Medical equipment pricing is completely broken when a sling costs $200(latimes.com)
latimes.com
Medical equipment pricing is completely broken when a sling costs $200
https://www.latimes.com/business/story/2019-09-12/medical-equipment-pricing
369 comments
I went to the ER with chest pains seeming like a heart attack. They did an EKG, determined it wasn't a heart attack, then a blood test, which determined it was low potassium, and did a chest x-ray just in case. I received a saline IV and potassium pills as treatment, and went home after a couple of hours. The bill was about $18,000 for this. The insurance negotiated rate was about $1,500, of which I had to pay about $600, then over the next weeks, I received about 20 bills, each of which was for a large amount, bit the resultant patient "responsibility" was about $20 - all from shell organizations like "CA ER Physicians", or "Hospital Diagnosticians", etc. It's such a mess!
Another example was the birth of my child. We prepared for this by setting up an FSA, and having really good PPO coverage that year, supposedly, with a 10% copay. After all the billing shenanigans, my copay was about 30% and well above the out of pocket maximum. How does that happen? You can go to an in-network hospital, and be treated by a mix of providers, all of whom bill separately. Some will be in-network, others will be out of network, so you are in effect deducting against two out of pocket limits.
Medical billing is fraudulent. Medical insurance is fraudulent. These people are all acting in violation of tons of existing laws - I don't understand why this isn't prosecuted.
Another example was the birth of my child. We prepared for this by setting up an FSA, and having really good PPO coverage that year, supposedly, with a 10% copay. After all the billing shenanigans, my copay was about 30% and well above the out of pocket maximum. How does that happen? You can go to an in-network hospital, and be treated by a mix of providers, all of whom bill separately. Some will be in-network, others will be out of network, so you are in effect deducting against two out of pocket limits.
Medical billing is fraudulent. Medical insurance is fraudulent. These people are all acting in violation of tons of existing laws - I don't understand why this isn't prosecuted.
I ended up in the ER a few months ago. The paramedics wanted around $2,500, the hospital (Dignity Health) wanted maybe $3,500, and the doctor had another few hundred in fees. Sadly that all felt pretty cheap.
Dignity Health deserves a special mention though. They obfuscate their billing as much as possible. The initial bill indicated they'd give me a cash discount and wanted something like $2500. Then they sent me another bill for $1800 if I paid promptly, with lots of weasel words to make it seem like I really owed more than $1800. So, of course I paid but I had no real idea if $1800 would be sufficient (in fact their online payment portal hinted it wouldn't be). The best part was getting a survey about the quality of their billing statements right after.
Dignity Health deserves a special mention though. They obfuscate their billing as much as possible. The initial bill indicated they'd give me a cash discount and wanted something like $2500. Then they sent me another bill for $1800 if I paid promptly, with lots of weasel words to make it seem like I really owed more than $1800. So, of course I paid but I had no real idea if $1800 would be sufficient (in fact their online payment portal hinted it wouldn't be). The best part was getting a survey about the quality of their billing statements right after.
Did you feel dignified?
They’re not shell organizations, hospitals just outsource tons of stuff, frequently including physicians. (In fact, in California, hospitals may not legally employ physicians to practice medicine)
Yeah, but when you pay for services you don't expect to have to write checks for every subcontractor your service provider users. They do that. You pay them. Everywhere but our messed up Medical System is like that.
Imagine if every time you went grocery shopping you had to pay for the people stocking the shelves, putting the carts back if you used one, the cashier, and each wholesale distributor. It's crazy and senseless. Just the way they like it so they can get away with so much more.
Imagine if every time you went grocery shopping you had to pay for the people stocking the shelves, putting the carts back if you used one, the cashier, and each wholesale distributor. It's crazy and senseless. Just the way they like it so they can get away with so much more.
> Yeah, but when you pay for services you don't expect to have to write checks for every subcontractor your service provider users.
Well, yeah, that's true by the definition of “subcontractor”, which doctors in hospitals often are not.
OTOH, healthcare isn't the only place where you might pay a fee to a facility for use of the facility and a fee to a service providers associated with the facility for services they provide in the facility. It's perhaps an inconvenient arrangement, but by no means unique.
Well, yeah, that's true by the definition of “subcontractor”, which doctors in hospitals often are not.
OTOH, healthcare isn't the only place where you might pay a fee to a facility for use of the facility and a fee to a service providers associated with the facility for services they provide in the facility. It's perhaps an inconvenient arrangement, but by no means unique.
> OTOH, healthcare isn't the only place where you might pay a fee to a facility for use of the facility and a fee to a service providers associated with the facility for services they provide in the facility.
Where else does this occur?
Where else does this occur?
> Where else does this occur?
Event facilities (for weddings, etc.) often have established partners for various event services that you pay directly rather than through the facility, which you also rent.
Dance studios where the dance instructor is affiliated but not an employee of the studio (especially where the affiliation is non-exclusive) will sometimes (especially for private lessons rather than group classes) charge a floor fee which you will pay to the studio, while the instructor is paid directly.
Fairs, etc., often charge you a gate fee, while you pay for goods and services inside to vendors directly (which vendors are also paying the fair for the privilege of being there, too.)
Arguably, residential real estate leases without included utilities is a closer analogy than any of those: there are a number of non-optional service providers you pay separately, on top of paying the landlord to occupy the premises.
Event facilities (for weddings, etc.) often have established partners for various event services that you pay directly rather than through the facility, which you also rent.
Dance studios where the dance instructor is affiliated but not an employee of the studio (especially where the affiliation is non-exclusive) will sometimes (especially for private lessons rather than group classes) charge a floor fee which you will pay to the studio, while the instructor is paid directly.
Fairs, etc., often charge you a gate fee, while you pay for goods and services inside to vendors directly (which vendors are also paying the fair for the privilege of being there, too.)
Arguably, residential real estate leases without included utilities is a closer analogy than any of those: there are a number of non-optional service providers you pay separately, on top of paying the landlord to occupy the premises.
Weddings: you pay the caterer directly, even if the facility dictates which caterer you use
That's a really obscure example. I have a lot of family around me and we have many weddings. Most of the time the venue is the caterer since that is what they charge for the venue.(500-900 people weddings, over 10 a year). Not always though.
BUT STILL, weddings are a really bad example here.
The people getting married get to chose from whom they want the table and chair covers, flowers, singer/band, catering, belly dancers/entertainment, lights people, AV people.
Those are choices you got to make and the bills will obviously come separate since there is clear distinction of entities. Heck, the venue and the singers might not even of said a word to each other, let alone have a billing agreement.
BUT STILL, weddings are a really bad example here.
The people getting married get to chose from whom they want the table and chair covers, flowers, singer/band, catering, belly dancers/entertainment, lights people, AV people.
Those are choices you got to make and the bills will obviously come separate since there is clear distinction of entities. Heck, the venue and the singers might not even of said a word to each other, let alone have a billing agreement.
How does this work with institutions like Kaiser? Are their hospitals not technically hospitals? Or are the physicians all technically contractors there?
California really makes it hard to have everything on one bill because no hospital can hire a doctor.
But businesses and some consumers do want things to be under one roof - no surprises on in vs out of network, they don't like separate bills from each doctor that sees them, easy referrals, etc.
Kaiser is sort of a funny workaround.
The Kaiser Foundation Health Plan, the Kaiser Foundation of Hospitals and The Permanente Medical Group = Kaiser Permanente
The win for the patient is everything in-network and under one roof. If you are in a Kaiser facility EVERYONE is basically in network (with the exception of some state mandated providers that have to go through their own state flows - yes, that's why sometimes you need to repeat info on forms even at Kaiser)
The win for doctors is you really don't have denied claims or the billing pain you might in private practice.
CMA I think has really fought these setups before, but now oddly (in part because of medical malpractice and EHR overheads etc) working for Kaiser isn't considered a dump job anymore.
Bad news, obamacare put demand through the roof at Kaiser (even though they are not the cheapest plan) so they are shortstaffed I think.
If you do or know anything about medical billing - medical providers probably hate it as much as you do. A patient with primary coverage through Kaiser and secondary through Medi-cal - just to bill Medi-cal for $40 - you could spend hours on that as you hoop jump.
But businesses and some consumers do want things to be under one roof - no surprises on in vs out of network, they don't like separate bills from each doctor that sees them, easy referrals, etc.
Kaiser is sort of a funny workaround.
The Kaiser Foundation Health Plan, the Kaiser Foundation of Hospitals and The Permanente Medical Group = Kaiser Permanente
The win for the patient is everything in-network and under one roof. If you are in a Kaiser facility EVERYONE is basically in network (with the exception of some state mandated providers that have to go through their own state flows - yes, that's why sometimes you need to repeat info on forms even at Kaiser)
The win for doctors is you really don't have denied claims or the billing pain you might in private practice.
CMA I think has really fought these setups before, but now oddly (in part because of medical malpractice and EHR overheads etc) working for Kaiser isn't considered a dump job anymore.
Bad news, obamacare put demand through the roof at Kaiser (even though they are not the cheapest plan) so they are shortstaffed I think.
If you do or know anything about medical billing - medical providers probably hate it as much as you do. A patient with primary coverage through Kaiser and secondary through Medi-cal - just to bill Medi-cal for $40 - you could spend hours on that as you hoop jump.
They are all salaried employees, so Kaiser can work from a 'fixed cost' perspective ( as told to me by a surgical nurse ).
There are there different entities that all work together: Kaiser Foundation Health Plan provides medical insurance. The Kaiser Foundation of Hospitals owns all the hospitals. The Permanente Medical Group, Inc. employs all the doctors. The latter is a Professional Corporation, so its allowed to employ physicians to practice medicine, but it doesn't operate hospitals.
100% false! That would be totally illegal. California CLEARLY bans hospitals from doing this.
I mean, you can even google it like I did, from this page: https://www.ophthoquestions.com/posts/why-i-left-kaiser-and-...
"For those who are not familiar with the Kaiser system, here is a very abbreviated explanation. Kaiser Permanente is an HMO, and consists of the Kaiser Foundation Health Plan (the Kaiser insurance) and the Permanente Medical Groups (the Kaiser doctors). The patients buy the Kaiser insurance and they are only allowed to see Kaiser doctors. The Kaiser doctors are salaried from the pool of insurance premiums and provide service only to the Kaiser patients. In the Kaiser model, services are prepaid, so there is no financial incentive or penalty to providing or receiving medical care."
"For those who are not familiar with the Kaiser system, here is a very abbreviated explanation. Kaiser Permanente is an HMO, and consists of the Kaiser Foundation Health Plan (the Kaiser insurance) and the Permanente Medical Groups (the Kaiser doctors). The patients buy the Kaiser insurance and they are only allowed to see Kaiser doctors. The Kaiser doctors are salaried from the pool of insurance premiums and provide service only to the Kaiser patients. In the Kaiser model, services are prepaid, so there is no financial incentive or penalty to providing or receiving medical care."
>in California, hospitals may not legally employ physicians to practice medicine
...why?
...why?
The sort answer is California Business and Professions Code 2417.5, but thats probably not exactly what you meant.
Most (all?) states forbid whats called the "Corporate Practice of Medicine." The idea is that profit motive of a corporation can lead the corporation to manage physicians contrary to the interests of their patients. To mitigate this, states only allow certain business models for physicians:
* Sole Proprietorships - they can work for them selves
* Professional Corporations - a restricted sort of corporation that requires all shareholders and executives to hold a license for the profession the corporation practices (ie, they all must be physicians)
* Some states have exceptions for research universities, public hospitals, non-profits, and other sorts of organizations.
The exact restrictions of course vary from state to state. Here's a state-by-state rundown: [1]
Its my understanding that analogous restrictions are common for other licensed professions such as law and accounting, but I know much less there.
[1]: http://archive.healthlawyers.org/google/health_law_archive/p...
Most (all?) states forbid whats called the "Corporate Practice of Medicine." The idea is that profit motive of a corporation can lead the corporation to manage physicians contrary to the interests of their patients. To mitigate this, states only allow certain business models for physicians:
* Sole Proprietorships - they can work for them selves
* Professional Corporations - a restricted sort of corporation that requires all shareholders and executives to hold a license for the profession the corporation practices (ie, they all must be physicians)
* Some states have exceptions for research universities, public hospitals, non-profits, and other sorts of organizations.
The exact restrictions of course vary from state to state. Here's a state-by-state rundown: [1]
Its my understanding that analogous restrictions are common for other licensed professions such as law and accounting, but I know much less there.
[1]: http://archive.healthlawyers.org/google/health_law_archive/p...
Medical cartel needs to be investigated by FTC. HHS and Medical Boards are infiltrated with physicians with conflict of interest, so their supervision is not enough.
The lobby for insurance companies, pharmaceutical companies, and hospital chains spend ungodly amounts of money to influence our political process. Once all the politicians are bought and paid for everything becomes kosher.
For some reason, Americans keep complaining about the same problems with their government over and over again - particularly lobbying, and yet every election they nearly universally reject all their concerns in favor of tribalism and vote for the same two parties that are responsible for everything they don't want, or nobody at all, which has the same effect.
Wouldn't it be fun if whenever somebody criticizes their government, they also state who they voted for to force them to open their eyes to the fact that it's their own fault.
People rationalize it by saying that voting for a 3rd party is "wasting" their vote, but in that sense, voting for anybody is wasting their vote because it never comes down to one individual's vote deciding things. Really they just have two driving forces - allegiance to whatever tribe they randomly found themselves feeling like a part of (and mysteriously agree with all the inconsistent aims of), and wanting to be on the winning team. Healthcare be damned.
Wouldn't it be fun if whenever somebody criticizes their government, they also state who they voted for to force them to open their eyes to the fact that it's their own fault.
People rationalize it by saying that voting for a 3rd party is "wasting" their vote, but in that sense, voting for anybody is wasting their vote because it never comes down to one individual's vote deciding things. Really they just have two driving forces - allegiance to whatever tribe they randomly found themselves feeling like a part of (and mysteriously agree with all the inconsistent aims of), and wanting to be on the winning team. Healthcare be damned.
https://en.wikipedia.org/wiki/Duverger%27s_law
Without a switch to range voting, approval voting, or one of the condorcet variants, the party system will remain broken into two corrupt halves.
Without a switch to range voting, approval voting, or one of the condorcet variants, the party system will remain broken into two corrupt halves.
Condorcet won't work.
http://scorevoting.net/NESD
http://scorevoting.net/NESD
> People rationalize it by saying that voting for a 3rd party is "wasting" their vote
It's actually worse than what people say. First past the post voting systems have a lot of problems, one of which is called the spoiler effect. By not voting for the major party you prefer you are actually voting against said major party.
Take this simple example: Major party A has 51% of the votes, while major party B hast 49%. Party A wins the election. Next election party C makes a big campaign at party A voters and convinces 3% to vote for them. Now we have A 48%, B 49% and C 3%. Party B wins the election. And if we look at the paper trails it probably doesn't surprise who funded party C's campaign.
Assigning this well studied behaviour of rational voters to simple tribalism is trivialising the core issue in the US: Elected officials are not representing the people. The way to fix this issue is to fix their voting system.
It's actually worse than what people say. First past the post voting systems have a lot of problems, one of which is called the spoiler effect. By not voting for the major party you prefer you are actually voting against said major party.
Take this simple example: Major party A has 51% of the votes, while major party B hast 49%. Party A wins the election. Next election party C makes a big campaign at party A voters and convinces 3% to vote for them. Now we have A 48%, B 49% and C 3%. Party B wins the election. And if we look at the paper trails it probably doesn't surprise who funded party C's campaign.
Assigning this well studied behaviour of rational voters to simple tribalism is trivialising the core issue in the US: Elected officials are not representing the people. The way to fix this issue is to fix their voting system.
“People rationalize it by saying that voting for a 3rd party is "wasting" their vote,”
I guess I am stubborn but I will never vote for one of the two big parties. However it would be great if smaller parties got some kind of representation in Congress. It seems ridiculous that in the 90s Ross Perot got 20% of the vote but that resulted in zero representation.
I guess I am stubborn but I will never vote for one of the two big parties. However it would be great if smaller parties got some kind of representation in Congress. It seems ridiculous that in the 90s Ross Perot got 20% of the vote but that resulted in zero representation.
There's an ideal world we want (that might never happen) and there's the real world. We live in the latter. Voting for the 3rd party is effectively voting one of the big 2.
Also, I find it curious that while our community has generally settled on "incremental improvement" approach, we expect different from our governments and want the "big bang" changes. Then we are surprised when things get worse.
Also, I find it curious that while our community has generally settled on "incremental improvement" approach, we expect different from our governments and want the "big bang" changes. Then we are surprised when things get worse.
“We live in the latter. Voting for the 3rd party is effectively voting one of the big 2.”
It’s not. It sends a signal that there is a desire for something else.
It’s not. It sends a signal that there is a desire for something else.
A signal to whom? Is that signal strong enough to persist in memory until the next election cycle?
What’s the alternative? Choose between two corrupt parties?
I don't know, I'm just questioning the quality and magnitude of the signal sent by voting for a third party.
The public memory is so short and so malleable, people forget things week over week let alone the entirety of an election cycle.
The issue with third party voting is a classic case of the problem of coordinated collective action.
Would-be voters don't participate out of perceived futility or participate in the dual party system for similar reasons.
I don't know how to solve it but there does seem to be growing agitation in the electorate with the current system as it stands, with the Electoral College under public scrutiny and with media support. To me that is a signal that times are changing.
The public memory is so short and so malleable, people forget things week over week let alone the entirety of an election cycle.
The issue with third party voting is a classic case of the problem of coordinated collective action.
Would-be voters don't participate out of perceived futility or participate in the dual party system for similar reasons.
I don't know how to solve it but there does seem to be growing agitation in the electorate with the current system as it stands, with the Electoral College under public scrutiny and with media support. To me that is a signal that times are changing.
> People rationalize it by saying that voting for a 3rd party is "wasting" their vote
In reality, voting for someone who didn't win the election is a "wasted" vote. But people will say that a particular candidate has no chance of winning the election, so voting for them is "wasting" your vote. Unfortunately, because most people follow this line of reasoning, it becomes a self fulfilling prophecy.
In reality, voting for someone who didn't win the election is a "wasted" vote. But people will say that a particular candidate has no chance of winning the election, so voting for them is "wasting" your vote. Unfortunately, because most people follow this line of reasoning, it becomes a self fulfilling prophecy.
I'm just saying we need to figure out how to change the lobbying process to not allow these big players (e.g. conglomerates) to influence the political process so much. However, I do agree with you that our country has descended into tribalism not seen before, which undoubtedly helps the folks who want to undermine our democratic process.
The people who are are paying attention are not the problem.
>then over the next weeks, I received about 20 bills
I'm going through this now! It is completely baffling! I went to the ER, and then I received a steady stream of bills over a period of months. They were so numerous and so devoid of useful context that I began to worry that they were illegitimate. The billing process is absolutely insane.
I'm going through this now! It is completely baffling! I went to the ER, and then I received a steady stream of bills over a period of months. They were so numerous and so devoid of useful context that I began to worry that they were illegitimate. The billing process is absolutely insane.
For full years after we had a baby we’d get 1-2 $20 bills a month. And they could always be traced back to a specific appointment or procedure, so we didn’t argue. But yeah, it’s loco.
> These people are all acting in violation of tons of existing laws - I don't understand why this isn't prosecuted.
$$$$$$.
