Somehow, you knew this was going to happen.
The woman who owns a small auto repair shop and is now the lead plaintiff in the case going to the Supreme Court to overturn Obama’s health care reform because she claims she should not be required to have health insurance, has filed for bankruptcy with a bunch of unpaid medical bills.
In other words, she is “an example of exactly the problem that the healthcare law was intended to address”. Her bankruptcy is one of the millions that will raise the cost of health care for all of us. According to a health law expert “This is so ironic. It just shows that all Americans inevitably have a need for healthcare. Somebody has paid for her healthcare costs. And she is now among the 62% whose personal bankruptcy was attributable in part to medical bills.”
And to make this a bit hypocritical, after the failure of her business she is now supported by unemployment compensation, which is opposed by the same people who want to kill health care reform. So much for personal responsibility.
25 Comments
Again not on the topic, I still think that no business should be required to pay health care, just people should be required. This gets health insurance out of the work place and lowers the cost of goods and increases jobs, brings the jobs back to our country. Those earning minimum wage are going to get free health insurance anyway under Obama’s plan going by income. Paid for by the rich when the money is recirculated.
What is the difference between making people pay for insurance or making people pay taxes which is then used to pay for medical insurance??
By giving in on every step in the health care process to the right and especially Ms. Snowe, the democrats have created a monster which just might not pass through the conservative supreme court. If they just pushed through what they wanted when they had 60 votes in the senate, we wouldn’t be here.
I would definitely prefer single payer. But the Democrats did not have the votes necessary to pass it because of the blue dogs. I’m still hoping we get to single payer eventually.
While I support your position on the first part of this, I think your last sentence doesn’t serve your overall argument and frankly, is wrong. Unemployment compensation is not public assistance. It is an insurance plan. And like any other form of insurance, employees are entitled to it because they pay into the fund directly.
This isnt very ironic. She had a downfall because of something she believed in. I’ve always said the gov offering insurance is cool, forcing people to take it is not cool. If people want to take on that risk then let them.
Also what kind of bullshit is this “her bankruptcy is going to raise the price for everyone else” shit. That’s like saying one person stealing a pack of batteries means the price is gonna be jacked up.
Duckman,
A lot of healthcare costs are shared among people who have insurance. Someone using those services and then not being able to afford it forces money coming from somewhere else to be used to pay for her treatment. As the quote says, someone paid for it, but it wasn’t (or wasn’t entirely) her. I don’t think the insinuation is that because of this one case healthcare prices will jump, but the cumulative effect of millions of people not having healthcare will drive up costs for people who do because they are ultimately left holding the bag. If millions of people stole batteries then yes, the price of batteries would rise.
ThatGuy:
I know what you are saying, but “Her bankruptcy will raise the cost of health care for all of us. According to a health law expert,” I’ll underline and capitalize her about a thousand times. It should read, cases like these, the more bankruptcies the more it raises, etc. Her puts the focus soley on this one person
If one person doesn’t raise costs, then 10 people can’t raise costs. And neither can thousands, or millions.
Word choice aside, the plaintiff in this case is one of millions. The difference between one person and millions is immense, but those millions are made up of individuals like her who believe that taking a risk with her health is her choice. To an extent, I agree, but that extent ends when her actions (and the macro effect of millions like her) impact other people.
I’m all for people taking their own risks if they are truly their own. In the case at hand, the woman and her husband took the risk to not have health insurance. A risk that banked on their having no medical bills that they couldn’t handle. They lost and now their succumbing to the results of their risk have put their health care providers at risk, too. Will their individual failure affect others’ health care costs? Not much, but it will still have some impact and if you take the failures of others who also have health care costs that they are unable to cover, the impact is very real. It’s just like the impact that folks going to emergency rooms for a chest cold have on overall health care costs.
So, this brings us back to who really was taking the risk of this woman and her husband not having health insurance. It isn’t just the two of them. It includes the doctors and nurses and hospitals and drugstores and druggists and (how I hate to say this) drug companies, etc., etc., all of whom have to set rates such that they can cover her and her husband’s unpaid bills. Their decision, the risk they take, is actually a shared risk; one in which most of those sharing the risk with the two of them have no say in. Get it? They are gambling that their “risk” won’t be called with someone else’s resources.
