Hospitals have an amazing array of expensive devices and costly specialists who can be and often are brought into the loop in treating the emergency room patient, among other obvious uses for these. Sometimes that's truly needed and effective; sometimes not. If the patient is insured, the more they are used and brought into the loop, the bigger the bill, the greater the payment from the insurance companies. The hospital covers up this income generation motive by complaining about potential liability, lawsuits, etc., and the mysterious nature of what is wrong with emergency room patients if they do not do everything they can imagine to get at what brought the patient into the emergemcy room in the first place. (I personally speculate that the greater reason is that they do this is managerial decisions higher up the food chain at the hospital, top-down, to generate more profits because that's simpler and makes more sense.) Some of that is a combination of medical analysis to try to solve the patient's problem and the rest is to ward off real legal risk, but we don't know how much of it this is or how to separate the two.

The "costs" billed by the hospital for its emergency room services are almost certainly an inflated rate for each part of the services rendered (band aids, aspirin, needles, etc.) because the insurance companies have in effect "negotiated" with this hopsital and all others in its system (and those not in it, too, I guess, though I really do not understnd how the "in-network" and "out-of network" systems work or are set up) a significantly lower rate of reimbursement for what is billed by the hospital. Since I do not know what these rates are, but am sure they are ubiquitous, I will use a blind guess of 40% of what is billed as the reimbursement rate. From this comes the bulk of the emergency room cost recoveries and profits from running emergency rooms. So the hospital jacks up the initial cost to get what it needs out of the 40% reimbursement rate from insurnace companies.

This leaves the uninsured paying the equivalent of the hospsital's "rack rate," as in hotel room rates, instead of a discounted rate that would be the equivalent of what the uninsured patient would have paid if he/she had been insured and the insurance company had paid at its 40% reimbursement rate. Ditto for the "out-of-network" insured patient, who will bear all of what the hospital charges at its rack rate and, upon submitting the charges to his/her insurance company, will get only, say, 70% of what the insurance company would have paid to that hospital would have been paid by that insurance company had it been an "in-service" hospital — a heavy hammer blow to the patient.

So: the costs charged by the hospital are not "real" in the sense that they reflect a kind of honest cost-plus billing method. Instead they may start there, but then those rates are doubled or worse to get what the hospital needs out of the insurance companies, thereby artificially raising the price to the uninsured and out-of-network patients.

Some of the uninsured, even if chased, will not or will not be able to pay, so that, too, has to be taken into acocunt by the hospital. Add in junk lawsuits, to use shorthand for legal costs and risk, and hospital greed, and we may approach an answer to why emergency room visit costs are so high.

If that is the case, though, why does no one suggest attacking and controlling those elements other than junk lawsuit cost (which at least the Republican proposals do), which admittedly ought to be curtailed by federal law (but with some senstitiy to the disincentive that removing legal threat would have on prevention of sloppy medical errors)?

What to do about these things? Well, here are some ideas that mysteriously don't seem to come up. For example, why not force insurance companies to pay what they are charged rather than discounting those bills by "negotiation" and spending a fortune fighting over the amounts and propriety of such charges? That is, do what the rest of us do: pay your bills!

Why not force hospitals to keep honest books (under heavy legal penalty, like public companies) at the individual hospital level, require hospital by hospital audits and reports from accounting firms, and compel them to observe some sort of limitation or ceiling on their cost-plus basis for charging (based on some geographic or other grouping of fees charged by others — e.g., all hospitals in Manhattan or whatever)? Then collect and publish these rates on the internet and let the patients take it from there?

As to the uninsured, why not permit hospitals to turn them away if they choose (eventually an incentive, like the need for basic shelter, to get insurance one way or another without need for a giant bureaucracy and new taxes to get there)? And why not force hospitals in a locality to pool uninsured visit risk where no payments are received (pro rata based on number of those -patients served)?

Wouldn't these steps slash emergency room visit costs so that theywouldn't be so high? Unless there's something wrong with this sort of approach — and I'm all ears if there is — we are all being conned by what's being put out there by the politicians, people who could, but for finaicial reasons of their own, who do not come up with solutions to the real problem: emergency room costs.

