Emergency room patients can face steep bills even when treatment is declined
vox.com
vox.com
Imagine if you took your car into the shop - there is no price list, they won't give you an estimate, and for weeks after they send you random bills without indicating what it's for?
This affects everybody in the US, and I don't understand why it's allowed to continue, except the medical industry has bought off all the politicians
Why should hospitals and doctors be forced to accept contacts from insurers that underpay for services rendered for nothing in return (being part of limited network)?
If the regulated standard treatment costs were somehow lower than the actual delivery costs, sure. But how on eath could that happen? It's in everyone's best interest for hospital administrators to be heavily involved in setting these costs, and they have no interest in losing money.
Regarding balance billing:
If Medicaid pays $100 for a $500 procedure, and private insurance pays $400 with the expectation of a 20% coinsurance from the patient but patient refuses to pay, who is going to pay the other $100? Is the expectation that hospitals or doctors shouldn't be compensated for services rendered? Should they work for free and go out of business?
What other business exists where it's ok for people to get something and refuse to pay the bill? Auto repair? Groceries? Legal advice? Housing construction? Land purchase? Auto fuel? Electricity?
On what planet would the special interest groups responsible for setting reimbursements make it less than the cost of delivery?
Let's try again:
> If a medical provider overcharges $100 for a $400 procedure
Ok now your position makes more sense. Debt recovery is a well-known problem and yes, providers write it off or sell the debt on.
> What other business exists where it's ok for people to get something and refuse to pay the bill?
Loans, contracts, anything covered by tort law really.
Take a guess what Medicaid pays for a labor epidural for a pregnant mother, which involves putting a very large needle next to a woman's spinal cord, with possible complications of paralysis, death, headache, back pain, infection, failure of epidural, etc?
If you run a hospital where 100% of patients are on Medicaid, the hospital will shut down immediately.
Medicaid simply pays less than the cost of delivery, and it does so because government knows it can get away with it. The government can impose its will with regulation and certification.
You have no idea how ridiculously underpaying Medicaid is. Can you imagine what would happen if government mandated that Facebook employees could only be paid a maximum of 10/hour?
I've looked up the price and for one hospital in Belgium [0]. The rates, including the room you stay in, are:
Uninsured: €140~€420 Insured: €17~€200 Insured with low income: €10~€190
The large variation is due to shared common room vs single personal room.
An epidural really shouldn't be insanely expensive. Of course, exposure to litigation and risk for the doctor is much lower here.
[0] https://www.azdelta.be/nl/patient/wat-het-u-zal-kosten/prijs... (in dutch)
https://www.kff.org/report-section/understanding-medicaid-ho...
The entire journey, my green OHIP card was all I needed, no insurance forms, no pre-approvals, no extra charges. 5 hospital visits with 3 treatments so far.
I'm flabbergasted when I talk to American friends and family and they all seem to think two things:
1. Canadian health care "is terrible, people die waiting in emergency rooms" 2. The US system is by far the best and that's why it's so expensive
3. Canadians pay for their health care in tax, anyways.
(However: https://www.investopedia.com/financial-edge/0411/do-canadian...)
Of course, over ten times as much is spent on the military. How can a country with no enemies nearby justify spending 60% of their budget on the military? Especially given how the only ones hostile to them are the ones they pissed off.
3. This is actually a good thing, because we get health care when we need it and aren't exposed to crippling debt?
(your system entirely indefensible from every possible view point)
Whoa there. My family has a good friend whose child was born with a severe genetic disease in Canada. They are paying a ton out of pocket for care for their child since the gov't doesn't pay (night nurse, some physiotherapy). Both parents are having to work full time just to pay the medical bills.
For your average Canadian everything gets paid for, but if you have special needs, you're sometimes on the hook big time.
Of course, if they lost their job they'd be SOL.
(indeed, it's unfortunate for your friend and I'm sorry that they're in that situation)
For the average person though (which, when we talk about American healthcare, is largely who we are discussing), and a for the majority of the population, things work out very differently. Myself and the members of my family have had countless hospital stays, ER visits, surgeries, checkups, ambulance rides (approx $300 flat fee), assessments, scans and x-rays. All without any of us carrying any debt or dealing with any related financial hardship (lower tax bracket, so no special benefit plans or anything).
Friend's kid's appendix needed removal, multiple night stay at the hospital. No cost. What does that look like in America?
I had a deviated septum and didn't breath great. I breath just fine now after my totally covered septoplasty. What does that look like in America?
Kids recently got strep throat and needed a doctors appointment to get a prescription for antibiotics ($42 to cover the prescription) What does that look like in America? (honestly I'm curious about this one, would it be more than a couple hundred dollars for that?)
edit (spelling)
It will depend upon your insurance plan, but this situation is pretty comparable. You'd likely pay a $20ish copay at the doctor's office and $20ish at the pharmacy.
I guess I'm just overly eager to tell Americans how crazy the system they accept is
4. Americans pay for health insurance through private companies, anyway. And then they still don't get the care they need.