I think about folks who don’t want to wear helmets when riding a motorcycle. They say it’s a personal choice and that only they are taking a risk. If that were truly the case, I’d be all for them taking the risk. If they signed a paper that said that their treatment for head injuries after an accident, regardless of who was at fault, is their sole responsibility and that no treatment would be performed that could not be paid for out of their resources, then we’d have them alone assuming the risk for their actions. This isn’t going to happen. A cyclist gets in a wreck without his or her helmet and they aren’t insured, they may die, but if they live we all pay for the treatment and the possible aftereffects.
This refusal to adequately address what are termed individual risks without fully factoring in the true risks and repercussions of an individual’s actions to include those who will be impacted by a failure in the face of said risk is one of the fallacies of many of the tenets of Libertarianism. We as a society no longer have the luxury to grant freedom to risk takers when we as a society must ultimately pickup the pieces when the cost of the risk taker’s actions exceed their resources. I’m all for personal choice, but so many of the choices, as much as we’d like them to be, aren’t really personal and have real impacts beyond ourselves.
I wish it were as easy as people “taking their own risks.” Some of us are forced into it. I live in Maine where we have guaranteed-issue laws and modified community-rating laws. Instead of having a dedicated stream of money set aside for high-risk health individuals (cancer, HIV, etc., because these people do need our help), my state has forced insurance companies to accept and cover all people equally with identical premiums. Therefore, insurance companies have left our state and we only have one now. Anthem can now do anything it wants to us.
I don’t health insurance. In order for my family to get it — two adults and one child — with an average deductible of say $1,000, $20 co-pay at the doctor’s office, and $10 co-pay for drugs, my monthly premium would be $1,800. Yes, that MONTHLY — $1,800. That’s more than our mortgage. We have two choices: We can have someplace to live or we can have health insurance.
I just had lithotripsy two days ago. We don’t have the money to pay for it, but we are going to try to come to agreements with the doctors and the hospital and see if we can pay them each $50 per month. We have up to $300 per month that we can dedicate to health bills. We are still paying for my husband’s hernia operation from 1.5 years ago and we still owe about $2,000 on it, but we are getting it down slowly. This new batch of medical bills will set us back far.
We WILL pay our bills. We WANT to pay our bills. We’re NOT bums. We work (self-employed) and we are educated. We would LOVE to have health insurance, but we just can’t afford it. We are very sorry if we are “impacting” what others pay, but we are doing the best we can.
I thought I might add this information, so you can get an idea of what is happening in Maine.
As of 2009-2010 statistics, the total population in Maine is 1,288,300. The uninsured make up 125,600, or about 10% of the population. But 184,100 are on Medicare, about 14% of the population. And 287,500 are on Medicaid, about 22% of the population. And 26,700 receive other public help, about 2% of the population.
You can now see that 49% of the population of Maine is either uninsured or receives government/public aid, which ultimately raises costs for everyone.
47% of our population (610,900 people) has health insurance through their employer, and that’s still VERY costly because I used to have that, but it’s not $1,800 per month out of the individual’s pocket.
4% of our population (53,500 people) has individual insurance.
You can find this information here: http://www.statehealthfacts.org/profileind.jsp?ind=125&cat=3&rgn=21
Melanie, I hope your lithotripsy was as successful as mine. 2014 if all have to have health insurance, it will be based on your income, not one size fits all. To me that is much fairer. And you can still deduct all you pay in health insurance from your businesses.
Had someone here today to use my computer. He is 59. Had colon cancer, no insurance. Doctor opened him up, sewed him right back up because he had no insurance. He went back to work. Cancer of course, stopped him working. This time he had insurance and was treated properly. Now that is over and his job is done, he has dropped the insurance. (“But hospitals can write off when someone doesn’t pay.”)
Once all have to have insurance by income, then Hospitals should be allowed to drop the law that everyone has to be treated. The charity hospitals can be revived for the interns and residents to practice in.
Hang in there Melanie, 2014 is coming.
Don, you’re kind of getting to the economic concept called externalities. The price of insurance for those of us that have it does not accurately reflect the cost of the transaction, as we are paying for an external benefit to a third party (the uninsured).
Melanie, my reaction to your story was somewhat ambivalent. I very much want to sympathize. I have a relative with a lot of problems with kidney stones. I know they’re very painful, and I hope your recovery goes well. And I understand that your decision to forgo insurance is perfectly rational. The cost exceeds what you can afford. Under the current structure of medical costs, you are simply making an economic decision to cut a cost that you can’t afford. It makes sense.
