When Medical Debt Collectors Decide Who Gets Arrested
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features.propublica.org
I am constantly getting third and fourth party bills for huge amounts re things I did not consent to be sent away or billed externally. That's AFTER asking up front AND paying huge amounts for the primary service up front. These things come many months later and I can see one easily getting lost or not sent properly and me ending up in a massive legal battle over debt and summary judgements behind my back. Even with paranoid checking of old accounts and services they continue to mess it up and debts show up later. I was ruined by this country's medical business and ultimately it's going to be the cause of my death as I am at the limit of what I can handle in all regards. I tried to get out of the country for good to places I have lived and can get better healthcare, and have at least some quality of life with my remaining health and years, but ironically since I am so broken because of this experience it severely limits my options. I feel trapped and hopeless.
>There are immigration requirements I cannot meet
If you could vastly improve your life by moving, why would you let immigration laws stop you? It's really hard to get kicked out of the EU and you shouldn't have any issues with access to healthcare in places like Catalonia, Helsinki and I'm sure many others.
Basically once you are removed from the ability to control and maintain independent life, to the normal degree most can, and there is no support network or safety net to rely on, you are faced with hits from every side which amplify each other and no matter how hard you try and what you do the exponential weight is crushing. There just wasn't enough help from family or systems when it would have enabled me to recover, and now I will never recover and there is even less help, meaning none, to survive when you are dependent. Likely since I have to move, I will just pack up and go abroad by end of year with whats left, rent a tiny flat for as long as I can, and hope a miracle takes place somehow before I am forced to flip the switch off. I don't have the funds, health, or support to survive anywhere legally or continuously alone...but I refuse for my last breaths to be here. Sorry for the anger...cathartic dumping as I have no real ear to bend regularly. It's been a rough few decades ;)
[0]: https://en.wikipedia.org/wiki/Healthcare_in_North_Korea#Heal...
Cross-country comparisons are dicey at the best of times because a whole stack of basic cultural assumptions are violated. Unless there is a thriving medical tourism trade to NK it is unlikely that any American would benefit from copying North Korea.
There is a long list of about about 150 countries that they could look to before even brushing against the idea of looking to North Korea for good ideas.
The problem necessitating bureaucracy in a separate system for the poor on top of the US’s mostly-private-pay health care system is identifying who is eligible and what they legally deserve.
That’s where having a separate system for the medically indigent in a mostly prvate-pay system becomes much more burdensome, per covered person, than a universal coverage system without private insurance.
Move to another country. One that has free healthcare even to foreigners. Yes, they exist. Brazil is one. I'm not sure but I've heard Spain might too.
Granted you wont get the best and most responsive health care in the world but at least you'll get some and for free.
Things are different out there. Worse in some aspects, better in others.
Just something to think about. Stay strong.
It's really easy to remain in EU forever as an illegal immigrant, in some places your immigration status will have no effect on your access to free healthcare.
Nobody has ever checked my immigration status while renting in the EU, nobody has ever cared about the fact that I work for an US company owned by me that pays my salary to my US account.
Sure, maybe you'll have a bad time renting in France. Don't go live in France unless you want to have a hard time while renting.
> A good friend of mine, without papers, was living 10+ people in a 2 bedroom flat
A good friend of mine, is here illegally and lives in a nice central 2 bedroom flat in Barcelona all by himself. He had zero trouble finding an apartment, the landlords just don't give a shit.
Many illegal immigrants are completely broke, but that's by no means a requirement.
It's a hard life in the US, often with access to even less things than illegal immigrants have here. Not sure what this "constant risk" is, unless you engage in violent crime you'll find it very difficult to get yourself deported.
By far the biggest thing you lose is the ability to fly around easily, but it remains (and will remain) easy to sneak out after overstaying your visa waiver.
> It's not "really easy" at all and I don't know why anyone would think that
Because I know multiple illegal immigrants who vastly improved their lives by moving. A good friend of mine spent 4 years going in and out of KS state prisons, after a while he decided that he needed a change of scenery and hopped on a plane to Spain.
There's little chance he could get a visa without lying, but that hasn't really affected his life. He makes a living freelancing online, gets paid to his US account and pays the IRS. Here he enjoys access to excellent healthcare without risking bankruptcy.