As always, that we don't have healthcare for everyone is a political problem, not a spending problem.
https://en.wikipedia.org/wiki/Comparison_of_the_healthcare_s...
She went to a Dr. in the states. They determined she needed surgery immediately.
Unfortunately, the local hospital would not let her have the surgery. Why? The billing department was closed for the weekend. She offered to pay cash. Still, the answer was no. The surgery was delayed for 3 days. In that time, she her situation severely worsened, causing permanent damage that would have been prevented by surgery.
She immediately made an emergency trip the Vancouver -- and was treated the same day, surgery and everything. No cost.
Basically, she would be compensated, and it would serve as a deterrent to our US hospital system to not behave as poorly.
I would even argue it is discrimination based on nationality.
Basically it won't be a deterrent to anything. They will just charge patients extra to pay for malpractice insurance.
In the UK, the entitlement is even more ubiquitous and fluid. I was diagnosed by my GP, referred to hospital and undergoing surgery under general anaesthetic, in half a day, without showing any form of ID.
That's changing a bit under the hostile environment.
https://www.gov.uk/government/publications/guidance-on-overs...
As a tall middle-aged white guy, I go wherever I want, nobody asks to see any ID, nobody checks why I'm there. If they need to interact with me they start by apologising "I'm sorry sir".
Hospitals, government departments, everywhere I go I look like I'm supposed to be there.
But behave the exact same way as a 5'6" black teenager and you'll get stopped and questioned constantly.
Looking like you belong has a lot more to do with your attitude than your race.
Cognitive dissonance and/or Stockholm syndrome?
You shouldn't have to do this in a first world country, but:
* Go to the ER without ID
* (optional) Ask how much it will cost
* (optional) They do not give prices, as a matter of policy
* They must treat you by law
* Afterwards, offer a cash payment you deem reasonable
* They will accept or decline it
Transaction complete.
For non-emergency care and prescriptions, get cash quotes up front, pay in cash, and order discount online prescriptions from canada, a first world country.
For chronic medical conditions, leave the US and immigrate to a first world country.
The job of the ER is to prevent you from dying, not fix you. If you are injured in a way that requires an expensive surgery and therapy to fix but won't actually kill you if left untreated, even if it cripples you, they are not obligated to fix you under the law.
Also, president Richard Nixon effectively linked national health care with socialism as part of Cold War propaganda. (That said, he did offer comprehensive health reform too that in a number of ways was more dramatic than we achieved under president Obama, but the congress killed it.)
The thing to realize here is that total government provision of healthcare is probably cheaper than the way the US does it, but that doesn't mean the market has failed. Healthcare in the United States is anything but a free market. It's the worst of all worlds: special interests extract rents through government regulations (drug patents, occupational licensing, handouts to insurance companies in legislation); the government effectively controls prices through its own payment programs; the whole system is over-regulated to an absurd degree. There is no price mechanism to help consumers or producers make proper choices.
So when someone says something like, "the free market can't effectively provide healthcare," I would kindly ask where they see a free market healthcare system. This sounds like a No True Scotsman argument, but it's not. You can't label something so ridiculous as US healthcare as "free market" without either total ignorance or intent to deceive.
In an ideal hospital, you should only have doctors, nurses, nurse assistants, nurse manager, accounting, pharmacy.
Think of all the unnecessary healthcare MBAs that siphon off enormous amounts of resources to generate as much profit as possible to be shared with other healthcare MBAs.
Think of all the suppliers of healthcare goods that try to patent and profit off of unnecessary medical "inventions" which do not make a difference compared to what was done previously.
Think of all the government bureaucrats paid to ration healthcare resources by underpaying for services which burden hospitals and doctors to raise charges for private insured.
Think of all the patients who don't give a crap about their health and refuse to correct their chronic conditions and rather go to the ER when things get really bad.
Think of all the lawyers who profit off of bad outcomes (not malpractice necessarily) which forces hospitals and doctors to practice defensive medicine.
Making everything single payor won't work, because guess what, there will still be a private insurance system for the people who can afford it vs the system for the rest. It doesn't fix anything.
I think the boom has been in pay and employment of hospital CEO, CFO, CTO, nurse directors, nurse compliance officers, legal, billing departments and supervisors of supervisors.
The people who actually deliver care, ie doctors and nurses, are being perpetually marginalized.
How do lawmakers in the USA convince people that this is acceptable? I have never directly paid a single cent for healthcare, and neither has anyone I know. When I had to get 6 stitches in my forehead at 2 AM on a Sunday morning, it cost me nothing. When my friend needed to get the tip of his finger reattached, it cost us $5 for parking. When my brother spend almost a week in hospital after coming off his motorbike, requiring surgery on both his knees, it cost him a grand total of $0 out of pocket.
Are people just so blind to how extortionate healthcare is in the USA?
The argument that I pay for my healthcare in my taxes doesn't hold water either. I pay less tax in Australia than I would in California, and I get free hospital care as part of that. I don't have health insurance and see no reason why I would purchase it either.