The Medical system is being used to transfer wealth from the working and middle classes to the capital class under the guise of "free market". That money is being used to shape legislation, buy politicians, influence elections and kill threats to the system, allowing for even greater wealth transfer.
The rigged markets of socialist Europe are far more transparent, fairer and free, whereas our "free market" is opaque, completely unfair, totally impossible to understand and offers very little in terms of real free market choice. Yet we are brainwashed to think that our system is superior, due to the propaganda the industry pumps out.
$$$$$$.
The Medical system is being used to transfer wealth from the working and middle classes to the capital class under the guise of "free market". That money is being used to shape legislation, buy politicians, influence elections and kill threats to the system, allowing for even greater wealth transfer.
The rigged markets of socialist Europe are far more transparent, fairer and free, whereas our "free market" is opaque, completely unfair, totally impossible to understand and offers very little in terms of real free market choice. Yet we are brainwashed to think that our system is superior, due to the propaganda the industry pumps out.
I don’t think you could find even one person who thinks our healthcare system is a free market system. If only we could make it a free market system I think most of the problems would solve themselves. Unfortunately, I don’t think it’s feasible to untangle the decades of junk laws. Instead, it honestly might just be a better idea to implement single-payer. At least the incentives mostly line up unlike 3rd party payer.
How can you have a free market system where the most expensive items are heart attacks, organ replacements, brain operations and other situations where you often don't have a chance to "shop around"? Unless we have price controls and socialized medicine like other more modern nations, our system will remain a failure.
People can think our system is awful and still not want the European one.
There is no single European one. There is a whole range of systems that are very different.
A lot of systems will work when the people involved are acting in good faith. And that is what's missing from the US system. US corporations and government have been captured by looters.
That’s probably the real problem.
What system do you want?
I would start by making all drugs legal without a prescription except in the rare case of a systemic risk. Antibiotics and super-bugs are one example of systemic risk. Grandma's heart medication, or Suzie's asthma inhaler are not. And of course you should be able to purchase those drugs from countries we generally would trust to create safe products: Canada, UK, France, Spain, Germany, etc.
Second, I would require that all medical products and services must have their prices acknowledged by the consumer before service is rendered. Obviously there would have to be some exceptions for extreme medical emergencies, but emergency care only makes up about 1% of healthcare costs, so that can slide.
I would disband medical unions such as the AMA, which spent decades artificially limiting supply of medical workers to keep wages sky high.
I would ban employer provided health insurance, decoupling healthcare from employment.
I would attempt to reshape the health insurance industry to actually work like insurance instead of total coverage. If you get the sniffles, just pay the market rate to visit the NP at the CVS minute clinic, get your antibiotic or whatever, and be on your way. Insurance should not be involved in that, and should be reserved for major medical emergencies or serious conditions like cancer.
I would have serious patent reform, moving pharmaceuticals to generics at a faster rate, and expedite FDA certification for generics. I would work to create a system of partner countries for healthcare certification. If your drug is approved in France, you get a greatly expedited process in the US and vice versa.
If those things didn't dramatically bring down the price of healthcare to a reasonable rate, then I'd consider some socialization of risk.
Second, I would require that all medical products and services must have their prices acknowledged by the consumer before service is rendered. Obviously there would have to be some exceptions for extreme medical emergencies, but emergency care only makes up about 1% of healthcare costs, so that can slide.
I would disband medical unions such as the AMA, which spent decades artificially limiting supply of medical workers to keep wages sky high.
I would ban employer provided health insurance, decoupling healthcare from employment.
I would attempt to reshape the health insurance industry to actually work like insurance instead of total coverage. If you get the sniffles, just pay the market rate to visit the NP at the CVS minute clinic, get your antibiotic or whatever, and be on your way. Insurance should not be involved in that, and should be reserved for major medical emergencies or serious conditions like cancer.
I would have serious patent reform, moving pharmaceuticals to generics at a faster rate, and expedite FDA certification for generics. I would work to create a system of partner countries for healthcare certification. If your drug is approved in France, you get a greatly expedited process in the US and vice versa.
If those things didn't dramatically bring down the price of healthcare to a reasonable rate, then I'd consider some socialization of risk.
That's a pretty good list.
I'd like to understand why healthcare doesn't bill using time & materials plus markup. All current pricing seems little more than make believe.
I also don't understand why different people are billed different prices. I get that different providers will likely (hopefully) have different billing rates. But isn't billing different prices for the exact same thing illegal?
I'd like to understand why healthcare doesn't bill using time & materials plus markup. All current pricing seems little more than make believe.
I also don't understand why different people are billed different prices. I get that different providers will likely (hopefully) have different billing rates. But isn't billing different prices for the exact same thing illegal?
And yet, Canadians and others come into these discussions talking about how sane and reasonable our system is, and invariably someone immediately jumps in with "yeah but at least we have CHOICE here instead of having to appear before DEATH TRIBUNALS and then going on INFINITY WAIT LISTS."
Oh, America, you will never change.
Oh, America, you will never change.
>I don't understand why this isn't prosecuted.
Simply examine the way the issue was presented by frontrunners in the supposedly liberal party of the United States on the debate stage yesterday.
Two candidates call for true universal coverage, a few call for a public option but brand it as universal coverage to confuse viewers, and several (with moderator and broadcast sponsor support) outright mislead by stating that universal coverage that eliminates private insurance will threaten access to health care.
We have a long way to go.
Simply examine the way the issue was presented by frontrunners in the supposedly liberal party of the United States on the debate stage yesterday.
Two candidates call for true universal coverage, a few call for a public option but brand it as universal coverage to confuse viewers, and several (with moderator and broadcast sponsor support) outright mislead by stating that universal coverage that eliminates private insurance will threaten access to health care.
We have a long way to go.
Three candidates actually. (Bernie, Warren, and Yang.)
...
Loss aversion is a powerful emotion with destructive effects on our politics.
Once enough people have something to lose from a change, change becomes extremely hard, even if the overall net effect would be positive.
Not only does this preserve bad policies, it turns some into a one-way ratchet--where it's easy to make things worse and very hard to make them better.
Examples
- Medical middlemen (insurance, insurance brokers, billing companies...) are pure waste. But they employ so many people and generate so much revenue that they are very hard to attack. The US has slowly climbed to ~2x the per-person medical spending of our peers... so now, any effort to reduce that to 1.9x will be met with fierce resistance.
- Prison guard unions are powerful nationally and in many states, including California. They fight any and all attempts to reduce incarceration. That was true in 1980 with ~100 prisoners per 100k population... and it's true now with ~650, by far the highest in the world.
- Realtors and car dealers essentially tax the two biggest purchases most people in America make, house and car. They have powerful lobbies in all 50 states.
There is no particular amount that will placate these rent-seekers. They just never want their income stream reduced.
...
Loss aversion is a powerful emotion with destructive effects on our politics.
Once enough people have something to lose from a change, change becomes extremely hard, even if the overall net effect would be positive.
Not only does this preserve bad policies, it turns some into a one-way ratchet--where it's easy to make things worse and very hard to make them better.
Examples
- Medical middlemen (insurance, insurance brokers, billing companies...) are pure waste. But they employ so many people and generate so much revenue that they are very hard to attack. The US has slowly climbed to ~2x the per-person medical spending of our peers... so now, any effort to reduce that to 1.9x will be met with fierce resistance.
- Prison guard unions are powerful nationally and in many states, including California. They fight any and all attempts to reduce incarceration. That was true in 1980 with ~100 prisoners per 100k population... and it's true now with ~650, by far the highest in the world.
- Realtors and car dealers essentially tax the two biggest purchases most people in America make, house and car. They have powerful lobbies in all 50 states.
There is no particular amount that will placate these rent-seekers. They just never want their income stream reduced.
They could be strung up as combined they do not have enough marketing power as a strong populist political party. Unfortunately, as we've seen, the closest USA has for this is Trump, who is playing the Republican playbook.
Both parties are economically right wing. Third party is easily squished by tribalism and system being unbalanced.
Both parties are economically right wing. Third party is easily squished by tribalism and system being unbalanced.
I strongly support the Warren/Sanders universal healthcare plan, but in terms of optics, I don't actually see what the point is to making “duplicate coverage” private insurance illegal. It invites FUD and provides a convenient bogeyman while being entirely irrelevant in practical terms. If the government is providing comprehensive free healthcare to all, why would anyone need duplicate private health insurance? There's no reason to make it illegal, because there's no reason anyone would continue to pay for it. It will shrivel up and die on its own.
The reason is so that there aren't "boutique" private practices. Keeping the rich people in the same boat as the poor people is actually quite important for the long-term health and welfare of the system. Members of the Canadian parliament have the same healthcare system as anyone else. Thus they aren't terribly tempted to cut it.
If private insurance was allowed (in Canada), the elite would have expensive plans that had physicians only caring for a few people each, and so on. This worsens the care in the general system but more importantly, it splits the interests of the elite from the general public.
If private insurance was allowed (in Canada), the elite would have expensive plans that had physicians only caring for a few people each, and so on. This worsens the care in the general system but more importantly, it splits the interests of the elite from the general public.
So how do you justify to your family that you are voting for someone who will reduce availability of very specialized treatment for them (those boutique doctors), so some random people you've never heard of can have better care "on average"?
Becuase that's where I get stuck.
Becuase that's where I get stuck.
From a selfish perspective, because you run into those random people. When your servers and your retail employees can go to the doctor instead of "waiting it out" because of medical expenses, that's less likely to make you and your family ill.
From a less selfish perspective, there but for the grace of God go you.
Hoy por ti, mañana por mi.
From a less selfish perspective, there but for the grace of God go you.
Hoy por ti, mañana por mi.
Specialized care is not synonymous with boutique care. We have a robust research and development economy in the US that will continue to exist without the perverse incentives of private insurance.
Is that why people from all over the world come to USA for cancer care, against all costs?
And people all over the world go to South Korea for plastic surgery. We don’t stop being the best because we now pay for the care for every American at the point of need.
Specialized illnesses don’t discriminate by class. Those without means don’t receive the care they need. We are fighting so that the system centers that care instead of revolving around a third party private payer that has every incentive to deny that care.
Specialized illnesses don’t discriminate by class. Those without means don’t receive the care they need. We are fighting so that the system centers that care instead of revolving around a third party private payer that has every incentive to deny that care.
Having boutique practices is what reduces the availability of very specialized treatment, not the reverse. You're stuck because your understanding is completely backwards.
Just FYI, Warren is backpedaling heavily on Medicare for All. She released her “healthcare plan” the other day and it its full of obvious outs and hedges away from M4A. Sanders is the only candidate still really fighting this fight.
Disappointing but expected.
M4A just won't work when half the country is completely against it. A public option as a stepping stone is much more feasible. We also need to stop limiting the number of doctors and nurses artificially.
It won't die, as private extra healthcare helps reduce queues, so a small amount thereof makes public services more available.
But they would never be able to outcompete it.
But they would never be able to outcompete it.
Elizabeth Warren’s plans are very vague, and only a few weeks old at this point. We still know very little about what she actually proposes. Bernie Sanders’ plans are about 5 years old at this point, and have been modified, but are rather solid.
Stories like this are scary. My employer based health insurance has an $18,000 deductible before it starts to cover 70% of approved, in-network bills. One visit to ER could easily cost me $20,000. A simple doctor visit can range from $150 to $1000. The effect is that any doctor visit is viewed as a last resort option.
Your employer is screwing the employees via a terrible grandfathered plan. Any new insurance plan after ACA would have a maximum deductible equal to out of pocket maximum, which for 2019 was $15.8k for non HSA and $13.5k with HSA.
https://www.uhc.com/employer/news/consultant/irs-sets-new-20...
https://www.cigna.com/assets/docs/about-cigna/informed-on-re...
But I’ve never heard of a deductible actually being set equal to out of pocket maximum or even anything close to it. Even the bronze family plans on healthcare.gov had deductibles of a few thousand.
https://www.uhc.com/employer/news/consultant/irs-sets-new-20...
https://www.cigna.com/assets/docs/about-cigna/informed-on-re...
But I’ve never heard of a deductible actually being set equal to out of pocket maximum or even anything close to it. Even the bronze family plans on healthcare.gov had deductibles of a few thousand.
I once went to the ER and the FIRST bill I received was from a law firm/collection agency. They actually employed a law firm to do first-line billing (which they of course double-billed, sending the bill to the insurance company and the threat to me at the same time!).
Because if they were truly investigated, our dire need for universal health care would become kite apparent and the party in power just can't have that can they?
America kills more people willingly than most other western countries. I work for a startup with a decent health insurance plan. But even then out of pocket is nuts.
For many procedures, we’ve just been avoiding going to the doctors. Doctors have been a hit and miss too. Most really don’t know what they’re talking about.
I’m kinda hopeful that someone will really commoditize common procedures and checks and will make them dirt cheap. May be amazon. Can’t say.
But shit like LapCorp and a whole swath of vulture physicians and insurance companies need to die.
US healthcare is really fucked up.
For many procedures, we’ve just been avoiding going to the doctors. Doctors have been a hit and miss too. Most really don’t know what they’re talking about.
I’m kinda hopeful that someone will really commoditize common procedures and checks and will make them dirt cheap. May be amazon. Can’t say.
But shit like LapCorp and a whole swath of vulture physicians and insurance companies need to die.
US healthcare is really fucked up.
I just got an emergency room bill. I had a severe sore throat and fever for 2 weeks, step tests came back negative. Then at night my back side started hurting so I went to the ER.
I paid $850 at the ER and today I received another bill for $850.
The only thing on the Bill just says
> "Charges": $11,680 > "Adjustmnets: $9,980
I just got off the phone with them and they say that it will take 10 business days to receive an itemized bill. However, that means the itemized bill will be delivered after the current bill is due.
How are they going to charge somebody $1700 without an itemization?
Furthermore, I am expecting another bill from the ER doctor that saw me because they bill separately and are not covered by insurance. The ER legally cant tell you if the doctor or the hospital accepts your insurance. Thats so crazy.
My wife was absolutely mortified. In brazil I never carried insurance but going to the ER I just had to pay R$400 flat fee for a private hospital. Anything else for tests they would give me the prices up front.
My wife about started screaming when the woman brought in the credit card machine while I was still in pain in the ER hospital bed. It was so embarrassing.
All this is with the top insurance my company (a ~$500 million startup) offers and to make it worse it happened when I was on a company mandated trip.
I paid $850 at the ER and today I received another bill for $850.
The only thing on the Bill just says
> "Charges": $11,680 > "Adjustmnets: $9,980
I just got off the phone with them and they say that it will take 10 business days to receive an itemized bill. However, that means the itemized bill will be delivered after the current bill is due.
How are they going to charge somebody $1700 without an itemization?
Furthermore, I am expecting another bill from the ER doctor that saw me because they bill separately and are not covered by insurance. The ER legally cant tell you if the doctor or the hospital accepts your insurance. Thats so crazy.
My wife was absolutely mortified. In brazil I never carried insurance but going to the ER I just had to pay R$400 flat fee for a private hospital. Anything else for tests they would give me the prices up front.
My wife about started screaming when the woman brought in the credit card machine while I was still in pain in the ER hospital bed. It was so embarrassing.
All this is with the top insurance my company (a ~$500 million startup) offers and to make it worse it happened when I was on a company mandated trip.
I am not a lawyer or financial advisor. But I’ve heard that you can’t be sent to collections if you make a good faith attempt to pay your (medical) bill. Which in practice might mean you just pay $5 while you wait for the itemization
Our first born came with a $42k bill. Hospital and doctor said we were covered by our insurance pre-auth, but come bill time apparently pre-auth was null and void b/c it was requisite on a negotiation that fell through. Each side had a different story and their representatives acted absolutely helpless.
We were broke at the time we found out about the pregnancy and memories of the first two years of my boy's life are largely dominated by this kafka-esque nightmare that took time and security away from our family life. I refused to pay a cent until what we were told was honored, my thinking being any sort of payment may legitimize it.
Eventually I didn't hear back from the hospital about our latest contestation for two months after confirming their receipt of the documentation (about a four hour process each submission, always new fax numbers, life-wasting hold times to confirm receipt of said documentation, transfers to other agents and departments, then a promise of giving a decision in a few weeks, often just reprinting the last non-descript document they used in the previous round without any real detail). Decided to just do nothing and ignore it as long as I didn't get contacted again and got everything ready to go to court if someone ever decided to pursue it against us again. The documentation I've been holding from the ordeal is 60 pounds of paper.
I still have no idea what the true status is, but it hasn't shown up on credit checks and our boy is now 5 years old.
I could not find anyone in various governmental institutions to even look into the matter and the lawyers I talked to said the outlook of winning was grim and would have cost a lot of money on top of that to even pursue it. Our insurance company [Anthem] posted a $17 billion profit that year. The hospital had the highest gross profit of any hospital in our city and the surrounding area at $80.4 million declared. Both entities make so much money they give away individual debts amounting in the tens of thousands of dollars for pennies (maybe ours included?).
It's an absolutely depraved system and my point is maybe be careful showing good faith to an entity trying to screw you lest it be taken as consent.
We were broke at the time we found out about the pregnancy and memories of the first two years of my boy's life are largely dominated by this kafka-esque nightmare that took time and security away from our family life. I refused to pay a cent until what we were told was honored, my thinking being any sort of payment may legitimize it.
Eventually I didn't hear back from the hospital about our latest contestation for two months after confirming their receipt of the documentation (about a four hour process each submission, always new fax numbers, life-wasting hold times to confirm receipt of said documentation, transfers to other agents and departments, then a promise of giving a decision in a few weeks, often just reprinting the last non-descript document they used in the previous round without any real detail). Decided to just do nothing and ignore it as long as I didn't get contacted again and got everything ready to go to court if someone ever decided to pursue it against us again. The documentation I've been holding from the ordeal is 60 pounds of paper.
I still have no idea what the true status is, but it hasn't shown up on credit checks and our boy is now 5 years old.
I could not find anyone in various governmental institutions to even look into the matter and the lawyers I talked to said the outlook of winning was grim and would have cost a lot of money on top of that to even pursue it. Our insurance company [Anthem] posted a $17 billion profit that year. The hospital had the highest gross profit of any hospital in our city and the surrounding area at $80.4 million declared. Both entities make so much money they give away individual debts amounting in the tens of thousands of dollars for pennies (maybe ours included?).
It's an absolutely depraved system and my point is maybe be careful showing good faith to an entity trying to screw you lest it be taken as consent.
You absolutely did the right thing in not paying a cent. There is virtually zero chance you will ever hear another word about it.
The $42k is a fantasy figure which they collect approximately 0% of the time. It's the easiest $42k you ever saved.
The $42k is a fantasy figure which they collect approximately 0% of the time. It's the easiest $42k you ever saved.
Is there any way to get this sort of advice for ordinary people easily? I remember when I was an exchange student to the US from Hong Kong and I got a flu, I thought I'd get it checked out just in case. I went to a clinic and they told me to get into a medical robe for a checkup and I thought wtf. I also remembered about reading all these horror stories. Of course it might not have been that bad since I didn't go through with the checkup but it's very different from what we have in hk and China where the doctor just takes a look at you, blood test at most, and gives you some pills, usually for no more than 40usd max
Why aren’t US citizens queuing up to emigrate?
At this stage, it seems like the US is the “land of the free”, whereby “freedom” is defined as the ability to freely exploit everyone.