And I’m sure you will have access to universal health system and private ones.
It would be nice if HN did a better job of treating statements like this as testimony regarding the problem space and not an invitation for personal critique. The odds are extremely poor that some random internet stranger can fix a mess like this by making one good suggestion in a public comment.
If you are genuinely willing to give someone like this scads of money or do a fundraiser (or otherwise actually try to help them in earnest), cool. But my experience suggests you probably aren't and multiple public personal questions easily comes across as invasive and blamey, especially for someone living with a lot of duress already.
It's possible to speak up and do so more considerately and thoughtfully than is typically done in response to such comments.
People, please vote for medicare for all candidates, it might not affect your life now, but you don't know what the future holds for you.
We're not talking about the life and death part though. There are already laws requiring emergency rooms to see anyone who shows up. The question is how to pay for it, which is a matter of economics.
Medical providers not being able to provide the total cost for a non-emergency procedure up-front but then expecting people to pay whatever price they make up after the fact is practically fraud. The fact that it leads to outrageous costs is entirely predictable.
I’d like to turn the question around and ask folks who believe that the healthcare problem is one of not enough market freedom: what’s an example of a country that gets a free market in medical care right, from your perspective?
We universal healthcare advocates have a couple of dozen examples lined up to support our perspective, what about from the other side?
But the primary reason you don't see more successes is the lack of attempts. It's not as if there is a long list of countries with failed free market healthcare systems, either.
I don't know in what meaningful sense Israel is a "hybrid" system, it functions almost exactly like a 'Medicare for all' type proposal would.
"Houses keep people warm, they should not cost anything" etc." I'm not sure who is arguing this, but it isn't a stretch for folks to agree that everyone should have access to shelter, even if you cannot afford it. I personally wouldn't mind standard and basic housing being free (Small kitchen/living room, bathroom, and bedroom or bedrooms)
I'd also point out that cross state competition would only help a little. Your laws need to be the same state to state, minimally, and most of the providers wouldn't change. Most insurance is provided through a job anyway, and I'd like to mention that most people's "tech company", besides social media, are ISP's with little to no competition.
What about the poor people who only have one hospital nearby that might not accept their insurance? What about people who go to a hospital that's in their network, but it turns out one of the many doctors was not? The people who have a time critical illness who can't afford to do the whole Free Market thing right after a accident?
How does anyone know that when they arrive somewhere the exact number of treatments needed to cure their illness? Are you expected to walk out of the hospital and refuse treatment because you've tabulated all of the prices for all of the services needed, then ask the ambulance to take you somewhere else?
The free market solution to health insurance simply does not work and it's insulting to see people suggest it time and time again. It ironically only works in heavily centralized areas where people actually have a choice, and not the more rural areas where hospitals are far more spaced out. There's far too many variables at play for even software engineers to manage unless you dedicate a significant amount of your free time to maintaining an excel spreadsheet of every hospital near you and their prices, formulate the exact cheapest plan on the fly according to your personal needs and can pull that out immediately when you have a medical emergency.
And that's assuming they didn't decide to go out of network the day before and delayed updating their database.
All of these only apply to time-critical procedures. Otherwise you should be able to use the doctor and hospital which is covered.
Let's assume that emergency medicine should be provided by cities in the same way as other emergency services like fire companies. What's the argument for doing it that way for all medical services, including the ones that are not time sensitive and allow you plenty of time to shop around and choose the provider with the best combination of price, distance, scheduling availability, etc.?
> There's far too many variables at play for even software engineers to manage unless you dedicate a significant amount of your free time to maintaining an excel spreadsheet of every hospital near you and their prices, formulate the exact cheapest plan on the fly according to your personal needs and can pull that out immediately when you have a medical emergency.
This is hardly the only circumstance where there are many variables. Should the government buy everyone the same car because there are so many different choices between prices and safety ratings and fuel economy and performance? How does that even help, since the solution space is the same and government knows less about your priorities than you do?
Because for a lot of people, there is no real choice involved. If there's one hospital around for hundreds of miles, they realistically don't have the option to go to one further out when their job expects them to be available for work every single day. Not to mention that requires every hospital to offer every service and to have every type of specialist for every type of disease.