I hate saying this next part, because it sounds cruel (especially given what you’re going through), and believe me when I say that I’m not trying to shame you. I’m really just trying to point out why our current system is broken. Objectively speaking, though, the cost of health insurance should be a factor in the decision to be self-employed. If one has no other option for employment, that’s one thing. However, if one passes up a job that provides benefits to pursue other interests, all costs should be considered for a rational feasibility assessment. Under the current, horrible health care structure that we have in this country, voluntary self-employment while forgoing health insurance is, in practice, mildly antisocial and selfish behavior because it is forcing others to subsidize your career choice. (By the way, it is my own personal view that everyone is mildly antisocial and selfish, so I’m not saying you’re a bad person. I’m just saying you’re normal.)
OK, now let me go back to actually having a heart…
I remember one of Obama’s early speeches that had the theme, “Help is on the way.” And it truly is. If you haven’t already, you should look at the Affordable Care Act timeline. In 2014, states will be required to provide Exchanges, which are regulated markets designed to give you better options. Hopefully, at that point, you won’t have to consider the cost of health care when deciding to be self-employed.
It should not be this way. Health care should not be a factor in your choice to be self-employed. Health care and employment should not be so intertwined. It wasn’t always this way. It grew out of the post-WWII economic period, in which employees had more power and employers had to compete for top talent by offering these types of benefits. However, the health insurance market has evolved into such a twisted scheme that regulation is now necessary.
Health care in this country is pretty much a textbook example of market failure. It’s not hard to see that if you look at the incentive structures and the basic principles that are supposed to underpin markets. For example, markets work when buyers can vote with their dollars. If you buy something from vendor A and decide it’s bad, you start buying from vendor B instead. But you can’t do that with health care. If you buy a bad plan from vendor A, you only discover it’s bad when you become very sick. And when you become very sick, you now have a pre-existing condition and vendor B will not sell you a plan. The free market structure simply does not work for health care.
Well put, Michael, and, yes, I guess I’m talking externalities, I’m just not smart enough to use the word. “>D
Couldn’t agree more that our health care systems is drastically broken. Your analysis of the broken market system under within which health care expenses are incurred and managed makes a lot of sense. Health care and employment shouldn’t be entwined at all, in my view, but, then again, I didn’t think the insurance industry and big pharma should have had such a big role in developing the health care reforms of which you speak which aren’t going to go nearly far enough to correct the market deficiencies you allude to. Oh well.
My guess is that the doctor and hospital will charge Melanie the actual cost of the procedure, and not charge the extra.
With major medical, I had to have a heart test which was within the deductible so not covered. I sent them money every month like Melanie is doing. Half way through paying it off, they realized they’d recouped the actual costs and forgave the rest. It can be done.
IK, going back to post #3, Blue Dogs or not, LBJ would have gotten 60.
excellent points from all and truly everyone should have access to healthcare. Problem is the cost and I know the HC act is supposed to bring down the cost for everyone by adding people to the pool and creating a level field of levels of care. But as Melanie pointed out we are talking about 49% of the population that may need help paying some to all of their care. I do not think the current HC act funding will be able to satisfy that need. I think revised CBO estimates double the cost and it will probably go higher then that. What we need is a payroll tax contribution for all, not just some. Similar to our FICA or Medicare taxes and employers can contribute a share. We should also drop the limits or raise them substantially. If we don’t, then we will drown in our debt and 15 trillion will look like pocket change in 20 years. Will be spending more in debt interest then we take in.
I appreciate these responses, and I hope 2014 does make things better for everyone.
Michael, it really wasn’t a “decision” to forgo insurance. We didn’t decide not to have insurance, it kind of decided not to have us. But that’s what happens when it costs $1,800 a month. As for being self-employed, well the insurance nightmare wasn’t always like this in Maine. It started in 1993, and in the beginning it wasn’t quite so bad. Self-employed people could still afford it even as it crept slowly upward. But more and more insurance companies left and premiums went higher and higher. Each time they went up, more of the healthier people dropped their insurance, which meant that the insurance company was collecting less and raised it rates yet again and again and more healthy people dropped out leaving more sick people insured … until we have gotten where we are.