At this stage, it seems like the US is the “land of the free”, whereby “freedom” is defined as the ability to freely exploit everyone.
Emigration is hard, and emigrating somewhere remotely decent is even harder (because everyone wants to do the same thing as you). I’d also wager that the people who truly need to leave have the least means to do so. Getting into Canada or Western Europe requires at least a college degree, and probably being in a sought-after field. And by that point, you’re probably doing okay in America (for now). I mean, I live comfortably, although even good insurance and a high salary isn’t a guarantee that you’ll be okay. I’ve thought of moving, but the difficulty (logistically and psychology) and the fact that I really am comfortable make it unrealistic at the moment.
I agree, though, the masses are exploited (us included), and it’s troubling.
I agree, though, the masses are exploited (us included), and it’s troubling.
most are still stuck in the loyalty type mentality buffered by things like patriotism and national anthems and flags for any event with >5 people and a TV camera.
50 years ago people had the same loyalty towards their companies, and look where that got US manufacturing workers. nowadays you'd be nuts to expect to stick with a company for 10 years. get yours and get out: others be damned.
so it shall be with citizenship. as more and more citizens have more and more power to up and leave, or work outside the confines of the US without too much hassle, questions such as "what on earth are we still doing here?" will be asked, at first in whispers (as they are now), later in louder volumes.
where things go from there, anyone knows.
50 years ago people had the same loyalty towards their companies, and look where that got US manufacturing workers. nowadays you'd be nuts to expect to stick with a company for 10 years. get yours and get out: others be damned.
so it shall be with citizenship. as more and more citizens have more and more power to up and leave, or work outside the confines of the US without too much hassle, questions such as "what on earth are we still doing here?" will be asked, at first in whispers (as they are now), later in louder volumes.
where things go from there, anyone knows.
Last time I went to the ER I got an itemized bill in a week for $300 or so.
All medical imaging I've had done has had pricing given up front showing what they where going to bill the insurance company and what the insurance company was going to pay and what I'd have to pay.
My non-emergency visits have a $40 copay up front.
Only the nightmare cases get talked about.
All medical imaging I've had done has had pricing given up front showing what they where going to bill the insurance company and what the insurance company was going to pay and what I'd have to pay.
My non-emergency visits have a $40 copay up front.
Only the nightmare cases get talked about.
Conjecture is silly when there's good data to be had.
The number one cause of bankruptcy in the United States:
> "medical expenses"[0]
The average amount charged for an ER visit in the United States:
> between 2008 and 2017, the average price of hospital ER visits rose 135 percent, from $393 to $924[1]
The cost of an ambulance ride in the United States:
> $164/mile[2]
And make sure to compound the monetary cost with the cost of people avoiding medical care out of fear and unknowns surrounding the actual monetary cost.
[0] take your pick of any study done by anyone
[1] https://www.beckershospitalreview.com/finance/average-cost-o...
[2] https://www.consumerreports.org/consumerist/164-per-mile-sur...
The number one cause of bankruptcy in the United States:
> "medical expenses"[0]
The average amount charged for an ER visit in the United States:
> between 2008 and 2017, the average price of hospital ER visits rose 135 percent, from $393 to $924[1]
The cost of an ambulance ride in the United States:
> $164/mile[2]
And make sure to compound the monetary cost with the cost of people avoiding medical care out of fear and unknowns surrounding the actual monetary cost.
[0] take your pick of any study done by anyone
[1] https://www.beckershospitalreview.com/finance/average-cost-o...
[2] https://www.consumerreports.org/consumerist/164-per-mile-sur...
ER visits at 924 are still far below the stories in this thread of 4-5 digit $ visits for simple issues.
The OOP is still averaging under 300, again, not the horror stories in this thread.
Problems exist, but it seems that only a small % of providers are horribly abusing the system.
(of course a small % across over 300 million people is still a lot of harm!)
The OOP is still averaging under 300, again, not the horror stories in this thread.
Problems exist, but it seems that only a small % of providers are horribly abusing the system.
(of course a small % across over 300 million people is still a lot of harm!)
USD 900 for an ER visit is a horror story too. Where does someone without savings get that kind of money from? At least it seems difficult for many: https://money.cnn.com/2018/05/22/pf/emergency-expenses-house...
I don't live in the US and I'm not American so perhaps I'm missing some information.
I don't live in the US and I'm not American so perhaps I'm missing some information.
It needs to be fixed, but a $900 average that includes $200 charges for a $25 "medical boot" and charges for a $30 bandaid sounds like it may be not too hard to reduce costs across the entire board.
If the average ER visit was 5K of unknown miscellaneous charges than that would indicate nationwide maliciousness on the part of nearly all hospitals. If only a small # of hospitals are engaging in that level of unfair billing, then they can possibly be investigated one by one.
It is the same thing as "we have thousands servers that are crashing at random multiple times a day" versus "we have a bunch of servers that are low on RAM, and a couple servers that crash 5 times a day."
Neither scenario is good to be in, but it is possible to get a hand on the latter scenario, while in the first scenario a "burn it all down and rewrite" fix might be appropriate.
If the average ER visit was 5K of unknown miscellaneous charges than that would indicate nationwide maliciousness on the part of nearly all hospitals. If only a small # of hospitals are engaging in that level of unfair billing, then they can possibly be investigated one by one.
It is the same thing as "we have thousands servers that are crashing at random multiple times a day" versus "we have a bunch of servers that are low on RAM, and a couple servers that crash 5 times a day."
Neither scenario is good to be in, but it is possible to get a hand on the latter scenario, while in the first scenario a "burn it all down and rewrite" fix might be appropriate.
Which metrics do you measure, optimize for your web services? P90 & P99?
Why would health care be any different?
Why would health care be any different?
For one, probably because these stories are the exception? I know a bunch of people will probably tell me I'm wrong and I might be (haven't used the US health system in a 3 or 4 years since I moved out) but for most people their insurance just covers it (or medicade if they're old).
Otherwise most people don't want to leave their friends and family
Note: not defending the horrible system. Only suggesting that most people using their company provided insurance probably don't run into these issues.
Otherwise most people don't want to leave their friends and family
Note: not defending the horrible system. Only suggesting that most people using their company provided insurance probably don't run into these issues.
Company provided insurance, only cost us $5k to have a healthy pregnancy followed by a healthy baby, with no special circumstances. This was the usual “negotiated” cost. Why not print $2mil for a yearly wellness check while you’re at it, and then give a generous 1.9mil discount? The whole system is absolutely positively bonkers. How much of my premium is going to professional negotiators for insurance, and how much of my hospital costs are going to professional negotiators for hospitals?
Not much. Your premium is going towards paying for the $1M NICU cases where it takes extreme interventions and the $1M/month hemophilia patients. Even a population of a small state like Iowa can have problems distributing costs like that.
https://www.desmoinesregister.com/story/news/health/2017/05/...
https://www.desmoinesregister.com/story/news/health/2017/05/...
I think distributing the costs is entirely reasonable; warranted, even. That is, after all, why insurance works at all. Distributing the cost by inflating receipts is, no matter how altruistic or “necessary” you may think it to be, a fraud.
I'm a lifelong patient. I currently have great coverage.
I don't know how it's possible, but our healthcare system has been getting worse every year. Even simple stuff like refilling scripts has become Kafka Meets Keystone Kops. The insurer has interjected itself into every single transaction, second guessing everything, adding ever more hoops to jump thru.
It's a wonder that we even bother with doctors any more, since the insurers apparently know better than my doctors.
Things are so bad, I wouldn't even know where to start if anyone wanted to fix things.
Better to just start over.
I don't know how it's possible, but our healthcare system has been getting worse every year. Even simple stuff like refilling scripts has become Kafka Meets Keystone Kops. The insurer has interjected itself into every single transaction, second guessing everything, adding ever more hoops to jump thru.
It's a wonder that we even bother with doctors any more, since the insurers apparently know better than my doctors.
Things are so bad, I wouldn't even know where to start if anyone wanted to fix things.
Better to just start over.
Because most of these stories are extremes. All my friends' pregnancies and major surgeries came with some hefty "residual" bills, but all got negotiated down or tossed. If you stand up to them they'll back off. About 80-90% of America has insurance that is "ok" and will keep you from going bankrupt. It's not as bad overall (big picture) as the anecdotes portray. Don't forget there are 340 million people in the USA (1% is still 3.4 million people, plenty of room there for stories to arise). It still really sucks and we need price controls and public option for insurance though. Also fear of the unknown, leaving your family behind, other countries in general don't like Americans unless you bring a few million dollars with you, other countries seem to have a very high barrier to foreigners working there, etc get in the way.
At least what we know is that currently the flow of migration is reversed with a lot of European countries. Many countries like all the northern countries, Netherlands, Switzerland, or even Spain have more Americans moving than their own citizen settling in the US.
Seriously thinking about it.
I am also a British citizen, so I'm at least waiting to see how this whole Brexit thing shakes out.
I am also a British citizen, so I'm at least waiting to see how this whole Brexit thing shakes out.
Australia has the largest British ex pat population: https://en.wikipedia.org/wiki/British_diaspora#Institute_for...
If you're considering somewhere in the EU other than Britain or Ireland, you should probably aim to be registered as resident before 31 October.
[deleted]
You'll probably get a bill in a few years for 10% of the original amount from a bill collector the debt got sold to. Don't pay that either. They should have made sure your insurance covered it, so the onus is on them.
That would "acknowledge the debt" or something like that from what I understand?
From what I understand it, it doesn’t mean you acknowledge that the entire bill is for the correct amount. Also if you know you’re going to have to pay at least $5 out of pocket anyway you’re not really losing money. But again IANAL I’m just parroting advice I read on Reddit one time
Insurance companies negotiate a lot of this stuff away. The poster needs to call them first, see if they can arrange a $5 payment without addition interest while the itemized bill comes in (honestly, there is legal ground here for not even being willing to honor any of the bill with itemization).
Get on the phone, try to keep cool, but realize you're probably going to yell at some poor customer service rep at some point. Apologize, keep going and get the full bill before you agree to pay anything. Then you gotta do the same thing with the full bill on ever bullshit charge, over and over again.
Honestly, how the fuck can they admit you and treat you and then bill you without telling you what the prices are up front? That's fucking madness right there. Imagine having to agree to having car or bicycle service without an estimate? Imagine the total cost being $2000 over the estimate? Would people pay? Of course not; it's worth it at that point to call a lawyer.
Get on the phone, try to keep cool, but realize you're probably going to yell at some poor customer service rep at some point. Apologize, keep going and get the full bill before you agree to pay anything. Then you gotta do the same thing with the full bill on ever bullshit charge, over and over again.
Honestly, how the fuck can they admit you and treat you and then bill you without telling you what the prices are up front? That's fucking madness right there. Imagine having to agree to having car or bicycle service without an estimate? Imagine the total cost being $2000 over the estimate? Would people pay? Of course not; it's worth it at that point to call a lawyer.
The trouble is that in an emergency or urgent situation, you can’t really shop around for service. “I’m having a heart attack, but can we try the hospital in the next town over? Their cardiologist is cheaper.” Bike service is a leisurely afternoon; emergency medical care is not.
It shouldn’t cost that much in the first place. You shouldn’t need to shop around for health care, and you shouldn’t be bankrupted by an emergency. Why people aren’t marching through the streets right now is beyond me.
It shouldn’t cost that much in the first place. You shouldn’t need to shop around for health care, and you shouldn’t be bankrupted by an emergency. Why people aren’t marching through the streets right now is beyond me.
At least one hospital was pretty aggressive:
https://www.washingtonpost.com/health/uva-has-ruined-us-heal...
https://www.washingtonpost.com/health/uva-has-ruined-us-heal...
if it was a work trip on company business, why wouldn't worker's comp kick in?
Talk to a lawyer.
Also, talk to your company. If it's a company trip, they may be on the hook this.
Any reasonable company should be taking out insurance for work mandated outings
Federal law means your insurance has to pay for emergency room care. They do like to try to weasel out of it by saying you actually have a true emergency though. You can push back and get your state insurance regulator involved.
Isn't this why the costs are so outrageous? The guaranteed insurance coverage means hospitals know they can charge whatever they want. This is why I'm not psyched about single payer healthcare solutions: It's not solving the problem, and may just mean huge government waste.
It'd be far more effective to aggressively regulate hospital billing, wouldn't it?
It'd be far more effective to aggressively regulate hospital billing, wouldn't it?
ERs are mandated to provide emergency care to anyone regardless of insurance status. They get sweet tax deductions to do so and they get reimbursed by medicare as well. Also they have to take every insurance. There's a limit though, usually they will do enough to stabilize you out of immediate danger. So if you go to the ER with cancer and no insurance they may help you stabilize but they won't necessarily treat your cancer.
> It's not solving the problem, and may just mean huge government waste.
You should look into the efficiency of medicare and medicaid if you're really worried about this. It might put some of your fears to rest.
You should look into the efficiency of medicare and medicaid if you're really worried about this. It might put some of your fears to rest.
Depends on whether hospitals execute efficiently on the capital they raise from bad billing practices. If they are, regulating billing either won't change the final costs, or degrade service.
That Single visit @ 11.5 k is about my total tax bill for a year in the UK.
This year I had sepsis and had a two week stay in hospital - o dread to think what that would have cost
This year I had sepsis and had a two week stay in hospital - o dread to think what that would have cost
A couple things you should know. First, there is no such thing as late fees or interest on a hospital bill. Second, if you have called to question the bill, they cannot send it to collections until they have fulfilled your reasonable requests for more information.
If you really did just get the bill it will be several months (and several more copies of the bill sent to you) before a final bill would show up that would indicate the account is "PAST DUE" and heading for collections.
IANAL but you can safely wait for the itemized bill.
In the future to save on costs, you might try to find a 24-hour Urgent Care instead of full-fledged ER. Unfortunately the level of equipment that they have to keep in a full ER means just having someone in a bed costs them a lot of money, even if they are just swabbing your throat for a strep test.
If you really did just get the bill it will be several months (and several more copies of the bill sent to you) before a final bill would show up that would indicate the account is "PAST DUE" and heading for collections.
IANAL but you can safely wait for the itemized bill.
In the future to save on costs, you might try to find a 24-hour Urgent Care instead of full-fledged ER. Unfortunately the level of equipment that they have to keep in a full ER means just having someone in a bed costs them a lot of money, even if they are just swabbing your throat for a strep test.
Re. the comment about ER equipment costs, I think people wouldn't be so mad if ER's didn't amortize the cost over every service they provide during a stay (like charging $40 for a tylenol equivalent) and instead billed simple services as reasonably as possible and put the bulk of the cost into the stay itself. Is there any reason why they don't do that? If they do that, then people can easily see that an ER costs money to operate due to the equipment and that the bulk of the payment they are making is towards that.
First, there is no such thing as late fees or interest on a hospital bill.
Sure, just like you can't charge extra for using a credit card in California as payment in most scenarios (you can get a cash discount though). There may not be late fees, but the hospital will absolutely offer to settle for a hefty discount if you pay ASAP.
By the time you get something claiming "PAST DUE" the hospital may be less willing to negotiate.
Sure, just like you can't charge extra for using a credit card in California as payment in most scenarios (you can get a cash discount though). There may not be late fees, but the hospital will absolutely offer to settle for a hefty discount if you pay ASAP.
By the time you get something claiming "PAST DUE" the hospital may be less willing to negotiate.
That’s not necessarily true. They would rather get something than nothing.
That’s not necessarily true. They would rather get something than nothing.
Who said anything about getting nothing? If the hospital sells your debt to a collection agency they get something. If the hospital deals with it in house they can act like UVA[1] and sue you to garnish your wages or take out a lien on your property. Playing chicken with the hospital billing department is a bad way to deal with medical debt.
1: https://www.washingtonpost.com/health/uva-has-ruined-us-heal...
Who said anything about getting nothing? If the hospital sells your debt to a collection agency they get something. If the hospital deals with it in house they can act like UVA[1] and sue you to garnish your wages or take out a lien on your property. Playing chicken with the hospital billing department is a bad way to deal with medical debt.
1: https://www.washingtonpost.com/health/uva-has-ruined-us-heal...
For whatever reason, the cost issue is completely missing from the dem primary debates on healthcare. Everything so far has been focused on health insurance coverage, and the candidates are really just debating what is the best way to cover more people.
A world where 100% of Americans are covered under the existing healthcare system is still a disaster because everything still costs so much between premiums, deductibles, copays and coinsurance. And on top of that, patient responsibility is still largely unknown until post treatment.
If you look at the cheapest Bronze plans on the Obamacare market, you're probably looking at $400/month for the premium with a $7500+ deducible for a single person. If someone is coerced into buying insurance and they can barely afford the premium, how is that something worth celebrating?
A world where 100% of Americans are covered under the existing healthcare system is still a disaster because everything still costs so much between premiums, deductibles, copays and coinsurance. And on top of that, patient responsibility is still largely unknown until post treatment.
If you look at the cheapest Bronze plans on the Obamacare market, you're probably looking at $400/month for the premium with a $7500+ deducible for a single person. If someone is coerced into buying insurance and they can barely afford the premium, how is that something worth celebrating?
Thank you so much for bringing this up! This is one point that has really irked me in the current discussions. It should be about common sense access and lowered, transparent costs.
In the UK, I could walk into a Boots (pharmacy), speak to someone there and get prescription eyedrops for cheap for an infection vs the crap you have to wade through in the US. Same for other doctor/healthcare visits I've had around the rest of the world.
In the UK, I could walk into a Boots (pharmacy), speak to someone there and get prescription eyedrops for cheap for an infection vs the crap you have to wade through in the US. Same for other doctor/healthcare visits I've had around the rest of the world.
Exactly. I don't care about health insurance costs as much as I can about health care costs.
Instead of MAGA maybe Make American Health Cheap?
I had a deep split over my eye (metal ring tossed while I was still down range) and knew going to the ER for stitches would end up costing thousands for a five minute stitch job, so I pinched it together and put on superglue. Healed better than stitches and cost me nothing. I hate our medical system too.
Loctite (blue package) works as good as superglue but stings a lot less.
You mean Loctite’s blue-package cyanoacrylate right, not their thread locker. Right?
Absolutely.
When you say superglue, do you mean an off the shelf superglue that you would pick up at a hardware or craft supplies store? Did it just dissolve on its own after X number of days?
Yes, cyanoacrylate (the group of adhesives that superglue belongs to), are used in medical and veterinary situations for exactly this purpose.
https://en.wikipedia.org/wiki/Cyanoacrylate#Medical_and_vete...
I've used off-the-shelf superglue on cut fingertips where I couldn't get bandages to stay. I believe it's also commonly used in place of stitches where you don't want the scarring that stitching would cause (e.g., parts of the face.)
It wears off in 3-4 days.
https://en.wikipedia.org/wiki/Cyanoacrylate#Medical_and_vete...
I've used off-the-shelf superglue on cut fingertips where I couldn't get bandages to stay. I believe it's also commonly used in place of stitches where you don't want the scarring that stitching would cause (e.g., parts of the face.)
It wears off in 3-4 days.
Yes I used some old super glue lying around the house. I was worried at first because even though I pinched it together, a large amount of glue went into the gash and so I was left with a hard shell over the wound and a clump of glue in the gash. But after 4-5 day the shell peeled off and the clump of glue fell out and even though the cut was completely through the skin, it healed perfectly. It was like the skin bitter together under the lump of glue until the clump was pushed out. I’m no doctor and only know about the glue because my mechanic brother in law uses it for every cut and gash he’s ever had.
