Greedy Hospitals Fleece the Poor | Hacker News Reader

Greedy Hospitals Fleece the Poor

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36 pointsProAm11 comments

Hospitals fleece the insured. Or their insurance companies. (But insurance companies are not a magic pile of money in the sky, everyone's premiums are affected.)

A poor, uninsured person visits the ER. They can't pay. The hospital writes it off.

An insured person visits the ER. Their insurance pays. The hospital charges outrageous prices to make up for the uninsured.

It seems like insured people are subsidizing uninsured people. Am I missing something?

They don't write it off immediately. They send it to collections, ruining the person's credit and sometimes forcing bankruptcy, and then write it off.

They charge outrageous prices to the uninsured just as much as the insured. The difference is they'll sometimes negotiate lower for the uninsured.

They negotiate for the insured, not the uninsured. The hospital charges the insurance, the insurance comes back and says nahhh, this is how much we're paying, and they talk back and forth sometimes and settle on the price.

For the uninsured, there is no negotiation until after the patient contacts billing and bets for it and they won't get anywhere near the deal that an insured person gets.

Since the uninsured pay more than the insured for the same proceedure, wouldn't that make it the uninsured who are subsidizing the insured?

Joking aside, tt is near impossible to find good numbers for this, but the research I read indicates that most of the money for uncompensated care ends up coming from government and any impact on prices of care for the insured is negligible.

So does that mean hospitals with low number of privately insured (instead mostly uninsured and medicare/medicaid) will perform just as well as those with high percent privately insured patients?

As I said, good numbers appear hard to find. Good luck even finding a good estimate of what percentage of uninsured care is paid for by the uninsured. The closest thing I found is that the insured and the uninsured tend to pay about the same amount out of pocket but the uninsured have consistently lower incomes so are spending a higher percentage of their income.

As a point of reference, I am uninsured and pay all my medical bills out of pocket. I have never received any uncompensated care (because I can afford it). I suspect that the uninsured pay for a much higher percentage of their care than people assume.

Yes its hard to figure this out. I've happened to find this interesting link. Not sure how unbiased it is. http://truecostofhealthcare.org/hospital_financial_analysis/

I have a pretty good private plan right now but being that I'm on dialysis, I'll be forced onto medicare soon enough because 30 months after starting dialysis, we have to switch to medicare as primary coverage. I just hope I don't end up paying more out of my pocket.

That sounds rough. I had a kidney scare earlier this year due to creatine. Luckily I recovered by being off of it. Can you tell a bit more about how your kidneys got to their current state? Could help me or somebody else out.

Mine is an autoimmune disease called IgA nephropathy. One day when your body is fighting a cold or something your immune cells decide your kidneys are a good place to attack. The immune cells are big so they damage the filtering capacity of the kidneys. And you don't even notice it until your GFR (level of kidney function) drops super low and you start feeling crappy.

There is not a lot you can do about IgAN except get lucky to catch it early and slow its progress. However mine was a quick progressing one and happened between doctor visits. Only thing I can say it get a baseline comprehensive metabolic panel blood tests (its very cheap) and do it periodically to monitor your health. The medical system tends to be reactive but you as an individual should be proactive. If you think about it people get their cars checked out more often than themselves.

Good point. When it turns out that uninsured can actually pay.

A couple things this argument is missing are hard numbers and also adoption of the affordable care act which requires health insurance and provides subsidized alternatives. Completely abstract hand waving that does not refer to actual charges or spending or legal context is unlikely to have much application to this complex problem.

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