Surely if people know they could be fined thousands for simple treatments like stitches they avoid medical care altogether? Then things could get worse and even more expensive...
Example: ending up in a hospital in Italy during a skiing holiday involves showing your insurance card (or simply giving the number). That's it: there is no payment, no negotiation, nothing — you just get healthcare services and you're done.
The EU gets criticized for many things, but universal healthcare across the entire union is something that should get more praise than it does.
As someone living in the US (thankfully well insured and decently paid), I can confirm dystopian reality. Everything works well 97% of the time, until you have something that falls out of the confines of the giant decision tree -- and then things go really wrong. I used to think everything was well until we had a difficult pregnancy/delivery. In such cases, there are professionals who's service is bill reconciliation!
US is the wealthiest nation but the deadliest nation too in terms of preventable deaths.
This is what happened to myself. I've had persistent breathing problems and the last time I went to a specialist for it they charged me $3,000 to breathe in a tube for 15 seconds and say they don't have any ideas as to what was wrong. I haven't been back and try to ignore the fact that I have trouble breathing daily.
As a child, breaking my arm was upsetting, but imagine if it put additional financial strain on an already strained family?
My motorbike accident age 18 would have just been flat out medical bankruptcy (and potentially worse/incomplete recovery). I was pretty miserable anyway, adding that would've been demoralising in the extreme.
FWIW, I've never had such extreme bills. The largest bill I've received in the last few years was $2000 for my wife's epidural, but I only paid about $400 of it (insurance paid the other $1600)
Unless you're claiming that hospitals only gouge some tiny subset of people and are benevolently generous to everyone else, that number is going to be much closer to 100% than 0.1%.
When I lived in the US, I have personally experienced this, even with top-tier insurance--from both ends: I've had insurance decline claims arbitrarily and pass on five-figure costs to me, and I've had hospitals misclaim things. In both cases, I had to spend dozens of hours on the phone to resolve it.
Most people in the US are far less privileged: Their insurance is not as good, and they don't have the luxury of spending dozens of hours on the phone.
It's just a matter of time until you experience this.
Actually, yes. Doctors and hospitals have relationships. When a hospital is aware that a good referral source referred them a patient, they will try to keep the patient happy to maintain that source of business.
They're very selective about who they try to screw.
Now if you walk in with no referral and no family doctor, then you're their source of profits and the party they'll try to milk.
You mean like, say, an ER visit?
Though, actually, the one time I've been referred to the ER by a doctor (he called ahead and everything), the billing was still a shitshow. Insurance delayed paying for months while they tried to work out a way to claim it was a pre-existing condition (this was pre-Obamacare), until the hospital gave up and tried to send me directly to collections for upwards of a quarter million dollars.
Given that most private practices (around here, anyway) usually have lucrative hospital affiliations, the incentive to keep doctors happy by keeping patients happy really doesn't exist.
Patient has a 20% copay. The provider bills $100,000. The provider "pays" $80,000. The patient pays $20,000.
Provider then pays a $70k kickback disguised as a discount on other charges, fees for participation in the system, etc. (or never even pays the EOB amount). In fact a total of $30k is paid for the services, and 66% of that comes from the patient.
Insurance gets away paying $10k instead of $24k (80% of $30k). Provider gets the business by being on insurer's provider list. Patient thinks "I'm glad I paid $20k for Insurance. My health-care-spend ended up being $40k instead of $100k." In fact, they'd have been better off without insurance, which would have only cost $30k.
Yes, very few here have been on the receiving end of a $143k magnitude extortion. The people who have are less likely to be writing HN comments and more likely to be slaving away in the mines of Rura Penthe. But these exceptional stories fit the exact pattern that anybody who has interacted with the healthcare racket has experienced, even though most ultimately dodge the (biggest) bullet.
2k USD for a few stitchies? That's still insanely high.
I kind of like Japan's system based on what I've read so far, but I'm still not sure of one thing:
Does regulated pricing have a chilling effect on drug companies?
It seems like it would be impossible for a Japanese drug company to be viable if the government gets to fix the price so that anyone can afford it seeing as new drugs can cost billions to develop.
The disaster that is the US healthcare system is architected to eliminate any concept of price transparency to directly confound free market processes, and is costly to line the pockets of middlemen and pharmaceutical and medical/biotech firms, because their pockets aren't being lined elsewhere in what is an essential and large global industry. The US effectively subsidizes healthcare around the world by paying out the nose, and the entire thing is perpetrated against the American people by intentionally introducing smoke and mirrors to the process.
Suddenly we'd be paying a lot less and if we are subsidizing the cost it'll for them to raise prices in those other countries.
It's almost Trumpian in its vague, implausible and detail-free appeal to the baser instincts in order deflect from clear and obvious fraud.
In more detail: Independent doctors (and their staff) functioned as buyers' agents would refer patients to specialists. "Doctor-Patient Relationship" and "Referrals" were the two main components of the system. Knowing that DR. JONES referred PATIENT SMITH to them, the specialist would treat PATIENT SMITH well and charge a reasonable amount.
It was unfortunate in that you had to "get in" to the system by finding a good doctor. It was (and more now than ever is) hard to "find a good doctor." Most are no longer accepting new patients, but it served all those parties. Doctors would have repeat customers. It'd reduce their work of learning new patients. Etc.
Without such a family doctor, you would go to a provider without a referral. The provider would then know it could gouge you without risking a referral relationship.
However this system was sub-optimal for insurance company profits and large scale providers. Which is exactly who pushed Obamacare, and lead to the break-up of so many of these relationships.
As background, Health Insurance has lists of "approved providers" which they carefully curate. The most straightforward method of breaking up relationships is to exclude providers. They also put these "good doctors" (from the patients' perspective) into plans with expensive premiums. They also churn. By raising prices selectively between plans with different providers insurance companies can encourage patients to "try out" a new doctor this year. They also churn provider lists.
This means Insurance companies are now a more powerful source of referrals. They also prefer institutional providers. Between both of that, fewer providers care about where their patients are coming from. The patients often don't have much choice where they go (one of 9 different locations of the same conglomerate) and don't know enough to make an informed decision anyway (as their family doctor used to do for them).
All of this is brought about by the individual mandate. It's not a free market if you're not free to abstain. By being forced in, cash buyers became a smaller segment of the market. Cash buyers were the very people holding it all together by selecting doctors of their choosing and forming these relationships. With these doctors going out of business (largely retirement) and being replaced by institutional providers it's just getting worse.
You are completely ignoring the insurance part of health insurance.
Some of us are old enough to remember dealing with healthcare before Obamacare, and can testify to this having been the status quo long before there was an individual mandate.
Free markets depend on leverage.
But then you get carted unconscious to a hospital you are covered for but looked over by an "out of network" doctor, whatever that is.
Being an American seems like a full time job. You have to watch your back so society doesn't eat you. The frequent obsession over credit scores I see on Reddit is another one that baffles me.
That said, keeping up with looking after your own back in America does feel like a full time job at times. :/