I'm unemployed and without insurance. If I go to the dentist's office to get a small no-anesthesia filling, as I did last week, they will accept $116 from an insurance company but will charge me $167 for exactly the same procedure because I'm a cash payer. When an insurance company pays them, they deduct the difference between $167 and $116 as a "loss" to reduce their taxes.
Paper losses like this are not tax deductible. I work with a medical office, and that is one of the first tax-related truths they discovered.
On the other hand, taking advantage of people is unfortunately part of human nature. The nice part about paying cash is you can say, "I will pay you in full now. If you bill the insurance company, you have to submit a claim and pray that they pay and not recoup the payment in the future. And, please give me your best price now because I am going to three of your competitors who are conveniently located in this same neighborhood and will ask them their best price. Then I will choose, and I won't be back if your office is not the winner."
This is called capitalism: make it work for you!
"surgeons sliced open their patients' shoulders and inserted the pulse-generating devices in the flesh near the heart, then attached tiny wires to the heart muscle
- 1. The incision is made in the skin, not a joint. The implant location is usually the left or right prepectoral region, which is an inch or two lower than the collar bone on the stated side. The pacemaker itself is placed in a "pocket" formed by separating the skin and its attached fat from the underlying muscle. If you have ever eaten chicken, you know that the skin and fat can be separated from muscle. In the uncooked human, of course, separation requires a bit of effort but not much, and a good surgeon will have the area complete numbed up so the patient doesn't feel anything. Thus, the pacemaker is not near the heart: it's outside the rib cage. There are variations on the implant location, but none of them is inside the rib cage.
- 2. The tiny wires (well, pretty tiny) are long, and extend from the area where the pacemaker is through a vein (not an artery, hopefully!) to the heart. The method by which the wires are put in the vein is simple but outside the scope of this post.
- 3. The access is always through a vein (femoral vein, in the case of the new device), not an artery. Blood clots (thrombi, when inside the body) will form on most foreign bodies. From the veins, they can spread only into the lungs, which is relatively safe. From the arteries, even tiny thrombi can cause trouble when they go the brain (strokes), heart (heart attack), gut (ischemic gut), limbs (ischemic arm, leg, etc). Not good.
- 4. The new device can still get infected and still can run out of battery power. What I haven't yet understood is how it can easily be extracted if it gets infected, which is necessary because life-threatening infection can (and usually does) result if an infected foreign body remains in the patient. I guess it's small enough that a new one can be inserted without removing the old one when the battery runs out. There are more technical limitations too that will likely be overcome as the technology improves.