Medical issues don't operate like a grocery store. You can't just walk into a hospital and choose between Name Brand MRI or Store Brand MRI. It requires a level of knowledge that most people don't have. It's knowledge I don't have! And something I'd prefer to never have to think about when I have other shit to deal with in real life.
> This is hardly the only circumstance where there are many variables. Should the government buy everyone the same car because there are so many different choices between prices and safety ratings and fuel economy and performance? How does that even help, since the solution space is the same and government knows less about your priorities than you do?
Your analogy falls apart because the government does make mandates for cars. Things like safety features. And you're trying to compare buying a car which is a fairly small subset of considerations for the average person versus trying to purchase medical assistance which is an incredibly wide field encompassing multiple types of examinations, surgeries, biopsies and more. When you're looking for a car, you have some properties of a car which are easily understandable. When you're searching for medical assistance, most people only vaguely know what's actually wrong.
Federal law requires employers to provide at least unpaid sick leave. That caps the premium a local hospital can charge over competitors at the loss of the day's wages and the travel costs, which are both dwarfed by the amount of money in medical expenses we're comparing them to for these bankruptcy-inducing procedures.
> Not to mention that requires every hospital to offer every service and to have every type of specialist for every type of disease.
Why would it require that? There are thousands of hospitals in the US. You don't need every hospital to do everything as long as there is some competition for any given thing.
And far away hospitals can provide competition even if people don't actually use them in practice. If it costs $1000 in travel and inconvenience to fly to another city for a procedure then people won't use a local hospital that tries to charge $10,000 more, so they charge only $900 more because it's all they can get away with. But that's only if there's price transparency -- if you can't find out ahead of time that it costs $10,000 more for the local hospital then people choose it anyway and there is no incentive for them to lower their prices, which is where we are now.
> You can't just walk into a hospital and choose between Name Brand MRI or Store Brand MRI. It requires a level of knowledge that most people don't have. It's knowledge I don't have! And something I'd prefer to never have to think about when I have other shit to deal with in real life.
And that option exists -- you buy an expansive low deductible insurance plan that covers everything. That necessarily comes at the cost of very high premiums, because it has to cover the cost of making you price-insensitive.
You can also buy a less expensive insurance plan that doesn't cover everything and then consider anything it doesn't cover as unavailable. That's what socialized systems generally do, because they do make people price-insensitive but still have budgetary requirements to meet. But there's no reason you can't get a private plan that does that either; just don't object when it doesn't cover everything. You pay for what you get, one way or another.
> Your analogy falls apart because the government does make mandates for cars. Things like safety features.
They also have mandates for medicine. There is a whole medical licensing system. That's independent from who pays for it.
> When you're looking for a car, you have some properties of a car which are easily understandable. When you're searching for medical assistance, most people only vaguely know what's actually wrong.
I don't see how it's different. There are plenty of subtleties when buying anything expensive that aren't readily apparent, like that car insurance can be more than the car payment, or that some models depreciate faster than others so you have to account for future resale value, or that some models have more frequent repairs, or more expensive repairs. Some people buy based on style and only later find out through experience the total cost of ownership is $40,000 higher than they expected.
It's the same thing with healthcare, but it's the same thing with healthcare either way. Regardless of who is paying, which doctor has the best patient outcomes? Which medication is more effective? What clinical trials are there for your condition? You can ask your doctor, but first you have to choose your doctor. And then, in the end, they only advise you what to do. It's still your decision and your life.
Not really. The law you're referring to is the Family and Medical Leave Act (FMLA), which only applies for childbirth and "serious health conditions". Most things you can shop around for also aren't serious enough to qualify, so you're not entitled to such unpaid sick leave.
But also, it's kinda a moot point because laws like that only apply to people that know them or can afford an attourney. Just like the person in the linked article didn't know she couldn't be harassed quarterly by the court system (rather, just yearly) due to being disabled, those who are most in need of that law are unlikely to know about it nor to have an attourney.
> If it costs $1000 in travel and inconvenience to fly to another city for a procedure then people won't use a local hospital that tries to charge $10,000 more
This assumes that people have both perfect knowledge of their procedure and the prices of all hospitals, and that people value money over convenience.
