Here is how it works:

Hospital emergency room.

1) First get all of the patient's info and various people bringing them into the emergency room. Create the Medical File.

2) Evaluate and Order Tests for the patient (err Medical File)

3) Doctor evaluation. Administer needed care or order still more tests for the Medical File)

4) Release patient, send Medical File to Medical Coding.

5) Consolidate charges by tabulating all the code numbers for anyone who touched or breathed on the Medical File (by secret code book) over to Billing

6) Match up the code numbers with the Billing Code numbers. It is at this point that finally one person knows the charges, but not ALL the charges. Some report their codes to Billing sooner than others.

7) Billing dept. Send out bills to the patient as you consolidate charges. Hence, never will be one total and complete bill sent to the patient. More come in on the Medical File over time.

8) Billing starts the 90 day expectation of Payment.

9) 30 day no payment received prompts notice of Government paid services, instructing the patient if they are having difficulty paying, please try to get on government care so they can charge the appropriate government 'service'.

10) No payment received in 90 days, sell of Medical Bill Invoice to 3rd party collections for 10% of face amount of total bill. Receive cash payment, close Medical File.

11) Collections peruses the Patient and has the right to now collect the medical debt. Medical debt is personal debt which a judgment can be made against you and all your possessions. If Married, community property applies. Only bankruptcy will stop collections from taking your personal and real property.

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So what is wrong with this picture? First, lets put in a real life example. You are 30, in good health, but you have a sharp pain in your lower left abdominal side. Despite aspirin, it continues on for several hours. You fear it may be an exploding appendicitis, which could kill you. You go to the emergency room.

There you give your name and social and address and phone for the Medical file. There after you are told to wait. You are treated to a hard chair. In 10 minutes if you are very lucky (some waits are hour(s) long), you get admitted into see the emergency nurse. She checks your vitals, asks standard questions, where is the pain, what did you do, eat, are you allergic to anything, takes your age, weight, height, temperature and passes the Medical File on for the Doctor.

The Doctor may not be the one to make the diagnosis, but will evaluate further by ordering medical tests to the Medical File, blood, urine, sonogram, perhaps an IV, and then the stomach surface digital exam (he touches your stomach, does this hurt?).

Then you wait, either back in the emergency waiting room, or if your temperature is over 101, you may get a bed or a chair near the nurses station. If you are cold, you may get a blanket. If you are hungry, forget about it. If you are uncomfortable, forget about it. Now you wait, and wait, and wait. Depending when you entered and what day it is, you can easily wait 9 hours to "get your results back".

Then you see a doctor who does the diagnosis. Good news, no appendicitis. Constipation probably. Let me give you an extra strength prescription laxative that you will need to go to the drug store and wait another couple hours to file. You pay $110 because "its special laxative".

You go home, take the medicine, and sure enough the pain goes away and you soon take the biggest dump of your life. Wow! Glad that was all it was. Glad its over.

HOLD ON. NOT OVER. You may be thinking, what could that horrific treatment at emergency room cost me? I saw two doctors, took some test, was treated like cattle, certainly NOT LIKE I AM THE HILTON IN VEGAS AS A HONORED GUEST. Btw, "honored guests are people who spend $10,000 a night". Vegas treats you realllllly well, like a King! So you may think, I've got a couple thousand in the bank, I'll be covered.

Not! Your Medical File has made the rounds, anyone who breathed on it through in their code number. Their code number was sent Billing who looked up prices. Then comes your first bill of _______ how many you don't know. Nor does the Hospital - yet.

14 days later, 1st bill: $3280.70. OUCH

4 days later 2nd bill. $1896.43 Ouch!

8 days later 3rd bill. $2398.99 Ouch!

12 days later 4th bill. $4489.27 Ouch!

14 days later the 5th and final bill $3,398.22

14 days later the 1st Bill is due reminder!

So you say like many people, $15,464 for an emergency room visit! And you got less than 90 days to pay up!?? Wow, that's a new car! And I didn't have any appendicitis !!!! Gee, how much would the real thing cost! You don't want to know. You think back to the nurse, the two doctors, the tests, the hours waiting, the LOUSY treatment you received, Come on in VEGAS if you spend $15k you are royalty for the night. Payments to the hospital will be $1498 a month! That is a GOOD house payment! You already got a house!

So you don't have medical insurance and your two grand in the bank ain't going to cover it. You have a good computer paying job and so the govt is not putting you on their state medical coverage plan.

You say, F*ck-it, let it go to collections, what can they do?

So here is a key point RON PAULERS, listen up. The Hospital SELLS the invoice for 10% to get its cash.

SO the hospital SYSTEM creates a HUGE bill, refuses to sell it to the patient for 10% (of course), and gets paid REALLY what their "Service" was worth all along -- $1,546 the very amount you had saved in the bank for such emergencies.

Now comes collections, and soon, at the age of 30, you'll be declaring bankruptcy all over an appendicitis that YOU DIDN'T HAVE.

Now what is wrong with this picture?

Where is the competition? Where is the pricing UP FRONT.

And why cannot hospitals be MADE to post up all their prices? Too many you say? I say hogwash.

$5,000 for anything from above the neck
$10,000 for anything below the neck and above the hips.
$5,000 for anything from the hips down.

Simple. There is your pricing for any Emergency hospital room in America.

Indeed, there is medical PRICING and SHOPPING going on in the world of Cosmetic surgery. AND THERE ARE EMERGENCIES in that line of medical business too. But they post their prices and YOU CAN SHOP THEM. Most of all, no health insurance is involved. Pricing for this has been going down while the QUALITY of service goes UP. Further, YOU ARE TREATED WONDERFULLY.

I read somewhere that in WWII, there was PRICE CONTROLS and RATIONING. Well employers, stuck with price controls, could not RAISE any salaries, but the IRS did let the employers Pay (for the first time this was done) the employees medical insurance bill. And so started the long road of 3rd party pays. This was the first time, or the FIRST GOVT FOOT getting into the medical door.

Companies paid and did not mind costs and employees did not notice when less pay was because the 20 smokers over there were calling in sick a lot. By the 1960s, LBJ and his medicaid came in and Government got its SECOND FOOT into the medical door. With 3rd party pays and then MEDICAID and then MEDICARE, government was fully into the medical business. By the mid 1970s employers where trying to save medical costs and HMOs promised they could do that. Still the 3rd party pays, and no medical customer knew what he was paying (other than the deductible office visit). For the doctors in the system, this is great. Customers who are not haggling and because State Med school admissions policy keeps the number of medical doctors down, HIGH DEMAND.

Wow, what a great deal for doctors. 3rd party pays, high demand, cartel of medical doctors -- WHY ADVERTISE and who even BOTHERS to advertise one's prices. Indeed, doctors themselves DON'T KNOW Their own prices. Its crazy. The only thing they notices in the 70's and 80's and 90's was the INCREASED paper work from insurance companies and difficulty in getting things covered.

In the 90's Hilary Care comes about to complete the government take over. NO PRICING, just ONE PROVIDER, GOVERNMENT. It failed...

Then OBAMACARE... it passed. But here its a FULL EMPLOYMENT Bill to the medical Insurance companies. YOU MUST HAVE MEDICAL INSURANCE.

But wise Patriots, does this solve the problem of 3rd party pays, shortage of doctors, no price competition, no posted prices UP FRONT, and the involvement of government in "buying" medicaid and medicare? No.

The fact is, not since WWII, have we had a free market in medical care. It has not existed in 70 years.

To get there, we must know WHY and then WHERE we must go.

In peace and liberty,
Treg