And we scream about healthcare costs??

[Christof]

Man, I was on the "healthcare costs too damn much" bandwagon, but after yesterday I may just re-think that....

Here's the story...

I am switching to cable internet... I figured to save some $$ I would run the cable myself. Simple enough... Even where they would eventually run the outside line, I had a great spot to run my cable out.. Stucco house with a tin extruded box covering my AC tubing, but plenty of room for a small hole.. I drill a pilot hole (5/32) before drilling the 3/8 inch hole for the cable.. Psssssssssssssssssssssssssssssssssssssssssssssssss ssssssssssssssssssssssssssssssssssssssssssssssssss ssssssssssssss... SHIT! Wouldnt you know it... The damn return line curved in the tin covering and was on the other side.. Hole right dead center..

SOOOO.... I call the AC people, "we will have someone right out"... He gets there, and looks at the hole, then says "easy enough... I just solder the small hole, hook up the vacuum to pull any moisture out, install an in-line filter to trap any residual moisture in the line, and refill the freon"..... I figure, cool, so rather than make the guy write up an estimate first, I figured "how much can that cost"... Took him 30 minutes... Then he writes out the invoice to the tune of $472.88 :eek: :eek: :eek:

WTF??

Hell, I have soldered my share of copper tubing, could have done that myself.. Secondly, I would expect a minimum $200 for a job involving AC, but $472????? I would think an estimate would be given prior to starting the job if it were going to be that damn expensive.....

Sometimes it just doesnt pay to try to save a few bucks....

[jackpine savage]

I bet it was a minimum 100 just to show up at your drive way, maybe more. You could have told him not to do it. Being in the trades myself when someone complains about my quote I just say fine and walk away. If you can do it by all means go ahead but if you can't then its all a matter of supply and demand

[richhermes]

Most cable companies will run cable for free if it's just one outlet and you're adding a service, such as your cable modem. I know Bright House will not charge you.

[junior]

I doubt you could get many reputable trades-people to do anything at your house for less than $300.

[jackpine savage]

Of course if you wanted to save a few bucks you could have hired an illegal

[bgbill]

Hell, I have soldered my share of copper tubing, could have done that myself.. Secondly, I would expect a minimum $200 for a job involving AC, but $472????? I would think an estimate would be given prior to starting the job if it were going to be that damn expensive.....

Sometimes it just doesnt pay to try to save a few bucks....

Christof,

It is not solder like you would use to sweat copper pipe for a plumbing application, it is stick solder, that will usually have between 5%-15% silver in it, it isn't exactly cheap, but it does go a long way.

Also I doubt you are "Certified" to handle refrigerant, as required by the EPA, which means you legally can not buy or posess Refrigerant.

I also doubt you have a Contractors license, so a A/C supply house would not sell you refrigerant or other supplie needed to do the job.

Do you have a Vacuum Pump (they cost about $450) Guages (they cost about $100) Thermistor guage or Vacuum Guage (they cost about $300) Torch set (they cost about $350), and the knowledge of how to use them?

$472 may seem like a lot of money for what they did, but I doubt you could have done it cheaper.

One thing you said does concern me though, you said it took 30 minutes to repair, did the A/C tech use a Vacuum Guage or Thermistor guage? and if he did, how many Microns did he pump the system down to?

BTW you can be fined up to $25,000 for illegally venting refrigerant into the atmosphere. ;)

[Prodigal Son]

I bet it was a minimum 100 just to show up at your drive way, maybe more. You could have told him not to do it. Being in the trades myself when someone complains about my quote I just say fine and walk away. If you can do it by all means go ahead but if you can't then its all a matter of supply and demand
I'd respect your statement if you would be willing to show the same understanding if your doctor held you to the same standard when you're seriously ill with condition requiring a significant out-of-pocket expense. I suspect you would not.

[jackpine savage]

thats why I have insurance, to cover these unexpected costs. My insurance, which is out of pocket runs me 5000

[junior]

Yes, who cries for the doctors:D

[Prodigal Son]

Jackpine, the amounts your insurance actually pays physicians is probably peanuts compared to their actual costs.