I know for a fact that I can fly to another country with free healthcare and get a procedure for cheaper than I can get it in the US, but hardly anyone does that regardless. It's just too inconvenient.
I also know for a fact that people rarely have even decent knowledge. Plenty of people buy incredibly overpriced cell-phone plans or internet. The free market hasn't been able to get those prices anywhere close what they should be even though people can switch providers, compare prices, and aren't stressed about their health.
But now you're not making an argument for socialized medicine, you're just making an argument for requiring unpaid sick leave for a scheduled medical procedure.
> But also, it's kinda a moot point because laws like that only apply to people that know them or can afford an attourney.
Are there many laws that don't work this way? Would the same people be any better off if the government would pay for their medical procedure but they didn't get it because they didn't know that?
> This assumes that people have both perfect knowledge of their procedure and the prices of all hospitals
Which is the point of requiring price transparency. Your doctor should provide you with a list of all the places that can do the procedure along with their locations and prices and any other information useful to choose between them.
> and that people value money over convenience.
But that is the mechanism by which it operates -- there is a point where the money is worth more than the convenience, and once people actually know the amount of money required, that limits how much providers can overcharge because past that the inconvenience is less than paying the money.
There is nothing wrong with choosing convenience. It's the thing that allows trade offs between price and convenience to exist. Maybe the clinic near the big city will always have the best price because it has the most patients to amortize fixed costs over, so the rural clinic can only stay in business by charging more per patient. If the higher price is worth not having to travel to the city -- and people know that -- then people will choose to patronize it, which is how we know its value exceeds its costs. If everybody chooses to travel to the city for the lower price then we know the rural clinic costs more than it's worth, which is the same mechanism that causes it to fold.
> I know for a fact that I can fly to another country with free healthcare and get a procedure for cheaper than I can get it in the US, but hardly anyone does that regardless. It's just too inconvenient.
Because flying to another country is very inconvenient, and not at all inexpensive on its own. So the limit it places on overcharging is not very strict. Especially when you don't actually know how much you'll be charged, so you don't even realize that it would have been worth it to do that until after it's already done.
The inconvenience is much less to go to another town than another country, so that would provide a much lower limit on how much anyone can overcharge before people would do that. If they were actually provided with the price differences -- so why aren't we doing that?
https://www.menshealth.com/health/a19543406/50-most-overpric...
My state has the highest rate of uninsured residents in the country and also one of the states that did not expand medicaid and take in federal funds to cover 90% of that. I paid for the best health insurance plan I could find on healthcare.gov and went with a doctor that was listed as a preferred provider with my insurance explicitly because my insurance provider claimed that any lab work, referrals, etc from that preferred provider would be covered and that they partnered with them to ensure that there wouldn't be any surprise out of network bills that weren't covered. The best health insurance plan I could buy left me out to dry for ~$600 in bills that were supposed to be covered 100% by my plan.
The notion of the magic of the free market driving down healthcare spending is nothing more than a libertarian fantasy. By any objective measure we spend far more than any other country on the planet for a given medical service. The fact that doctors and hospitals can't even tell you how much a given service will actually cost beforehand should be enough to tell you that the free market clearly isn't working here.
How do prices not help? You at least know how much you'll have to pay, which is certainly relevant information. You still may not know which one is best (no guarantee that it's the one that costs more), but what solution are you proposing to that anyway? Even if the government was paying for your medicine, how would that help you choose which doctor to listen to?
> When you are under, you don't get to consent to the actions of the surgeons ,anesthesiologists or whomever else they decide to bring in to assist.
Which is why it may make sense to have an insurance plan that fully covers emergency services regardless of network. But emergency services aren't the majority of medical costs.
First things first, you probably have little choice in where you are going to get things checked out, as there may only be one place in town or one place your insurance covers or one place that works with the hospital your doctor goes to. It isn't like you can opt out if you suspect things like breast cancer, which might kill you, or if you are getting anything done in an emergency fashion. AT best, knowing the cost might give relief or stress and at worst, it'll cause some folks to die a slow death because they can't afford the cure.
IIRC, they aren't always upfront about this stuff during surgery. You simply don't know or there might not be folks in your network available for a variety of reasons (like your anesthesiologist being sick that day).
