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> The American health-care system is ludicrous!

No, because there is nothing that can properly be called "the American health-care system".

America has a large number of different public and private health care financing systems (e.g., insurance and insurance-like programs), a large number of different and uncoordinated public and private health care delivery systems, and extremely inefficient, costly, and poorly standardized interfaces between all those different health care financing and delivery systems.

> IMO, America is one fantastic country if you're rich - but it seems much much harder to live here than in Europe on meager salaries.

These are both by design.

Careful. Hospitals and doctors often report the amounts that insurance companies report based on a master price list that bears no relation to what the insurers actually pay. Insurers are presumably fine with misleading reports that puff up their value.

Because that value is directly correlated with the price that insurance companies can charge consumers.

I don't think that's true.

If they pay 20% of price A and the insurance theorethically covers 80% of A, but in actuality pays only B << 0.8 A, then that sounds like fraud.

Because everyone in all industries pays list price. Right.

The problem isn't the insurance negotiating a discount - it is that if your insurance has agreed to pay 80% of the cost of your care, and then is able to negotiate a discount, you should pay 20% of the discounted price, not 20% of the pre discount price.

I've never not had my co-insurance portion be anything but the percentage of what their negotiated rate was. I don't know if it is fraud, but breach of contract would probably apply if you did (assuming it wasn't in the fine print).

So would the uninsured pay the prices on this price list?

At every hospital I've ever been to (N=3) that answer is a firm "no". With one hospital the price was automatically knocked down 75% before any negotiations took place and this policy was advertised everywhere. At another hospital I simply had to speak to a account manager to get a drastic reduction (> 80%). The third hospital took a harder line, but ultimately caved. If you are uninsured you should never pay more than 15% spread out over 6-12 months (less if you're going to pay in a lump sum). Everything is negotiable.

So, basically, the list price is just an inflated number they can use so insurance companies pay them just enough to cover what they'd charge everyone else. This, my friends, is what madness looks like.

Not madness! Capitalist free-market efficiency!

The healthcare market is anything but a free-market.

When you're sick or dying, there is no "free market". You pay what you have to to the health cartels, and you don't have either the energy or will to negotiate.

A real driver for the inflated price is so that they can cover the marginal loss they're taking on every Medicare patient. That loss is only going to get worse as the program expands.

The whole joke about it is that they aren't taking a loss they are just not profiting as much, which is a completely different thing. It's like me saying I don't have a drinking problem because I only drank 2 bottles of vodka before lunch, instead of the 3 I could've drank.

In any other industry the practice of inflating the value would be illegal, specially when done in the cartelesque way it's done in health insurance/healthcare. 'Luckily' the health insurance industries has managed to lobby its way into getting all kind of exceptions, and our representatives are hard at work to keep it that way.

A close friend of mine is an ophthalmologist. The Medicare reimbursement rate for a cataract surgery is a little over $300. This is surgery that restores eyesight. How much would you pay to have your eyesight restored? It's clearly not market rate.

I guarantee that at least in this situation his practice is not turning a profit on these surgeries. $300 certainly doesn't cover the labor expense.

This story is, of course, anecdotal. I'd be eager to hear of similar stories of Medicare reimbursing appropriately.

Insurers apparently also are fine with the side effect that hospitals overcharge non insured patients, sometimes bankrupting them in the process.

For those who want to know more about that master price list and how its prices have little to no correlation with reality: http://www.time.com/time/magazine/article/0,9171,2136864,00....

Retail prices in hospitals take into account a high-percentage of non-payment...which is why they are high to begin with! They have complete correlation with reality: an uninsured person is more likely not to pay, so prices are higher so that works out. Now, the higher prices lead to more non-payment, and a vicious cycle ensues.

This is why the mandate in Obama care is so important, to stop this cycle.

she (we?) got pregnant

Off-topic, but I hate the abuse of the English language which is "we are pregnant" (except when the speaker and another are both pregnant women). Pregnancy is a physiological state, not a psychological or sociological state.

You are expecting; but she is pregnant.

It's a common way of describing that shared experience. There's no need to restrict our speech or feelings to the strictly literal. If you don't like the phrase you don't have to use it, but to many couples the experience is meaningful enough that the phrase is also meaningful.

Meaningful to whom? Seems to me that the existence of an internal feeling experienced by some couples is not enough to warrant misusing a precise term.

If she's pregnant and insists I say "we", I say "we".

That simple.

Meaningful to them and to most of the rest of us.

Life is much more than utility.

There's something called an "uncompensated care pool" that serves as a perverse incentive for medical providers to issue insanely high bills.

Say they charge $10,000 for a procedure that costs them $500. They collect $1000 from the insurance company and claim a loss of $9000 in the "uncompensated care pool" for which they can apply for a government rebate at the end of the year.

The practice originated to help reimburse hospitals that provided charity care, but it's morphed into something entirely different.

How is your girlfriend paying $7,000 per year for insurance as a university student? My wife and I each paid $2,300/year while we were in school, and like your plan ours covered 80% of the cost of pregnancy and birth (capped at $2,000).

$7000 for normal-deductible family coverage does not sound out-of-whack.

Ah, I guess I hadn't considered that her plan covered him too. Still, pretty expensive for a plan that only covers 80%, especially if the $7,000 is before the kid.

Don't forget that university student plans are often unusually cheap because the enrollment requirement ensures a relatively inexpensive risk pool. They can also come with unusual restrictions (e.g. your PCP must be at the campus health center), though I think PPACA may no longer allow some of those practices.

In any case, since it sounds like he isn't a student, they probably don't qualify for a student plan and are falling back to something more expensive.

It all depends on the state. NY for example forbids underwriting, so age doesn't come into the equation.

State regulatory or university requirements for health insurance for international students are often stricter (e.g., no limits on coverage).