My husband just turned 65 in February, so thankfully he now has Medicare. I am only 48, so I have some time to go. My husband still works full time and most likely always will. He owns a karate school and has been teaching for over 30 years. Because of this, he is in dynamite physical condition for his age and doesn’t have many health problems.
We have helped to shape the lives of many children in our area. We are a traditional school and very strict. We teach discipline, manners, self-respect, self-defense, hard work, goal-setting, etc. I can’t tell you how parents come up to us and beg us to help with a rude and undisciplined child and later thank us for what we have done and helped them to do as well. Many of our kids go on to college who might ordinarily not have done so. We help to keep them busy, focused, healthy, and off the streets. I like to think that we are really doing something for our community. So many people contact my husband 25 years after learning from him to thank him for what he has done. They tell him now that they are older, they realize how much more than just karate they learned. It is very good to hear this. Here is our website if anyone cares to see: http://www.karatemaine.com
Up until December, I worked as a medical transcriptionist for the University of California at San Francisco. All of my work was done online. I worked for the cancer research/experimental cancer treatment department for the most part. It involved a lot of research and constant studying to keep up with new treatments. But now my job is being done by an Indian because it is cheaper to have Indians do it, and they have learned English quite well. I don’t begrudge them; I would do the same thing if I were an Indian. But it does hurt to be dropped like that after years of faithful work.
I worked as an independent contractor for another contractor who worked for UCSF. We are all self-employed, though, and there is no health insurance even though we work in the health field. There used to be health insurance. People who did my job used to be “employees” and got benefits. But the hospitals/doctors/universities, etc., decided they could save money by having us contract with them instead of “hiring” us, and that was the end of insurance for people like me.
I don’t know how much assurance people with insurance have anyhow. So many times during my years of working, sick cancer patients used to get dropped by their insurance companies. These were people who had paid their premiums all their lives, but when they needed their “insurance,” they got dumped. At least that’s a thing of the past now, and thank goodness for that.
I didn’t choose to be self-employed because I was selfish or unthinking. I was married to someone else at the time. For a while we did have health insurance through his employer, but we did drop it when it reached $1,200 per month because we couldn’t afford it after that. We just didn’t have anymore money. It’s not like we were squirelling it away and saying, “Too bad for everyone else, they have to take care of me!” We immediately tried to get a health savings account but got turned down. It turns out there’s a law that you MUST have insurance to get a health savings account. If you have insurance with an enormous deductible, then you can get an account. If not, you can’t get an account. Crazy, isn’t it? Anyhow, we did faithfully put money away in a regular account to pay for any medical care we needed, and for the most part it worked out fine because we were very young and healthy (and lucky).
I became self-employed because I had a very young child at home and we couldn’t afford good daycare. I wanted to be home with her and yet I wanted to work at the same time. I did go to college and did get a B.A., two of them actually, and I always planned to work. But it’s a tough dilemma when you have children as kids do have to be taken care of. That’s why I did it, and I actually ended up loving my job. It was very interesting and I was never bored, and it sure helped with our bills. Plus I could stay home and take care of my child and see all those wonderful “firsts” that many mothers sadly miss these days. I wouldn’t trade it for anything in the world, and now I have a terrific 14-year-old who is doing great in school and life.
Anyhow, I got divorced and remarried a few years later. When my new husband was 50, before we met, he decided to try to “fit in” more. He continued his karate school but went back to school himself and got his CPA. He had a 4.0 average. He went to work for about three years as an accountant. They were three of the most miserable years he had ever spent in his life, he tells me. He hated being an accountant. He tried to like it, he thought he might, but in the end he hated it. He said it was slowly killing him. He’s a teacher and he loves kids, and he’ll always be a teacher. So he went back to teaching children full time, and he has never regretted it. I don’t think he’s selfish.
His school is incorporated. Unlike many of these enormous corporations that actually get money back from the government instead of paying taxes, we have to pay the full 35% tax rate as we have no offshore shelter. Then we have to pay personal income tax for what we earn. Our tax rate is over 50% and we pay it in full every year. As taxpayers, some of our taxes in one way or another go toward helping people with healthcare, like Medicare and Medicaid, etc. As consumers, every time we buy a product, we help an employee of the producer and seller to have health insurance. Yet we do not have health insurance ourselves.