Pretty sure if you go through the effort to challenge such charges you can get them changed. https://www.vox.com/2019/3/22/18261698/how-to-fight-expensiv...
That lawyer's name is Sue Null!?!?
You would need to do this for every change, every time. Hardly a good solution.
Opt-out vs Opt-in
You need very strong nerves. Their collectors can be very aggressive.
Incredibly useful phrase: "I'd love to get this in front of a judge."
The thing I don't understand about tips like these is, what obligation does the other party have to cooperate at all? Like you "ask for a supervisor" (and then a director!) what incentive do they have to not just say no? Or if you ask for an itemized bill, what if they just refuse? How are you supposed to get past a blunt refusal, which to me seems like the easiest response for them?
Once upon a time, I had a surprise bill for about $4,000 that health insurance decided should have been $700 for that procedure. I fought it and won. But it took forever, almost a year of calling them and going back and forth - and this was actually decent corporate health insurance.
It took a lot of reading through the 600+ page plan document and finding loopholes. For example, I asked them that if they thought it should be done for $700, who would actually do it for $700? They couldn't list one provider that would accept the payment rate they thought they should pay. And since this was a reimbursement, and they had already pre-approved the procedure (knowing the price), I think I caught them already saying they would do it, but them not following through. There was a lot of going back and forth about in-network vs out of network, but again, no one in-network would perform the procedure. In the fine print of the plan document, it said if there are no in-network providers, the plan must provide you were in-network rates and deductibles for using an out-of-network provider.
So I told them if they can't find anyone who will accept what they are willing to pay, their figure is obviously wrong. It helped that with my health insurance, everything was supposed to be covered, 100% with no copay. So the fact that they tried to charge me for the $3300 overage was very out of line for them.
They never just said "no, we're not going to cooperate" it was more just endless stalling on their part. It was never really a blunt refusal, or if they tried that, I just proved how ridiculous their arguments were. I kept a lot of documentation.
I think in the end, they just relented because they were spending more dealing with me than actually just paying me my money. But it was certainly an uphill battle the whole way, and not one I would recommend to someone who isn't well versed in legalese.
It took a lot of reading through the 600+ page plan document and finding loopholes. For example, I asked them that if they thought it should be done for $700, who would actually do it for $700? They couldn't list one provider that would accept the payment rate they thought they should pay. And since this was a reimbursement, and they had already pre-approved the procedure (knowing the price), I think I caught them already saying they would do it, but them not following through. There was a lot of going back and forth about in-network vs out of network, but again, no one in-network would perform the procedure. In the fine print of the plan document, it said if there are no in-network providers, the plan must provide you were in-network rates and deductibles for using an out-of-network provider.
So I told them if they can't find anyone who will accept what they are willing to pay, their figure is obviously wrong. It helped that with my health insurance, everything was supposed to be covered, 100% with no copay. So the fact that they tried to charge me for the $3300 overage was very out of line for them.
They never just said "no, we're not going to cooperate" it was more just endless stalling on their part. It was never really a blunt refusal, or if they tried that, I just proved how ridiculous their arguments were. I kept a lot of documentation.
I think in the end, they just relented because they were spending more dealing with me than actually just paying me my money. But it was certainly an uphill battle the whole way, and not one I would recommend to someone who isn't well versed in legalese.
These stories are horrifying to me. I live in a less developed country than the US, other businesses may be crooked and all but at least the medical field is manageable.
If they give in to the few people who have the initiative to complain, they likely placate the few people who'd have the initiative to demand change.
See also, the TSA precheck systems. By allowing people like frequent flying businessmen and politicians to avoid the standard TSA experience, they reduce the likelihood that such people might use their influence to advocate against the TSA, for the betterment of all passengers.
See also, the TSA precheck systems. By allowing people like frequent flying businessmen and politicians to avoid the standard TSA experience, they reduce the likelihood that such people might use their influence to advocate against the TSA, for the betterment of all passengers.
Generally, these excessive bills are, to put it mildly, of questionable legality. If you complain, they assume you're the type with enough savvy to maybe sue them, so they'll give in to placate you. And yet they do this anyway, knowing that some people will not properly contest the bill.
See also the US unemployment benefits situation, where many employers will contest an unemployment insurance claim by default even when the worker is actually eligible, in the hopes that some workers will not navigate the bureaucracy well enough to fight back. Because of the weakness of their case, however, they will then back down as soon as their denial is challenged.
See also the US unemployment benefits situation, where many employers will contest an unemployment insurance claim by default even when the worker is actually eligible, in the hopes that some workers will not navigate the bureaucracy well enough to fight back. Because of the weakness of their case, however, they will then back down as soon as their denial is challenged.
Sometimes the first price quoted is just a formality. One time my significant other went to an optometrist for a contacts prescription, without optical insurance (long story), and the bill was for $1000. She emailed asking why, and they just replied "here's your updated bill: $250"
I was reminded of this just yesterday by a similarly simple story: https://twitter.com/chrisalbon/status/1172161958759395333
It's sort of like "add to cart to see the real price" but they can't say that. And sometimes hospitals are in a different mode where they fight for it. It's not logical, it's screwed up, but anyway the first bill is usually just fake.
I was reminded of this just yesterday by a similarly simple story: https://twitter.com/chrisalbon/status/1172161958759395333
It's sort of like "add to cart to see the real price" but they can't say that. And sometimes hospitals are in a different mode where they fight for it. It's not logical, it's screwed up, but anyway the first bill is usually just fake.
Even worse, the people that would fight are often: dead, incapacitated, have age related mental issues, or old enough to not care to fight...
[deleted]
It might be that a blunt refusal would look bad in court if the billed party took them there.
I've thought about this aspect, but the thing is, how would you ever even show you were refused without a recording? (Say if you're in a 2-party-consent state? Which they would obviously not consent to?)
Civil cases are based on preponderance of evidence, and your testimony is evidence. If they refute it and they're lying, that's a felony, and I don't think these professionals are being paid enough to commit felonies for their employer.
This reminds me of another question I've had -- does anyone ever get prosecuted for false testimony? I feel like I don't really hear of this happening, which has always baffled me.
Young and middle-aged people need to vote. I've been in and out of hospitals for the last few years, months, days, hours with relatives, and guess what they don't ever worry about: medical bills. Like never.
And guess what they won't ever vote for: Those of us younger than 65 ever having the same luxury. We may be visiting them in the hospital every day, but they don't really see us.
And it's hard, because our generation loves them and wants the best for them, but most of us know we won't ever get the same quality of care for ourselves unless something changes...and as a human, well, you know, you get kinda bitter counting up "Wow, this is awesome, but what would it cost if I had this happen to me?"
Vote, people, because if our elderly are getting state-of-the-art amazing life-saving care, why shouldn't our young people, upon which our economy depends, be getting the same great service?
And guess what they won't ever vote for: Those of us younger than 65 ever having the same luxury. We may be visiting them in the hospital every day, but they don't really see us.
And it's hard, because our generation loves them and wants the best for them, but most of us know we won't ever get the same quality of care for ourselves unless something changes...and as a human, well, you know, you get kinda bitter counting up "Wow, this is awesome, but what would it cost if I had this happen to me?"
Vote, people, because if our elderly are getting state-of-the-art amazing life-saving care, why shouldn't our young people, upon which our economy depends, be getting the same great service?
Are you referring to Medicare part A and B coverage? They paid out the whole $50k bill for triple coronary artery bypass. Apparently they cover 60 days of inpatient hospital stay for any health issue. I hope I have this coverage when we hit 65....
It is amazing...then, if you ever get alllll the way down to their private insurance policies, you find that they are nothing like our generation's insurance policies...they actually pay for stuff and have low deductibles!
I try not to get too bitter about it, though, because their great coverage means we don't go bankrupt trying to help them: we're very lucky for that (although eldercare is a whole other ball of wax)...
It just kills me to see all of these young people begging on GoFundMe just to afford insulin -- and dying! Over insulin! -- while it's stockpiling pretty nicely in Medicare-recipients' closets thanks to overzealous pharmacies that know Medicare will pay for whatever they keep shipping, and seeing young people cobbling together their own makeshift slings for broken bones while so many nonagenarians are technically part-robot thanks to Medicare's great coverage.
I try not to get too bitter about it, though, because their great coverage means we don't go bankrupt trying to help them: we're very lucky for that (although eldercare is a whole other ball of wax)...
It just kills me to see all of these young people begging on GoFundMe just to afford insulin -- and dying! Over insulin! -- while it's stockpiling pretty nicely in Medicare-recipients' closets thanks to overzealous pharmacies that know Medicare will pay for whatever they keep shipping, and seeing young people cobbling together their own makeshift slings for broken bones while so many nonagenarians are technically part-robot thanks to Medicare's great coverage.
Ok so know that you can go against this.
I was once charged $1,500 for a doctor to talk to me (without ever touching my physical body) to “prescribe” me over the counter motrin....
I then questioned them on this and they said “well it was a prescription” : i said you never even physically touched me. “So im going to tell you what this was worth to me: $50”
They then said “okay we will charge you $297 for the visit”
I said “you made me wait over 45 minites before even seeingg me, at 9:00 pm when i was the only person in the waiting room. NO; im am going to charge YOU $50 for my time wasted”
The dropped the entire bill completely.
Good samaritan hospital in los gatos ca.
(Where my grandmother worked for decades, and after el camino hospital bout them and i was the technology designer for their upgrade)
You can negotiate codes with hospitals.
Source: i have built more than ten hospitals; el camino, good sam, ucsf, nome, sequoia , zucks sf gen, etc...
Dont let their coding depts fuck with you - take a stand.
I was once charged $1,500 for a doctor to talk to me (without ever touching my physical body) to “prescribe” me over the counter motrin....
I then questioned them on this and they said “well it was a prescription” : i said you never even physically touched me. “So im going to tell you what this was worth to me: $50”
They then said “okay we will charge you $297 for the visit”
I said “you made me wait over 45 minites before even seeingg me, at 9:00 pm when i was the only person in the waiting room. NO; im am going to charge YOU $50 for my time wasted”
The dropped the entire bill completely.
Good samaritan hospital in los gatos ca.
(Where my grandmother worked for decades, and after el camino hospital bout them and i was the technology designer for their upgrade)
You can negotiate codes with hospitals.
Source: i have built more than ten hospitals; el camino, good sam, ucsf, nome, sequoia , zucks sf gen, etc...
Dont let their coding depts fuck with you - take a stand.
Awesome story, any good references for you to date medical coding based off your background?
Codes are negotiated costs between insurance providers and hospitals, individually. So a cost for the same procedure at one hospital or another can be different.
Frankly you should challenge every single hospital charge you ever receive, they will always go lower.
As an example, just two weeks ago I made an appointment to go see a doctor. They called me back (kaiser) and said “ just come into the ER”
I said why, they said I don’t know, that’s what they told me to tell you.
So I called and verified my copay $30 and coverage etc.
When I got there they took my blood pressure asked a few questions, and then gave me the prescription I was asking for.
When I went to pay they tried to charge me $250
I said fuck you, I called and made an appointment, my co pay is $30 so that’s all I’m paying you period.
They conceded and accepted.
Frankly you should challenge every single hospital charge you ever receive, they will always go lower.
As an example, just two weeks ago I made an appointment to go see a doctor. They called me back (kaiser) and said “ just come into the ER”
I said why, they said I don’t know, that’s what they told me to tell you.
So I called and verified my copay $30 and coverage etc.
When I got there they took my blood pressure asked a few questions, and then gave me the prescription I was asking for.
When I went to pay they tried to charge me $250
I said fuck you, I called and made an appointment, my co pay is $30 so that’s all I’m paying you period.
They conceded and accepted.
I always think that in threads like this one a little name and shame is called for.
Most people would be surprised how closely hospitals and other medical companies pay attention to their social media and Google alerts.
Most people would be surprised how closely hospitals and other medical companies pay attention to their social media and Google alerts.
Sorry about your friend.
Similar to your situation, I went to a dermatologist concerned about a bump. Turned out to be a skin tag which she cheerily said "We can take care of this right now" and snipped. That snip cost $250 (wasn't on the genitals but was close enough for them to bump up the cost). I called their billing company and spoke to their office manager. She said that "the doctor just wants to make sure customers are happy and doesn't really concern herself with the billing part" when I brought up that if something is going to cost something they should say so upfront if it's something not necessary.
Thanks for the heads up about the glue. They really do take advantage even when you're a bad situation.
Similar to your situation, I went to a dermatologist concerned about a bump. Turned out to be a skin tag which she cheerily said "We can take care of this right now" and snipped. That snip cost $250 (wasn't on the genitals but was close enough for them to bump up the cost). I called their billing company and spoke to their office manager. She said that "the doctor just wants to make sure customers are happy and doesn't really concern herself with the billing part" when I brought up that if something is going to cost something they should say so upfront if it's something not necessary.
Thanks for the heads up about the glue. They really do take advantage even when you're a bad situation.
It’s worth writing a long article about. In the US there’s no cost conscious party that does price shopping or similar to bring the costs down. There’s only cost pushing parties. Hospitals pushes it to insurance, insurance to employers and employers to the govt as a tax write off. The person getting the treatment only looks at where the “best” care is. That is usually a code word for finding the most expensive hospital my insurance will cover. Insurances don’t have the power - and also they mostly don’t care - to negotiate with hospitals. Employers have to provide coverage by law. So they do the least they can to satisfy it. Who in this system keeps the costs in check?
The insurers would be able to keep the costs in check, IF the employers were taken out of the equation. With employers, especially white collar ones, siphoning the healthy lives into their own separate insurance pools, the remaining pool of lives is costly to insure and thus only a very small number of insurers can afford to exist. If the pool of healthy lives was bigger to offset the cost of the sick lives, then multiple insurance companies can exist and compete on healthcare.gov to offer lower premiums which they can offer because they negotiated lower prices with providers.
What did you pay? What did the insurance company actually end up paying?
This is one of the areas that open pricing should help.
This is one of the areas that open pricing should help.
I'm not sure open pricing would help seeing as how the average person doesn't have much knowledge to defend themselves against gouging. And when I've got a gash on my head, I'm not going to call around for prices and special discounts.
Another commenter said they asked the hospital and they just bill 8x the Medicare rate. Price transparency should help equalize the market. Right now it’s very much a smoke and mirrors pricing scheme.
What we should do is declare that you can't charge any patient more than you charge Medicare. Single pricer.
I just linked the Schedule of Benefits from OHIP in another comment I made, but your comment made me curious to look it up.
Z176 - Repair of lacerations - up to 5 cm = $20.00 Note: Wound closure via tissue adhesives (such as cyanoacrylate) is payable at 50% of the appropriate fee.
Meaning, in Ontario, your procedure would have cost us $10. I'd have to look through to see what other costs would be incurred for the ER visit, but suffice it to say, it's probably well under $6,000.
Oh, and that's $10 CAD, which is like 2 Freedom Bucks. ($7.52 USD)
Z176 - Repair of lacerations - up to 5 cm = $20.00 Note: Wound closure via tissue adhesives (such as cyanoacrylate) is payable at 50% of the appropriate fee.
Meaning, in Ontario, your procedure would have cost us $10. I'd have to look through to see what other costs would be incurred for the ER visit, but suffice it to say, it's probably well under $6,000.
Oh, and that's $10 CAD, which is like 2 Freedom Bucks. ($7.52 USD)
Bill to you or your insurance?
I'm less concerned if they're scamming the insurance (although I'm existentially and politically interested) than billing of individuals.
I'm less concerned if they're scamming the insurance (although I'm existentially and politically interested) than billing of individuals.
[deleted]
Just a reminder for those reading: you don’t need to pay medical bills, nothing is going to happen except a bad credit report.
Go to the hospital, let them bill you, and then throw the bills in the trash.
Go to the hospital, let them bill you, and then throw the bills in the trash.
They can (eventually) garnish your wages. I wonder at what point they do that.
Only if they sell the debt to a creditor (hospitals and doctors can’t garnish wages) sue you, win, and pursue the judgement. And then they can only take from your disposable income (after rent, food, other bills, etc.)
And you can wipe out all of it by filing bankruptcy.
And you can wipe out all of it by filing bankruptcy.
I have seen nothing about this - and know folks that were sued by the hospitals. It has been some years, mind you.
Is it possible that they cannot garnish wages in your state? Where are you getting your information?
Is it possible that they cannot garnish wages in your state? Where are you getting your information?
Do not make money in the sick room - Hippocrates
I went to the ER last year. They ended up making me stay overnight.
I was hit with a bill for over $10K, with much of that falling on me.
I also used to work in corporate finance and I have a good intuition for how billing works.
Before I even got the bill I mentally prepared myself for it by telling myself that it's going to be a long drawn out process.
I waited and waited and received an initial bill a few months after my hospitalization. It was for the aforementioned amount.
I called and politely asked to have it itemized. Naturally,that took several more months.
The bill was reduced, but the itemization was incorrect, so I asked for a correct itemization.
I went through a few more iterations of this. Each time the bill got lower and lower.
Eventually, I had to pay something like $1.5K out of pocket, which would have been a lot less if I didn't have an HSA.
The whole process took almost a year.
If you ever have to go to the hospital, just assume that it will take forever and nitpick the bill (within reason) and continue to challenge it. They will often give up and reduce your bill. Whatever you do, never pay a bill that is not itemized. As a former finance professional I am shocked that hospitals can get away with this, this would never fly in the B2B world, professionals always push back against "mystery bills" that show just the bottom line number.
I was hit with a bill for over $10K, with much of that falling on me.
I also used to work in corporate finance and I have a good intuition for how billing works.
Before I even got the bill I mentally prepared myself for it by telling myself that it's going to be a long drawn out process.
I waited and waited and received an initial bill a few months after my hospitalization. It was for the aforementioned amount.
I called and politely asked to have it itemized. Naturally,that took several more months.
The bill was reduced, but the itemization was incorrect, so I asked for a correct itemization.
I went through a few more iterations of this. Each time the bill got lower and lower.
Eventually, I had to pay something like $1.5K out of pocket, which would have been a lot less if I didn't have an HSA.
The whole process took almost a year.
If you ever have to go to the hospital, just assume that it will take forever and nitpick the bill (within reason) and continue to challenge it. They will often give up and reduce your bill. Whatever you do, never pay a bill that is not itemized. As a former finance professional I am shocked that hospitals can get away with this, this would never fly in the B2B world, professionals always push back against "mystery bills" that show just the bottom line number.
What do you mean when you say the itemization was incorrect? Do you mean that the prices that they list were incorrect, or that the items didn't make sense given the treatment you received?
In either case, what reference do you use to ascertain correctness? I feel like information asymmetry is a problem for a lot of patients. It's hard to tell if you actually need a treatment, or if you're being charged fairly for it.
In either case, what reference do you use to ascertain correctness? I feel like information asymmetry is a problem for a lot of patients. It's hard to tell if you actually need a treatment, or if you're being charged fairly for it.
Upcoding is extremely common and almost never comes with any consequences. It's routine for staff at the hospital to add line items for things that never actually happened. I've personally seen procedure codes for neuropsychological testing in the ER when the staff never completed those exams, as an example. The billing codes require very specific actions to have taken place in order for the insurance companies to reimburse. It's not often done out of malice, the codes added are likely what should have taken place but the hospital staff are overworked and end up cutting corners.
