Insured, but Still Owing $109K for a Heart Attack
khn.org
khn.org
Sounds all fine and dandy until you realize that these charges will just be made up for by people that aren't able to get NPR to publish a story about them.
No, St. David's has already fully recouped their costs and then some. They were simply trying to extract as much money as the stone could bleed.
Disclaimer: Universal healthcare advocate
sources:
https://www.beckershospitalreview.com/hospital-transactions-...
They came by the name honestly, but it is indeed a shame the way it has gone since the St. David's Foundation partnered with HCA.
The hospital(s) were originally founded and run by St. David's Episcopal and were one of the first and foremost hospitals in Austin, with very high quality care and good service to the community.
After operating them for nearly 75 years, and growing to an enormous enterprise, it became clear that a church congregation simply couldn't and shouldn't be operating them any further and they were spun out. Some of the profits are still sent back to the foundation for community health care grants.
This particular wealth extraction strategy would never have occurred under church leadership.
(disclaimer: I was a member of the church during this period and hold it in very high regard)
Well at some point she needed surgery (at HCA), and about five months later after dealing with 10 < x < 20 bills including one we'd never heard about until collections came knocking she just looked at me and said "Nobody knows what this is going to cost." It really bums me out that a human being working in healthcare here isn't able to even remotely predict the cost of a procedure at the hospital at which they work.
FTFY.
But seriously, how can it possibly be the hospital's fault for doing exactly what the law and market incentives give them every reason to do? There's almost no downward pressure on prices: little competition, no transparent pricing, huge barriers to market entry, and third party payers.
Because they're the ones actually doing it? Because they're run by adults who are fully capable of taking responsibility for their actions?
Worse, it's frequently the same people who argue that corporations are "people" arguing that corporations as a whole shouldn't be held responsible for their actions.
But to use people's lives as leverage to extract absurd amounts of money goes well beyond being immoral, it's just downright evil.
Of course they deserve to be paid. And paid quite nicely, too, considering the education levels needed to work such jobs (Lifeguards, obviously requiring significantly less than doctors)!
But they can be paid nicely while charging reasonable prices. The $164k the hospital charged that man for his heart attack is beyond unreasonable.
Why? Not out of the kindness of their hearts. They know that their name showing up with a bill for $500 for ASA is bad PR, so better to make those common things realistic, and pad their numbers elsewhere (like charging $19,500 for a $1,500 stent)...
I once played dumb to an importer abusing fees, after monthes of bouncing mails to different people babbling the same thing over and over, then dealing with a 'lawyer firm' who behaved the same (basically nobody knew precisely what they were talking about). They suddenly accepted to give me a rebate of NN%. So I received a new bill with 100$ - '80$ promotional deal' = 20$ (normal fee). A very partial grin ensued.
I'm assuming you mean "gospel" and not the 1971 Broadway musical.
Hell one time I got a $15k bill for something insurance should have covered. Called the hospital, turns out insurance had covered it and I didn't actually owe any money at all. How many people get this kind of stuff and just pay it anyway?
> Hiring someone became imperative for me when coordinating my mother’s care got to be a way-more-than-full-time job. (In retrospect, I wish I had done that months earlier.)
> It could also be worthwhile in less critical cases, if no one in the family can take enough time off from work, or in which you’d simply rather pay someone else to clean up after a hospital’s paperwork pollution.
> This role has developed only recently, as systems have broken down. There’s not yet a standardized term; “health care advocate” is one among several.
> Mine specializes in gerontology and dementia. Others specialize in other disease areas; or in other aspects of the administrative nightmare, such as sorting out bogus hospital bills, which frequently include fraudulent additions.
> They are not inexpensive (mine charges $150/hour), so not an option for everyone.
> There are good and not-so-good advocates. I spoke with several before hiring one. Some were clearly clueless; the one I hired last month has seemed consistently competent.
> Since they recommend particular providers, there is an inherent principal-agent problem. Ask if they get any compensation from services they recommend. Take their recommendations with a grain of salt in any case.
I went through surgery at the Stanford Hospital, using Stanford's insurance. Prior to the surgery, they charged me $2000, the out of pocket maximum. Then, a couple of weeks post-surgery. I got another $250 bill. I had to spend the whole day on the phone first with the hospital, then the insurance, and then the hospital.
Turns out, that all I had to pay was $250, that the hospital had made a mistake in billing me $2000 at the door. I got my money back a month later.
I would normally attribute this to ineptitude. But the frequency and scale with which this happens, reeks of widespread scams.
I'm much less worried about the folks who pay it anyway than I am about the folks whose lives are destroyed by an industry predating on people in the worst of circumstances.
https://gist.github.com/ndarville/4295324
I'd start with a mentally forced mashup for each to get a few that might work. e.g. "If i've got to make money by lead generation with a medical bill review service/app, how could i do it?"
Then i'd focus on how we'd drive value to the consumers.
Then think about driving value to others parties who may be willing to pay for something similar.
ie would pharmaceutical and medical device companies be willing to communicate directly with these consumers?
note i'm not saying its easy by any means, but i do think its a real problem that could take off if an elegant and worthwhile solution came about.
But then I almost had a hard attack when the statement arrived. The first number I saw was 24k, WTF!! Well, reading on there was a very large "discount" applied and the final bill to the insurance company was about right. I could only imagine though, that under some circumstance, the hospital would have tried to stick me with that totally bogus 24k bill had the insurance not covered it or the pricing not been negotiated in advance..
I'm not saying, "ignore it and it goes away." Just that the billing side of things has no interest in working when they already have your money.
> In a statement, the hospital said this offer was contingent on Calver submitting his application for a discount based on his household finances. Calver disputed that he owes any additional money to St. David’s and said this situation should have been resolved long before now.
I might be misreading, but is this saying that Calver isn't going to accept even the $700 charge, just to make a statement? I obviously side with him but this seems like a crazy stand to take on principle alone.
Sounds a bit like getting support from Google.
She told them "I'm on Social Security for $1000/mo, I'll pay you $50/mo". It was basically that or sending it to collections and never getting a dime from a retiree. So they accepted and told her a "non-profit" paid for the doctor's portion of the bill, which was all but about $40k.
She'll probably be around another 10 years max, which means she'll end up paying about $10k of that balance.
Medical debt is the least concerning type of debt for most lenders. If you ever fall into this hole, don't sweat it. [Unsolicited advice.] Just let it go to collections. You'll get harassed for a little over a year. Debt older than a year is almost never pursued by collections agencies. After things quiet down start sending letters to the credits agencies saying the collections debt has been settled. The collections agency will usually slip up and not respond at some point and it'll be gone from your credit history.
Just another data point, a large property management company I used to work for specifically exempted bankruptcies due to medical debt when calculating applicant credit scores.
Also, if you're ever called by a collections agency, you should ask them to provide proof that they actually hold the debt you're obligated to pay. In some cases they've just bought the data, usually from another collections agency who couldn't collect, and they're trying to shake you down. Once you use the magic phrase "provide proof" they give up and stop hassling you, because they have no proof.
I wonder what would happen if it was widespread knowledge that the smart money was in never paying it.
Total cost, something around $23,000 I think. This is somebody who was making maybe $10/hr. They took a payment plan of around $15/month, so she will be paying it back for the next 128 years.