Michael, when you say that it is antisocial or selfish to be self-employed instead of working for someone else, it makes no sense to me. The idea, you say, is that we are forcing others to subsidize our career choice. Are you blaming victims here? I dislike to use the word “victim” when I talk about myself because to me it brings up an idea of someone who is helpless, and I don’t think we’re helpless. It’s a negative word so I use it with caution. But really, people who are forced into our position — and we HAVE been forced slowly and step by step — are being victimized.
Could we try to get jobs for other businesses in Maine? I guess we could try. It would still cost us $1,000 or more per month for health insurance if we did, assuming that we could find jobs — he at age 65 and me at age 48 with many young people here who are educated and unemployed and desperately looking for work. Maine is a very impoverished state. Yes, theoretically, I guess we could try.
Some people say, “If you don’t like this country, leave it,” or “This country is Christian, so get out if you don’t like it,” or “He got diabetes because he ate sugar when he was younger so it’s his fault so why should we pay for his mistake” or “She asked for it by dressing that way. If she had dressed differently, that wouldn’t have happened. She must have wanted it.” And on and on. They’re really all saying, “If you don’t do things the way WE say you should do things, then you deserve to be deserted or dumped or mistreated, etc., because you brought this on yourself by not following our rules.” As if they have the right to decide how another person ought to live. As if this country can only be one way–their way. As if someone who complains or doesn’t quite fit the mold should leave or at least shut up when they’re in pain.
I hope I am making sense here. The sense I get from you, Michael, is “You must live your life in very narrow confines that will keep you safe (according to an arbitrary definition of safe that keeps changing), and if you step over the line, you deserve what you get and don’t ask for help because this is your fault. You are selfish because I am doing what is right and you are doing what is wrong.” Is this what you are saying, or am I misunderstanding you? That is a possibility, of course. You did afterward pretty much agree that our healthcare system in this country has failed.
One would think that my husband and I left wonderful jobs with insurance to go traipsing off into the woods and become full-time hikers trying to make a living off of writing about our fun experiences and then getting angry that we can’t make enough cash off of it. We both work very hard, and I help even more at his business now that my own job has been terminated. We are both in very good health for the most part and very good condition because of our physical activity. We pay all our bills and contribute to charity monthly. Really, we are not antisocial or selfish.
Ebdoug, I am hoping that the hospital and doctors will charge a fair price and not an inflated price, as they often do to insurance companies. I realize they have done a job and want to be paid, and they DESERVE to be paid. When I work, I want to be paid. Why shouldn’t they be paid? I just hope for a decent price, and we will pay it off slowly as we always have.
Well, I thank you all for listening and for your input. It helps to know the way other people think.
Oh, by the way, I am now studying to take my GRE. It will take a while to relearn much of what I have forgotten (especially math as I was never very good at it). When I do, I will go back to school and hopefully get a good job. My current profession has gone the way of the dinosaur what with India and voice recognition, etc., so I’m hoping to start again. Thank you all again.
Duckman, I think you are making a minor semantic point, but I updated the language in the post. Better?
IL-08, do you think even the master arm-twister LBJ could have gotten 60 votes today? I seriously doubt it.
This is a fascinating and rewarding conversation. Thanks to all the commenters. I think we can all agree that our health care system is pretty broken, and while Obama’s reform is a step in the right direction, more is needed.
I can’t add anything of significant value as everyone has already brilliantly articulated it.
One point, though – Psgt, you said, “revised CBO estimates double the cost”. That is Faux News conservative propaganda. They are twisting the CBO report. The original, 2009 projection of the NET cost of the ACA was just over $900B. The new projection is a NET cost of about $1.1T, DOWN from last year, and the only noticeable difference between the 2009 estimate and the 2012 estimate is that unemployment remains stubbornly high, so more people are uninsured through employment than originally projected. If the unemployment rate was coming down over 10 years the way they originally excepted, the costs are identical.
The Faux News BS is that the GROSS cost (before any adjustment for revenue additions and cost savings) is almost 1.8T (hence their lie that the cost has doubled from 900B) but when you add in the cost savings and revenue additions, it’s 1.1T.
When any conservative news source makes an outrageous claim, it’s always good to go back to the original non partisan source and actually read what they said, because inevitably you find distortions like this one.