This is outright fraud.. I wish I could wear a bodycam into the hospital and have the footage confirm everything I'm billed for is actually administered and necessary for the diagnosis I'm provided by the physician.
That’s disgusting of them to do — disgraceful part of the country
i.e. play the same game that insurance company play with us.
Here in europe we don't get to see the bill at all. The hospital sends the bill directly to the insurance company. Think about it. The negotiation of the costs will take place between two companies (B2B). In this case the insurance company becomes the advocate of the people not their opponent.
This is staggering..
Also reminds me of unplanned importation fees. Transporter started to send me letters after letters. I bounced emails as long as possible asking for some explanation. After a few months and a few lawyer agencies (mind you it was just a few SBC bought online) they accepted to make me pay for a much smaller amount, sending me the same bill but with an added line "deal rebate" and that was it.
I wonder how much money get lost this way...
Also reminds me of unplanned importation fees. Transporter started to send me letters after letters. I bounced emails as long as possible asking for some explanation. After a few months and a few lawyer agencies (mind you it was just a few SBC bought online) they accepted to make me pay for a much smaller amount, sending me the same bill but with an added line "deal rebate" and that was it.
I wonder how much money get lost this way...
Just to pile on about how ridiculous medical costs are:
After giving birth my wife was offered Ibuprofen. On the bill we were charged $80 for the 2 pills she took. This was before Obamacare.
After Obamacare I twisted my ankle and the doctors insisted I wear a cheap fabric boot with stiff plastic plates while it healed over the next couple weeks. I asked how much it cost and they said $280. I took it off and refused it while they gave me dirty looks.
A medical facility is basically a monopoly. The switching costs are high and there are no prices on anything.
Unfortunately getting everyone insurance was only the tip of the iceberg of the actual problem. We still have a long, long way to go before we have real, competitive medical pricing with high quality care.
After giving birth my wife was offered Ibuprofen. On the bill we were charged $80 for the 2 pills she took. This was before Obamacare.
After Obamacare I twisted my ankle and the doctors insisted I wear a cheap fabric boot with stiff plastic plates while it healed over the next couple weeks. I asked how much it cost and they said $280. I took it off and refused it while they gave me dirty looks.
A medical facility is basically a monopoly. The switching costs are high and there are no prices on anything.
Unfortunately getting everyone insurance was only the tip of the iceberg of the actual problem. We still have a long, long way to go before we have real, competitive medical pricing with high quality care.
The ACA was a blatant failure in most states. It's still not affordable and large groups of people were never insured. ACA approved plans proved to be bogus. I wrote about this once before:
https://fightthefuture.org/article/returning-to-america-and-...
https://fightthefuture.org/article/returning-to-america-and-...
ACA plans on healthcare.gov are only too costly because employers were allowed to keep their grandfathered plans silo-ing healthy lives in low cost plans to benefit big white collar businesses. This had to be done to appease the Republicans who need to “cross the aisle” and vote for it (and Lieberman who was basically a Republican too).
If everyone was forced onto healthcare.gov, there would be enough healthy lives to offset costs from sick lives to create an effective market.
If everyone was forced onto healthcare.gov, there would be enough healthy lives to offset costs from sick lives to create an effective market.
It was a wrap for the ACA when Lieberman used all his remaining Joementum to kill the public option.
It isn't just about getting everyone insurance. It's about fixing the whole process. My Dr ordered some not too expensive tests for me. My insurance refused. I was like, wait, what? You're overriding my Dr? It's insane.
The health insurance company also has doctors working for them. Similar to how auto insurance companies will have mechanics working for them to ensure they aren’t getting ripped off on repair costs.
DME is the absolute worst. Try getting a CPAP machine anywhere near MSRP. It's a joke. We are being fleeced.
No kidding. In my experience even the most aboveboard DME vendors very aggressively push replacement of consumable components/supplies on the absolute minimum schedule allowed by insurance. They make a performance of confirming that you're ordering things that actually need to be replaced, but it's blatantly obvious (even to me, a person who largely sucks at reading social cues and verbal subtext) that the rep is just reading it off of a script to cover the company's ass.
Yeah it's nuts.
Someone I know sprained their ankle. They recommended that he should use a cane for a while and said they had one to give him. When the bill came weeks later it was $200 for the cane that looked really close to what you can get for $20 at Walmart.
The really messed up thing is I drove him to the doctor and I carried some of the paperwork out (wasn't the bill) so he could use both hands to move around safely. When I was outside I held the piece of paper up and a gust of wind bent the paper in such a way that I ended up with a really nasty paper cut. Like a 2 inch slice on the inside of my finger. One of the worst paper cuts I've ever gotten.
So I went back into the medical center and I asked them if I could get a band-aid. They asked why, so I explained. I got a few smirks from them (they borderline laughed in my face) and they told me that they weren't allowed to give away medical supplies and that I should go a few blocks away to a CVS (a local drug store). Meanwhile just to be insured costs $450 / month for the bare minimum (which I don't pay for but I've payed many thousands in fines for not having insurance).
Someone I know sprained their ankle. They recommended that he should use a cane for a while and said they had one to give him. When the bill came weeks later it was $200 for the cane that looked really close to what you can get for $20 at Walmart.
The really messed up thing is I drove him to the doctor and I carried some of the paperwork out (wasn't the bill) so he could use both hands to move around safely. When I was outside I held the piece of paper up and a gust of wind bent the paper in such a way that I ended up with a really nasty paper cut. Like a 2 inch slice on the inside of my finger. One of the worst paper cuts I've ever gotten.
So I went back into the medical center and I asked them if I could get a band-aid. They asked why, so I explained. I got a few smirks from them (they borderline laughed in my face) and they told me that they weren't allowed to give away medical supplies and that I should go a few blocks away to a CVS (a local drug store). Meanwhile just to be insured costs $450 / month for the bare minimum (which I don't pay for but I've payed many thousands in fines for not having insurance).
Yeah for spite, I would have bled all over their counter and caused a biohazard mess. If you laugh at me like that, I'm not going to be pleasant.
Wow way to add insult to injury, couldn't even spare a simple band-aid...
> I asked how much it cost and they said $280.
I'm shocked they could give you a price. Anytime I ask for a price it takes hours of talking to multiple people spread across several days.
I'm shocked they could give you a price. Anytime I ask for a price it takes hours of talking to multiple people spread across several days.
My son broke his femur at school. He was transported to hospital where he underwent surgery to insert rods. He stayed for four nights in a state of the art, brand new children’s hospital, brimming with wireless tech. The nursing care was top notch.
I had to pay for parking.
Once he was back at school, the school district brought out occupational therapists who assessed his new disability and provided extra assistance while he was wheeling around.
He has had four follow-up visits with the orthopedic specialist. In a month or two he will have another surgery to have the rods removed.
I will then have to pay for parking again.
Welcome to Canada.
I had to pay for parking.
Once he was back at school, the school district brought out occupational therapists who assessed his new disability and provided extra assistance while he was wheeling around.
He has had four follow-up visits with the orthopedic specialist. In a month or two he will have another surgery to have the rods removed.
I will then have to pay for parking again.
Welcome to Canada.
Is the parking $20,000?
The parking is actually quite expensive, when my stepmom had cancer, I went a few time with a car and it was 16$ per day. That hospital made 60 millions in parking fees in 2015 as a reference...
That was the time I understood how lucky we are, when the final diagnostic fell, it was the first thing that came to my mind, what would have they done if it wasn't free... they would have to decide whether they try to give her a few more years and pay hundred thousands, or just watch her suffer a few more months. Sadly even with the amazing care she got, she died less than a year later, but at least they got that time and they never had to worry about the cost of it.
That was the time I understood how lucky we are, when the final diagnostic fell, it was the first thing that came to my mind, what would have they done if it wasn't free... they would have to decide whether they try to give her a few more years and pay hundred thousands, or just watch her suffer a few more months. Sadly even with the amazing care she got, she died less than a year later, but at least they got that time and they never had to worry about the cost of it.
Canadian. So, about $2.50 US ;-)
I’m sure going to get downvoted for this but.... I just don’t pay my medical bills I pay my dentist and eye doctor bills since those are different. But I just let my insurance pay their part and I walk away from the rest. I haven’t had anything catastrophic yet. But have and do have bills in the 1,000s.
My credit score is great in the 740+ range.
I know big stuff they could take me to court or put a lien on my property. They haven’t yet.
It’s my little protest against all of this crazy healthcare prices and system we have here in the US.
My credit score is great in the 740+ range.
I know big stuff they could take me to court or put a lien on my property. They haven’t yet.
It’s my little protest against all of this crazy healthcare prices and system we have here in the US.
I tried to make payments to the hospital on a few thousand in bills, fell behind, and eventually got sued. I would not offer this as advice to anybody.
If somebody from the hospital had told me _before_ I got served that I could get 85% of my bill written off just by submitting some paystubs, I would have appreciated it. If you're in a similar spot, call and ask about patient financial assistance or similar programs.
If somebody from the hospital had told me _before_ I got served that I could get 85% of my bill written off just by submitting some paystubs, I would have appreciated it. If you're in a similar spot, call and ask about patient financial assistance or similar programs.
Do you go to a different dentist and eye doctor each time?
Also, if you had to go to an emergency room, would you give them fake personal info so they can't send you bills?
Also, if you had to go to an emergency room, would you give them fake personal info so they can't send you bills?
I pay my dentist and eye doctors. Those are treated differently. There really isn’t eye insurance and dentists usually have normalish prices compared to other doctors.
I mean I can ask my dentist how much it’s going to be and he can actually give me a price before my procedure.
But as I stated above the insurance pays their portion so it’s not like nothing is being paid. Just not the 900% markup.
I don’t recommend doing this. I’m sure it will bite me eventually but it’s been 10+ years. And yes I haven’t had any major or catastrophic medical event in my life. So the bills haven’t been in the +10k range. I’m pretty sure once it gets there they will put a lien or sue me.
I go the same facility every time. I haven’t been denied. My family hasn’t been denied.
If I did go to an ER for something serious I would give them my real name and info. I do have insurance and it will pay a portion. Depending on the size I might pay it. I might not. Just haven’t had anything really large.
I mean I can ask my dentist how much it’s going to be and he can actually give me a price before my procedure.
But as I stated above the insurance pays their portion so it’s not like nothing is being paid. Just not the 900% markup.
I don’t recommend doing this. I’m sure it will bite me eventually but it’s been 10+ years. And yes I haven’t had any major or catastrophic medical event in my life. So the bills haven’t been in the +10k range. I’m pretty sure once it gets there they will put a lien or sue me.
I go the same facility every time. I haven’t been denied. My family hasn’t been denied.
If I did go to an ER for something serious I would give them my real name and info. I do have insurance and it will pay a portion. Depending on the size I might pay it. I might not. Just haven’t had anything really large.
I think one of the reasons why most dentists can give you a straight up price on the spot is because they own the practice which means they are the decision maker when it comes to prices. Plus with a dentist, there's a pretty decent chance you're not dealing with insurance companies. With a hospital you're dealing with a million layers of abstraction at both the hospital and insurance company level.
I'm definitely not defending hospitals and most doctor's offices but I think that plays some part in it. There's also a decent amount of dental competition when it comes to routine work such as cleanings, so prices wind up staying somewhat reasonable where as with a hospital there's no competition really due to how insurance works.
I'm definitely not defending hospitals and most doctor's offices but I think that plays some part in it. There's also a decent amount of dental competition when it comes to routine work such as cleanings, so prices wind up staying somewhat reasonable where as with a hospital there's no competition really due to how insurance works.
I always use dental insurance and always get a price before a procedure, and I have six kids.
Say, that's an interesting idea.
Develop a good-quality fake identity purely for skipping on medical bills.
Just to add an alternative that I've considered (now being a kind of programmer emeritus) is to go into a full-tilt asset hiding mode. There's just too many ways to lose your hoard of cash.
Develop a good-quality fake identity purely for skipping on medical bills.
Just to add an alternative that I've considered (now being a kind of programmer emeritus) is to go into a full-tilt asset hiding mode. There's just too many ways to lose your hoard of cash.
You can be several thousands in arrears (and even in collections) to the hospital and still visit the ER, see your doctor, get a CT scan etc. I know because I've been doing it since 2017, but I have insurance and the people I see probably just assume the bills are getting paid if I keep coming back. Care providers and admitting people don't generally access your financial/billing information.
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You are far from alone. And people wonder why hospitals try to squeeze patients so much. Medical debt is extremely hard to recover.
I do the same, but it's not a protest, it's because I literally can't pay. They have sued me though, and they won, but nothing happened after the lawsuit closed. This country is headed towards mad max territory.Yippee ki yay boys, I'll see you on the road.
My girlfriend fell skiing and tore her ACL. We were taken down to the mountainside clinic. They were just gonna do a basic check and give her some Advil and a brace.
I asked how much it would cost. They said they were not ALLOWED to tell me. Which is different than not knowing. I told them what insurance I had. They said many people came in with that insurance. I asked how much of the procedure is normally covered. Also apparently a secret.
I just can't see how it's legal to bill someone for services received while refusing to give information on what it will cost. If the bill had been $50k what recourse would I have had?
I asked how much it would cost. They said they were not ALLOWED to tell me. Which is different than not knowing. I told them what insurance I had. They said many people came in with that insurance. I asked how much of the procedure is normally covered. Also apparently a secret.
I just can't see how it's legal to bill someone for services received while refusing to give information on what it will cost. If the bill had been $50k what recourse would I have had?
semi-seriously wondering if you could claim your sincerely held religious beliefs prevented you from entering a binding contract without knowing the terms/cost of such a contract. would your religious beliefs trump their position?
What are you gonna do? You’re injured. Gonna go somewhere else? Everywhere it’s the same. The greatest scam of our time.
We had a call with someone who works on the pricelist/chargemaster for a major metro hospital recently, they set their prices by taking the Medicare reimbursement rate, and multiplying by 8.
If any other business tried billing people like hospitals and doctors do, people would go to prison.
At least if it was an inelastic good like health care.
Gas goes up a quarter and elected officials are thrown out of office. $600 for a drop of super glue? Okay then.
Gas goes up a quarter and elected officials are thrown out of office. $600 for a drop of super glue? Okay then.
That $600 is just monopoly money to the majority of constituents, because they have insurance of some kind or they're on Medicare/Medicaid. So those people are usually, not always, but usually fine.
And that of course is part of the problem. Medical billing is like playing numberwang or who's line is it anyway. No two numbers on a bill seem to be correlated in any way to another except as upper or lower bounds.
When someone without coverage comes in then, they have to play that stupid game with all the numbers, and of course they either ignore it and go into debt, pay the cash price if they're able, or they manage to negotiate it down by orders of magnitude - proving the price didn't matter anyway.
And that of course is part of the problem. Medical billing is like playing numberwang or who's line is it anyway. No two numbers on a bill seem to be correlated in any way to another except as upper or lower bounds.
When someone without coverage comes in then, they have to play that stupid game with all the numbers, and of course they either ignore it and go into debt, pay the cash price if they're able, or they manage to negotiate it down by orders of magnitude - proving the price didn't matter anyway.
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That’s what i don’t get. A lot of the billing is clearly fraudulent. They routinely bill for treatments that never happened or for drugs that were never given.
Simple change to next year's Medicare plans: if you accept Medicare you cannot charge any patient more than you charge Medicare.
Simple way to put most hospitals out of business overnight.
Or, more likely, simple way to force hospitals to make drastic cuts to services.
Or, more likely, simple way to force hospitals to make drastic cuts to services.
Or Medicare prices rise to be closer to real costs, instead of forcing them to be subsidized by the uninsured.
That was tried during the Clinton administration. Result: many doctors dropped all their Medicare patients, making it impractical for Medicare patients to find a doctor to treat certain conditions.
Then Medicare needs to pay a little more for those specialists.
This is pretty common. Uninsured patients are such a small percentage of revenue (and many aren't going to pay anyway) that hospitals don't put much effort into setting prices. Negotiating with insurers and navigating billing them is a big operation as it is.
Yeah, and there’s the Lesser Of clause in their insurance contracts - they’ll be reimbursed at the lesser of their retail rate and their negotiated rate. So they make their retail rate ridiculously high to make sure it’s never the limiter for insurance payments.
" they set their prices by taking the Medicare reimbursement rate, and multiplying by 8."
lol. Seriously? Well it's a simple system.
I wonder what happens when it's Medicare-for-all. Do they make 1/8 as much all of a sudden?
lol. Seriously? Well it's a simple system.
I wonder what happens when it's Medicare-for-all. Do they make 1/8 as much all of a sudden?
Hospitals that take a majority Medicare patients go out of business. Medicare patients are subsidized by the rest of a hospital’s patient population.
That’s a common but false talking point. Hospitals with above average Medicare patients generally get paid more than the general population. It’s also a question of what percentage of a nominal bill gets paid vs sent to collections.
Given that it's a common misconception, would you supply some evidence for your position?
Hospitals receive extra payments when they have an unusual number of Medicare patients.
https://www.medicaid.gov/medicaid/finance/dsh/index.html
It’s just another case where the government splits spending across multiple programs.
https://www.medicaid.gov/medicaid/finance/dsh/index.html
It’s just another case where the government splits spending across multiple programs.
When they have a disproportionate share of Medicaid, not Medicare patients.
And the added payment isn’t that much.
Generally Medicaid pays below cost. Medicare is reasonable and leaves providers with a small profit (single digit percentage).
And the added payment isn’t that much.
Generally Medicaid pays below cost. Medicare is reasonable and leaves providers with a small profit (single digit percentage).
Should have been more clear.
From 2015 to 2017 Medicare lowered it’s uncompensated care payments. However, that program covers uncompensated care underpayment. Medicare explicitly does not pay for everything at hospitals: https://www.medicare.gov/coverage/inpatient-hospital-care
From 2015 to 2017 Medicare lowered it’s uncompensated care payments. However, that program covers uncompensated care underpayment. Medicare explicitly does not pay for everything at hospitals: https://www.medicare.gov/coverage/inpatient-hospital-care
That's Medicaid, not Medicare
I didn't know that program existed. Still, I don't see that the existence of the program adds up to your assertion:
> Hospitals with above average Medicare patients generally get paid more than the general population.
> Hospitals with above average Medicare patients generally get paid more than the general population.
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I realize that this article and the HN comments are centred on the US, but here's a link to the Schedule of Benefits (i.e. the costs) for all insured services that are compensated for by the Ontario Health Insurance Plan (OHIP): http://www.health.gov.on.ca/en/pro/programs/ohip/sob/
Meaning, while most Canadians do not know what our healthcare actually costs, it's all itemized, standardized, and freely available.
I just looked it up and was surprised to see that C-sections are only about $80 more than vaginal delivery (we just had a kid), so it's nice to know that there isn't much incentive for doctors to push one over the other. I realize that's a gross oversimplification, since there's probably a lot of other billing codes that get tacked for surgeries.
Meaning, while most Canadians do not know what our healthcare actually costs, it's all itemized, standardized, and freely available.
I just looked it up and was surprised to see that C-sections are only about $80 more than vaginal delivery (we just had a kid), so it's nice to know that there isn't much incentive for doctors to push one over the other. I realize that's a gross oversimplification, since there's probably a lot of other billing codes that get tacked for surgeries.