The high risk insurance pools by most states aren’t exactly great. They have a tendency to be rather expensive, have lower benefit amounts as well as lower percentages of coverage after the deductible and only provided a modicum of financial relief from a medical bill that appears huge and had a much lower lifetime cap, usually about $500,000 when the routine standard was $2,000,000 and exceptionally good ones were $5,000,000.

I think it may not be constitutional for the federal government to require its citizens to have health insurance and then create and impose legislation forcing the preponderance of the citizens to enroll in their contrived (as well as ill conceived) universal government run health insurance plan. The liberals concept of universal health care appears to be in contravention with my life, liberties and pursuit of happiness; how about yours?

I think these Law makers are actually Infiltraitors serving foreign interests like Obama.

Just for fun I dashed off Articles for Obama’s Impeachment, appropriate to release it here as House 111 wrecks American Health Care by essentially a Communist take over of Cold War proportions. Come on Ann Coulter, flesh it out.

ARTICLE 1 : Acts of Treason, against the Constitution, False Swearing a Senate Oath, and Conspiracy to serve a Foreign Interest in Congress.

ARTICLE 2 : Acts of Treason, against the Constitution, Fixing Elections, Buying Elections, Creating Organizations for the purpose of Election Fraud (ACORN), Fixing Elections by Intimidation, unlawful attacks on opponents of election, fixing the electoral process while infiltrating the United States Government in the Interest of Foreign Powers.

ARTICLE 3 : Abuse Of Power, against the Constitution, the establishment of Foreign Interest mandated but unlawful and not republican and representative government styles: of Communism, Socialism, Humanism (Czars), in abrogation of lawful Constitutional mandated government. Creating abusive and Unconstitutional Laws, crafting criminality into Law.

ARTICLE 4 : Conspiracy, against the Constitution and the People of the United States, unlawful infiltration, cause of unlawful Communism to arise, Nationalization of means, unlawful Socialism and totalitarian government, and fulfill the Plans Of A Foreign Interest.

ARTICLE 5 : Conspiracy, Racketeering, Influence and corruption, unlawful payments, unlawful favors, vote buying; Conspiracy to change America by intimidation, coercion, usurping, re-writing Laws, Texts, Curriculum, against the Constitution in conspiracy and collusion with Foreign Interests, Long Standing Enmity against the Constitution. False Oath Taking.

ARTICLE 6 : Treason, infiltrating and operating in public office, including President, against the Constitution, against the Interest of the People and in the Interest Of Foreign Powers of long standing enmity.

IMPEACH ALL OF THEM!

And you have hit the problems on the head, with solutions that will work to help fix the problems.

A little late, given all the power the RNC squandered while in full control of all branches, but better than never.

A little concerned about the pre-existing coverage…I like the concept of giving it back to the States to be smart about it, but I hope that nobody goes the route of rewarding NOT having insurance until you have a problem, then giving you cheap insurance once you have a problem..this would encourage people to not insure themselves until they have a problem.

Lastly…is there a way to build in an incentive for people to buy their own health insurance? I recall when California required showing liability insurance in order to renew our Driver's license and how the numbers of insured suddenly soared, and competition got fierce with lower rates here.

What about linking proof of health insurance coverage to a privilege like obtaining a driver's license or getting a welfare check? This would mean that the 10 million or so who are already eligible, but just haven't signed up, for Medicaid etc would have to sign up. That would lower by about 10 million that famous "uninsured" number. It would also mean all those 20-somethings who want to drive their cars that they can afford would have to spend the $100/month for health insurance that they don't think they need in order to drive.

Just like the number magically dropping from 47 million uninsured to 30 million uninsured once the Dems figured out that 17 million of that number were not citizens, the number would magically drop to 10-12 million once all the folks who can actually afford insurance are incentivized to buy it, and all the folks who are already eligible for govt programs are incentivized to register BEFORE they land in the hospital.

Thank you..keep up the work. Keep shouting from the rooftops.

And next time you are in power, don't lose your conservative-libertarian ways.

NO PART OF ABORTION APPLIED. Pregnancy, for the most part, is a result of a personal act and should be expensed by these persons.

Democrats belittle the people, have no faith in people to have the dignity to take on their responsibility of their own human existence for themselves and families.

DEMOCRAT GIVEAWAYS CREATE CRISIS FOR GOVERNMENT TO TAKE AWAY FREEDOM FROM ALL.