[bgbill]

Yes, who cries for the doctors:D

No One, until you need one. ;)

[junior]

I often wonder how many more high end consumer items the average doctor could own if insurance didn't knuckle them under and low income types would just pay their damn bills:D

[jackpine savage]

Jackpine, the amounts your insurance actually pays physicians is probably peanuts compared to their actual costs.

I am aware of that. Getting back to Christofs post, he could have tried to fix the problem himself, he choose to bring in a tradesman therefore he is stuck paying the rate that man charges. I have learned to do basic plumbing and electrical so I dont have to bring them in when I have a problem.

[Bill McIntyre]

Jackpine, the amounts your insurance actually pays physicians is probably peanuts compared to their actual costs.

Even though the thread title was misleading and he really didn't want to talk about healthcare costs, I appreciate the excuse to discuss it.

On my first recent shoulder surgery, I got a statement from Medicare showing that the amount billed by the physician was $15,000. The amount allowed by Medicare was $1290.07. Medicare paid $1032.06. Most patients would have had to pay the remaining $258.01, but as a military retiree who pays Medicare Part B premiums, that amount was picked up by Tricare for Life and I paid nothing. But no matter who paid that $258.07, all the physician received was $1290.07.

No private insurance such as the group plan through my wife's employment that I used until turning 65 would have paid the entire $15,000, but they would have paid a much higher percentage than Medicare.

My physical therapist tells me that many good orthopedic surgeons that he works with have simply refused to take Medicare patients. Or if they do take them, they have to pay full price up front and then bill Medicare themselves for whatever they can recover. I feel fortunate that my surgeon was willing to take me for the pittance that Medicare pays him, but I wonder how long it will last. Bush's new budget proposes cutting Medicare payouts to providers over the next few years so that tax cuts for the wealthy can be made permanent.

Being entitled to Medicare won't be very valuable to me if good physicians refuse to treat me.

[ApneaSpearo]

The tragedy here is that if someone is uninsured they get billed that same full amount for a procedure, but since they don't have an insurance company or medicare fighting for them they HAVE TO PAY THE FULL AMOUNT, no matter how high. This results in many uninsured individuals losing everything they have worked for and more in order to settle the debt from a single health issue. I know victims of this system and it is tragic, and it should be changed. There should be a system setup where uninsured individuals are only asked to pay out-of-pocket the same rates that medicare or insurance companies get.

Not trying to start a fight here, just mentioning something that is horrible about healthcare in the US.

[mnguy]

The tragedy here is that if someone is uninsured they get billed that same full amount for a procedure, but since they don't have an insurance company or medicare fighting for them they HAVE TO PAY THE FULL AMOUNT, no matter how high. This results in many uninsured individuals losing everything they have worked for and more in order to settle the debt from a single health issue. I know victims of this system and it is tragic, and it should be changed. There should be a system setup where uninsured individuals are only asked to pay out-of-pocket the same rates that medicare or insurance companies get.

Not trying to start a fight here, just mentioning something that is horrible about healthcare in the US.

So basically, what you're saying, is that we should give uninsured people the benefits of insurance without having to pay for it? Hold on, lemme cancel my policy and take an extra vacation a year on the backs of the rest of yous guys who keep the policies:rolleyes:

I guess the moral of the story for Christof would be to get an estimate before getting the work done.

[ApneaSpearo]

So basically, what you're saying, is that we should give uninsured people the benefits of insurance without having to pay for it? Hold on, lemme cancel my policy and take an extra vacation a year on the backs of the rest of yous guys who keep the policies:rolleyes:

They still have to pay for the bills themselves, they don't have an insurance company paying it, so the only benefit they are getting is not having to pay the inflated amounts that are usally charged for medical procedures that no doctor ever expects to be paid by insurance or medicare.

It wouldn't hurt you at all, I don't know why you have a problem with it. Your insurance wouldn't go up just because individuals without insurance aren't asked to pay the inflated, unrealistic prices.