Recently she got a bill for $250 for the ambulance, which she paid, and another letter saying her bill for the hospital stay was settled. She told me she would have offered $15/mo had they held her to the $25k or told them to screw off if they didn't accept. They're not even bothering anymore.
I don't understand. Is there no penalty to not paying other than a hit on your credit score? Can't you end up with wage garnishments or liens or something like that?
Yes, the hospital or collections agency can sue you to try to garnish your wages. If they win, you're boned.
If they lose, or they never sue for garnishment, it's unclear what happens if you refuse to pay. From what I can tell, the debt disappears from your credit report after seven years, but the debt is still valid and they can still try to recover the money from you, but they won't be able to use the courts to do it.
However, there's always the option of declaring bankruptcy. Even if they garnish wages, declaring bankruptcy will wipe it away. Obviously, that's the nuclear option and will destroy your credit rating for seven years.
I've had 4 different cell phone numbers in my lifetime. All of them were still getting debt collection calls or still are up to 15 years later. I've had my current number for over 15 years. I'd love to meet Tanya who ran up the bills for my current number.
Also, I had my appendix rupture right after getting laid off and going on COBRA. I am still getting occasional calls about that even though the insurance eventually paid off. That was over 10 years ago.
COBRA is another scam. $1650 per month that my employer was paying ~$600 for.
Scumbaggery is rife in the insurance industry. The Rainmaker should be required watching...
COBRA is whatever the employer was paying + 2% administration fee.
And, to be clear, they charged $19,000 for the stent, not "stent plus theater time to place it plus surgeon, anesthesiology, OR nurses", of course not. Those are all absolutely billed separately.
If I can source the same stents for cheaper than the hospital bills me, they should be required to erase them from the bill and accept them as material replacement.
It's not as if medical supplies are unavailable to the end consumer.
https://www.esutures.com/product/0-in-date/41-boston-scienti... Here are the stents available for under $1000.
When I had a broken finger and was uninsured, I was charged ~$40 for a finger splint that costs $7 at Walgreens (yeah, the very basic one made out of aluminum and blue foam).
Also, a word of advice - never ever pay what you were sent from the hospital right away. I personally throw most medical bills in the trash and wait until they call me, then negotiate it down to a fraction of what was billed, offering to pay in cash.
My situations varied, but when I had no insurance and was living off of savings, I found a generic "hardship" form and explained my situation to them - they waived 80% of the fee without much resistance. This is compared to the laughable discount of 2% they offered me on the spot if I paid in cash (at the moment of the visit)
In other situations, I'd imagine it's more a question of persistence, but I'd venture to say you can knock off at least 50% on _any_ hospital bill.
I recently bought a house, and my credit was 800+, so I don't think it does in any appreciable way.
That wasn't the gist of my post though. I was advocating more to resist the bullshit and to legislate something that allows the customer to replace materials instead of paying a hugely marked up item.
Same concept would be applicable, for example, for a car mechanic shop. Just because they billed me $600 for brake pads doesn't mean that they've actually provided me with a 10x markup of value on having bought brake pads myself for $60 - at some point this needs to be treated as "usury" (I don't know if there's a word for exorbitant markup on a regular good).
Another thing I would add - don't put your social security number on medical forms. I've never seen it enforced and there's no medical reason for them to have it.
This is actually good advice. It shocked me when I realised it. But it’s good advice.
They ended up dropping the bill altogether as insurance had already paid them.
I know the US system is different to what I grew up with (UK NHS), but I have had similar "treatment" when ill as a tourist in 3rd world countries: couple of pills / drip.
I understand that the difference of systems in regards to extensive care, but a couple of pills and a drip - why on earth is such basic care just not free to all?
I mean, I know this seems like just a snarky political comment. But it's just the honest answer. Our federal government is simply completely dysfunctional right now, incapable of solving anything.
For what it's worth, "Medicare for All" has been polling increasingly higher recently, due to more Americans being basically ready to give up on the current private system entirely.
Just now? It’s seemed dysfunctional to me since I was capable of understanding government, circa 15 years ago. My parents felt the same way 30 years ago, and their parents felt the same way 50 years ago.
> If I can source the same stents for cheaper than the hospital bills me, they should be required to erase them from the bill and accept them as material replacement.
Meh. The only reason they inflate supply costs is because that's where insurance negotiations let them. Mandating supplies must be available at-cost to consumers is just a stupid cost-shifting game. Consumers shouldn't care in particular about the cost of supplies — overall cost is what matters.
Price-fixing in general does not really work. The difference is made up somewhere. Things that would actually reduce pricing stupidity and surprise bills are obvious things like: increased pricing transparency, consumer stake in reducing costs (HDHPs are a stab in this direction), and single payer.
https://www.commonwealthfund.org/press-release/2017/new-11-c...
> Mandating supplies must be available at-cost to consumers is just a stupid cost-shifting game.
That's not what I suggested in my post at all.
Also, if it reduces costs for the end consumer, what's the harm? Why should consumers subsidize hospitals with cutthroat billing departments who make up numbers out of thin air?
Not trivially? [1]
[1] https://www.theguardian.com/society/2017/jul/18/uk-cancer-su...
Less profit for the company.
> Most do not have the time or expertise for that, nor would anyone want to do it.
Is that a joke? You can find most of those things with a 30 second Google search. I thought this was a forum with technically apt people?
Yes, mandating supplies be sold at-cost is exactly what you proposed:
> Hospitals should be legally mandated to accept replacement of materials in lieu of payment.
> If I can source the same stents for cheaper than the hospital bills me, they should be required to erase them from the bill and accept them as material replacement.
And to address:
> Also, if it reduces costs for the end consumer, what's the harm?
The problem is in the condition. At the end of the day, ineffective regulation increases costs for the consumer.
Healthcare can and should be heavily regulated, its not like buying a hammer.
I agree that regulation makes sense, just not with the extremely specific proposal that medical devices be sold at cost (or whatever slightly higher unit cost is available to consumers).
The supply chain has to be verifiable as genuine goods from the factory to the hospital floor. Trying to verify the authenticity of patient-supplied replacements would be a nightmare.
I wasn't actually seriously suggesting that patients be required to source the item physically, then physically deliver it to the hospital in person.
Also, people like you who force hospitals to chase you down to pay a bill are part of the reason why it's so expensive in the first place.
$10,920 for room charges is absolutely ludicrous.
I'm asking because a friend was in the hospital in the bay area for 7 days and his room and board was approximately $21,000
In regard to your friend ... his 7 x 2 = $14k. That's a LOT for basically a bed, blood draws daily, limited TV and cafeteria food, but in the center of Los Angeles, that's what you get.
About 5 years ago, I had 6 weeks in hospital, a total of 3 angiograms, one MRI scan...and then 5 stents (should have been 4, but they tore something and had to put in a covered one!).
The wait was mainly down to an unfortunate series of events: One stent was needed in a 'tricky' place and so I was timetabled to be operated on by a specialist surgeon elsewhere, but his father fell seriously ill so he went on leave. My first op was rebooked for another hospital...and they had a 'flu outbreak so ops were postponed. Eventually I was booked in elsewhere had a one hour ambulance transport ride for 'third time lucky'.
