington and run their own plans with those taxes, instead of subsidizing Red States as they do now?

What have we here? Isn't this a great way to foment the end of the United States of America? Take a bow, Bannon et al.

Thanks, Nicole, I looked it up and it looks like the term insurance plans have a penalty. I didn't realize that.

Chisue....my medical and dental insurance is the lowest it's ever been! And...it's not federally funded. My car insurance and home owners insurance is affordable as well and "not" federally funded.

Also did I mention my medical insurance is locked in for three years! No rate increases for three years! That's unheard of with Obama Care.....

I have a private policy through Blue Shield and have never paid any penalty.

angelaid.....you don't understand. Also my policy is NOT short term. And...that is correct. It's not because it's a private policy that I pay a penalty/tax.

My insurance does not pay anything until the deductible is reached. I also excluded maternity care from my policy since I'm too old to get pregnant. :0)

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To avoid paying the tax, individuals must purchase health insurance that includes a minimum of 10 essential health benefits – such as hospitalization, maternity care, prescription drugs and more – and covers at least 60 percent of their medical costs. People who have coverage through their employers or are enrolled in government-subsidized health plans such as Medicare, Medicaid, the Children's Health Insurance Program or TRICARE don't need to worry about the tax.

nicole -- Have you had cause to use your health insurance against significant costs? How did it perform? One of the things the ACA wanted to accomplish was to drive out of business the "Promise High, Deliver Low" and "Cherry-picking" policies. Just what are you insured against?

Public Health costs money. You don't want/need maternity care. Other women and children do. What is a fair way to fund that? You aren't covered for preventive care. Will you be in the emergency room instead?

The 'old' way to fund public health was to charge more to people (or their insurance plans) to make up for the cost of urgent care to people who can't pay. This doesn't work for preventive services, resulting in more seriously ill people, who then need more expensive urgent care, more often -- without increasing the general health of the adults and children around us.

Good health insurance isn't cheap. Without single-payer Medicare, we'd be paying much more for *comprehensive* policies. We still pay too much for medications because prescription drugs are not cost-controlled by the government in the US.

DH and I have Medicare. That's $108/month.

Medicare recipients are required to have a Drug Plan; our plans are about $40/month, and mine has a $450 deductible. If we didn't each have one expensive medication, we could pay less for Plan D. (My daily Advair is nearly $5000/year retail).

We have High-Deductible Plan F Medicare supplement plans ($2300 deductible) that cost $100/month. So...$9000/year for two for coverage, not including out-of-pocket or dental.

I had two hospitalizations last year. Medicare covered everything. I did pay my whole deductible,I was only paying $1200/year for the coverage. I'm out $3500 on the year, but I didn't pay the $80,000 billed --and would not have paid more than that if the billable had been many times that.

We don't have dental insurance because the policies cost more than the pittances they pay against expensive crowns, root canals, extractions, etc. , and our chosen dental professionals do not accept less expensive plans.

I don't know why employers agree to pay health insurance for workers when their competitors in countries with national health insurance do not have this burden. All of the health premium costs I outlined above were absorbed by my DH's employers for decades.

"I don't know why employers agree to pay health insurance for workers when their competitors in countries with national health insurance do not have this burden"

In most Western European countries, chisue, both employees and employers are subject to a payroll tax for health insurance. It's often part of the "social security" system. Most countries have a compound social security payroll taxation system composed of many individual elements. Like - this percentage for health insurance, this percentage for pension, this percentage for unemployment, this percentage for elder care, etc., total = X. It's paid for, just as here, only in a different form.

Here, oftentimes employers pay health insurance as one element of providing competitive benefits to attract employees. It's as important as paying competitive salaries.

chisue...I pay 4x what you pay a month. It's the same United Health Care plan I had previously with Obama care, just no free preventative mantenance care. They pay nothing until my deductible is met. The deductible is 2 months of insurance premiums with Obama care.

People cherry pick insurance prices when shopping for car & home insurance.

Wow. My husband and I are extremely lucky to have the insurance that we do. We are both retired State employees. We both have Medicare Parts A (hospitalization) and B (medical), and we also have a Blue Cross PPO supplemental plan which includes prescription drug coverage so we don't need a separate Medicare Plan D (prescriptions). We both receive a monthly retirement pension from the State as well as Social Security retirement benefits. Our Medicare premiums are deducted from our SS payments. Our Medicare premiums include the Income Related Monthly Adjustment Amount (IRMAA) for Parts B and D because our income exceeds the maximum to pay only the regular Medicare premium. Our Retirement Health Benefit reimburses us in full for our Medicare & IRMAA premiums and also reimburses us in full for the monthly premium for the Blue Cross PPO supplemental policy. The reimbursements are included in our monthly retirement pension payments. (Well, the reimbursements for the Medicare & IRMAA premiums are included. They don't deduct anything for the supplemental policy because it's covered by the Retirement Health Benefit.)

The supplemental policy covers the Medicare deductible, and it also pays the portion of the Medicare-approved amount for services that Medicare doesn't pay (the portion that the individual would normally have to pay). And if Medicare doesn't cover something (hearing aids, for example), the supplemental policy covers it. We will never hit the "donut hole" on prescription costs because the supplemental policy would pick up the costs (but neither of us currently takes enough meds to ever hit the donut hole).

So, we pay no premiums, and we pay no deductibles or co-pays. For medications, we pay $5 (or less) for a one-time prescription, and $10 for a 90-day supply of a continuing medication (like my blood pressure medication. If a medication is only available as a brand-name drug but it is on the formulary, we would pay $40 for a 90-day supply.

For dental insurance, we each pay a $12.91 per month premium, which is not reimbursed by the Retirement Health Benefit. We each have an annual deductible of $50, and the maximum payout per year is $2,000.

We also both have vision insurance through our employment with the State, and it pays for new (gas permeable) contacts for me each year and new glasses for Hubs. It costs me $35 each year for the contacts (and I wear true bifocal contacts), and for $60 Hubs gets a new pair of prescription sunglasses and a new pair of "clear" prescription glasses each year.