Think about this: you get shoulder surgery like Bill mentioned above, the doctor bills $15,000 and your insurance says "woah, we determined that procedure should cost about $3,000, which makes it profitable for the doctor and covers all expenses, so we'll pay $3,000." The doctor is content with the $3,000 he receives. Now imagine if you had lost your job (and insurance) due to being laid-off before the surgery, but you needed the surgery so you elected to have it anyway. Well, now the doctor still charges $15,000 but you have to pay the entire bill, not the $3,000 rate which is what the doctor would expect to receive from the insurance of a patient. Does that seem fair? Would you be upset that you had to pay 5X what the insured rate is?

You'll probably say "well, I would just purchase non-employer insurance after losing my job" but what if you couldn't afford the sky-high premiums after being out of work for an entire year and had to cancel the insurance and THEN needed the surgery? There's no way you would be happy to cut a check for $15K when you're out of work, broke, and aware that the procedure should cost $1-3K.

I'm a huge advocate of working hard and only getting what you deserve, but the raw deal the uninsured receive from the health care system ruins a lot of lives.

[Stealthdiver]

Pay the bill, chalk it to,your f-up, and if you could have fixed it , you would have, so considering you didn't , probably saved yourself calling someone else for another f-up ! :D

[mnguy]

They still have to pay for the bills themselves, they don't have an insurance company paying it, so the only benefit they are getting is not having to pay the inflated amounts that are usally charged for medical procedures that no doctor ever expects to be paid by insurance or medicare.

It wouldn't hurt you at all, I don't know why you have a problem with it. Your insurance wouldn't go up just because individuals without insurance aren't asked to pay the inflated, unrealistic prices.

Think about this: you get shoulder surgery like Bill mentioned above, the doctor bills $15,000 and your insurance says "woah, we determined that procedure should cost about $3,000, which makes it profitable for the doctor and covers all expenses, so we'll pay $3,000." The doctor is content with the $3,000 he receives. Now imagine if you had lost your job (and insurance) due to being laid-off before the surgery, but you needed the surgery so you elected to have it anyway. Well, now the doctor still charges $15,000 but you have to pay the entire bill, not the $3,000 rate which is what the doctor would expect to receive from the insurance of a patient. Does that seem fair? Would you be upset that you had to pay 5X what the insured rate is?

You'll probably say "well, I would just purchase non-employer insurance after losing my job" but what if you couldn't afford the sky-high premiums after being out of work for an entire year and had to cancel the insurance and THEN needed the surgery? There's no way you would be happy to cut a check for $15K when you're out of work, broke, and aware that the procedure should cost $1-3K.

I'm a huge advocate of working hard and only getting what you deserve, but the raw deal the uninsured receive from the health care system ruins a lot of lives.

Half of the benefit of insurance, then, is the lower rate paid out. The other half is the fact that they pay it. So if the uninsured get the same rate that the insured pay the company to get, they are getting a benefit of insurance without owning it.

The market is currently tuned the way it is and seems to be working just fine. If you suddenly lowered the price by 500%, who knows how the market will react. You may see our highly trained and experienced professionals moving to other countries to set up practices/work in hospitals where they get paid much better than the -500% wages they get.

If you want people to not get a raw deal like that, be prepared to pay most of your income to taxes like in the Scandinavian countries.

You'll probably say "well, I would just purchase non-employer insurance after losing my job" but what if you couldn't afford the sky-high premiums after being out of work for an entire year and had to cancel the insurance and THEN needed the surgery? There's no way you would be happy to cut a check for $15K when you're out of work, broke, and aware that the procedure should cost $1-3K.

I think you've got bigger fish to fry in this doomsday sort of scenario. If you couldn't afford the premiums, you probably can't afford either bill and will probably declare bankruptcy/go become Grizzly Adams/hide out in Mexico post-op.