The stents were fitted in two separate operations about two weeks apart. The most notable expense I incurred was for data top-ups on my cellphone because hospital wifi was still being setup and hadn't quite made it to my ward.
The NHS gets a lot of flak, and it's by no means perfect, but it's generally there for you when you really need it.
PS: I'm on a slew of meds for my heart condition and T2 diabetes - all free at the point of collection.
Also, in speaking with a vascular surgeon I know, their hourly rate is between 200-350/hr. The middlemen and hospitals have figured out how to milk this cow and they're feasting.
It took 2 months for the bill to arrive.
Healthcare in US is like legal extortion. You could literally bill for breathing hospital air and people would have to pay.
Don't be ridiculous. You'd be billed for air and hospital odor separately!
Though I should note that a delivery is usually more complex than simply waiting there for the little one to fall out, there is some after care and such that is being performed plus the doctor is usually not that cheap either. (They have a lot of student debt to pay off after all)
There is also a huge industry built along the lines of phony testing.
The term used for that think is called 'basin test', basically samples are flushed down the basin and made up numbers are put in reports. You can put in what you like as the doctors know the patient is healthy.
So while dying of a heart attack he should have been negotiating with the ambulance driver, the paramedics, the nurses, each intern and doctor to make sure they are "in-network".
> St. David’s said it was now willing to accept $782.29 to resolve the $108,951 balance because Drew Calver qualifies for its “financial assistance discount.” I
You can pay $100k or just $700, whatever is cool with us. I guess, go to the media and try to shame everyone involved is your best hope? I can see if they did this to people buying luxury suites or yachts. Doing this to people who are dying of a heart attack is particularly disgusting. And it's not like anyone involved is going to be punished for this practice or learn a lesson. They'll turn around and do the same thing to the next patient.
Absolutely! </s> I work in EMS. Thankfully, our Medic One system is funded entirely by property taxes and we simply do not bill (at all) for any treatment or transport.
However, a few years ago United got a lot of grief over denying airlift transport claims from things like MVAs, or traumas in remote locations, stating that the "transport had not been pre-approved through the insurer".
Apparently in their mind, us paramedics (or maybe the chopper pilot) should have been calling in between stabilizing our patient...
"This is John, I'm a paramedic working on one of your patients who was hit by a truck. We would like to fly him to the hospital due to his extensive multisystem trauma but we need your approval. His name? Hang on, let me find his wallet. No, that's Smythe, S-M-Y-T-H-E, sorry, it's a bit loud with the jaws of life in the background... Yes, I can hold for a nurse consult..."
At these rate differences it starts seeming prudent to medical airlift to the right hospital...
Turns out the doctor that the hospital assigned to me did _not_ take my insurance.
I got billed the full amount, yelled very loudly at lots of people, and when I “resubmitted” the claim ended up paying like $50 out of pocket. I’m pretty sure that every item in the hospital is purchased by a separate company and that the Venn diagram of approved insurance companies never intersects.
My dad is a nurse and I grew up hearing how insurance was destroying health care. As a free market libertarian, I have no idea what to do about it. But next time I need stitches I think I’ll just opt for the super glue in my workshop...
As someone who used to be a free market libertarian: take is as a data point, and make appropriate conclusions. Such as: free market doesn't solve every problem. It doesn't mean that we should ditch it - it's still the least invasive way to allocate resources, so it's a reasonable default. But we shouldn't elevate it to dogma. When it works, great! When it doesn't, regulate it. And thus, we can have the best of both worlds.
You have a need that the customer (patient) needs to fill with a product (medical care).
The problem is, if the customer doesn't get the need fullfilled within the next 10 minutes they die of cardiac arrest. Or worse, the customer is already in cardiac arrest and requires resuscitation.
An unconsicous customer can't make market decisions.
So now we get to the next stage, a hospital revives/saves the patient but they are unconscious for a few days in the ICU.
The patient can hardly walk away while being non-responsive or later when drugged up on painkillers so they don't scream all the time.
By the time a patient can leave a hospital without dying the hospital has likely already spent 90% of the money that would be spent if the patient stayed for a few days more to recover.
But is it free market to bill the patient for actions taken while they were non-responsive or not even consented too (because they were non-responsive and/or dying)?
IMO the answer is simple; free markets don't exist. They are an ideal construct similar to how a bouncy ball should mathematically bounce forever but doesn't. And especially in healthcare there are too many interfering patterns for a free market to actually exist. In other markets, you could make a free market because people could pick and choose and compare and consent (ie, buying logs of wood for your fireplace). But dying people can't participate in the market to not die freely.
I also advice against superglue for wounds, the stuff can be toxic and/or nasty and will likely lead to an infection. There are some natural glues that your body produces to stitch wounds and you can obtain them in your supermarket, though they aren't clean enough that I would consider them fit for that use either.
Super glue aka “Dermabond” https://emedicine.medscape.com/article/874047-overview
Insurance is a business. They aren’t looking out for you, or your loved ones. I hate to sound cynical, but boy, these past 4 months have shown me the deepest, ugliest side of commerce that inevitably results from aligning incentives with profits.
Untrue, because health insurers profits are limited by law, sure, but to a specified fraction of the costs they pay; if their payouts are too small, they have to refund the excess profits to the people paying premiums.
That's not really the source of the lack of competition, as employers are motivated to minimize rates for what they ger, whether they are seeking to fulfill a government minimum-coverage mandate or provide a competitive benefit to attract/retain staff.
(It is a source of some other problems, just not the one at issue.)
Employer provided insurance absolutely reduces competitive forces (among other problems it causes, as you point out).
It's not a market with particularly robust competition, due to small number of players, and barriers to entry, both natural (two-sided network effects, practical capital requirements) and regulatory.
Insurance companies are mandated to strict profit margins, yes. But they aren’t mandated to align with what the other parties say a patient needs. This creates a situation where insurance companies can discriminantly choose which services, and level of care to agree to pay for.
I see it happening right now: Long story short, to put it into everyday terminology, our family and the mechanic is urging for a new engine. Insurance is saying “all you need is air in your tires. That’s all we’ll approve.”
That almost never happens.
And despite what caps exist (can you point me to resources on this topic?), the industry is enjoying record profits right now. That's not to say hospitals aren't as well, but I'm puzzled that so many people seem to want to point the fingers at doctors. Doctors and nurses actually provide the care. If there's anyone I'm less worried about making a little more, it's the people actually doing the work. The administrators and the corporations that set and negotiate prices with the insurance companies though... I'm with you there.
Lastly, the incentives of insurance companies do not align with the patients unless you ignore most of how the industry works. Insurance companies make money when they're able to deny you coverage or require you to pay more out of pocket (in vs out of network). That doesn't align with patients at all.
There should not be a profit incentive in health insurance.
This is not correct, as I understand it. Under the ACA (Obamacare), health plan providers had to ensure that at least 80% of premiums were paid out for patient services. That leaves 20% for overheard, including profit and compensation.
The "trick" here is that service providers (doctors, hospitals, MRI facilities, labs, etc.) are not limited in this way (except by "usual and customary" terms where applicable), and there are LOTS of layers of providers. So in the end you can get many multiples of actual costs by simply washing the underlying treatment or service through 5 or so layers of providers.