With the explicit goal of causing the individual marketplaces to implode. In the meantime it's increased the cost to taxpayers of subsidizing marketplace plans!
https://www.cnbc.com/2018/01/04/obamacare-health-insurers-se...
> That report instead finds that the Obamacare market has continued "stabilizing," and that insurers are "regaining profitability" despite continued political uncertainty over the health-care law.
For a bit of anecdotal data, my premiums went up 2% last year, after 17% the previous year. I also got a $500 refund as they'd exceeded the 20% non-medical costs cap.
I guess we are pretty screwed though, there's no willingness to prop up the buy side of the market and no willingness to make regulatory changes that would negatively impact incumbents on the sell side.
(the fair, "market based" approach to decreasing medical costs in the US is to dramatically increase the number of doctors and mid-level providers).
I live in Belgium, mostly good and free healthcare (barring payment of a few euros here and there). I have 3 cousins who are (or are studying to become) doctors and while specialised doctors can make decent money (€75 -> 450k), they don't come anywhere close to what a US based doctor might be making.
Someone making between $1 to 2m in the US (e.g. certain surgeons) might "only" be making $300 - 400k here. And the quality level is exactly the same.
http://www.commonwealthfund.org/publications/in-the-literatu...
One side of government is intent on breaking government and then using that dysfunction as a justification to create more dysfunction. The American political environment relies entirely on fear and creating fear using misinformation.
It is a defined political strategy that one side is committed to[0]. There is a difference between a group of people doing things that you think will break government and a group of people doing things with the intent of breaking government.
This type of 'counter argument' is a symptom of exactly what I'm talking about.
There was no treatment for his condition beyond palliative care. He was on life support for the rest of his life, no matter what anyone did.
His doctors, whose duty is to the patient, determined that it was more harmful to artificially keep him "alive" (he was in a semi-vegetative state due to serious brain damage) than to disconnect his life support and allow him to die.
The offer of "care" in another country (the Vatican) was simply palliative care: they intended to simply keep him alive on life support indefinitely. There was no treatment for his condition.
His doctors, quite rightly, concluded that transport to another country would do him no good and would instead cause more harm.
The court case was between his doctors and his parents. The UK government had absolutely nothing to do with it.
Is there a difference in terminology here? The courts are part of the government in my mind. And they have the ability to overrule unjust law.
IANAL but I believe in this case, the point of law it came down to was largely about deciding what was best for the patient, not the parents.
I'm not hugely well informed on US law so could be misunderstanding this process.
Edit: Wikipedia tells me Article 3 of the Constitution makes the federal courts part of federal government
Appointed by, but not accountable to once appointed, and the appointments are permanent. The President can't direct judges or fire them because he doesn't like how they do their job (Congress can “fire” them by impeachment, but that requires a supermajority in the Senate after charges by a majority of the House, which means it doesn't happen on a whim of the political majority.)
The courts quite often upset UK governments (of whichever party) when they strike down bad laws via judicial review, or by finding some aspect of government policy illegal.
Imagine if Mitch McConnell runs the executive, he gets to pick Senators for important stuff like the Secretary of State, and lesser things like the top of the FCC go to Republicans in the House. They're still in Congress, they just are now also running an executive. Just as now all the real work is done by career civil servants, the politicians are there to set political direction.
The Palace where the UK's elected legislators meet is divided down the middle so that members of the political parties that aren't in Government are quite literally "the opposition" - they're facing the members from the governing party.
Because power might shift suddenly a serious opposition political party has to have "shadows" of every major executive role. A Shadow Environment Minister for example doesn't have a huge Department actually governing the environment like the "real" Environment Minister but they need to know what's going on in that department and be able to explain how their party would do it differently, because tomorrow they could be in power.
The messed up thing is, the US also offers "catastrophic" insurance for about $150 / month but they only allow people under the age of 30 to apply for it. But at the same time I'm pretty sure hospitals are forced by law to perform emergency surgery on you regardless of whether or not you have insurance (don't quote me on this).
In 2017 I had to spend thousands of dollars in tax penalties for not having insurance. Welcome to the US!
Living in the midwest has changed my mind, here people need the system to be true because it is the basis for their entire way of seeing the world. They listen to Rush adn to Fox News...and they accept it at a philisophical level. They rely on being told it because otherwise they would have to confront a lot of realities all at once. I don't see brainwashed as a slight, I see it as said with compassion and sadness.
What are the other options? Most dont choose their health insurance based on belief in one system or another.
I agree there are plenty in the midwest, with conservative views, who believe in conservatism to unhealthy levels, no thanks to the crack pots they listen to on the radio.
The only person I’ve heard who felt the american healthcare system was the best in te world was in a speech by GW Bush. His speech was answered with silence because the audience was in such shock.
People under 30 who have nothing (known) wrong with them. I was rejected for a condition which barely affects my life, at a time when I was a poorly-paid contractor with no insurance through work.
It is, though. Insurance is expensive, but it's not a scam. That money tends to go mostly for care, overall. Someone has to pay it.