Plus, there are options now when it comes to getting procedures done. Some HMOs are now offering treatment vacations, where you go to some other country for a week or two and get the surgery done for alot less. Hell, people are whisking themselves off to Los Algodones, Mexico (across the border from Yuma, AZ) to get their dental work done because it is significantly cheaper(they are trained as well but the practices are cash only, no credit cards, no insurance)

[ApneaSpearo]

Half of the benefit of insurance, then, is the lower rate paid out. The other half is the fact that they pay it. So if the uninsured get the same rate that the insured pay the company to get, they are getting a benefit of insurance without owning it.

The market is currently tuned the way it is and seems to be working just fine. If you suddenly lowered the price by 500%, who knows how the market will react. You may see our highly trained and experienced professionals moving to other countries to set up practices/work in hospitals where they get paid much better than the -500% wages they get.

If you want people to not get a raw deal like that, be prepared to pay most of your income to taxes like in the Scandinavian countries.

In the current system we are asking the uninsured (and almost always the most destitute individuals) to pay the highest rate for a procedure, how does this make sense? We are asking those people who have the least to make up for what the insurance companies hold back from the doctors. Those who have the least are asked for the most.

I think you've got bigger fish to fry in this doomsday sort of scenario. If you couldn't afford the premiums, you probably can't afford either bill and will probably declare bankruptcy/go become Grizzly Adams/hide out in Mexico post-op.

Even if you can't afford either bill it's a lot easier to scrape up $1,000 rather than $15,000. It's the difference between selling your spearfishing equipment (luxury) and selling the car you use to get to get to your crappy job where you get no insurance and no benefits (necessity). You can be certain that you would save a large proportion of individuals from declaring bankruptcy just by making this change to the amount due.

Plus, there are options now when it comes to getting procedures done. Some HMOs are now offering treatment vacations, where you go to some other country for a week or two and get the surgery done for alot less. Hell, people are whisking themselves off to Los Algodones, Mexico (across the border from Yuma, AZ) to get their dental work done because it is significantly cheaper(they are trained as well but the practices are cash only, no credit cards, no insurance)

It's great that there are options, but how would you feel having to travel to Mexico to get your tumor removed for $3,000 when that would be the price in the US for the same operation from a trained and experienced surgeon???? The only difference being that you don't have access to that price cause you don't have insurance, so you are asked to pay $15,000 for the same exact operation.

I know people who have been stuck in this scenario, and next time you get a doctors bill check out what the doc billed to your insurance and remember that if you weren't insured you would be asked to pay that total amount with no adjustments. You wouldn't be a happy camper. I see my wife's and grandfather's doctors bills and they make me sick, I thank God we have insurance, but truly feel bad for those who don't.

[Bill McIntyre]

The market is currently tuned the way it is and seems to be working just fine.

I don't agree that it works fine. Its an inefficient expensive mess. Even the managements of some of our biggest corporations are saying something has to be done because health insurance costs are keeping them from being internationally competitive.

We pay around 15% of GDP for health, by far the highest percentage of any nation, but we don't get our money's worth in results. I just did a Google search of "international public health comparisons." It hard to wade through that data, there is not always consistency in measurement years, etc. but here are some figures from one comparison of 10 developed wealthy nations.

The US was #1 in health expenditure per capita at $4631. Germany was a distant second at $2696. Canada was $2058.

The US was 4th in percentage of infants immunized against measles and 9th in percentage immunized against diptheria, tetanus, and whooping cough.

The US was 10th in life expectancy at birth.

The US had the second highest rate of perinatal mortality (death within 7 days of birth)

The US had the highest rate of infant mortality.

Does that sound like a fine tuned system that works?

A World Health Organization comparison of countries said that the US had by far the highest percentage of overhead and admin cost, and that this was our main problem.

Everyone likes to mention those high taxes that other countries pay and use that as an indication that our health care system is cheaper and better. But for one thing, those taxes pay for other things besides health care, and again our per capita expenditure is the highest and our percentage of GDP spent on health care is the highest. We are paying for it some how, and we are not getting our money's worth. In our irrational fear of "socialized medicine" we are letting insurance companies rake off a huge proportion of total health care expenditure, and none of that money improves our health. I believe I've read that admin expense for Medicare is about 5%, the most efficient system by far, but instead of trying to expand its reach, the current administration is trying to limit it so that more money can go to those private insurance companies that are so generous with campaign contributions.