Doesn't this imply that it's in the interest of health plan providers for patient services in general to be as expensive as possible? That means premiums will have to be correspondingly high, and the 20% available for profit and compensation will be larger.
Trying to make health insurance affordable is a fool's errand as long as hospitals can charge whatever the hell they want.
And since taxpayer funded healthcare is off the table in the US, we have to work with what we can. The biggest problem with health insurance right now is everyone is not forced to use healthcare.gov so the risk pools don't have the correct distribution of healthy and unhealthy people.
This might stand up in a highly competitive market, but even there you have network effects, and asymmetric power/information issues, that keep it from ever being completely true. In a market like health insurance where large fractions of people get their coverage from their employers who make choices for their employees, it's not really credible to say that high premiums will drive an insurance company out of the market. Moreover, the data bears out that premiums, profits, and executive compensation are all increasing while the overall cost of our healthcare as a nation spirals out of control.
> And since taxpayer funded healthcare is off the table in the US, we have to work with what we can.
If you expect elected officials to fix it by writing them letters and angry comments on the internet, well, yes. But campaigning and petitioning are not the only routes to accomplishing political goals. The teachers' union/wildcat strikes across states with unified Republican control of the government that successfully forced wage and funding increases, despite timid unions that wanted to push for less, should be an indication of what actually works. We don't have to accept the system as it is.
> The biggest problem with health insurance right now is everyone is not forced to use healthcare.gov so the risk pools don't have the correct distribution of healthy and unhealthy people.
That's a problem in that will cause premiums to spiral faster and eventually shutter those insurance pools. But that's a slow death. The largest problem in health insurance right now are the actual, living people being forced across the country to either suffer or die from solvable medical problems, people who are rationing medication because they cannot afford to buy more, people who are being forced into bankruptcy by a broken system. When lives are already being destroyed today, a patch that prevents the rate of lives from being destroyed from increasing quite so quickly is nice, but it quite clearly misses the forest for the trees.
I refuse to believe that the US medical system is run by humans, and not trolls we pulled from under a nearby bridge.
From what I read going to a hospital is pretty much a gamble that has a certain probability to bankrupt you and there is pretty much nothing you can do about it.
There should be bipartisan agreement that these practices are just not acceptable and that there must be a way for a patient to get binding information upfront.
If I think you are trying to extort me, I am just going to go to another hospital.
Insurance companies are the reason the costs are not clear and up front.
No. Just the ones that are true emergencies where you won't have time to do any shopping around ahead of time. Why is this such a hard concept? Think of all the times you've seen a doctor in your life. How many of those were super time critical? Big accidents and heart attacks are. Having a cold or flu isn't. Heck, even cancer isn't super time critical, you could take a few days to shop around treatment centers. Shopping around for most medical care shouldn't be that weird of a concept.
Another option would be to only have insurance for those critical time sensitive events, then you don't have to be super price sensitive for those, and the free market could drive down prices of all the other medical care we get.
So for each item on this list you'll need to find out every possible treatment and drug and what they cost at every hospital within ~50 miles. Make sure you look up allergies and any side effects when combined with medication you regularly take, you don't want to be in a situation where you listed Hospital X for meningitis, but their cheap drug can't be combined with your asthma medication, or whatever.
And again, how often do you update this will? And what about travel?
Is there anything else in your life that you shop around for in case of emergency?
"Is there anything else in your life that you shop around for in case of emergency?"
Have you never heard of Preppers? But seriously, yes, I shopped around a little for a fire extinguisher in my home, I shopped around a bit for a good first aid class so I'd have some skills. I have spare batteries around the house in case the power goes out and shopped around for a flashlight. I have practiced changing a tire for my car just in case. I have a little food stored up in my house.
Why is preparing ahead of time completely off the table for people when it comes to medical care?
I don't know, I think most? I am not a medical expert, and as such am not qualified to answer that question. I think that means I'm also unqualified to draw up a living will detailing what to do if I exhibit symptoms of any of these.
> I shopped around a little for a fire extinguisher
And then bought it immediately, right? You're not gonna wait for a fire to buy one. Same with the first aid class, the batteries, the flashlight, and the food. You cannot buy medical care ahead of time, or take a class to train you to treat yourself.
In case you missed it in my other comments, how often would you update your living will in this world? How would you prepare for travel within the US?
Actually, that's pretty much what our current "insurance" system tries to look like, so maybe you do have a point there :-)
Let's go down the list for things that don't need treatment in minutes:
- Malaria
- Rabies
- Salmonella
- Lyme disease
- Malnutrition and starvation (though you'd rather have this taken care of fast if possible, in severe cases minutes would count)
- Attempted suicide, non fatal (though only if you aren't up for anything else as a result of said attempted suicide, you'll be fine if you don't get immediate treatment)
- Psychotic episode (under supervision)
- Suicidal ideation (if you're under supervision)
- Smoke inhalation (in very very minor cases)
- HELPP syndrome (doesn't seem to be very dangerous in the minute range though you'll want treatment either way)
- Priapism (although it is very painful)
- Sexual assault (before you downvote consider that sexual assault is generally not fatal itself and you don't need urgent medical attention, though urgent psychological attention is, in general you'll survive if you need more than a few minutes to the hospital)
Most of these come with a few ifs, notably that no other medical emergency coincides and some depend on severity, the rest of the list is to my knowledge pretty deadly if you don't get it taken care of as quickly as possible and for half the list it is likely you'd be either in extremely severe pain, unconscious, non-responsive, dying or a combination of the previous in any order.
"The next day, doctors implanted stents in his clogged “widow-maker” artery."
By that time they could have clarified the insurance situation. In any case I don't think it's acceptable that any kind of emergency can bankrupt you if you have the bad luck to end up at the wrong hospital or wrong doctor.
That's outrageous. These guys are protected by your politicians and make use of mercenary tactics. Villains in doctors clothing.
I'm for free markets but we are kinda going over the limit here. Maybe have fixed rates for emergency where you can't get the approval of the patient. Maybe give the patient the possibility to pay for these ridiculously priced items after.
I mean if I get you 1l of NaCl we'd be cool. And fix the rates for emergency.
The use of the health care system to extract every single excess dollar from the middle class extends to many, many layers of the supply and service chain. It may be that the saline was "merely" marked up by a factor of 2x.
What is needed is a monopsony buyer who can negotiate in this arena on a more even footing. In other words, single-payer.
For free-market to work, a consumer needs to be able clearly understand what he is buying and how much it will cost before he consumes whatever he buys. This allows him to shop around, and find the best seller and price.
The current system just drives prices up instead of down, as the seller, who is in it for the profit, can set his prices after the goods have been bought. Ofcourse prices will go up, there's no competition anymore, as the buyer has already consumed the goods.
Trying to make this transparent before an operation would not work. It would just turn healthcare into another IT project, where seller will offer you the lowest prices, and then come up with extra-work that also needs to be done. Image being operated on, and the surgeon informs you they've discovered some required extra work, asking you if you will agree with the additional cost...
It's clear to me that healthcare and free-market are an incompatible combination, it needs to be heavily regulated, and probably single-payer.