Thanks for the reference. I'm not Canadian, but it was very enlightening to browse through and surprisingly well organized.
When my wife was 25 weeks pregnant she started feeling ill and we noticed her blood pressure kept going up. We went to the hospital. Turns out she was pretty sick she so they made her stay for 4 days.
A few weeks later we had our son’s ashes and a $148,000 bill.
A few weeks later we had our son’s ashes and a $148,000 bill.
Adding insult to the injury. Im sorry for your loss...
We lost our first, and er visit costed us much less. Few thousands... Didnt have the energy to fight that time...
We lost our first, and er visit costed us much less. Few thousands... Didnt have the energy to fight that time...
:( sorry - it sucks
We had insurance so we didn’t pay that crazy amount but it’s just absurd what these places charge.
We had insurance so we didn’t pay that crazy amount but it’s just absurd what these places charge.
I was assuming that. Even still, 148k bill, and an unimaginable situation is still a shocker.
I am willing to fight, even though my out of pocket is also very small.
I am willing to fight, even though my out of pocket is also very small.
I'm very sorry for your loss.
This is the only country in the world where there are people who will divorce on their hospital death bed, because they are so fearful of the financial impact on their remaining family.
And a non-insignificant part of the population finds this acceptable because they see the alternative as "the government treading on me".
This is the only country in the world where there are people who will divorce on their hospital death bed, because they are so fearful of the financial impact on their remaining family.
And a non-insignificant part of the population finds this acceptable because they see the alternative as "the government treading on me".
I'm so, so sorry for your loss.
As a German, this whole thread reads entirely bizarre. The US health system is the blind spot of the nation. The kind of fuckery you people have to endure every day and the kind of thought processes it requires, is astonishing.
As a German, you don’t have to spend any brain cycles on health insurance or medical costs. If you’re self-employed, you maybe need to think about getting private insurance. Besides that: health care is just there for you. You don’t have to pay almost anything from your own pocket (besides glasses and some depending on the age).
The financial aspects usually can’t ruin you. Prices are "normal". I had a US friend over a while back. She had a tooth ache. The dentist fixed it and the bill was like 180 bucks or so. She couldn’t believe how cheap it was compared to the US. And this wasn’t some shitty job with inferior materials or whatever.
As a German, you don’t have to spend any brain cycles on health insurance or medical costs. If you’re self-employed, you maybe need to think about getting private insurance. Besides that: health care is just there for you. You don’t have to pay almost anything from your own pocket (besides glasses and some depending on the age).
The financial aspects usually can’t ruin you. Prices are "normal". I had a US friend over a while back. She had a tooth ache. The dentist fixed it and the bill was like 180 bucks or so. She couldn’t believe how cheap it was compared to the US. And this wasn’t some shitty job with inferior materials or whatever.
Why is insurance tied to "employers" in Germany? That seems antithetical to the "healthcare for all" that I keep hearing about Germany and other European countries. Why would a private contractor be on their own for health care? Taxes? I mean even as a contractor I still have to pay taxes like everyone else.
Same goes for education, I remember the awkward silence when I told to a NY girl that tuition fees for public college in France was around 500eur/year. Of course taxes are different.
and I bet it's all completely untied from 'employment', right? this is the other huge blindspot we have here (US) - we've got generations of people who all have some odd belief this is somehow morally 'better' than employers provide this (because... that means you're 'working' and you need to be 'working' for the right/ability to have access to medical care).
The whole ecosystem has evolved to loot people when they are at their most vulnerable moment. There is no two ways about it. It goes unchecked because insurance companies cover a bulk of the cost and so most ordinary people don't see it. The poor and uninsured get the bad end of the stick but no one cares about them. Just a pathetic state of affairs.
I live in the UK. My father had a stroke a couple of days ago. He’s in intensive care on a ventilator.
Total bill so far: £2 parking. Also the coffee machine in the relatives waiting room was out of sugar.
Total bill so far: £2 parking. Also the coffee machine in the relatives waiting room was out of sugar.
I'm from the UK, but live in the SF Bay Area, and this is the single biggest thing I don't get about the US (with education costs being second). I kind of get the libertarian view of not wanting to trust the government but when the alternative is some kind of Mad Max dystopian hellscape (where people are literally dying), surely looking around the world for alternatives that actually work makes sense?
It's not libertarian. The US system is cronyism, statism at its finest, possibly illegal. Honestly, I think with current US laws and a willing political force, a lot of top players in the current US healthcare system could be punished, even with the death penalty (especially if reinstated at the federal level).
Dreams aside, in order to have a free market healthcare, which is what informed libertarians want, you need to abolish medical license, the FDA, patents and many other State's interventions. There is a reason why the healthcare system in the US is insane, and it's because the laws are made so that cronies have the monopoly on your health. Neocons are pathetic when they defend the current system.
Without the free market (the real one, not the scam you have in the US), healthcare will be a mess more than any other industry and at that point is better to have a single payer, universal system, because in the end they have the same problems of the current US system but at least you don't get ruined.
Dreams aside, in order to have a free market healthcare, which is what informed libertarians want, you need to abolish medical license, the FDA, patents and many other State's interventions. There is a reason why the healthcare system in the US is insane, and it's because the laws are made so that cronies have the monopoly on your health. Neocons are pathetic when they defend the current system.
Without the free market (the real one, not the scam you have in the US), healthcare will be a mess more than any other industry and at that point is better to have a single payer, universal system, because in the end they have the same problems of the current US system but at least you don't get ruined.
A functioning market is one where multiple market participants exist (both buyers and sellers) and both are able to make educated choices.
How can a market like this exist when the buyer is incapacitated, not to mention even when not incapacitated, the buyer is not sufficiently educated to understand what they are buying?
How can a market like this exist when the buyer is incapacitated, not to mention even when not incapacitated, the buyer is not sufficiently educated to understand what they are buying?
You could buy the services of an expert in medical decision-making who will negotiate for you when you're incapacitated.
Also, supposedly people aren't total dicks. At the moment the healthcare industry rewards a lot of psychos due to its incentives. Hopefully with a free market the dicks would be weeded out due to increased choices. Also having a free market means that there would be an incentive to make medicine more accessible, while still correct, because more people could be willing to become healers, maybe specialized healers. Who knows, what's certain is that we have not discovered the full potential of humans healing other humans and the current regulations are a big brake on new systems and innovations.
So, for now I'm ok with the whole single-payer/universal healthcare deal.
Also, supposedly people aren't total dicks. At the moment the healthcare industry rewards a lot of psychos due to its incentives. Hopefully with a free market the dicks would be weeded out due to increased choices. Also having a free market means that there would be an incentive to make medicine more accessible, while still correct, because more people could be willing to become healers, maybe specialized healers. Who knows, what's certain is that we have not discovered the full potential of humans healing other humans and the current regulations are a big brake on new systems and innovations.
So, for now I'm ok with the whole single-payer/universal healthcare deal.
Or you can just not do free market on something that should be a human right given the capabilities of modern medicine. It shouldn't be left up to market forces to decide who gets help. That kind of makes sense for some things like TVs and laptops but not life and death when for the most expensive items your only choice is life and death.
Just like the USSR wasn't communist.
Someone close to me had a rare stroke (intercerebral hemorrhagic stroke) and Medicare part A and B are covering 60 days of full inpatient stay at a state of the art ICU. I guess things aren't so bad for Americans over 65 on Medicare.
Good luck to your dad, wishing him a speedy recovery as I also sit next to my loved one also on a ventilator and in a medically induced coma as their brain recovers from the large hematoma left behind from the stroke.
Being in a situation like this really makes me come to terms with my own mortality and how short life truly is in the grand scheme of things. I think I'm going to start volunteering to help those in need and donate my time and professional skillset to nonprofits as a result. Good luck with everything friend.
Good luck to your dad, wishing him a speedy recovery as I also sit next to my loved one also on a ventilator and in a medically induced coma as their brain recovers from the large hematoma left behind from the stroke.
Being in a situation like this really makes me come to terms with my own mortality and how short life truly is in the grand scheme of things. I think I'm going to start volunteering to help those in need and donate my time and professional skillset to nonprofits as a result. Good luck with everything friend.
If healthcare costs are so astronomically high, why are so many Americans supportive of mandatory insurance that forces insurance companies to pay those prices? It sounds as bizarre. It's like if a normal pair of shoes cost $1000, and people decided shoes are a right and everyone should subsidize each other's $1000 shoes. How about fixing the root problem first: a pair of regular shoes shouldn't cost a thousand dollars! Find the laws that enable this to happen (patent, IP laws, etc) and change them! Forcing everyone to pay those prices seems to mainly benefit the very people charging those ridiculous prices and enables it to continue.
A lot of rural areas tend to vote for their party rather than for what makes sense.
American's are brainwashed to vote against their interests because there's significant money to be made. The healthcare lobby spends enormous sums lobbying (bribing) politicians, influencing debates, changing public opinion and killing legislation.
American's hear a word like "socialism" and think that it's a lack of competition and thus innovation. They don't think of it as a regulatory floor to a market. A standard of service to surpass (if even possible).
The correct way to sell this to the populace is probably by framing it as a "minimum standard of service for all", and "getting the full value out of your taxes".
The correct way to sell this to the populace is probably by framing it as a "minimum standard of service for all", and "getting the full value out of your taxes".
> Hillary Schuler-Jones, a Breg spokeswoman, declined to answer questions about the price of the Deluxe Shoulder Immobilizer. “It is important to note,” she said, “that Breg’s customer is not the patient, but the healthcare provider.” In most cases, “we don’t sell our products directly to patients, and we therefore don’t have a patient price list.”
This is pretty infuriating given that the article previously said that Breg directly billed the patient in a "surprise billing".
A company with seemingly no connection to the hospital directly bills the patient $200 for a $12 item and then when asked about this by a journalist says "We don't sell direct to patients" and refuses all further comment.
If they don't ever sell direct to patients then the bill must be fraudulent, sent by an imposter.
Curiously enough last year I received one of these sorts of fraudulent scam bills. A traffic camera ticket. It had my name but no street identified, no license plate or car description, no drivers license number, and no photo of the alleged infraction. The mailing address was to a location far away from the city, neither location which I had driven in recently, and the company I was supposed to write the check to didn't have a lot of information about who they were online. I was not allowed to contest it unless I signed an agreement to accept private arbitration results. I went to the city it allegedly came from and asked at their courthouse about it and the clerk told me "You are required to pay this" but said she was not able to verify anything about the ticket, give me a license plate number, or the name of an intersection or photograph, referring me instead to the arbitration and saying that "privacy laws" prevented her from saying anything else. So I didn't pay it, ignored it and never heard about it again. As far as I'm concerned it was a scam. If it really came from the city it was unconstitutional because there was no due process. It also wasn't served, it was mailed bulk rate and not even registered, which such mailing is not a valid server process in this jurisdiction.
Given that this company Breg says they don't sell to patients, the patient has a legal basis for refusing to pay this bill claiming to be sent from them, because the company itself has claimed in an official statement to a journalist that the bill is fraudulent.
This is pretty infuriating given that the article previously said that Breg directly billed the patient in a "surprise billing".
A company with seemingly no connection to the hospital directly bills the patient $200 for a $12 item and then when asked about this by a journalist says "We don't sell direct to patients" and refuses all further comment.
If they don't ever sell direct to patients then the bill must be fraudulent, sent by an imposter.
Curiously enough last year I received one of these sorts of fraudulent scam bills. A traffic camera ticket. It had my name but no street identified, no license plate or car description, no drivers license number, and no photo of the alleged infraction. The mailing address was to a location far away from the city, neither location which I had driven in recently, and the company I was supposed to write the check to didn't have a lot of information about who they were online. I was not allowed to contest it unless I signed an agreement to accept private arbitration results. I went to the city it allegedly came from and asked at their courthouse about it and the clerk told me "You are required to pay this" but said she was not able to verify anything about the ticket, give me a license plate number, or the name of an intersection or photograph, referring me instead to the arbitration and saying that "privacy laws" prevented her from saying anything else. So I didn't pay it, ignored it and never heard about it again. As far as I'm concerned it was a scam. If it really came from the city it was unconstitutional because there was no due process. It also wasn't served, it was mailed bulk rate and not even registered, which such mailing is not a valid server process in this jurisdiction.
Given that this company Breg says they don't sell to patients, the patient has a legal basis for refusing to pay this bill claiming to be sent from them, because the company itself has claimed in an official statement to a journalist that the bill is fraudulent.
> asked at their courthouse about it and the clerk told me
Sounds like they were in on the scam. What would be the appropriate method to legally-resolve this and shut it down?
Contact the state's Attorney General?
Sounds like they were in on the scam. What would be the appropriate method to legally-resolve this and shut it down?
Contact the state's Attorney General?
Do you think the clerk was in on the scam, or just couldn't be bothered to look into it? Unbelievably shitty either way.
I was charged $50 for 2 tylenol when I had my appendix taken out. The CVS down the street would sell you a 24-pack for $5.
Of course, that was just a minor component of the final $50,000 bill ($4k for me after insurance), but it still sticks out in my mind many years later because it was an easily comparable baseline.
Health insurance companies get alot of the blame for the broken healthcare system in America but I place most of it on the providers - doctors, hospitals, and drug companies. They bill an order of magnitude too much. Sometimes more. Attacking doctors seems to be a much less politically palatable option than attacking big insurance corporations, even though those doctors are essentially gouging their loyal patients with no qualms about it.
Of course, that was just a minor component of the final $50,000 bill ($4k for me after insurance), but it still sticks out in my mind many years later because it was an easily comparable baseline.
Health insurance companies get alot of the blame for the broken healthcare system in America but I place most of it on the providers - doctors, hospitals, and drug companies. They bill an order of magnitude too much. Sometimes more. Attacking doctors seems to be a much less politically palatable option than attacking big insurance corporations, even though those doctors are essentially gouging their loyal patients with no qualms about it.
The hospital charged me $1,700 for 1.5mg of xanax during a 3-day stay. It's utterly ridiculous what they're allowed to get away with.
I live in Canada. I have visited the ER probably 5 times in the last year with different kid ailments. I pay MSP about 30$ a month CAD and that covers me and my kids. I do pay out of pocket for medications but any visits to the doctor or hospital are completely covered. Work benefits covers 80% of the meds I have to pay out of pocket. I don't have to second guess when to go in I just go in when things get bad, no questioning will this visit leave me financially unable to feed my family and take care of my health in other ways. I just go in. I hope you guys get something better working for you.
This is identical to what had happened in my case, the patient was my son who had fractured his arm.
Had taken him to Stanford Emergency, he got a a cast and a really cheap sling.
Received a bill from a Texas based company, don't remember the name, for about $200-$300, for the sling. Looked online, there were bunch of BBB reviews about this, including about calling them where the issue was settled. Same sling on Alibaba.com was $1-$2.
I called them up. I was told we were out-of-network for the sling, even though Stanford hospital was in-network. However, since we were in CA, we are kinda protected if we don't know this (in/out of network) in an emergency room.
I had the option of asking Stanford and insurance company to refile, or pay them $20 (from original invoice of $200-$300). I paid them $20 to settle the claim.
Had taken him to Stanford Emergency, he got a a cast and a really cheap sling.
Received a bill from a Texas based company, don't remember the name, for about $200-$300, for the sling. Looked online, there were bunch of BBB reviews about this, including about calling them where the issue was settled. Same sling on Alibaba.com was $1-$2.
I called them up. I was told we were out-of-network for the sling, even though Stanford hospital was in-network. However, since we were in CA, we are kinda protected if we don't know this (in/out of network) in an emergency room.
I had the option of asking Stanford and insurance company to refile, or pay them $20 (from original invoice of $200-$300). I paid them $20 to settle the claim.
Reading this in Europe.I'm sure if I'd go with article alone to my American colleague on Monday, he'd defent the system even if he'd have to die for it. Knowing he's a healthy 20something man with affluent parents that could potentially bankroll even a year's stay in a private hospital- I could understand it to certain degree, however I fail to understand why nobody really is up for changing this system,where millions upon millions left woth no choice but to struggle anything but basic medical care.
> however I fail to understand why nobody really is up for changing this system,where millions upon millions left woth no choice but to struggle anything but basic medical care.
Plenty of people are up for changing it. It is quite literally the center of a huge debate at the moment in the Democratic primary, and there is a broad spectrum of changes being proposed, from Medicare for all with price controls to a slightly modified Obamacare. Only one candidate among those more or less supports the status-quo.
And the Republican party is currently avoiding discussing the way they'd like to change the health system (repealing Obamacare, fee for service care) because it isn't particularly popular at the moment.
Meanwhile, stories like the ones you see piling up in this thread happen every day.
Plenty of people are up for changing it. It is quite literally the center of a huge debate at the moment in the Democratic primary, and there is a broad spectrum of changes being proposed, from Medicare for all with price controls to a slightly modified Obamacare. Only one candidate among those more or less supports the status-quo.
And the Republican party is currently avoiding discussing the way they'd like to change the health system (repealing Obamacare, fee for service care) because it isn't particularly popular at the moment.
Meanwhile, stories like the ones you see piling up in this thread happen every day.
> And the Republican party is currently avoiding discussing
Are you so sure about that? A republican president recently signed an executive order for more transparent pricing:
https://www.npr.org/sections/health-shots/2019/06/24/7355785...
Are you so sure about that? A republican president recently signed an executive order for more transparent pricing:
https://www.npr.org/sections/health-shots/2019/06/24/7355785...
The centerpiece of their plan is removing the protections provided by Obamacare, like pre-existing conditions coverage, the state insurance exchanges, and getting rid of the Medicaid expansion. They don't want to talk about any of that right now, even though it was the central refrain of what they ran on 4 years ago.
But that's smart actually. They correctly realize that it is political suicide to run on taking health protections away from people at this time.
But that's smart actually. They correctly realize that it is political suicide to run on taking health protections away from people at this time.
[deleted]
I couldn't believe when I first heard about this -- Trump doing something potentially beneficial. Sounds like it will have no actual impact, but I hope it does.
And early on prior to the election, Trump was also talking about repealing Obamacare and putting in single payer.
As much as I despise Trump, this idea wasn't terrible. Obamacare/ACA was only a stepping stone. But the republicans had a 'talking' with him.
https://www.npr.org/2019/04/02/709175203/trump-backs-off-oba...
As much as I despise Trump, this idea wasn't terrible. Obamacare/ACA was only a stepping stone. But the republicans had a 'talking' with him.
https://www.npr.org/2019/04/02/709175203/trump-backs-off-oba...
Essentially everyone wants to change the system. The problem is that half of the voters want to fix it by having the government provide universal coverage, and half want to fix it by getting government out of the picture as much as possible and letting the market solve everything.
Of course, when it comes to health care, 'letting the market solve everything' actually means 'letting poor people die'. Sometimes it even means 'letting poor people die because poor people deserve to die' (look up prosperity gospel).
That's not true, there is about 70% support for a public option.
It BS to say "nobody is really up for changing this system", the whole dem party is for it. I don't like blanket statements like you're making. Some of us have been fighting this for years. There are 340 million Americans, we aren't all the same.
I have very good insurance by US standards through my FAANG employer. My son recently got a full body reaction to poison oak exposure. No hospitalization, just a couple dermatologist visits, 30 minutes each.
After insurance paid its portion, I got a bill for $800 in out-of-pocket charges.