This morning I discussed this subject with my physical therapist to take my mind off the pain while he tried to tear my arm out of the socket, and he said that his wife spends 8 hours per day 4 days per week just calling insurance companies trying to get what is do him. They say they never got the claim, so resubmit. Then they say they already paid, but he never got the check. Their entire purpose is to make money, and one of the methods used is to make it hard for patients and providers.

Our system sucks by almost every objective measurement.

[Prodigal Son]

I believe I've read that admin expense for Medicare is about 5%, the most efficient system by far, but instead of trying to expand its reach, the current administration is trying to limit it so that more money can go to those private insurance companies that are so generous with campaign contributions.
I wanted to avoid doing this, but for crying out loud Bill, get off the "Blame Bush for everything" bandwagon. I can tell you as a physician that many of my colleagues and I view GWB as the least of our problems. America's healthcare problems pre-dated GWB, and will follow him long after he's gone. We've gotten royally screwed by Democrats and Republicans alike. The former with their screwy socialist utopian ideals (pandering the people) and the latter by pandering private industry. CMS (Center for Medicare & Medicaid Services; formerly known as HCFA), which you seem to hold in such high regard, is probably the biggest offender; the private insurance companies have just been going along for the ride. CMS, through the Medicare Fee Schedule (MFS), essentially enforces price fixing, which private industry follows (-20% to +30% MFS at my institution). What's worse is that they continually introduce all sorts of onerous unfunded mandates (e.g., HIPAA) and an arcane, often shallow and contradictory, coding system for billing that they often don't even understand or follow. Medicaid and MSI are indexed to reimburse well below the MFS, making physicians and hospitals doubly screwed when taking care of indigent patients. Where I work, the two organizations that consistently deny reimbursement (despite appropriate documentation of need) or inappropriately bundle codes in a post hoc fashion to markedly shortchange reimbursement are Medicare and Blue Cross. CMS also reimburses hospitals based on DRGs, which intentionally omit more expensive and technologically advanced procedures to avoid having to pay for it. The problem is that physicians and hospitals do not have the money or resources to battle the state or federal government, and the government knows this. If Medicare is so great, then why is the system destined to become bankrupt within a decade? Why are doctors resigning their Medicare paneling? Why are increasing numbers of good physicians leaving the field? Why am I even considering switching careers too? I could keep going on with the number of abusive business practices done by CMS and private insurers, but it wouldn't be worth it. You wouldn't understand, I don't have time, and I'm fed up with arguing on Spearboard. I come here to escape my problems at work for a moment and learn about spearfishing. I regret posting a reply to jackpine's original comment. I'm currently wrestling with the decision to leave my field for another line of work, and his comment just touched a raw nerve. Bill, give me a call when you're feeling better. You can stop by the office sometime. We can talk a little about this (and a lot more about spearfishing) over some lunch.

[Bill McIntyre]

Howard,

About all I could clearly understand in your rant was that by mentioning the current administration, I triggered your "protect Bush" reflex.

I fully understand that our medical system problems predate the current administration, but the current President's proposal to cut payouts to providers is only going to make it worse. I certainly don't have the inside knowledge that you have, but let me run my personal concern by you once more. My PT tells me that many good orthopedic surgeons already refuse to take Medicare patients. If payouts are reduced, it seems likely that even more will refuse. Am I wrong in that assumption?

If Medicare is so great, then why is the system destined to become bankrupt within a decade? Why are doctors resigning their Medicare paneling? Why are increasing numbers of good physicians leaving the field?

I believe the main reason its destined to become bankrupt is a demographic problem, more baby boomers reaching age 65. What to do about that could occupy another long thread, but I for one would be willing to accept means-tested premiums. Conservatives seem to resist that idea though.