From my experience, it is completely legal for any medical practitioner to say they accept an insurance even though they really do not.
It just means they will exchange paperwork with said insurance company. Whether or not your policy/company covers treatment is a completely different issue.
the words used here have vastly different meanings to each party.
If you have a hospital with a certain list price for a particular procedure, why is it legal for them to charge one insurance company 5% of that price and charge another insurance company or someone without insurance full price? It seems like exactly the kind of scenario that price discrimination laws are meant to prevent.
Similarly for the insurance plans themselves, why can you sell basically the same plan to employees of a large company for much cheaper than you sell it to employees of a small company? (This one might need to be a new law specific to insurance companies, because clearly there are many other products that give group discounts when selling to large companies, but I think health insurance should be treated differently).
I'm sure I'm missing what some of the downsides might be, but it seems like making these kinds of backroom network-based deals illegal in health insurance would go a long way in making prices more understandable/predictable, and that might allow for more fair competition on price to emerge.
Because hospitals, and physicians, have decided that, for the most part, it is better for each of them for physicians to be "independent contractors", so the situation of "your hospital is in network, but your physician was not".
Or for me, most recently, going to my doctor for a checkup on my hypertension at an Urgent Care/Family Practice hybrid. Facility? In network? Physician/Assistant? In network? Lab in the same building (to be clear, it wasn't a multi-tenant complex, this was a medical practice) that they sent me for CBC draws? Out of network. Boom, hundreds of dollars in lab bills.
This is far from an ideal free market.
I realize it's a complex subject, but at the end of the day, the insurance companies advertise and sell: insurance.
That the government will protect you, in theory, is not the same thing as in practice.
It’s not forced arbitration at all. You can still sue them.
"A new study that looked at more than 2 million emergency department visits found that more than 1 in 5 patients who went to ERs within their health-insurance networks ended up being treated by an "out-of-network" doctor — and thus exposed to additional charges not covered by their insurance plan." https://www.cnbc.com/2016/11/16/many-get-hit-with-surprise-o...
And it's not just health insurance. Case in point: we have companies writing tax accounting software lobbying against simplification of tax code. And it works!
https://www.vox.com/2016/3/29/11320386/turbotax-boycott-lobb...
This same concept applies to some medical issues, but there are a lot of medical issues it does not apply to. Getting a routine infection and needing antibiotics? Everyone is going to need that. It makes no sense to pool our money and pay out for the rare person that needs money for that. How many other medical expenses are like that? Even things that are rare for a group of 20-year olds like heart attacks are actually a lot less rare (more common than house fires, probably) for an older age group. So while it might make sense for a group of 20-year olds to pool money together to pay for the rare heart attack amongst that group, it might not make any sense for an over-50 group of people to do that same. It definitely doesn't make sense for a 20-year old to join that group. Yet this is exactly what we do. We all pool our money together and use it to pay for every medical expense that comes up. Minor infection? Use insurance! Need a couple stitches? Use insurance. Routine screening? Wow, didn't see that coming, good thing I have insurance.
This is insane, and this is the root of all our problems.
It seems what people really need is just a savings account and some incentive to actually save money for future expenses (because knowing that someday you are going to get an illness that 100% of people get apparently isn't enough motivation).
The thought I have is we should all definitely carry catastrophic health insurance, but then people should be on their own for the rest. I'm sure that payment plans and medical care clubs would spring up to fit the needs of those who absolutely need a way to force themselves to save ahead. Those things should not be called insurance, they should not be sold as insurance, nor should they encroach at all into the territory of true insurance that is meant for rare and catastrophic events.
You are basically guaranteed to receive care in the United States, doesn’t mean it’s affordable. The people that can’t afford the ~$300 screening or basic healthcare end up waiting until it’s major then we’re back to catastrophic level. People who can’t or don’t pay their medical bills still cost everyone using the health system money, it’s just hidden in fees, higher costs, tax write-offs, etc.
Insurance covering a minor infection prevents needing to handle a major infection. Your system assumes humans are rational and a good judge of risk, something that has proven to be untrue countless times.
Ex: Human memory sucks, but you can generally trust the immutability of books, despite them being written and copied and bound and distributed and sold by humans.
It's all about using strengths in the right direction and order to sidestep weaknesses.
Fortunately their supposition is false. Humans are not generally shortsighted and stupid, if you give them a chance.
“But the average American has less than $4,000 in savings, while 57% of U.S. adults have less than $1,000 to their names.”
https://www.usatoday.com/story/money/personalfinance/budget-...
No, a fallacy of composition would be "the organization is stupid because its employees are stupid", or "metal boats are impossible because metal sinks in water." It involves something which is composed of the smaller pieces.
What you're describing is more like a hasty generalization, where individual-qualities within a sample lead to a conclusion about individual-qualities shared by the entire population.
> I was trying to point out that if their supposition is true then we are all screwed no matter what.
And -- even if their supposition is true -- I disagree!
Metal boats can float on water, even though individual metal pieces sink. Institutions can solve problems, even ones that individuals humans suck at.
The man had insurance, it didn't pay out. Or more accurately, the hospital intentionally overwhelmed the insurance company's willingness to pay.
I can't think of the right analogy for house fire insurance. Because you can take your payout after the fire, and either rebuild or use it to buy another house. There's never a situation where you have house fire insurance, and end up paying MORE when your house burns down.
The amount of misery and unpayable debt it seems to cause people who live in the US seems really unecessary. Not to mention nearly everyone in good heealth has a certain level of anxiety about whether their insurance is good enough and will cover them.
Mind you guns also seem unecessary yet the general response to that seems to be, It's ok, we will live with our fear and everyone should be carrying guns and make it so everyone needs to be prepared to kill other people in gun fights. If you get wounded of course, then prepare for living the rest of your life in medical debt.. :I
The US has had majority public support for fully-public healthcare for at least ~30 years.
What it has lacked—even among politicians championing “healthcare reform” like Bill Clinton and Barack Obama—is politicians willing to challenge the insurance industry even with the backing of majority public support.
https://www.cnbc.com/2018/08/28/most-americans-now-support-m...
Sounds just like St. David’s Medical Center in Austin, TX is run by crooks. I like the take-home message that "Faced with a surprise bill or a balance-billing situation, don’t rush to pay any medical bills you receive."
The point of insurance is to prevent that from happening. I pay a small amount so that if I get unlucky, I'm not ruined. I don't care if "oh the bill was actually much higher before" because the number never mattered- me being ruined is what mattered. If I still am, then the insurance did not do what I wanted it to do.
There's a pretty clear answer to this question almost every single time it's asked... the people who benefit are wealthy and the people hurt are poor. The latter structurally lack the ability to fight it or lobby their congresspeople to change the law to help them. Until a mass movement steps forward to say "no, we will not tolerate this", nothing can possibly change. We have no recourse but each other and collective action.
And it's not necessarily true among those who do vote either:
https://krugman.blogs.nytimes.com/2007/09/24/bubba-isnt-who-...
It's an old article and I don't doubt that 2016 has messed with the numbers, but the narrative of poor rednecks screwing themselves over every election is largely unfounded and smacks of classism.