Melanie, thank you for your story. That was certainly more than I expected to hear, and my heart does go out to you. You touched on so many points that just struck an emotional chord with me. I have a martial arts background (including instruction), so I know the value of your husband’s work. I also have a background in computing (web consulting for a while, then transitioned–long story–into semiconductor engineering, then grad school, now a CS professor); I can certainly relate to the rampant ageism, worker exploitation, and job outsourcing that goes on there. I feel for you in so many ways…
Regarding my previous comment about “mildly antisocial and selfish behavior,” I was not attributing any malicious intent to your choices. As I said, I’m not saying you are a bad person. What I am trying to say is that the effect of your choices (which are perfectly rational and very good choices, all things considered) ends up negatively impacting others. You don’t mean to do any harm, but some harm results from your actions. In legal jargon, your career paths exhibit actus reus without mens rea. In other words, the result of your choices (which actually benefit society as a whole) place a harm on others in society, even though that is not your intent.
This may sound like a silly and contrived analogy, but maybe it will help illustrate what I mean. Assume you are standing on one side of the road. On the other side, someone is having a heart attack and needs CPR. You want to cross the street and help them (because you know CPR). However, some jerk just told you that if you cross the street, he’s going to punch the old lady he’s standing next to. In the end, crossing the street is the best decision, even though the old lady gets punched. So the punching is an effect of you crossing the street, but it’s really the jerk’s fault.
The sense that I am trying to give you is, “The current relationship between employment and health care, coupled with the absurd power imbalance between large corporations and every one else, forces the vast majority of people to live their lives in very narrow confines of conformity. If you dare to step over the line, the system is going to punish you, and it is going to inflict pain on others as a result of your choice. Thus, any attempt at individuality will incur antisocial side effects.”
So, again, I hope your recovery goes well. I wish you the best of luck with whatever you are going back to school for, and I hope things get better.
By the way, you also mention the issue of the prices charged by hospitals and doctors. On the one hand, my spouse works in the medical field–but she’s not a doctor–so I know some of the factors that go into prices. However, a number of studies have come out that suggest high medical prices in the U.S. are simply the result of high doctor salaries. Of course, that varies based on specialization, etc. And we could then trace this back to the need to pay off student loans for medical school, etc. But that’s a different discussion…
Thanks Arthanyel
Michael- on the high doctor/hospital/ prices I’d have to say I mostly agree with Melanie. My son was in a car accident last year. We had both comprehensive including medical on our car insurance and my health insurance. When a neurologist billed the car insurance $450 for a 20 min appt and they responded that the limit was reached after paying ER expenses, the hospital rebilled us for $165 for a 20 min visit. (which we then turned over to my insurance and I just paid the 20% co-pay). Now as just one example, this particular Dr. wanted 6 follow-ups with my son for concussion. and would have billed the insurance for $2900., but was fine with $990 billed to us. I’m not saying Drs don’t deserve to be compensated for their expertise and (in this ones case about 8 yrs of doctoral level work),but hospitals and doctors seem to milk insurance companies for all they can get. Perhaps if evreyone is insured this will A) either naturally make prices go down, or B) make hospitals and Doctors very wealthy. This is not to mention the Rx market, oh boy.
Thank you, Michael. I think I understand what you are saying.
All of our choices affect one another, sometimes for good and sometimes not. There’s no way to predict it, and you “can’t not” live your life simply because something unplanned might happen that might affect someone down the line. You do the best you can and keep going. There are probably a million things you do yourself that inadvertently and unintentionally hurt someone somewhere. But that’s part of life and none of us are bad people for it. I like to think that the good things we do such as buying from local businesses, giving to local causes, paying our taxes, etc., balance out any accidental negative impact our other actions might have.
America isn’t just about freedom of religion as everyone is talking about these days. Many people came here for free enterprise too, for the “American Dream.” Many people were living in places where they were born into a certain social class, or caste if you will, and there was no getting out of it. Coming to America allowed them to improve their lot in life, to take chances, to start businesses, etc. Striking out on your own is as American as apple pie, so don’t let the large corporations or fear stand in your way.
Thank you for your kind words on my recovery. I am already feeling much better. Oh, and I’m not sure if you are currently still in a dojo, but if not, get back in! 🙂
EBDoug, are you being facetious? Many hospitals charge more to people who are uninsured. My understanding is the insurance companies negotiate prices that are not available to most people and the hospitals make up the difference through the uninsured.
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