I'm not sure what "paneling" means. But if it means they are refusing Medicare patients, we already discussed that.

You obviously know more than do I, but I'm guessing a big reason good physicians are leaving the field is that their delivery of health care is managed more and more by insurance companies. Of course that includes Medicare, but you yourself mentioned private insurance companies too.

How about we leave the profit motivated private companies out of it and streamline and improve the government entities?

I know that this is hardly anything beyond anecdotal, but from the patient's POV, Medicare and Tricare have been totally free of problems for me. However at the same time, my wife has had to jump through hoops to get Blue Cross to pay for two surgeries and extensive therapy on her hand. She gets bills from the therapist saying insurance has not paid and its time for her to ante up. She calls Blue Cross and finally discovers that the bill went to the HMO section rather than the PPO section, and they promise to fix it. It doesn't get fixed and she calls again. This time she is told that Blue Cross cannot transfer the bill from one side of the house to another, and the therapist should resubmit. I can't possibly remember all the remaining steps, but you get the idea.

Meanwhile, I go to Doctors and therapists, show them my Medicare card and military ID card, and the next time I hear anything is when I get a statement from Tricare showing that Medicare paid its portion, Tricare paid the deductible, and I owe nothing. It sure looks smooth from my end, and I have yet to see evidence that a provider was turned down and had to resubmit.

I can't help noticing that you didn't address the fact that we pay more for healthcare than anyone else on a per capita basis and on a percentage of GDP basis and then get those poor results. Are those figures wrong or misleading?

I'm fed up with arguing on Spearboard. I come here to escape my problems at work for a moment and learn about spearfishing.

Then why the hell did you venture onto the Politics/Religion forum. It looks to me like a self-inflicted wound.:)

[Prodigal Son]

Then why the hell did you venture onto the Politics/Religion forum. It looks to me like a self-inflicted wound.:)
The original thread was in Off Topic. I made a resolution never to post in the Politics/Religion forum, and I hope to never break it again. Regarding my post, I didn't want to spend the time refuting your assertions point-by-point. As I said, I don't have time. I already addressed some of your points, such as the higher perinatal and infant mortality rates, in a thread a few years ago when you made the same claim, and I really don't want to repeat myself. My point wasn't to "protect" GWB per se, but to singly dispute your assertion that Medicare is currently the best healthcare solution we have in this country. It most certainly is not, and I believe that it is one of the causes of our current healthcare problems. A meaningful discussion on identifying and fixing America's healthcare problems lies far outside the realm of a spearfishing message board. If you want to discuss it, it's far more efficient to do it person. My offer to you still stands, not as a confrontation, but just as a break from the troubles of everyday life. It'll be my treat Bill.

[junior]

I honestly think that some of those stats that you mention can be as easily tied to prenatal and post natal care from incapable parents. It's similar to schools...there is only so much either professional can do to fix the end result of bad care at home.

[Bill McIntyre]

I honestly think that some of those stats that you mention can be as easily tied to prenatal and post natal care from incapable parents. It's similar to schools...there is only so much either professional can do to fix the end result of bad care at home.

That could be a partial explanation for some of the stats, but then why do we have more incapable parents than other countries? Could it be that they don't get the pre natal and post natal care that is taken for granted as the right of all citizens of those other countries.

[junior]

Somebody has to have more incapable parents than someone else. Might as well be us. That is a real moving target since the quality of private home life is relatively difficult to measure. My understanding of pre and post natal care is that it is pretty much available to anyone who knows enough to look for it in the right place. It's not a big secret. But, (I almost feel lead here:D) many OBs may not accept high risk mothers due to potential malpractice due to birthing or post-natal complications. I suppose "high risk" being at the care providers judgement. My experience has been that "high risk" is usually written all over some people's forehead...

[Megabeast]

I can't help noticing that you didn't address the fact that we pay more for healthcare than anyone else on a per capita basis and on a percentage of GDP basis and then get those poor results. Are those figures wrong or misleading?