After insurance paid its portion, I got a bill for $800 in out-of-pocket charges.
How much of that was your deductible?
Generally really good insurance has a 10% co-insurance charge. But the first $X amount is entirely borne by you.
Generally really good insurance has a 10% co-insurance charge. But the first $X amount is entirely borne by you.
Writing this from basically a 3rd world country, Serbia, which you might have heard of in context of a series of armed conflicts, civil wars and highly corrupt governments (current one being orders of magnitude worse)...Even after all that, and civil infrastructure and industry having been bombed back 50 years into the past (by NATO), we still have free high quality education and free healthcare...Those are simply the basic functions of a society - a lot can not function and be in a bad shape, but if you don't have these - what do you have from a government? How the US managed to get it perverted to this extent, is beyond me...
I don't understand the arguments that private health care is better because of competition. What competition? I can't comparison shop for health insurance, if I don't use what my employer chooses I have to pay thousands of dollars more in premiums for an even worse plan. And then I am limited in the providers available by the network. Not to mention that comparing prices is impossible when you don't know the price until months after you receive the service.
My son had a minor in & out surgery earlier this year. Could have done it in the office, but the doctor recommended a surgical center that was out of my insurance network. "Our patients have been very happy with the price."
I called the surgical center, and was told it was a flat fee of $500, payable in advance, for which I received a receipt: "Facility fee".
We did the surgery. The doctor's bill was well under a thousand dollars.
Almost six months later, the surgical center sent a bill to my insurance for $48,000 as a half-dozen line items, each listed as "facility fee". My insurance says they paid $25,000 and the patient responsibility of about $10,000.
We haven't seen a bill from the surgical center, and I told the insurance it was either a billing error or fraud, as it was 100x the price I was quoted and accepted up-front.
I called the surgical center, and was told it was a flat fee of $500, payable in advance, for which I received a receipt: "Facility fee".
We did the surgery. The doctor's bill was well under a thousand dollars.
Almost six months later, the surgical center sent a bill to my insurance for $48,000 as a half-dozen line items, each listed as "facility fee". My insurance says they paid $25,000 and the patient responsibility of about $10,000.
We haven't seen a bill from the surgical center, and I told the insurance it was either a billing error or fraud, as it was 100x the price I was quoted and accepted up-front.
Reposting s comment I saw on something similar:
>My wife has Stage IV breast cancer. She has been a public school teacher for 20 years and we have pretty good health insurance. She continues to work. She will teach as long as she can because she wants to...and financially she will need to.
>Even with good health coverage, we have STILL spent thousands of dollars the past couple years out of pocket. If/when she takes medical retirement, it will get much worse. It will cost her 75% of her retirement income just to purchase health insurance. The rest will go to copays, gas for hospital trips, etc. Oh by the way, we still pay thousands in federal taxes each year, while corporations and the rich avoid most taxes and pay very little. It's fucking criminal. Fuck everyone who developed this system and fights to maintain it.
From this thread on medical bankruptcy being a uniquely American phenomena: https://www.reddit.com/r/politics/comments/d10ab6/medical_ba...
>My wife has Stage IV breast cancer. She has been a public school teacher for 20 years and we have pretty good health insurance. She continues to work. She will teach as long as she can because she wants to...and financially she will need to.
>Even with good health coverage, we have STILL spent thousands of dollars the past couple years out of pocket. If/when she takes medical retirement, it will get much worse. It will cost her 75% of her retirement income just to purchase health insurance. The rest will go to copays, gas for hospital trips, etc. Oh by the way, we still pay thousands in federal taxes each year, while corporations and the rich avoid most taxes and pay very little. It's fucking criminal. Fuck everyone who developed this system and fights to maintain it.
From this thread on medical bankruptcy being a uniquely American phenomena: https://www.reddit.com/r/politics/comments/d10ab6/medical_ba...
I have seen this with people who had cancer. Even with insurance they slowly got sucked dry. They spend hours and hours on the phone with insurance and doctors and if you don’t have a lawyer on retainer or really good nerves all the billing mistakes slowly bankrupt you. It’s a horrible system where the patient is just a football to be kicked around between hospitals, doctors and insurance.
Another thing that bugs me in the whole "medical cost" disaster that is the USA. Whenever you talk to Doctors or other medical practitioners about the situation they blame the hospitals, or the insurance companies or <fill in the blank here> but ultimately they are complicit in the mess, but they don't want to rock the boat, its just shameful.
The whole system of massive school debt and massive salaries for doctors resting on the AMA artificially limiting the supply and scope of doctors? Yea I'd say so.
> AMA artificially limiting the supply and scope of doctors?
I see people say this, but what does this mean? Should we not certify our doctors? Should just about anyone be able to hang out their shingle?
I see people say this, but what does this mean? Should we not certify our doctors? Should just about anyone be able to hang out their shingle?
You could increase the supply of doctors without impacting quality, by training more doctors. Medical schools are the main bottleneck, and their sizes are regulated by the AMA to constrain supply.
Schools are not the bottleneck, residency spots are the bottleneck. Residency spots are governed by the federal government (Congress) and someone, somewhere must be lobbying to keep the number of spots low.
https://www.huffpost.com/entry/who-pays-for-resident-sal_b_1...
https://www.huffpost.com/entry/who-pays-for-resident-sal_b_1...
There are options between "free for all" and "highly restricted to the point of public harm".
Another thing would be to expand the scope of nurse practitioners where it makes sense.
Another thing would be to expand the scope of nurse practitioners where it makes sense.
This is why I like Kaiser so much. If you make it to a Kaiser emergency room, and you have Kaiser health insurance, you are not going to get an out-of-network surprise bill. Everyone at Kaiser works for Kaiser and is paid a salary by Kaiser and the Kaiser hospital is the only one that bills you.
... what if you don't make it to a Kaiser emergency room?
The Kaiser system would be great if every major hospital nationwide was under it. Kind of like a national healthcare system...
The Kaiser system would be great if every major hospital nationwide was under it. Kind of like a national healthcare system...
My wife had an emergency, which ended up with removing one of her ovaries. Kaiser was pretty insistent about transferring her from the closest ER to one of their facilities (which was stressful), but after that the treatment was awesome. After a some major surgery and a few days recovering the bill was completely covered. Kaiser isn't perfect, but they're the closest thing to a reasonable health-care system I've seen in the US. Agree that there are worse models for how to do healthcare, within some of the constraints of the US system.
Kaiser covers ER trips to other hospitals (I think they are probably required to by law). Any other Dr visit needs to be at a Kaiser though and it is def to your benefit to try to make it to a Kaiser even for the ER if you can.
My experience has been fine with Kaiser for an out of network ER visit, I just got charged the standard copay. CA law seems to specifically protect those of us on HMO plans: https://www.sfchronicle.com/bayarea/heatherknight/article/SF...
""" Under state law, the practice of “balance billing” — sending a bill to a patient if his or her insurance company doesn’t pay the full requested amount — is illegal for people insured through a health maintenance organization. Kaiser is an example of an HMO, a network of doctors that supplies services to its members. """
""" Under state law, the practice of “balance billing” — sending a bill to a patient if his or her insurance company doesn’t pay the full requested amount — is illegal for people insured through a health maintenance organization. Kaiser is an example of an HMO, a network of doctors that supplies services to its members. """
Kaiser is great for critical care and general practitioner stuff. But they do most of their cost-cutting in specialty care; the stuff that is rare or tends to not be easily diagnosed while having a major impact on patients' quality of life. Just lookup lawsuits and Kaiser mental health.
I get the general feeling that KP tends to under-prescribe care, but other doctors definitely over-prescribe care. That's what the financial incentives are for each anyways.
Also terrible with mental health from what I hear.
There is an art to navigating specialist care at Kaiser for sure. Personally I don't think you are likely to have a significantly worse experience at Kaiser than you would with the average Dr, but you will also never have the _best_ experience. You do have to know when to be pushy and when to demand a different specialist.
That said, a lot of the reason the specialists costs are lower at Kaiser than other offices is because they don't all have their own little office and staff. Many specialists in the US are expensive because they have to have a secretary and an accountant, etc. At Kaiser they are just part of the system, so the costs look a lot lower.
That said, a lot of the reason the specialists costs are lower at Kaiser than other offices is because they don't all have their own little office and staff. Many specialists in the US are expensive because they have to have a secretary and an accountant, etc. At Kaiser they are just part of the system, so the costs look a lot lower.
Same experience here: routine care is ok, emergency care is great, hospital also pretty good, but trying to get them to refer you to proper specialist and figure out what's wrong when you yourself don't know it (e.g. not a cold or broken leg when it's obvious but kinds of conditions where you may need to ask several specialists to figure it out) is a long uphill battle and they are very reluctant to cooperate. It's a bureaucracy which likes doing what they know and hates complex cases and exceptions.
The hospital sling was $200 according to the article.
Amazon sling is $12.99 to $16.99 according to the article.
So hospital sling is 12-15 times more expensive.
So I suspect that the original writer of the article correctly wrote that hospital sling is 10 times more expensive.
Then the editor came and decided that 10 times more expensive looks not as scandalous as 900% more expensive.
The result is false precision https://en.wikipedia.org/wiki/False_precision and bad journalism.
Amazon sling is $12.99 to $16.99 according to the article.
So hospital sling is 12-15 times more expensive.
So I suspect that the original writer of the article correctly wrote that hospital sling is 10 times more expensive.
Then the editor came and decided that 10 times more expensive looks not as scandalous as 900% more expensive.
The result is false precision https://en.wikipedia.org/wiki/False_precision and bad journalism.
I have no idea what you're complaining about here.
If they had taken the $12.99 price (an actual exact price, with 4 actual significant figures of precision), the $200 bill (also an actual price paid, with five significant figures of precision) is actually, really-not-false-precisely, 1440% more expensive than amazon.
They allowed in the article that the sling might be a bit nicer than the ones on amazon - it had some padding. So they rounded its value up to roughly $20, giving, as you suggest, 10 times more expensive, as an estimated factor. Let's assume that's only good to one sig fig. That's fine for an estimate, and consistent with the 'probably worth a bit more than the ones on Amazon, let's say somewhere between $16 and $25' methodology.
"900% more expensive" is a perfectly accurate restatement of "10 times as expensive" to a single significant figure. Would you rather they went with "1000% more expensive" to make it feel more Benford's-law-comliant in its imprecision? That would surely have helped your supposed sensationalist editor, right?
"900% more expensive" is literally just another way of writing "ten times as expensive".
So I really don't know what kind of editorial sensationalism conspiracy you are trying to posit here. Wouldn't a sensationalist have gone with the 1440%, and nefariously rounded it up to 1500% to punch up the headline?
This seems like a weak place to try to hang an argument about the innumeracy of the press....
If they had taken the $12.99 price (an actual exact price, with 4 actual significant figures of precision), the $200 bill (also an actual price paid, with five significant figures of precision) is actually, really-not-false-precisely, 1440% more expensive than amazon.
They allowed in the article that the sling might be a bit nicer than the ones on amazon - it had some padding. So they rounded its value up to roughly $20, giving, as you suggest, 10 times more expensive, as an estimated factor. Let's assume that's only good to one sig fig. That's fine for an estimate, and consistent with the 'probably worth a bit more than the ones on Amazon, let's say somewhere between $16 and $25' methodology.
"900% more expensive" is a perfectly accurate restatement of "10 times as expensive" to a single significant figure. Would you rather they went with "1000% more expensive" to make it feel more Benford's-law-comliant in its imprecision? That would surely have helped your supposed sensationalist editor, right?
"900% more expensive" is literally just another way of writing "ten times as expensive".
So I really don't know what kind of editorial sensationalism conspiracy you are trying to posit here. Wouldn't a sensationalist have gone with the 1440%, and nefariously rounded it up to 1500% to punch up the headline?
This seems like a weak place to try to hang an argument about the innumeracy of the press....
> "900% more expensive" is literally just another way of writing "ten times as expensive".
No, it is not.
Same way as "ten times more expensive" is not the same as "10.000000 times more expensive".
Using percentages here implies high precision.
> Would you rather they went with "1000% more expensive"
"10 times more expensive" sound just right.
> I really don't know what kind of editorial sensationalism conspiracy you are trying to posit here.
Sorry, no sensation here. Just false precision which is a bad sign.
No, it is not.
Same way as "ten times more expensive" is not the same as "10.000000 times more expensive".
Using percentages here implies high precision.
> Would you rather they went with "1000% more expensive"
"10 times more expensive" sound just right.
> I really don't know what kind of editorial sensationalism conspiracy you are trying to posit here.
Sorry, no sensation here. Just false precision which is a bad sign.
The cost of medical equipment in the US often has very little to do with the BOM costs (Bill of Materials, the cost of the parts required to manufacture the product). Medical equipment providers have massive and onerous regulatory burdens on top of certification requirements. Even a relatively simple product an cost tens of millions of dollars to bring to market after design and engineering is completely done.
This is one of the key problems with the US healthcare system and why talk of this or that insurance scheme (regardless of content) is absolutely ridiculous.
To use a parallel, it's like talking about selling a $10 burger for less without changing the underlying cost structure that causes a burger to have to be sold for $10.
Anyone who proposes a "new and improved" insurance scheme betrays an utter lack of understanding of the most fundamental of concepts: If you don't do a thing about baseline costs there is no insurance-based solution that can ever "fix" the problem.
This means taking a very hard look at the cost (in time and money) of the regulatory burden as well as the other element of that cost structure: Tort reform. Both of those factors increase the cost of absolutely everything even remotely related to the medical industry. Fix that first and then medical insurance will magically become cheaper and better.
This is one of the key problems with the US healthcare system and why talk of this or that insurance scheme (regardless of content) is absolutely ridiculous.
To use a parallel, it's like talking about selling a $10 burger for less without changing the underlying cost structure that causes a burger to have to be sold for $10.
Anyone who proposes a "new and improved" insurance scheme betrays an utter lack of understanding of the most fundamental of concepts: If you don't do a thing about baseline costs there is no insurance-based solution that can ever "fix" the problem.
This means taking a very hard look at the cost (in time and money) of the regulatory burden as well as the other element of that cost structure: Tort reform. Both of those factors increase the cost of absolutely everything even remotely related to the medical industry. Fix that first and then medical insurance will magically become cheaper and better.
i wonder if a hospital would still charge you if you refused
thier price gouge materials and used your own purchased at a proper price, as in "thanks for setting the bone, i dont need your sling i have my own and it will do fine, here is my lawyers contact card."
We asked for an itemized price list when my wife gave birth. They claimed she received lactation consultation even though she rejected it, as this was our 2nd baby. Despite having documentation saying so it went back and forth and we just paid it because it was too time consuming.
Anyways. In the itemized bill they charge about $40 per ibuprofen. If we knew the price, we should have brought our own and just rejected theirs.
Someone might come along and reply with that $40 covers nurse salary, tracking the medicine etc. Yeah... Bull$hit.
Anyways. In the itemized bill they charge about $40 per ibuprofen. If we knew the price, we should have brought our own and just rejected theirs.
Someone might come along and reply with that $40 covers nurse salary, tracking the medicine etc. Yeah... Bull$hit.
The hospital definitely didn't carefully consider the $40 price to cover the actual cost of delivering the medicine to you. They just multiply their cost by some number and call it a day.
The fact is that hospitals aren't built for itemized bills because very few patients pay the posted prices out of pocket. Medical debt is extremely hard to recover in the US, so why bother expending the resources to figure out a sensible pricing structure for a small minority of your customers who mostly aren't going to pay that price anyway?
The fact is that hospitals aren't built for itemized bills because very few patients pay the posted prices out of pocket. Medical debt is extremely hard to recover in the US, so why bother expending the resources to figure out a sensible pricing structure for a small minority of your customers who mostly aren't going to pay that price anyway?
Out of interest, can I ask how much the "lactation consultation" cost?
Here in the UK, my wife's breast feeding help consisted of an inexperienced midwife (possibly only a trainee), awkwardly being remarkably unhelpful.
Here in the UK, my wife's breast feeding help consisted of an inexperienced midwife (possibly only a trainee), awkwardly being remarkably unhelpful.
I believe it was $200. For our first daughter ours was helpful. We took a class (paid by ourselves) before hand but it definitely helps to have someone walk through it with your actual baby. However for each delivery the nurses knew enough to be helpful too.
Also, since my wife has had surgery to remove a benign tumor in her breast, lactation consultation was covered the first time. No idea WTF happened the second time. This is the US medical system for you.
I'd also like to add we received a random bill for our first daughter 2 years later. No idea what it was, but the insurance covered all of it so I didn't care.
Also, since my wife has had surgery to remove a benign tumor in her breast, lactation consultation was covered the first time. No idea WTF happened the second time. This is the US medical system for you.
I'd also like to add we received a random bill for our first daughter 2 years later. No idea what it was, but the insurance covered all of it so I didn't care.
“OK, the cost of setting that bone just went up $900.”
That’s probably what they would do. We know that they don’t base prices in any kind of rationally economic way.
That’s probably what they would do. We know that they don’t base prices in any kind of rationally economic way.
hence the lawyers contact card.
I have Kaiser health insurance in the bay area. Whenever we needed a hand or foot brace or walking boot, they seemed to just give out the basic stuff at no extra charge beyond the visit copay. Per the insurance plan there is a copay but they just give it out. Other times they will just recommend something you can buy locally or online. They would give a printout with suggested brand/SKU to consider. They don't mind if you price shop.
IIRC prior to being treated you agree to be financially liable for the costs. Prior to even knowing that that will be or even the costs involved. Or even if you know what is involved are you going to understand what a reasonable cost is? EG: Sling is easy but what about a x-ray study? Is that 200$ or $150?
Just like a proper capitalist system! You know, like when you agreed to pay whatever for your iPhone prior to even know it'll work.
Just like a proper capitalist system! You know, like when you agreed to pay whatever for your iPhone prior to even know it'll work.
> You know, like when you agreed to pay whatever for your iPhone prior to even know it'll work.
I can contact Apple for help with any issues I have with my iPhone. I can contact my carrier for any issues I have with my iPhone. I can return my iPhone within a grace period if I don't like it.
Try doing any of that for medical costs.
I can contact Apple for help with any issues I have with my iPhone. I can contact my carrier for any issues I have with my iPhone. I can return my iPhone within a grace period if I don't like it.
Try doing any of that for medical costs.
For fun I do this: I ask them how much it'll cost upfront. (they can rarely even give bounds). Ask about refund policy (?!?!?!). Tho must be done nicely as the person handling the questions is no way responsible for the absurdity.
I know these won't actually succeed in adding a bit of capitalism but it does succeed in highlighting the absurdity.
I know these won't actually succeed in adding a bit of capitalism but it does succeed in highlighting the absurdity.
I'm not sure what your argument is. Is it that it is fine that our healthcare is like shopping at an Apple store? Or that medical costs cannot be predicted? Or that we should be happy with the system we have?
Other than pedantry, what are you trying to get across?
Other than pedantry, what are you trying to get across?
Given the responses I succeeded in my goal: highlighting the absurdity in the current system :)
We don’t have a capitalist system, we have the worst of all possible systems. There’s no competition, yet the state doesn’t control the prices.
Has anybody ever hired a high powered attorney to challenge medical billing in the US? This feels like something one or two successful lawsuits could change really quickly.