It's true that on the whole, the US tends to overpay for care and that other systems tend to get similar results for less cost. But that's a constant factor on the insurance payment.
Obviously many of us think making this an individual burden is a bad idea: obviously it's regressive and burdensome for the bottom of the income distribution, and more subtly it's a moral hazard for the healthy, who are tempted to forego insurance figuring that they don't need it and thus pushing the cost of providing care disproportionately onto the sick and the elderly.
But again, someone has to pay it. There's no magic wand here that makes health care cheap or free. Health care is expensive, someone's got to write that check.
> In 2017 I had to spend thousands of dollars in tax penalties for not having insurance. Welcome to the US!
Because someone has to pay it, and you didn't!
A lot of the full time RV community parks and walks over to Los Algodones, Mexico for eye care/glasses, dental and some medicines that aren't a certain schedule they can get and are allowed to take back a certain amount. They pay cash directly, no insurance is needed.
I guess they don't drive because of needing a separate auto insurance policy for Mexico. I believe most US policies cover only Canada, but not Mexico for trips across the border. Plus it might be quicker to just walk back and forth for a day trip. There's a official border crossing back and forth on foot for pedestrians, compared to cars which has a lot longer line.
However I'm not too sure what kind of recourse you have if a dentist or some other doctor messes up. Haven't researched it too much personally. There's some YouTube videos about it though, they have like a entire block of just dental offices back to back. Kinda amazing, but it's a popular area for medical tourism. A lot of them even speak English in that town, accepts US dollars and everything. Some people just visit for lunch and check out the town.
The party on the left who complain the loudest about health cost are incidentally heavily supported by the plaintiffs lawyers. Look at who opposed tort reform in Texas — it wasn’t Republicans, they are the ones that proposed it; it was plaintiff lawyers and the candidates they purchase.
Literally billions a year is paid in malpractice claims and punitive damages in the 7 figures is common. Who pays those awards? We do. Try suing the NHS. Or in the case of Alfie, try even having someone else willing to pay to leave the hospital — not happening.
There is also cross-subsidation as well. When an uninsured “undocumented” person visits the ER for a sore throat — that money is almost never collected, hence the $100 bed pan. When services are effectively shoplifted, everyone else covers the loss. For data on this, look at the finances of south Texas hospitals compared to a hospital in Wyoming. Or better yet, go work in a hospital billing department. Those that disagree with this have never worked in an ER.
Ironically, in Mexico, if you need an emergency surgery, you better have proof of funds or they will literally let you die in the waiting room.
Even the “beloved” NHS will deny care to non-citizens: https://www.independent.co.uk/news/uk/home-news/pregnant-bri...
But the US? Pregnant woman walks in to any US hospital, they’ll be treated regardless of ability to pay or citizenship — which is a good thing, but then we can’t be surprised when we get to pay for that when we visit the ER.
Yes but the govt already takes a bit over 40% of my income (I run my own business). I'm certainly paying my share. It's not my fault that the govt would rather use those funds on non-healthcare related things.
I'm all for a true universal health care for everyone, but if you're already taxing me so hard, I shouldn't have even more taken away from me. That's unreasonable.
> Because someone has to pay it, and you didn't!
I would bet anything the amount I paid in penalties is more than what most people pay to be insured just going by the average income in the US compared to the "assisted pay" discount you get for having a certain bracket of income.
I don't even make that much either. I'm in the "typical software developer income" bracket, but I'm self employed so I have no help or matching from an employer. I'm essentially paying both halves with no benefits (health or retirement).
And to top it off, if I get into medical trouble I'm left hanging.
That seems very hard to determine, especially as a business owner. What's the value to you of safe shipping lanes to get raw materials to you? What's the value of employees not worrying about being executed by warlords? What's the value of having US customers who can afford your products?
I don't think you can say what your "fair share" is as some limit for what you pay. Rather, the amount the businesses are taxed has to be a matter of pragmatism.
> I would bet anything the amount I paid in penalties is more than what most people pay to be insured
One would hope so. That is the point of penalties, after all.
I am a freelance web developer and online teacher. I have no employees or physical goods.
About half of my customers are from the US and I am in a hyper competitive world wide market.
You pay a premium for coverage of unexpected medical costs and you agree to pay a copay and pay up to a deductible amount.
If you don't like the contract, enter into a different contract with a different company, or start your own private insurance companyn or self insure.
With heavy regulation (Obamacare, net neutrality), it is much harder for the small time players to start their own businesses to address shortcomings of the existing companies.
The Australian model is that health care providers can charge what they like, but Medicare only pays a predetermined amount for every kind of treatment. Providers are free to charge more, but have to capture the difference as a 'copay' or by billing the patient's private health insurance.
Part of the reasoning is that prices are high because of excessive regulation, like that requirement to treat all emergency cases. Get rid of those and prices will become affordable, the theory goes. I don’t think that would help nearly enough to make it work, but others clearly disagree.