It will take something like the union/wildcat teachers' strikes, that forced Republican majorities with unified control of state governments to raise wages and increase funding, to do anything about healthcare or the many other structural challenges we face as a nation.
Actually, they are saying if you choose to cut premium costs by selecting a narrow provider network, well, there's a reason why the premium costs are low.
> Why the fuck isn't there a law against this kind of shit?
Because Republicans actively oppose any attempt at health security, and Democrats keep ignoring the majority support for single-payer that polls have shown for close to 30 years in favor of Rube Goldberg solutions that keep private insurers and this type of network-based limitation as central features, despite the fact that hey have less public support and are thus more subject to being politically sabotaged before passage (Clinton) and after (Obama).
Though there's signs of potential for that to change on the Democratic side in the near future...
My first point is what the insurance company is saying. It's absolutely true that they are saying that. (It's also a true claim; your argument that all provider networks are limited such that the risk of similar problems exists at some level in all insurance plans is perhaps pedantically true, but not necessarily relevant—e.g., it may be that the only reason the care from the profile provider in this particular case was out of network was that the district's individually negotiated narrow network plan excluded providers that would have been included in standard plans this insurer offered in the area.)
> Not to mention that almost everyone is stuck with the plans their employers choose.
That's factually false; only 49% of Americans are covered by insurance provided by an employer (either their own or as a dependent) health insurance, and not all of them have no other practical option than that plan, so, no “almost everyone” is not stuck with their employer's plan choices.
But, in any case, the employer's plan choice is exactly what the insurance company is highlighting as the issue in this case.
Because the laws are made by people bought and paid for by the people perpetrating this fraud?
https://www.opensecrets.org/industries/summary.php?ind=H&cyc...
https://twitter.com/sensherrodbrown/status/89082321753065062...
>UPDATE: Monday, shortly after publication and broadcast of this story by Kaiser Health News and NPR, St. David’s said it was now willing to accept $782.29 to resolve the $108,951 balance because Drew Calver qualifies for its “financial assistance discount.”
That sounds absolutely dystopian. A politician running on a platform to reform healthcare can’t possibly be bribed by the companies that would die in the process.
At any point in time I could require medical services and have medical service providers simply decide that I owe them a truly massive amount of money. The only route I have to mitigate that risk is through creditor protection laws.
In Texas, wage garnishment is limited to child support, unpaid taxes, and some other limited categories that medical billing doesn't have access to. Creditors can sue you, but they can only seize bank accounts, brokerage accounts, and the like - your primary residence is completely exempt, as are employer-sponsored retirement plans and IRAs.
So my emergency medical debt plan is to liquidate all taxable investments and close out bank accounts, send the cash from that to pay down a mortgage, and tell them to pound sand. The only real consequence is having to head to Walmart each month to cash paychecks and mail out money orders to pay bills.
Edit: it's also known as unsecured-debt, which means the worst thing anyone can try to do to you is ruin your credit score. This isn't worth dying over and America is designed to bear the cost.
Fortunately, it's Texas, so wage garnishment is out, as is seizing your primary residence. So is seizure of retirement accounts. Really the practical amount of debt is what the creditor can force you to pay, which is capped at your liquid assets.
What that doesn't help with, though, is something like being diagnosed with a chronic condition where pills cost $800 a pop.
Got there and asked at admittance, "Do you take my insurance?" Was assured they did.
Got a big bill a few months later and it turned out the doctor working in the covered ER was not covered by my insurance.
I guess you have to ask if the doctor who may or may not see you depending on what you're in for also takes your insurance? I don't even know.
So apparently the "max out of pocket" on the cover sheet of your plan is b.s. and only applies in-network. I guess good luck having in-network coverage if you're on a vacation and have an emergency.
Actionable advice: check if your employer-provided healthcare is a self-funded insurance plan or a fully insured plan. And then look up the relevant consumer protections in your state for that type of plan.
Also, in case you're wondering what the hell all those hospital administrators are dong, the answer is "shaking down your employer and screwing you over":
> In a statement, St. David’s HealthCare defended its handling of Calver’s bill and sought to blame the school district and Aetna for offering such a narrow network.
>“While we did everything right in this particular situation, the structure of the patient’s insurance plan as a narrow network product placed a large portion of the financial responsibility directly on the patient because our hospital was not in-network,” the hospital said.
> WellRithms reviewed Calver’s bill in detail at the request of Kaiser Health News and determined that a reasonable reimbursement would have been $26,985. That’s less than half what Aetna paid.
So the last line, "less than half what Aetna paid", does that ostensibly mean the hospital is definitely charging an unreasonable price, and by having been paid twice what is reasonable by Aetna that ostensibly this teacher shouldn't have to pay a dime? It's just a contractual reason he owes this money?
Not ostensibly, but actually.
The article goes on to identify some concrete charges that independent auditors felt were ridiculous, including charging $19k for stents that the hospital most likely purchased for about $2K.
> It's just a contractual reason he owes this money?
The hospital just straight up dropped all but $800 of the charges when they got PR heat.
People in the US are used to their employers purchasing group health plans from insurance companies. In that model, a premium (often part paid by the employer, part by the employee) is paid to an insurance company in return for coverage. When there's a claim, the insurance company pays, out of its own money, and the insurance company's profit comes from taking in more money in premiums than it pays out in claims.
In a self-funded plan, the employer and employees still pay premiums, and all that money goes into a pool which is used to pay the claims. Typically a company is hired to administer the plan, but that company is not an insurer, and that company does not pay claims; the money to pay off claims comes directly out of that pool of premiums.
What this means is that the administrator just pays whatever it's told to pay by the company that hired them to run the plan. It's not the administrator's money being spent, and their profit is in the fees they charge to run the plan, not in denying or underpaying claims.
My very first real job out of school, years and years ago, was a place that did administration for self-funded plans. About once a month we'd get a call from one of our client companies saying "yeah, we know our plan's rules say not to pay that claim, but we want to pay that claim". And we'd say "OK, it's your plan and your money, you make the rules".
The downside is that if the company gets into financial trouble, its contributions to the pool of money that pays claims are often one of the first things to stop happening. I remember pretty clearly one client company that went bankrupt and just stopped paying into its plan, and once the money in the plan's pool ran out there were no more claims paid.
My guess is in a situation like this I'd get the reasonable amounts for services provided from my insurer and use them as a basis to refuse any unreasonable charges.
Another option is maybe to require that language on the "patient responsibility form" to include the blurb about fair prices. For instance:
In the event that my health plan determines a service to be “not payable”, I will be responsible for the complete charge and agree to pay the usual, customary, and reasonable costs of all services provided.
Nothing. That's why everyone always asks for a good and trustworthy mechanic. Or an HVAC repairman.
Sure, you lose out on the ability to sue them if things go awry but where is the tradeoff between six figure debt at an old age vs paying $10000 to get the whole thing done?
I think a lot of people do but in a lot of situations you need to deal with things right now.
If you get a heart attack, you can't just hit the pause button on life, crack open Google and start searching for "best heart attack treatment center outside of the US", then research things, book the travel arrangements and take a long flight.
For what I'm readying, for a lot of non-life-threatening care, it's way cheaper to fly here (Uruguay), have treatment, stay a month, and then fly back, than stay one DAY in the U.S. - a plus is that treatment will likely be better.