So, no, "insurance" will never under any circumstances be the correct model to work from. (And no, I don't know what is.)
No, they don't. When you're out of breath with pain running down your left arm and are about to collapse, you're going to try to get to the nearest hospital, not first shop around to see which one has the most competitive rates like you're buying a new car or something.
Sure, you technically have time to shop, but it seems to me that this is just an excuse and makes sick people suffer more.
1. Take 30 mins to find the most affordable option. 2. Ask for a lower price.
You also could just live in a country with a good single payer health service, and know that you'll be treated without any bullshit.
The fact that anyone would seriously suggest shopping around for treatment, as if there is a convincing and credible reason why anyone should even have to consider this, is beyond astonishing to me.
I have heard multiple stories now whete independent practices now just want cash, without insurance, payments for much cheaper, and they get paid more in the end.
We are expecting a baby, and one of the tests we had to get done early in the pregnancy was NIPT. There was 2-3 companies we could go with, and when we asked for the price they responded some number between >2.7K - I don't really recall - it could even be 8K. When asked for the cash price, they said 250$.
Crazy.
A family friend, a very smart guy himself, was recently diagnosed with Parkinson’s Disease. Since I’m a neuroscientist, he asked me for advice. I work on brain stimulation, one of the better treatments for Parkinson’s Disease. My institute is a Parkinson’s Centre of Excellence, and I collaborate with movement disorders specialists. I have easy access to experts and tons of relevant training and literature. Nevertheless, I found it very hard to make a recommendation, even between the options his doctor had laid out—-and I wasn’t even considering price, since he has excellent insurance. This decision was smack in the middle of my wheelhouse too; helping with, say, a decision about kidneys would have been even worse.
There’s no way people, especially people in vulnerable situations, can reasonably be expected to catch up with experts that have a decade of advanced training and then second-guess them.
A Bismarck system (nonprofit govt sponsored insurance companies that all charge the same and are taken by all doctors) would be fine too, but that's not on the table in the US
Even for the most urgent issues like universal healthcare that have been literaly implemented by all western countries a long time ago as well as in most developing countries, you say : "But me..."
Since you're not directly affected by the matter, you simply don't care. Even if you could be the next...
You're part of the problem and nothing will never get done in America because of people like you.
Selfishness will break America.
Before your country collapses under its own debt, America will be filled by slaves and a clique of companies and billionnaires owning them.
Selfishness is healthy in moderation. It's what helps people come to the conclusion that they have a shared interest on which they can collaborate.
> Before your country collapses under its own debt, America will be filled by slaves and a clique of companies and billionnaires owning them.
So the answer is to bankrupt the billionaires so everybody is living a terrible life?
> You're part of the problem and nothing will never get done in America because of people like you.
You don't know me and you don't know what I do / do not vote for. I recommend you keep your insults to yourself.
See https://www.youtube.com/watch?v=8q71hrwUcu0 and the more complete https://www.youtube.com/watch?v=rWlk9HreE7U.
He explains how regulation eventually results in a centrally planned setup that is less efficient than what used to happen.
There's no such thing as a healthcare system where nobody profits in some way. Lots of people working in "non-profit" organizations are still lining their pockets.
> A Bismarck system (nonprofit govt sponsored insurance companies that all charge the same and are taken by all doctors) would be fine too, but that's not on the table in the US
You must be alluding to the German system. We actually have two-class healthcare: Private insurance for those who are self-employed or who earn well enough to afford it and public insurance for everyone else (15% of income).
Those with private insurance get preferred treatment at almost any level, because while price controls exist for both public and private treatment, the amount of money doctors get for public patients is a joke.
It doesn't stop there of course, salaries for all healthcare workers are extremely low, as is the budget for cleaning personnel. Pretty disgusting, but also dangerous. Our rates of MRSA are extremely high, for instance.
Lots of German healthcare workers are moving to Switzerland (private system, but compulsory), being replaced by Eastern-Europeans. That doesn't bother me per se, but if we didn't have that kind of cheap labor, the system would just collapse.