A plastic surgeon specialises in repairing or reconstructing damaged body parts: in this case, the treatment is clearly reconstructive surgery on the patient's ear in the hospital. The patient was weighing the cost of that surgery against living with a damaged ear…
Plastic surgeons also do cosmetic alterations of body parts, such as removing moles, etc. Some platic surgeons work privately to only do these kinds of procedures for celebrities etc., so you may be more familiar with this minority & their work rather than their primary specialty.
That aside, I had a few different people give me the following reason why this is acceptable to them. "Why should we pay any of our hard earned money to the government so some drug addict can get their fix?" "Why should I pay for single mothers who made bad decisions?" It is almost always other people making poor decisions or getting into poor situations that justify their choices on this type of stuff.
When you ask about parents who's kids can't get surgery, they reply in a similar fashion, "there's government programs for them, so I don't need to pay anymore taxes." They have never had to use one of these "wonderful" government programs. That's key to their thinking.
Try to tell them that it could be their kids that need a surgery they can't afford and it'll go something like, "well that's why we pay for insurance out of our pocket." They never stop to think about people who are in a bad situation.
There is NO getting through to some of these people until they need the help they refuse to pay for. I have seen one couple change their minds once their insurance refused to cover something for their kid. Immediately they were "raising awareness" for this type of stuff... but whatever at least they eventually came to.
So to answer your question, they aren't blind per se, as they see how stupid it is. They are however selfish as shit and don't care about anyone outside of their initial friends and family.
https://www.nytimes.com/2012/04/18/us/no-savings-found-in-fl...
> Because the Florida law requires that applicants who pass the test be reimbursed for the cost, an average of $30, the cost to the state was $118,140. This is more than would have been paid out in benefits to the people who failed the test, Mr. Newton said. As a result, the testing cost the government an extra $45,780, he said.
60% of the US budget is spent on the military. Reduce that to just 50 or 40% and suddenly, hundreds of billions would become available to spend on health care, education, infrastructure, etc.
Raising taxes is probably also something to do though, the US is racking up trillions in debts at the moment.
No, it's 16%.[1]
[1]https://www.nationalpriorities.org/budget-basics/federal-bud...
evidently people in Canada, the UK, Japan, Sweden, Singapore and other places where there is a comprehensive, well-managed health care system are not "selfish as shit."
so, we should probably ask: "why? why are people selfish as shit in America?"
furthermore, taxpayers already foot the bill for these cases anyway since the government reimburses the hospitals, at least partially, for treating the uninsured. What the govt doesn't reimburse, the hospitals pass on to the insured customers (at this point it is hard to call them patients) in the form of higher costs.
There's a risk associated to the type of thinking that takes root before a breakthrough experience like this: it's the idea that if something bad like were to happen to them, it's because they are exception to the rule, where the rule is plugging your ears and repeating personal responsibility over and over again.
That's to say such a situation gets internalized as, "It's unfair that my treatment isn't covered because I pay for insurance coverage, so of course I expect to be covered when I'm sick. If you don't pay for insurance, you shouldn't expect anything."
Which is a close relative to, "It's okay that I'm benefiting from public assistance, because I'm actually suffering and I'm not cheating the system like everyone else."
"Choose what X is right for you and your family"
This allows the wealthy the chance to choose a better level of healthcare, schools, and basically everything else leaving the rest of the nation to choose only what they can afford (guess what, its not much). By patronizing the nation by saying "You're so smart, you know better what you need than a stupid Washington bureaucrat like me!", they stroke our ego's just enough to convince people that they are able to get a better deal (ie, beat the system).
It infuriates me that the people who ran for office and chose to "represent" us in a lot of cases completely abdicate their responsibility to do anything. Not to be partisan, but one party is a lot worse about this than another, to me if you go through all the trouble to put yourself in government and enrich yourself handsomely while you are there, at least fucking pretend you are going to try and solve something rather than this self-deprecation that comes out of the Republican party.
And I mean....maybe there is a little bit of truth to that, but what sort of attitude is this? It was almost pride as in "yeah we're paying through the nose so you don't have to"?
Keeping our military in European bases certainly does cost the United States significant resources to counter the Russian threat to Europe. While NATO countries don't pay their fair share of costs of maintaining their security, the United States has to pay the balance.
If European countries actually spent what they ought to, they absolutely would have less money to spend on their welfare systems.
The counterpoint here is that US keeps American bases in Europe because US wants to keep their bases here and it serves their interests first and foremost, any defensive goals are secondary, if not tertiary. All Nato nations could contribute exactly ZERO to the budget and US would still be getting the best deal out of everyone here.
The US could clearly exit NATO to save some (a lot) money.
How is paying for someone else's defense a good deal for America?
>>How is paying for someone else's defense a good deal for America?