HCA has profit margins around 10%, which do not appear to me to be exorbitant. (https://investor.hcahealthcare.com/press-release/hca-reports...) While this patient's experience is clearly out of whack, and the $19k for a $1,500 stent thing is nuts, this points to a larger pricing / business model issue within US Healthcare. Typically, a few medical specialties (Surgery, Imaging, Rad Onc) have high profit margins, but are offset by losses in other departments (ER).
Here is the thing: This hospital is a vampire. They WANT to send you to collections. They WANT to take your house and everything you own.
My aunt is still employed, fully insured, and every day is a fight between her and her insurance company. They randomly deny claims for chemo treatments, and put her through invasive procedures to verify the disease after doctors formally diagnosed her.
The list of landmines they strategically place that could cause her to lose her insurance seems to only grow. This payment isn’t made on this date? Insurance gets cancelled. This form isnt filed on this day three months from now? Insurance gets cancelled. Forget the fact that she is too sick to work; her insurer is already busy trying to figure out how to not pay.
Unless you are wealthy enough to pay for everything yourself, everyone in the US should expect to be left behind by the health insurance they’ve paid their entire life for as soon as the insurer can figure out how to do it.
Without that, competing hospitals can arise that will compete on price.
EDIT: I am responding to a comment that the AMA is the problem. Maybe the AMA is a problem but it has nothing to do with hospitals not competing over prices.
The real crux is that point, the patient is removed from pricing and so the whole market becomes distorted. It’s like going to a store without price tags and complaining that your bill is much higher than you expected.
It's more like only having stores without price tags and then when you overpay people telling you that you should have shopped around for a good price.
But it isn't reasonable to expect upfront pricing in things as complicated as heart surgery. Or where you are going in for unknown problems. There is no way to know what complications may arise or additional procedures, x-rays or scans may be required.
On the consumer side I just found out about healthcare blue book and they have prices for just about any procedure.
Surgery outcomes in Indian top cardiology hospitals are better than in America. And they're cheaper. And more available. And perform more surgeries per week. Competition is good.
That is why i laugh at republicans (Ben Shapiro et al) argument that healthcare competition is what making it the "best" in the world. Don't compare it with restaurant business.
Patients shop on reputation. In a country with less regulation, like India, you see competing hospitals across the spectrum of price and performance. Everyone knows which ones are good and which ones are expensive. People know which hospitals they're going to attend before they fall sick. The outcomes in their top cardiology departments are way better than those in top American cardiology departments.
Their doctors perform way more surgeries and are therefore far more practiced and experienced. They are far cheaper because there are so many more of them.
For the majority of lower-middle and poor class, medical care is hard to obtain because they cannot afford the private care, and the government-run hospitals that offer low-cost care suffer from bad service, and inadequate facilities/medicine.
India is well on its way to emulating the American medical system:
(1) medical costs have been rising at a rate of 15-25% a year (where inflation has been 5-10%). This is okay for now, but in about 2 decades will price out even the affluent classes.
(2) Health insurance is being touted by the Indian government as a solution to this -- which is the first step to going down towards the American model of healthcare. India also has poor safeguards against crony capitalism so I expect large insurance companies to capture the regulatory framework to frame rules in their benefit.
https://www.npr.org/sections/health-shots/2018/08/27/6408918...
Second reaction: It doesn't seem as bad because it's put in context of "40k" - in reality that's still pretty bad.
So tax hospital revenues (yes, revenues) to fund residencies and have an objective standard for accrediting medical schools, where meeting the objective standard automatically qualifies the seats.
Of course patients will then be paying for the residencies, but that's fine, it even makes sense.
Having more nurse practitioners and physicians assistants would also help, but doctors lobby against them starting independent practices.
The scary part is you must carry this risk to your insurance who can then deny the out-of-network claim.
Am I misunderstanding something here, or is everyone else not understanding?
The simple fact is that I don't know anybody from my European family or friends who would willingly switch their system to the US one. And as a very well insured employee in the US, if, hypothetically, I had the option to use my European health care in the US, I'd switch immediately a well.
I doubt it. Someone needs to pay for it, so this switch would have to imply a 20% tax increase. Unless you’re paid peanuts, it’s not worth the tradeoff.
I know an expat who moved to work for citi in the states from the UK and he was paying around 20% just for him -his wife kids are covered by her federal Job.
UK NI is about 13% and that includes state pension, unemployment and the NHS
I wouldn’t.
Or you could pay less for it.
There are many studies that show how the US system has incredibly high overhead that simply isn't needed.
Just an example: in the US, a primary care physician usually has a nurse and somebody who handles paperwork, insurance BS, and what not. Most European countries simply don't have this, mostly because there is no insurance BS to deal with.
There is insurance related overhead every step of the way.
And that's not including the free-for-all pricing of $500 saline bags.
Your 20% tax increase is ridiculous. It doesn't have to be nearly that high (and it isn't.) And even though I'm in the highest tax bracket, I'd gladly pay 5% more if it meant quality medical care for everyone without any risk of bankruptcy.
The US health care issue can only be solved by higher taxes and lower cost (it’s currently at 2x the cost of developed countries.)
https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?year_...
A number of other commenters have castigated politicians on suspicion of being in the pocket of insurance companies or health care companies. Sure such things may happen occasionally. More certainly, politicians and bureaucrates are regularly attentive to the budget and financing of the government.
If medical care was cost efficient, it would 1) reduce GDP and the appearance of economic growth, and 2) wreck the back office math concerning whether the federal government can afford the deficit and the interest on the national debt. Elimination of mass incarceration and criminalization would cause a similar dilema. US economic growth has been 2-3 percent in recent years. If that were negated by substantial reduction of waste-masquerading-as-productivity, then the federal budget could not be financed without massive cuts or dramatic manipulation of interest and inflation rates.
There are others who potentially benefit from denial of treatment or claims beside the insurance company. Beside the doctors, medical institutions, and insurance companies are another set of actors: the benefits management and payment processing companies, who often profit per transaction. Some of the calculus in this camp can be seen in [3]. This part of the system (and others) can benefit when a patient is denied or discouraged from or uninformed of curative treatment and manipulated into some ongoing palliatve therapy - despite the possibility of greater overall long-term cost. The cash-flow gets distributed differently than curative treatment, and there are more smaller on-going transactions enabling a higher percentage of skim.
[1] Sep 2012 - https://www.propublica.org/article/a-costly-equation-medical...
[2] Nov. 2017 - https://www.propublica.org/article/a-hospital-charged-to-pie...?
[3] Nov. 2017 - https://www.bnymellon.com/us/en/what-we-do/business-insights...
Then consider we are the only first-world nation in which medical bankruptcy is not just a thing, but a profound source of anxiety and genuine risk.
What do we get in exchange for worse care, worse lives, and risk of financial ruin...?
A "free market" like the one functioning in OP's case. Oh, and in the time since the ACA passed? Record private industry profits.
It's not just Trumpism sh-tcanning this country.
What conditions are you thinking of that don't have "approved" treatments?
The richest usually purchase insurance to be operated in the U.S. by top doctors (ironically, probably cheaper than what U.S. nationals pay for the same service), but local doctors are very good (there ARE some services where U.S. expertise is preferable).
