First, I'm very sorry to hear of your health problems, Trebs. Sounds like you've had a real shit set of cards dealt and I hope you can make a good recovery. In Britain we all pay an insurance contribution through the state taxation system. So it's an efficient system - it avoids the huge costs of individual policies and individual underwriting and money handling - but just as with any healthcare system there are problems with delivery, which have been widely reported. But we've had a comprehensive national health service - the NHS - free at the point of delivery since 1948. That's a long time. We were broke when it started - just after WWII - and we're still broke now so nothing's changed Alongside the NHS we also have private health which provides everything except A&E. So we can have hip replacements done through private healthcare but these would cost nothing like the figures you quoted. Maybe the existence of the NHS acts as real competition to the private healthcare sector. Or maybe our private insurance - much of which is through mutuals - keeps a tighter lid on costs. No it's not perfect and it won't ever be, though most people in Britain are pretty happy with what they get. It takes away the worry. But this year the NHS has undergone the biggest changes since it was created and much of the money will now go to private healthcare providers. The jury is out on how those changes will affect delivery and cost.
 

Trebs, I want to offer you coverage if I could

On the flip side of things, on the hospital and insurance fronts, it's messy. While HIPAA has pushed procedures and accountability up for everyone, there's a cashflow issue within Hospitals. Of the costs a hospital actually pays out, I can tell you from experience almost 60-70% comes from doctors billable hours. They make about 2.5 times more than me on average before taxes. In the past, Hospitals and health centers used State augmented funds to offset the costs of doctors between billing and receipts of insurance premiums. That stopped 2 years after Massachusetts adopted our Health Care reform act.

Cash issues are compounded by our net terms from Insurers; you may see a bill for $100,000 for surgery on your details, but the Hospitals cannot collect the entire amount. For Blue Cross Blue Shield for instance, you would need to wait 90 days to see payment. The Blue Cross adjuster would fix in a rate against the billed $100,000, paying about $25,000 to the Hospital. Now that doesn't seem that bad, but if your doctor and nurse costs for those 3 months amounted to $42K (30K for a single "new" doctor with an average of 120K/annual + 12K for 3 nurse practitioners), you're talking about net loss in those 3 months of $(17)K.

In essence Trebs, don't think what's on your bill is actually paid to the hospital. News reports might state big numbers, but insurance industry is not stupid. They use CMA (US Center for Medicare) standards for adjusters to bring every penny billed down to the legal minimum.

Sometimes, if your hospital is part of a larger network, you can force a premium adjustment based on volume, i.e. while the adjusted payment is only 25K, insurers can add back in 30K due to hospitals hitting a managed care goal of 100 patients.The bigger hospital networks can make a profit, but nothing like what News stories seem to suggest. For smaller hospital like my old firm, our margins were squeezed so badly that we had to mortgage out Medicare payments to meet payroll during the HIT conversion. It's ugly.

From my standpoint, I wouldn't mind something simpler; I've been in health care for 5 years now from several angles of the finance side. Maybe this detail is going to go over everyone's heads, but still it is very common knowledge in the industry.

In Canada we have OHIP  its not the greatest but it does allow us to go to the doctor's and even hospital without having to pay out of pocket.It is dwindling rapidly we now pay for more things than what we used to.  We never had to pay for Ambulance, things like that. Last year my husband and I had to drive for an hour to check on my daughter she kept calling us but we couldn't figure out what she was saying so we drove down to her apartment to find her lying on the floor she had had we called her dr. not realizing we had the dentist lol but was told to call 911 we did and in a few days we ended up getting a bill for the ambulance ride and because the hospital was extremely busy and she was kept in the hallway for hours with the ambulance crew because they couldn't sign off on her she was charged extra, thankfully the disability coverage she had covered it but that is over and above OHIP. We later found out that she had had a stroke and another the day after she was finally admitted to the hospital. So here in Canada it is a bit better because basic stuff is covered unlike in the U S but on the other hand we do suffer because we still lose doctors to the American people cause they can make more money in the states than they do Canada. So whats it really like here with OHIP yes we have the basics covered and with additional coverage taken out of pocket from employment it can be very good but having good coverage or even basic coverage doesn't really mean much when you don't have the doctors or medical personnel to help the people. The states have the people but don't have the coverage we have the coverage but a serious shortage of personnel to help not really that great of a trade off is it eh?