For instance: a hospital charges patients $300 for an X-ray if they pay directly in cash. However, insurer "X" has a policy that they only pay 25% of standard rate for all procedures. So the hospital states their standard rate is $1200 for an X-ray.
So now I (as an insurer "X" policyholder) get billed $1200, but my insurer decides it's a non-covered expense. Does the hospital adjust my bill down to their cash rate of $300?
No.
That would violate their agreement with the insurer and potentially mean that the insurer would only pay them $75 per x-ray moving forward on ALL of insurer "X"'s policyholders.
So now I hypothetically am stuck with a bill four times as large as it would have been if I were entirely uninsured.
This is a product of the impersonal transformation of medicine caused by corporate ownership (and accounting) of local care facilities combined with the legal/profit seeking power of large insurance firms.
I think that is one of the main challenges of health insurance.
In my country (Germany) I have actually shied away from switching to private insurance, because they pay doctors more, and doctors are known to do as many tests and procedures as possible (not always a good thing, but in the end it is a gamble - too many examinations/procedures or too few?).
The "public" health insurance is quite regulated as to what gets paid and how much. The downside is that doctors have to waste a lot of time on bureaucracy (every examination has to be entered into the computer to determine the costs), and transparency is still missing (patients typically don't even know how much their treatments cost). And some committee decides what procedures get paid. I don't trust committees. I trust the market (I mean I trust "in" markets, not necessarily any given market as markets can be broken by regulations, lack of transparency, all sorts of things). I have also spent a lot of money on things that weren't covered by public insurance.
One story I heard is that for example in the UK they won't pay for dialysis after a certain age. So public health insurance is not an automatic solution to every problem.
I think it is actually unavoidable that insurance will have to make a cut at some point, because medical procedures can become arbitrarily expensive. Perhaps even now for the right money, people could be kept alive indefinitely.
I would have no problem with a doctor trying to be profitable - just as with other businesses. I guess the classic assumption is that to be profitable, businesses have to provide good service.
A quick Google search reveals this claim is spurious, so maybe don't believe everything you hear.
This is not true. In fact, most people getting dialysis are over 65.
https://www.renalreg.org/wp-content/uploads/2014/12/Incidenc...
> Kidney disease is more common as we get older, and although people of all ages can need to start dialysis, it most commonly affects people aged between 65 and 84 years. Figure 2 shows the number of people starting dialysis or going straight to transplantation in each age group and it can be seen that the age group with the most people was 65–74 for both haemodialysis and peritoneal dialysis. In 2013, the average age of people starting treatment was 65 years and this has changed little over the last six years. The average age at start was 67 years for people starting on haemodialysis, 60 for people starting on peritoneal dialysis and 50 for those having a transplant before they start dialysis. In 2013, more men started treatment than women (63% male versus 37% female). Diabetes was the single most common cause of kidney failure (25%).
Here's a document talking about cost of dialysis for older people: https://academic.oup.com/ndt/article/18/10/2122/1807737/Cost...
The NHS Constitution for England forbids discrimination based on age, as does the Equality Act 2010.
https://www.gov.uk/government/publications/the-nhs-constitut...
> The NHS provides a comprehensive service, available to all
> It is available to all irrespective of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status. The service is designed to improve, prevent, diagnose and treat both physical and mental health problems with equal regard. It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population.
Speaking of kidneys - don't they prioritize recipients of organs somehow? If age based discrimination is forbidden, an 85 year old person would be as eligible as an 8 year old to receive a new kidney?
Not saying it would be wrong, just curious.
Can you name any?
This is completely WRONG, there are NO age-related limits for treatment like this in the UK. Dialysis is a life-saving procedure for those with kidney failure, and is available to everyone in the UK who requires it regardless of age. The same goes for heart surgery, bypass operations, stents etc. which are also sometimes claimed to be age restricted.
The fact that people actually believe that a cruel system like this (one that would cause people to die by withholding treatment just because of their age) might really exist probably says much more about the way US health care works and the perceptions surrounding it.
Nevertheless I think there will always be procedures that won't be paid for, in any health care system, because it would always be possible to incur arbitrarily high costs. As an extreme example, you could assemble a team of 1000 scientists to try to cure one person.