Just get rid of the notion that America is "paying for someone else's defense" and it should become clearer - US currently has a complete military hegemony worldwide, and you can't maintain it without having forward bases all over the globe - countries inr Europe provide space for these bases, sometimes willingly, mostly over promises of things that have never materialized. In a lot of cases I think it's clear that the presence and actions of American forces around those bases are antagonizing Russia - at which point I'm not asking myself "why is Russia upset" but "wtf are the Americans doing". I have zero faith that in case of any conflict with Russia, US would come to our help or even prioritise us on the list of locations to defend - I'd much rather rely on our neighbours for help than a country literally on the other side of the planet whose interests don't necessarily align with ours.
hospitals and doctors are in it for the money. so anything that forces you to pay, they will make you pay, because they will get money and that's the American dream.
the incentives are all wrong. remember the news about a bank telling drug companies to straight out quit researching cures and only go for treatments because those generate more money? its all the same problem
I pay a significant amount in the UK in tax towards the NHS ( I think about £7500 a year of my tax goes towards it) but that's nothing like what I'd pay in the USA.
It's not just the system there that is poor, it's how expensive it is in addition.
They don't; it's a lot easier to channel blame for the problem in the wrong direction than to sell the system as acceptable, so that's what they do.
Bernie Sanders' "medicare for all" is the plan I've seen get the most support. If we got single payer healthcare, it would probably happen that way. It would cost $1.4 trillion per year[1], which is more than everything the government currently spends outside of entitlement programs. Adding this much spending without raising revenue would more than double the annual deficit.
"Tax the rich to pay for it," Bernie says! Okay, sounds good. His supporters will point to how the top marginal tax rate in the 1950s was 91%[2], and everything was great during that post-war boom. Here's the problem: regardless of the tax laws or rates, the US federal tax revenue has always been 15-20% of GDP[3] (we are currently at 17.3% of GDP). This figure has not changed since 1945, even as the tax law has been wildly changed many times over. That's not to say that nothing can ever change this figure -- it is different in other countries after all. But numerous attempts to change it by manipulating marginal tax rates have failed, and there's no reason to think that Bernie's tax-the-rich plan will do any better.
[1] http://money.cnn.com/2017/09/12/news/economy/sanders-medicar...
[2] http://www.politifact.com/truth-o-meter/statements/2015/nov/...
It can be done, we the people need to stand up and demand it while voting in leaders who will make it happen.
So let's say we want to add Bernie's $1.4 trillion Medicare-for-all to 2020's projected budget of $4.6 trillion -- we're now spending about $6 trillion total in 2020. To maintain the same annual deficit we have in 2017, we'd need tax receipts of $5.3 trillion, or 24% of the projected GDP. If we wanted to balance the budget, we'd need tax receipts of $6 trillion, or 27% of GDP. That is massively higher than the US has ever been able to get. Undoing the Republican tax cuts would barely put a dent in it.
Since raising revenue to 27% of GDP through aggressive taxation is unrealistic, let's say we could do 20% of GDP -- Bill Clinton and Jimmy Carter era policies were able to reach that level. That means we need to raise $6 trillion in 2020, and we need that to be 20% of GDP. So our GDP in 2020 would have to be $30 trillion. We would need to sustain 16% annual economic growth during a period of record taxation to get there. The growth has never been that high, not even during record booms, and we would need to reach it and sustain it for three years straight.
Bottom line, if you want Medicare-for-all, you're going to have to accept much higher annual deficits than this country has ever seen -- and that's after a major tax increase on the rich.
The data supporting this post is here: http://www.taxpolicycenter.org/statistics/federal-receipt-an...
It is often very difficult to convince these groups, especially the economically prosperous ones, to contribute to a system that helps the others, even to their own detriment. The rich don't want to pay for healthcare for the poor, the conservatives don't want to pay for healthcare for illegal immigrants, the mid-westerners don't want to capitulate to the coastal-elite agenda, progressives have zero respect for the values of conservatives and on and on. There are cultural lines drawn, and crossing those lines is nearly unthinkable to many Americans, even if it costs them their health.
American culture is broken and divided, most people can see that but they think that the other groups are the problem, and I'm not sure we will make much progress on our massive problems unless something changes with it.
Trump being elected is not actually germane to this discussion.
Indeed. Americans spend more per capita on healthcare than any country in the world, and needless to say, for all that spending we don't even cover everyone.
To put it another way, we _already_ spend enough on healthcare to cover everyone. That we don't cover everyone is a political problem (allowing for the existence of a for profit system with no public alternative), not a spending problem.
Yes, Americans are utterly blind to this. It's amazing. But it has taken no small amount of effort on the part of specially interested parties to create and maintain that blindness.
When comparing different health care systems there are dozens, probably even hundreds, of points they can be compared on.
If a US politician or party advocating universal, affordable, effective healthcare uses Australia, or Canada, or the UK, or Germany, or any other specific system as a model, or even just as an example to compare to, their opponents can find for that specific system something that it does not handle as well as the US currently does. They use those to convince their constituents that the current US system is better than the proposed replacement.
If the politician advocating change does not reference specific other systems, then their opponents say they are pushing for a government takeover of healthcare using an untried, untested system based just on theory and speculation.
Another thing they like to do is label every other system as "socialized medicine", and paint a picture of adopting such a system meaning we will have to go to government assigned doctors who work in government owned hospitals and deal with a giant, intrusive, inefficient bureaucracy for every medical thing we do no matter how minor.