You'd be hard pressed for anyone the medical field to address that comment Bill. It's like them saying, "I know I'm overpaid, what's your point?" If doctors didn't assume so much liabilty, they would be grossly overpaid, but since they do accept responsibilty for their work (when they're forced to), I guess they're only moderately overpaid.

I am someone who hasn't had health insurance in about 5 years, and by god I wish there was something in place for me when something serious happens to me. The walkin place is ok, (it's better than my old primary care place, where you couldn't get an appointment for 4-6 weeks, and they always made you sit in the waiting room for 45 minutes, while the doctor is screwing around talking about fishing on his cellphone, or flirting) It's real easy for you guys with your 50+k a year jobs to make blanket statements about how 'people without insurance are the most destitute alley trash walking the earth, since they can't afford insurance, they get what they deserve. If they weren't such crack smoking subhuman filth, they could afford it'. I've sat in hospital waiting rooms with half my face hanging off for like 3-4 hours, seeing what happens to folks who didn't have insurance, thanking god I did at the time(did I mention I sat for 4 hours with half my face hanging off). I can't imagine what would've happened to me if my parents didn't have insurance at that time. Maybe I'd of had to stuff all the stuffing in my lips back in myself, and my mom could've sewn it up. I could do on.... but it's infuriating/disheatening and I'm sure some the doctors on here and the guys with the great insurance from their jobs will tell me I'm wrong for feeling the way I do. My sons mom is a nurse, and her mother before her, they've got some great stories.

The end result is always the same. Money has corrupted medicine. Medicine is a business, not a service, and it shouldn't be that way. It should be a service provided for everyone. Doctors should be more concerned about the health of a patient and the fact that somebodys mom/dad/son/daughter maybe dying in front of them, instead they spend all their time sweating liabilty and what they feel is the appropriate amount they should be paid. :rolleyes:

I can see why they'd want to get out of the field. If I had to chase my money all the time, I'd get out of the field too. Of course, that gets us back to square one, the inflated bill in the first place, that no one feels is fair except the doctors themselves.

[Christof]

Christof,

It is not solder like you would use to sweat copper pipe for a plumbing application, it is stick solder, that will usually have between 5%-15% silver in it, it isn't exactly cheap, but it does go a long way.

Also I doubt you are "Certified" to handle refrigerant, as required by the EPA, which means you legally can not buy or posess Refrigerant.

I also doubt you have a Contractors license, so a A/C supply house would not sell you refrigerant or other supplie needed to do the job.

Do you have a Vacuum Pump (they cost about $450) Guages (they cost about $100) Thermistor guage or Vacuum Guage (they cost about $300) Torch set (they cost about $350), and the knowledge of how to use them?

$472 may seem like a lot of money for what they did, but I doubt you could have done it cheaper.

One thing you said does concern me though, you said it took 30 minutes to repair, did the A/C tech use a Vacuum Guage or Thermistor guage? and if he did, how many Microns did he pump the system down to?

BTW you can be fined up to $25,000 for illegally venting refrigerant into the atmosphere. ;)
I have "sweated" a lot of joints, didnt know it was different and you are right, he used a rectangle "stick" for the job.... I know it isnt cheap guys, but I feel that if something is going to cost near $500, a warning would be in order... I asked him "whats this gonna run me" about half way thru the job and he ho-hum'd so I said "just give me a ball-park figure.. He said "shouldnt be more than $300 I'd think".... He was wrong...

The refridgerant was $140, the invoice doesnt say how much the filter was..

I bet they rake in the dough once it gets hot....

[Christof]

I guess the moral of the story for Christof would be to get an estimate before getting the work done.
Yes, thats the lesson I learned... No "It shouldnt run more than this", but hard numbers on paper that I can sign.....

And the other half of your post almost made me choke on my coffee.. No shiat!
But there are a lot of folks who do think just what you propose is how it should be...

