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The way it SHOULD be going is that as a patient you can get a quote for the "standard package" plus X (X being unexpected stuff happening).

Says who? You're not an expert and not even that knowledgeable. Your just spouting socialist dogma. You demonstrate severe misunderstandings about the medical industry in general.

First off, it's been discussed many times before, the medical industry is incredibly complicated and most people, including you, don't understand most of it. There's lots of potential improvements but "doctor shopping" has several functional limitations as well as limited cost-savings.

All physicians are told what they're going to be paid by the third-party payers. So the doctors, especially the hospital-based physicians charge according to the reimbursement schedule of the payers. So the doctors don't even set their rates anyway. Hospital-based docs could provide a ball-park figure for what a patient is scheduled for, and IF ASKED, would willingly tell the patient whatever the patient's payer will pay for the SCHEDULED services. But most don't and that's not the doctor's fault, and it's no excuse for not paying their bill.

If you knew a little about what happens in medical practice and particularly in the surgery arena, you'd know that SCHEDULED procedures that finish AS THEY ARE SCHEDULED only make up a moderate percentage of total cases. Usually they're the simpler elective cases on reasonably healthy patients (for example a hernia repair, or tubal ligation, gall bladder, etc). But many surgical cases end up requiring additional surgical work that neither the surgeon nor the anesthesiologist could predict. Or a patient develops a complication and requires additional services. The anesthesiologist has no control over these things and certainly can't predict them. And it happens much more than people realize.

Hospital-based medical services are mostly contracted with individual physician groups to provide services. I could provide volumes on why the advantages far outweigh the disadvantages, but for everybody's benefit, it's logistically and financially and medically more advantageous. So if a patient is going to go to a certain hospital, they get whomever the hospital-based physicians that practice at that hospital. And since the rates are set by the payers, I can tell you that there is almost no differences between anesthesia charges from one hospital to the next in the same area.

Furthermore, considering the totality of a hospitalization for surgery, the anesthesiologist's fee is usually baby-sch*t compared to the rest of the bill. The anesthesiology fees, probably range between $400-$1,000 for most single operations with an average of about $400-$600. Naturally, longer cases (say 14-16 hour surgery) or highly difficult cases may go a little higher but rarely surpass $1,500 for a single surgery. Compared to the $10k-$100K total cost, it's a "tempest in a teapot". There's no "extra" charges for night, weekend, or holiday surgery. The fee is the same....whatever the payers sets. So if the anesthesiologist gets called in at 1:00 A.M. Christmas Day on a Sunday for a 6 hour transplant or ruptured aneurysm, there's no additional charge. Try calling in a plumber, HVAC, electrician or other union worker for those hours and a big complicated emergency job and see what they'll charge. I guarantee you it'll be three time what we get paid....IF we get paid. Lots of night-time and weekend stuff are NO-PAY "freebies". The union guy might tell you he's charging triple-time labor, but can't tell you how many hours it'll take, what's wrong, or how much the parts will cost.

In the grand scheme of things, physician charges aren't the 800 lbs gorilla in the room. There's a laundry list of things that in total dwarf physician charges.

JLC's lawyer patient is being an *ss and most reasonable people know it. We know you're a big socialized medicine nut, so we'll just stipulate that we acknowledge all your usual arguments and assertion and then remember that all socialized medicine systems eventually fail like all socialized anything fails. But socialists never learn.
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