I'll bet the hospital sees that as 'fixing the situation' and all I am left wondering is how many other people don't have Vox reporters sending emails for the same type of treatment. I'm hoping the CMS plan [0] to require published prices might help this type of nonsense just a little.
[0] https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-rele...
While hospitals are already required under guidelines developed by CMS to either make publicly available a list of their standard charges, or their policies for allowing the public to view a list of those charges upon request, CMS is updating its guidelines to specifically require that hospitals post this information. The agency is also seeking comment on what price transparency information stakeholders would find most useful and how best to help hospitals create patient-friendly interfaces to make it easier for consumers to access relevant health care data so they can more readily compare providers.
One reason to doubt it is that an awful lot of people live within reasonable distance of 1 hospital, and almost everyone else lives near busy hospitals.
This requirement is useless, though. The "standard charges" don't reflect reality. My wife receives regular infusions in an infusion center. They bill $3k to insurance each time. Insurance pays about $400, which the hospital happily accepts. That $3k number is what an uninsured patient would be asked to pay, and it's the number they'll list as the standard charge, but it's complete, invented bullshit.
It's a good talking point though, several people in this thread are excited about the potential for it to bring about change.
On the other hand, Hoboken University Medical Center would have closed a decade ago if not purchased by CarePoint at the time. Prior to that acquisition, it was a non-profit community hospital for over 140 years -- it's the oldest hospital in the state, but it eventually hit severe financial difficulties. Today it has a good reputation in some areas, especially obstetrics. But as someone who lives a few blocks away, the poor reputation of its ER's billing practices is definitely worrisome.
Disclosure: I worked at the same company as Jess Pell and vaguely recall hearing about this overbilling situation a while back, but that's far from the only time I've heard about this particular ER overbilling someone.
ER visits are difficult in their own ways; you can be brought in unconscious and go through treatment you can't agree to, you can be close to death and the time it takes to check costs could impact if you live or not. This means you'd want to do something like fixed costs for these services but with good medical coverage for everyone those fixed costs could be what people do in place of insurance.
I don't have an answer other than universal healthcare. There are reasons that this can't happen at the moment and it's still difficult to implement in a way that works across the board. This is a hard problem and will take a lot of effort to get right
What about requiring published price lists? Maybe you need twelve procedures because you're in bad shape, but at least the bill won't be arbitrary.
https://en.wikipedia.org/wiki/Chargemaster
That said, mandatory transparency (from both the hospitals as the insurance/healthcare plans on what exactly happens in what scenario (say x-ray for possibly broken elbow), and the current rate/probability of scenarios) should be requisite, but that is only a necessary condition. The behaviours of the medical industry should also be binding.
They wired me up to machines and made me wait 5 hours for the scan, then 3 hours to get discharged. They wouldn’t let me leave until the doctor on duty wrote up her treatment recommendation. Even though I was just there for a scan.
No insurance last year so after my “35% cash payer discount” it came out to $5500 after the many parties in the ER sent me separate bills. Scan was $2000 of that, but I could have paid $600 across town.
Don’t go to the ER unless you’re unconscious. It’s that rare case where you are paying AND you are the product.
I initially stopped at an urgent care facility, but they told me to sit and wait before even asking my symptoms. I'm not afraid of many medical things, but my appendix has always made me extra nervous. So we left and went to the ER, where they asked a few questions and rushed me into a room, and then a scan shortly after. We had caught it very early.
So I did what he said.
Stories like this make me very happy that I no longer live in the US. The constant fear of a surprise medical bill is a stress I don't need.
If you prefer, you can visit any hospital you want in the United States, as long as you pay for the medical care. Why should hospitals accept low insurance payment from insurers who do not give them a benefit of increased patient volume?
Why not?
If you are in the insurer side, you think you have a competitive advantage compared to company Y. Sharing what you are paying per procedure is bad business
If you are on the Hospital side, you want to make sure the insurers keep paying more, and publishing means a quick race to the bottom.
This means that in most cases in america, you cant know what something is going to cost until after you get billed. Its great for literally everyone except the consumer.
Disclaimer: I only lived in the US for a year.
Isn't this in the same boat as price-fixing?
My 3 year old son hurt his arm. It was after 7pm so we had to go to the ER. We see a nurse, she didn't check anything. X-Rays and then they gave us a hospital room. Immediately I realized we were getting into a spending black whole. After 30 seconds I told the nurse we wanted to leave. My son wasn't crying and he was climbing a chair using his "hurt" arm. They wouldn't let us leave. After hustling with them we left. we got a $1,500 USD bill that we had to pay because we didn't know what to do.
Hospitals have these bullshit inflated fees, once they accept the insurance payout that is all they're getting from me.
They're all "non-profits" that scam the system by writing all this shit off as goodwill or bad debts.
I went to the ER a while back, my insurance paid roughly 1600 for the 8k+ they billed. I have a HSA that pays out as well, yet they have tried to bill me on top of that. They'll never see another cent.
Credit is overrated anyway. Causes more troubles than it's worth.