[Christof]

In the current system we are asking the uninsured (and almost always the most destitute individuals) to pay the highest rate for a procedure, Man, you are surely smoking something.... The destitute have the best healthcare bud, it's called MEDICAID and they dont pay a fricken dime.. No copay, no deductable, etc.... It is the middle class that have no insurance that have it the toughest.. But most of them, per my other posts on healthcare, CHOOSE not to buy premiums... As far as the reimbursed costs, you think $3000 is "fair" for a surgery?? You add up all the costs, including the crew of nurses, anesthetist, tools, room rent, drugs, gas's, etc... Then take into account that these f*khead lawyers have driven liability insurance for many MD's over the $100k/yr mark, it all adds up... No, I dont feel bad for MD's, they make a lot more than I for a lot less work... But to try and say that medicare/medicaid reimbursement is "fair" is BS.... Thats why the "have's" are footing the bill's for the "have-nots"... I think it is time to change that, and the "have the ability but are too fu**ing lazy" folks get off the free-lunch wagon.... Not a shift, not ONE goes by where I do not see the freeloaders making up the overwhelming majority of bullshit ER visits... Someone has to pay for their idiot behavior, unfortunately it is the taxpayer...

[Christof]

travel to Mexico to get your tumor removed for $3,000 when that would be the price in the US for the same operation from a trained and experienced surgeon???? The only difference being that you don't have access to that price cause you don't have insurance, so you are asked to pay $15,000 for the same exact operation. LMFAO!!!!

Yeah, and when that surgeon *****s up your surgery, try to find a lawyer that will file a suit for you in mexican court.... You cant sue them if they screw up.. Big difference... AND dont expect much service while you recooperate... No frills down there....

[Christof]

I wanted to avoid doing this, but for crying out loud Bill, get off the "Blame Bush for everything" bandwagon. I can tell you as a physician that many of my colleagues and I view GWB as the least of our problems. America's healthcare problems pre-dated GWB, and will follow him long after he's gone. We've gotten royally screwed by Democrats and Republicans alike. The former with their screwy socialist utopian ideals (pandering the people) and the latter by pandering private industry. CMS (Center for Medicare & Medicaid Services; formerly known as HCFA), which you seem to hold in such high regard, is probably the biggest offender; the private insurance companies have just been going along for the ride. CMS, through the Medicare Fee Schedule (MFS), essentially enforces price fixing, which private industry follows (-20% to +30% MFS at my institution). What's worse is that they continually introduce all sorts of onerous unfunded mandates (e.g., HIPAA) and an arcane, often shallow and contradictory, coding system for billing that they often don't even understand or follow. Medicaid and MSI are indexed to reimburse well below the MFS, making physicians and hospitals doubly screwed when taking care of indigent patients. Where I work, the two organizations that consistently deny reimbursement (despite appropriate documentation of need) or inappropriately bundle codes in a post hoc fashion to markedly shortchange reimbursement are Medicare and Blue Cross. CMS also reimburses hospitals based on DRGs, which intentionally omit more expensive and technologically advanced procedures to avoid having to pay for it. The problem is that physicians and hospitals do not have the money or resources to battle the state or federal government, and the government knows this. If Medicare is so great, then why is the system destined to become bankrupt within a decade? Why are doctors resigning their Medicare paneling? Why are increasing numbers of good physicians leaving the field? Why am I even considering switching careers too? I could keep going on with the number of abusive business practices done by CMS and private insurers, but it wouldn't be worth it. You wouldn't understand, I don't have time, and I'm fed up with arguing on Spearboard. I come here to escape my problems at work for a moment and learn about spearfishing. I regret posting a reply to jackpine's original comment. I'm currently wrestling with the decision to leave my field for another line of work, and his comment just touched a raw nerve. Bill, give me a call when you're feeling better. You can stop by the office sometime. We can talk a little about this (and a lot more about spearfishing) over some lunch.

FWIW, me too... I am so burned out on this healthcare field.... I am going back to school or something... Hang in there with spearboard though... Great site...

[bgbill]

I bet they rake in the dough once it gets hot....

That is one of the reasons I am getting my A/C Contractors License, people will write big check when their fat ass is sweating. ;)