Scary stories intended to distract from systemic dysfunction are also just what they are.
Obesity rates and chronic diseases that are the result of lifestyle choices are not health care issues, they are public health issues or public health policy issues. No doctor can legitimately be assigned responsibility for citizens who live unhealthy lifestyles.
When comparing cancer survival rates the US is, again, among the top for many types of cancers. It's almost impossible to compare infant mortality rates because the US doesn't adhere to any international norm for what is considered a live birth and reviews of the data have shown that the US will frequently label an extremely low birthweight child as a live birth, while many other countries will label the birth as a still birth.
The reality is that actual care in the US is what you'd expect from a developed country. The reports that put the US down the list of first world health care systems universally factor in cost and accessibility. These are real issues, but it's not the same thing as "paying more for crappy outcomes."
Countries with different systems have their own issues, which is why I pointed out situations like Alfie Evans. There was also Oliver Evans whom the NHS said could not be saved and would not get treatment. The family paid $170,000 out of pocket and crowd funded another $100,000 to bring him to the US where surgeons in Boston successfully removed a non-cancerous tumor from his heart and saved his life.
Poverty in the US has gotten so bad in some places that it rivals the worst of Africa[0][1].
[0]: https://www.nytimes.com/2018/01/24/opinion/poverty-united-st... [1]: https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?N...
Use of ultrasound imaging to measure the thickness of the inner walls of the carotid arteries that supply blood to the brain. Increasing carotid artery intima-media thickness, or CIMT, indicates a build-up of fatty deposits, known as plaque, in crucial arteries to the heart and brain. Plaque build-up in the arteries, which is usually affects adults, can restrict the flow of blood, causing heart attacks or stroke.
Both MRA and CTA are really expensive.
Bloodwork can point to problems but there is still a plenty of differential diagnosis involved... You need a bunch of history (main factors are currently age and family history) to reasonably evaluate risk using e.g. European joint guidelines.
You can perhaps guess better based on local doppler USG of some big extremity artery or of carotid. Doppler of heart is not precise enough to show anything useful.
That just happens. There are people who are in great health and drop dead one day. Whatever you do lifestyle-wise just improves your chances of being healthy but there are no guarantees. You can smoke a pack of cigarettes daily and live up to 100 and others will get lung cancer without ever touching a cigarette.
When did you last have an ultrasound of scan of your LVA? Have you had imaging done of your bile duct to rule out pancreatic cancer? Why don't you know your health status?
The answer is, of course, because there was no good reason to do the invasive testing needed to determine that status. There is an entire medical field dedicated to measuring the benefit vs cost (including testing-induced problems) of such things. No one recommends that ironman competitors do heart scans or arteriograms.
1. Under/over working out, especially for white men over working out can lead to increased shear stress on the arteries
2. Genetic familia hypercholesterolemia aka high cholesterol. This is caught by a blood test and fixed with statins.
3. High Blood Pressure again exams and medication
4. Size of ldl particles, this one is new
5. Genetic markers especially 9p21.3, sadly about a third of people have this marker. How it works we don't entirely know, but the best guess I've come up with is it has to do with interlukin
6 signaling which signals inflammation. Solution to this might be taking curcumin, lower weight, Mediterranean diet.
7. Low HDL again mostly genetic, niacin may help some as may exercise
From my research into the matter it seems that the initial damage is done via HBP, shear stress, or cell repair failure. Then inflammatory markers attach to site causing white blood cells and ldl to infiltrate between the inner and outer walls. Eventually the plaque grows and the inner wall continues to thin until one of two scenarios occur 1) hard cap forms (calcification) and the plaque grows until it restricts enough blood that it causes heart attack or 2) The much more dangerous scenario of the inner wall thinning and breaking causing a clot and instant heart attack. The bad part about 2) is that its undetectable except for angiograph or nuclear stress (treadmill can if the heart rate goes high enough and the doctor skilled at interpretation). Some hope for 2) is that statins seem to encourage calcification of those thin walls thus preventing the heart attacks.
This is just what causes the heart attack and the actual fix (stenting and balloon angioplasty) has its own issues. Where the only surefire fix after a heart attack is a bypass, but if more than 2 plaques are found you need to harvest veins which don't last as long. What the entrepreneur world needs to focus on in my opinion is easier at home detection of coronary plaques (sound, radar, electrical, magnetic, etc.). If the government got involved nanorobotics and bio compatible hearts could be explored along with angiogensis via external stimulation, but each of those would be a moonshot program.
http://www.zoeharcombe.com/2016/11/familial-hypercholesterol...
A few of the other facts/assumptions you make are outdated. Statins do very little to improve mortality. Inflammation can be reduced by cutting out carbs and sugar. Eating more saturated fats and omega 3 also reduces your risk of heart disease.
In fact the whole dietary advice given over the last 60 years is responsible for the epidemic we now have with obesity, diabetes and heart attacks. But they can't come out and say they are wrong, but they are slowly changing it a bit at a time.
[1] https://www.nejm.org/doi/pdf/10.1056/NEJMoa1405386 People with a gene that naturally produces lower ldl levels lead to less Hard CD events.
[2] https://www.thelancet.com/journals/lancet/article/PIIS0140-6... Statins cause less heart disease and strokes even more than originally thought.
[3] https://www.thelancet.com/journals/lancet/article/PIIS0140-6... Even if people with low risk factors cutting LDL with stains causes lower number of events
> e. In each study, we estimated the odds ratio for disease among carriers of any NPC1L1 inactivating mutation, as compared with noncarriers. We then calculated the summary odds ratios and 95% confidence intervals for coronary heart disease among carriers, using a Mantel–Haenszel fixed-effects meta-analysis without continuity correction
[2] This starts off by saying that if we gave statins to 10000 people who are at risk that it would help 1000 and 500 people only. In addition 100 people might have adverse effects. If you ask me, an expensive drug that barely helps and only increases mortality by 5 days on average isn't worth it, and it comes with chances of adverse affects. If we just eat foods high in saturated fats and raise our HDL that is far better.
[3] a meta analysis of randomized trials. Says 11 out of 1000 patients had a reduction of major vascular events. So that is saying out of 90 or so people who take statins, only 1 of them will see any benefits.
Basically statins are poison that give hardly any benefit and treat an assumption that lower ldl leads to less heart attacks.
Try this one https://bmjopen.bmj.com/content/5/9/e007118.full
> The median postponement of death for primary and secondary prevention trials were 3.2 and 4.1 days, respectively.
The average life increase of taking statins is 4 days!
https://www.biznews.com/health/2015/02/16/science-says-tim-n...
There is NO evidence that:
- too much saturated fat raises cholesterol
- saturated fat causes heart disease
- high cholesterol causes heart disease
- lowering cholesterol reduces heart disease
- there is a correlation between obesity rates and the amount of fat consumption
- there is a correlation between obesity rates and the amount of protein consumption
And there IS evidence that:
- there is a correlation between obesity rates and the amount of carbohydrate consumption
- the obesity and diabetes epidemics are a direct result of the misleading cholesterol campaign.
Studies also show that the advice of replacing fats with carbs increases your risk of heart disease.