Absolutely false. Modern FICO scores are doing that. The FICO score your bank will actually use doesn't differentiate debt.
> Credit is overrated anyway. Causes more troubles than it's worth.
I suppose if you never want to be a homeowner that's true.
No insurer pays 100% of every medical bill, no matter what, with no expectation of copay or deductible. Even if you had that sweet deal, you would be paying premiums that nobody could afford.
Do you have a right to receive services from another human without appropriate payment?
The one caught in the middle is the individual who gets screwed by both the hospital and insurer/government.
Maybe you should make up your mind.
I just play the game. They make the rules. Don't like it, tough shit, I've paid in hundreds of thousands to insurance over my lifetime. So cry me a river that they've created this shit system we've got with their lobbying and private/public monopolies.
Typically I ask what their settlement price is in the rare instances I've had to use them. So they can take that or send it to collections.
1. Los Angeles County, of 10.1 million people, runs its own hospital system.
2. New York City, of 8.6 million people, runs its own hospital system.
3. Colorado, of 5.6 million people, runs its own hospital system.
Etc etc. (All of them quickly add up to the population of Canada.) They still do these horrible things we're talking about here, even though they're ultimately accountable to the people and must do what our laws says they must do.
And we think we're gonna suddenly be like Canada, like magic? If so, get the five people running the LA County hospitals to do so. (Yes, five people represent 10.1 million people, lol.) And the same goes for NYC and CO and the rest.
https://www.vox.com/policy-and-politics/2017/4/25/15356118/s...
I had gone to ER only because it was at an odd time and no other hospital was open.
Emergency rooms should be for emergencies. You yourself will know if you are about to die.
We get these complaints in Germany too (where I currently live) BTW. "A five-minute drive with an ambulance shouldn't cost €500!" someone complained to the newspaper here recently. It doesn't, what costs €500 is keeping enough ambulances ready that one can arrive within x minutes with y% probability, for IMO overcautious values of x and y.
IIRC an ambulance ride in the US is 10-20k, that's indicative of just how much more medical care costs over there.
What might be similar that the billable item is not the costly item. Of course I don't know the first thing about US health care costs (as opposed to billable items).
No hospital administration would allow this: they would refer you to a separate medical imaging clinic, or run one on hospital grounds that all departments would refer patients to.
I.e. you, as the hospital, inflate your price, by X00% margin over what you actually plan to charge the insurance. Then you let the insurance negotiators negotiate, and you negotiate down to the reasonable price.
This looks really good on the paper. Unfortunately, you as a patient, if you don't have good coverage, you end up paying the inflated price, that you didn't really have the chance of negotiating (and wouldn't really have the chance even if you hadn't been unconcious ;)
Like, if I compare it to Czech Republic, where I live (or even Germany), the prices seem much more reasonable (i.e. you would be able to get a complication-free birth in hospital for ~400$, more complicated, i.e. cesarean section ~1500$, including hospital stay, in US it seem to be 5-10x as much)
Not American, but from what I've read in these types of news articles, you often CAN negotiate it down a lot, but when you get a huge bill in the mail, the first thing you think isn't "I'm going to try to haggle down my $5000 bill with this huge hospital" you think "I'm so screwed. Time to google 'personal bankruptcy', was it 7 years?". Pharmaceutical companies are also always saying that they will subsidize prescription medications for those who can't afford it, but I dunno how much that is BS or not.
(but you are getting the negotiated price anyway; the paranoid part of my brain thinks they run a scam here by recoding bills that come after the deductible has been met, which is a different sort of negotiation than agreeing on prices for services)
If you claim to not have insurance, the same visit is $80.
She felt that losing her ear was a possible outcome of the accident, which certainly seems like an emergency.
More broadly, it can be difficult for a layman to determine what warrants emergency care vs what doesn't.
And all of that only happened because my friend didn't take multiple "no" from the ER doctor for an answer and insisted that I get at least a rudimentary checkup by them, otherwise I would be dead. So, respectfully, your comment is bullshit.
Your friend was right in that the emergency room doctor should do their job, but their job isn't to be the primary physician, they're there to diagnose and treat emergencies.
If you were tachycardic, tachypneic, apneic, hypotensive, hypertensive, febrile, hypothermic, bloody, pale, in severe localized pain, slurring speech, paretic, then the ER would investigate until answers are obtained, because all of the above are concerning.
A complaint of only fainting has many non emergency causes, and you would have to provide additional information that would warrant investigation. Ordering fishing expedition tests in the ER is extremely wasteful in a non emergency situation. Imagine how many people go to the ER for nonemergency care and expensive tests are ordered unnecessarily! Because of defensive medicine, this happens way too much, which is why healthcare costs so damn much in this country.
Medical care is anything if not statistical. If an ER is receiving non-emergency patients, they know it, and can design their care processes to handle those patients efficiently.
If they're billing patients $5k for a bandage, it's solely a financial boondoggle. There is also a political aspect -- blaming poor people for "wasting" care by making unnecessary use of the ER.