Hospitals seem to have done an amazing job of charging just enough after insurance for the upper/middle class to be willing to pay to avoid hurting their credit scores, but so much that everybody else just doesn't pay and files for bankruptcy if anybody ever comes after them.
Hospitals seem to have done an amazing job of charging just enough after insurance for the upper/middle class to be willing to pay to avoid hurting their credit scores, but so much that everybody else just doesn't pay and files for bankruptcy if anybody ever comes after them.
It's not the hospital alone. I went to my Kaiser optometry for my wife's glasses yesterday, and they said it would cost $375 for her pair. Her insurance would cover $175 + $100 discount, and the rest she has to pay. She has a Platinum coverage with Kaiser.
We went home and she ordered 5 pairs online for $50. The anti-reflective coating cost $90 at Kaiser, but only $6 online.
Fortunately, I don't wear glasses.
We went home and she ordered 5 pairs online for $50. The anti-reflective coating cost $90 at Kaiser, but only $6 online.
Fortunately, I don't wear glasses.
Kaiser is actually the best/most European option, if it's available to you. This exact thing happened in my family, but the lesson I took away is being grateful to Kaiser for letting us know the price ahead of time, and all but forcing us to go a different (much cheaper) route for my wife's glasses. Don't hate the player, hate the game, and all that...
Eye care is mostly a monopoly where luxotica owns the market.
Warby parker, zenni, etc are the disruptors.
Warby parker, zenni, etc are the disruptors.
Apologies for being a little off-topic, but what online vendors did you use? Asking because I have the very same issue in New England.
I live in a developing country ... Thailand.
Reading things like this, stories in this thread, and about how people are avoiding seeing the doctor because they're afraid of the bills ... makes me realize in some ways Thai people actually have a higher quality of life than many in US in this respect.
Costs are order of magnitude(s) lower. A night in the hospital is typically 5,000-10,000 baht or $166-$333. And the quality of care is at a good standard .. so much so that Thailand has become a Medical Tourism destination:
https://www.health-tourism.com/thailand-medical-tourism/
If you have some money, you can pay more for faster service and more attentive care at more expensive private hospitals.
And if you can't pay, you are still covered by Thailand's Universal Healthcare:
"What Thailand can teach the world about universal healthcare" https://www.theguardian.com/health-revolution/2016/may/24/th...
"Thailand: At the forefront of Universal Health Coverage" https://medium.com/health-for-all/thailand-at-the-forefront-...
Thailand is a relatively poor country, but we are still able to do this. In the US, I guess some people would rather die than admit needing help from the government ... or trying to clamp down on healthcare costs cause it would be too much 'regulation'?
Reading things like this, stories in this thread, and about how people are avoiding seeing the doctor because they're afraid of the bills ... makes me realize in some ways Thai people actually have a higher quality of life than many in US in this respect.
Costs are order of magnitude(s) lower. A night in the hospital is typically 5,000-10,000 baht or $166-$333. And the quality of care is at a good standard .. so much so that Thailand has become a Medical Tourism destination:
https://www.health-tourism.com/thailand-medical-tourism/
If you have some money, you can pay more for faster service and more attentive care at more expensive private hospitals.
And if you can't pay, you are still covered by Thailand's Universal Healthcare:
"What Thailand can teach the world about universal healthcare" https://www.theguardian.com/health-revolution/2016/may/24/th...
"Thailand: At the forefront of Universal Health Coverage" https://medium.com/health-for-all/thailand-at-the-forefront-...
Thailand is a relatively poor country, but we are still able to do this. In the US, I guess some people would rather die than admit needing help from the government ... or trying to clamp down on healthcare costs cause it would be too much 'regulation'?
Sounds like people should take some time off work and fly to Thailand for treatment. Any reason why there isn't more medical tourism?
They do this in the UK for getting dental treatment in Eastern Europe where fillings can cost €20 each.
They do this in the UK for getting dental treatment in Eastern Europe where fillings can cost €20 each.
Well, one reason people don't become medical tourists are concerns about quality. Americans in particular are still convinced, despite ample evidence to the contrary, that our medical system is the highest quality in the world - and that this justifies the costs.
I believe this is false. Healthcare quality is basically the same in all first-world countries, the only difference is cost structure. (My wife had a c-section in Germany and our total cost was about 100 euros for an optional private room.)
I believe this is false. Healthcare quality is basically the same in all first-world countries, the only difference is cost structure. (My wife had a c-section in Germany and our total cost was about 100 euros for an optional private room.)
> Healthcare quality is basically the same in all first-world countries
While this statement is correct, my understanding is that there are still small quality differences, and the US is in fact the word leader in quality. Thinking about it, this also makes sense – if you are willing to pay extreme amounts to doctors, you should also see at least some improvements in quality.
But we are talking something like <1% better quality for +100% the cost, so this is clearly not worth it. But if I was a billionaire with a difficult disease, I would definitely at least consider going to the US for treatment.
While this statement is correct, my understanding is that there are still small quality differences, and the US is in fact the word leader in quality. Thinking about it, this also makes sense – if you are willing to pay extreme amounts to doctors, you should also see at least some improvements in quality.
But we are talking something like <1% better quality for +100% the cost, so this is clearly not worth it. But if I was a billionaire with a difficult disease, I would definitely at least consider going to the US for treatment.
Does anyone else find this business arrangement between the DME provider and the hospital to be fishy?
> they dispense the product on Breg’s behalf and Breg follows up with its own bill.
My intuition tells me that this relationship may have generated a little side hustle for the hospital, which if it really occurred would be extremely illegal. That reporter should dig a little more.
> they dispense the product on Breg’s behalf and Breg follows up with its own bill.
My intuition tells me that this relationship may have generated a little side hustle for the hospital, which if it really occurred would be extremely illegal. That reporter should dig a little more.
Has anyone here ever worked in this industry? I'm curious what the justification for these prices is?
I can't imagine it is quite the scrooge mcduck caricature where the people reaping these profits are literally trying to defraud people. I would love to talk to a health insurance insider or something and ask them to justify this stuff.
I can't imagine it is quite the scrooge mcduck caricature where the people reaping these profits are literally trying to defraud people. I would love to talk to a health insurance insider or something and ask them to justify this stuff.
Two guesses: 1) return money to investors at all costs. 2) inability of us to get any sort of Tort reform going in this country.
My mom worked in medical records at a small hospital. The way she explained it to me was that insurance companies negotiate prices way down, and expect to. So in order to make enough money to cover costs, the hospital has to put astronomical sticker prices on everything so that insurance can "talk them down" to the actual price they expect to receive.
Mostly our healthcare system is completely fucked and we should all feel bad.
Mostly our healthcare system is completely fucked and we should all feel bad.
I've spent my whole career working for hospitals primarily dealing with cost data.
There's not much incentive to create a sensible pricing structure because very few patients actually pay the posted prices. Most revenue comes from the government or insurers, and neither of them give a fuck what you charge for a sling. Hospitals have limited resources, and dealing with insurers is a big enough operation as it is. Most chargemasters are created by multiplying acquisition cost or Medicare rates by some absurd number (typically 8-10) and calling it a day.
Frankly, I see this whole thing as a red herring. I get why people get upset about it, but if you ended this practice then the money would just shift somewhere else. Hospitals are mostly non-profits with small margins, so the money has to come from somewhere. Instead of charging 10 times cost for everything they would just dump it all into a generic fee. This kind of stuff isn't actually relevant to the core problem of why healthcare is so expensive in the US.
It's definitely not a scrooge mcduck caricature situation. Like I said, most hospitals are non-profits who post their financial statements online. You can probably go look at your local hospital's statements to see what kind of margins they're working with. There are exceptions, but I'd bet they're pretty low.
There's not much incentive to create a sensible pricing structure because very few patients actually pay the posted prices. Most revenue comes from the government or insurers, and neither of them give a fuck what you charge for a sling. Hospitals have limited resources, and dealing with insurers is a big enough operation as it is. Most chargemasters are created by multiplying acquisition cost or Medicare rates by some absurd number (typically 8-10) and calling it a day.
Frankly, I see this whole thing as a red herring. I get why people get upset about it, but if you ended this practice then the money would just shift somewhere else. Hospitals are mostly non-profits with small margins, so the money has to come from somewhere. Instead of charging 10 times cost for everything they would just dump it all into a generic fee. This kind of stuff isn't actually relevant to the core problem of why healthcare is so expensive in the US.
It's definitely not a scrooge mcduck caricature situation. Like I said, most hospitals are non-profits who post their financial statements online. You can probably go look at your local hospital's statements to see what kind of margins they're working with. There are exceptions, but I'd bet they're pretty low.
Non-profit just means they don't pass money on to shareholders, right? That doesn't mean there isn't management taking a large cut. Recently a hospital near my family was bought up by CHI[1], making them the only game in town. Is there any reason to believe prices wont go up?
* https://en.wikipedia.org/wiki/Catholic_Health_Initiatives
* https://en.wikipedia.org/wiki/Catholic_Health_Initiatives
Yes it's called lack of competition. It's hard to blame them when you face jail time for offering an alternative
Is any organized collective action from the public possible here?
What if we had a service that would take your itemized bill and spit out the fair market prices. Then, you would tell the hospital/doctor/insurance that you would pay this price and nothing more.
If enough people did that, could it actually work?
What if we had a service that would take your itemized bill and spit out the fair market prices. Then, you would tell the hospital/doctor/insurance that you would pay this price and nothing more.
If enough people did that, could it actually work?
Reminds me of the brief hospital visit I had in Paraguay where I needed to have a friend or relative always with me because the hospital didn't stock anything. If ibuprofen, bandages, syringes, antibiotics, etc were needed, the hospital staff would tell me and I would have my friend or relative run across the street to buy the necessary supplies from one of the pharmacies so the doctor or nurse could treat me.
Cheap hospital bill, cheap pharmacy bill, pain in the butt for my friends and relatives.
Cheap hospital bill, cheap pharmacy bill, pain in the butt for my friends and relatives.
Would this change if the government paid 100% of the bill?
The insurance wouldn't be so much of a problem if things like saline solution didn't cost $595 (personal experience)
Such a long article, and the reporter never bothered to talk to a doctor and get reassurance that indeed the hefty price of the sling is unjustified. This isn't journalism, it's gossip. Sling may or may not be overpriced. Amazingly, you can't tell from this 1000 worder
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Why medical tourism not a big thing ? All incidents mention could be cure in India at nice competent hospitals at fraction of this bill including air travel. What is the biggest problem in this space ?
Trust. People here are conditioned to not trust socialized medicine or medicine from less wealthy countries.
First sentence of the article:
> Cathy Birker-Hake tripped over a hose in her Valley Village backyard not long ago, dislocated her shoulder and made a beeline for the emergency room.
Nobody’s hopping on a plane to India with a dislocated shoulder.
> Cathy Birker-Hake tripped over a hose in her Valley Village backyard not long ago, dislocated her shoulder and made a beeline for the emergency room.
Nobody’s hopping on a plane to India with a dislocated shoulder.
Yeah I would imagine because most trips to the hospital aren't planned. I'm not flying to India or anywhere if I have a fever/flu and just need to get looked at.
I would definitely fly somewhere for a planned surgery.
I would definitely fly somewhere for a planned surgery.
I went to a travel medicine clinic, and got two shots.
The cost for the shots was ~200$, and ~300$ for consultation, which was a PA giving me printouts about information of what diseases are found in which countries.
What a scam.
The cost for the shots was ~200$, and ~300$ for consultation, which was a PA giving me printouts about information of what diseases are found in which countries.
What a scam.
Interesting. I know some places require yellow fever but think that’s the only one commonly required. Seems common for South America. I think a world cruise be fun if ever rich enough so sounds like would need to get it.
Personally not a fan of vaccines for multiple reasons, but I got a feeling at some places if you just wanted only what was required they’d try to convince or guilt you into getting the others. Maybe though if knowing you are going to go on a trip where you need it, get it elsewhere... say you go vacation in Europe, probably cheap enough to self pay even without being covered by their insurance. Plus the ingredients can vary by country too. I guess the one approved for Canada and the one approved for the US are different yellow fever wise.
Personally not a fan of vaccines for multiple reasons, but I got a feeling at some places if you just wanted only what was required they’d try to convince or guilt you into getting the others. Maybe though if knowing you are going to go on a trip where you need it, get it elsewhere... say you go vacation in Europe, probably cheap enough to self pay even without being covered by their insurance. Plus the ingredients can vary by country too. I guess the one approved for Canada and the one approved for the US are different yellow fever wise.
I asked MDs about that, beside the normal certification fees there's also market dynamics at play. They know they can raise prices because hospitals and doctors can spend more.
Shit like this makes me incredibly grateful for the NHS. It's one of the best things about the uk and I'm incredibly proud to be joining it next month.
The sling for $400 is what triggered my personal ‘down the rabbit hole’ of the in-transparent hospital cartel system. pricepain.com was one outcome.
Where does she get insurance for 1500 annually?
'And that doesn’t include the nearly $1,500 she pays in annual insurance premiums.'
Australian here. We just had a baby. Emergency c-section - 5 night hospital stay,
Amazing care. Amazing team and happy healthy wife and baby
Total cost? $0
Yep we do it well
Amazing care. Amazing team and happy healthy wife and baby
Total cost? $0
Yep we do it well
What does the same medical equipment cost in countries with nationalized health care?
ibuprofen also costs $80 a pill at a hospital ..this was 7 years ago, no idea what it costs now!
You think $200 for a piece of cloth is bad?
Lil 8mm screw in my leg. I got a bunch. $800 each. TLSO brace, $4,000. Literally a modified dirtbike chest and back plate.
The medical system is entirely broken. Ditto the insurance system.
Lil 8mm screw in my leg. I got a bunch. $800 each. TLSO brace, $4,000. Literally a modified dirtbike chest and back plate.
The medical system is entirely broken. Ditto the insurance system.
Medicare for All! Please fix this, America
yes. something is very wrong. everyone in America has known that for decades. the LA Times very often states the obvious in its headlines.
Well, popcorn in a movie theater also costs 10x more than it should, because they have you as a captive audience.
And it doesn't help that the price is basically opaque and paid for by insurance, for a person who doesn't care about the price at that moment.
It's a ridiculous system.
And it doesn't help that the price is basically opaque and paid for by insurance, for a person who doesn't care about the price at that moment.
It's a ridiculous system.
I get the price of the popcorn up front, and I don’t die if I skip it.
Movie theater does not give you the popcorn and tell you the price a week after. Also, you can say no to the popcorn in a movie theater; you cannot control the fine details of your treatment.
A movie just isn't the same without popcorn :)
And you're a captive audience; they don't allow you to bring in your own supply.
And you're a captive audience; they don't allow you to bring in your own supply.
This is why I've considered and End-Server License Agreement. In providing service to me as a User, yada-yada-yada yada.
If I actually went through the trouble of formally writing one up, and spreading it far and wide on the winds, and could actually get a significant portion of the population serving it in instances of predatory policy/pricing, and refusing the product such that a meaningful impact was made on service provider's bottom line, I've often wondered whether or not an equilibrium could finally be established where businesses stopped looking at customers who don't complain as people not yet sufficiently fleeced.
If I actually went through the trouble of formally writing one up, and spreading it far and wide on the winds, and could actually get a significant portion of the population serving it in instances of predatory policy/pricing, and refusing the product such that a meaningful impact was made on service provider's bottom line, I've often wondered whether or not an equilibrium could finally be established where businesses stopped looking at customers who don't complain as people not yet sufficiently fleeced.
You know, I've recently seen here on HN complaints about "product substitution" at Amazon - getting, not what you ordered, but something that Amazon thinks is equivalent. I'm not sure medical supplies is where you want that to happen. I'm therefore not sure that the comparison of price to Amazon is fair.
Note well: Yes, hospitals also gouge you. I am not claiming otherwise.
Note well: Yes, hospitals also gouge you. I am not claiming otherwise.
Clearly they used Amazon as a proxy for "place you can buy it".
The important part is being over-charged 900% over retail price, not the exact retailer you buy it from.
Also, it's a sling, not an anti-HIV drug. Hardly a "medical supply".
The important part is being over-charged 900% over retail price, not the exact retailer you buy it from.
Also, it's a sling, not an anti-HIV drug. Hardly a "medical supply".
Regulations criminalizing "product substitution" for healthcare products and foods are also in order.
So I work in manufacturing. On one of our systems, we recently upgraded the fleet to a $10k computer with a 22nm processor running RHEL 7 supplied by the system vendor. We had all of the install files and could have bought a $2k computer and gone through an extended install and qualification process, and closing the door to some support from our vendor, but we didn’t. We paid the extra $8k for a guarantee that it would just work and that we could get the exact same computer for years to come.
I see these high prices for what appear to be commodity items in a similar light. You are paying for a certain amount of comfort that the sling will just work. Amazon is not going to care if the sling, which might be a cheap knock-off, rips apart while you’re walking and unseats your unhealed bone.
I see these high prices for what appear to be commodity items in a similar light. You are paying for a certain amount of comfort that the sling will just work. Amazon is not going to care if the sling, which might be a cheap knock-off, rips apart while you’re walking and unseats your unhealed bone.
Here's where that analogy falls apart: If your 10K computer fails, your vendor will fix it under the support contract for free. If the hospital-provided sling falls apart and you go back to the hospital, they'll charge you again. In most cases, the product is the same one you can get yourself elsewhere, and it still doesn't come with a guarantee.
While that is absolutely true, there is a level of confidence in knowing that the one from a hospital was sourced from a legitimate supplier and that it likely meets some level of quality control standards, legal standards, and supply chain controls.
But this is more of a criticism of Amazon than anything, as those things would be true for a drugstore as much as it would be for a hospital.
But this is more of a criticism of Amazon than anything, as those things would be true for a drugstore as much as it would be for a hospital.
Agree on that - things sourced from Amazon are increasingly likely to be suspect quality these days.
I think you missed the point that we need an open pricing system. Sure you are willing to pay $200 for that sling but others might decide differently if they see the price beforehand!
I worked in a newspaper plant. We did everything you just described for all of the same reasons. The system delivered was worse in every way than the one we ended up building for ourselves in the end, didn't work right anyway, and was "supported" by incompetent temps that damaged expensive equipment as they ham-handedly learned their jobs on our dime.
Sometimes its all just a paper facade over simple stuff we can easily do for ourselves with the smallest amount of courage and effort.
Sometimes its all just a paper facade over simple stuff we can easily do for ourselves with the smallest amount of courage and effort.
There are things like that in the hospital, sure. For example some surgical tools are glorified versions of construction tools (hammers, chisels, drills) but you are paying a premium for materials (have to be autoclave-able) and QA.
However for a lot of other things though are literally the same product, so it really isn't equivalent. If you are paying more for an individual (regular) Tylenol than you would have regularly paid for a box of them, it's hard to argue "value".
However for a lot of other things though are literally the same product, so it really isn't equivalent. If you are paying more for an individual (regular) Tylenol than you would have regularly paid for a box of them, it's hard to argue "value".
On top of the nearly $6k in other charges from the hospital, they charged $531 for one dab of superglue or "liquid stitches" on my forehead for something that would have healed by itself.
One of my friends died two years ago from pneumonia. He didn't go to the hospital when symptoms first started because he was afraid of the bills that would come from it.
They don't ask you if you want to spend $500 for a dab of glue on your forehead, they just do it and you're essentially writing them a blank check in the process. I hate our medical system.