In effect, I can tell you how to get "affordable" healthcare, whether it is public or private: Just pay your healthcare workers dramatically less money. Instate price controls. You'll have a lot of frustrated workers in a system constantly working at the brink of collapse, but it does work.
If you don't have insurance in Germany you'll have to pay for that yourself as well. That's rare, but it happens especially with the precariously self-employed.
The issue with the US system is that you can't have it be both non-compulsory but also that coverage must be offered to everyone, no matter their state of health. Then you'll have a few healthy people pay huge premiums to finance treatment for those who never bought insurance until they're sick.
It is my understanding that a compulsory purchase (as in Switzerland) would be unconstitutional, so I guess "Medicare for all" in the form of a tax would actually be the next best thing. Just keep in mind that with US levels of healthcare salaries, that wouldn't come cheap.
The difference is GKV being the default, and opting out of that kind of hard. You have to earn €5,062+ per month, for a start [0]. And the step is intentionally hard to reverse. I consider that a decent compromise. At that point people have to actively shoot them self in the foot, and I've little pity for those.
If you didn't opt out, thus are still under the GKV, the system will cover emergency services. Even if you haven't payed (yet).
[0] https://www.bundesaerztekammer.de/weitere-sprachen/english/h...
It's not hard at all, just go self-employed and you have the option.
> And the step is intentionally hard to reverse.
Yes, so that people towards the end of their lives don't profit from a system they never paid into. You're stuck with expensive private insurance for the rest of your life. In the US however, you would qualify for Medicaid.
> At that point people have to actively shoot them self in the foot, and I've little pity for those.
It's actually not that uncommon for people to fall into the trap of working self-employed for most of their lives, then retiring poor because they never paid into the pension system and their private insurance costs them over 500€/month.
In Switzerland, it is compulsory to purchase insurance, there's a basic plan that all insurers must offer, and if cost exceeds a certain fraction of the income, the state chips in.
The difference in payment between US and European health care workers isn't large enough to make much of a dent in US healthcare expenses. The big sources of costs is the US massive bureaucracy dealing with bills, insurance and negotiation, as well as the medical inefficiency and overprovision inherent in the system. Also high drug prices.
For example, a US medical doctor makes about 100 000 $ more than the European average, although a few countries pays doctors more. There are about 1 million doctors working in the US. So thats 100 billion. US overspending is about 1 500 - 1 800 billion.
Germany today has a public/private mixture, Switzerland and Netherlands is fully private. I'm making this distinction because private profits do exist in these system, while the original comment I replied to lamented them.
> The difference in payment between US and European health care workers isn't large enough to make much of a dent in US healthcare expenses. The big sources of costs is the US massive bureaucracy dealing with bills, insurance and negotiation, as well as the medical inefficiency and overprovision inherent in the system. Also high drug prices.
Are you sure about this? Last time I looked it up, I came to a different conclusion: Administrative overhead (~8%) is neither a huge part of costs, nor is it massively different than in Europe. Drugs prices also only account for 10%.
Salaries for workers on the other hand are a significant chunk, and those are easily double than those in Germany in most cases. Note that I'm talking about all salaries, doctors, nurses, clerks, cleaners...
I agree with the overprovisioning being much costlier, but those are due to legal liabilities being more expensive in the US in general. In Germany, even if you win a malpractice suit, you get a pittance.
> There are about 1 million doctors working in the US. So thats 100 billion. US overspending is about 1 500 - 1 800 billion.
Again, this disregards the vast majority of worker salaries involved.
Private insurance in those countries works because those markets are highly regulated, and they don't have a corporate culture of trying to rip off people as much as they can.
The [majority of hospitals in the US are non-for-profit](https://www.aha.org/statistics/fast-facts-us-hospitals). Needless to say, they are not able to provide a cheaper service than the for-profit hospitals. So there is some factor, unrelated to profit, which makes healthcare expensive.
If profit was causing healthcare expenses to rise, then non-for-profit hospitals should be be able to maintain lower prices than for-profit ones. They can't. So what's driving up the cost? The answer is pretty simple: government intervention.
Sure, there aren't shareholders getting dividends. There are plenty of other motives that push non-profit hospital systems to want to make money. New buildings, fancy robotic surgery machines, cushy patient amenities to compete with the other system in town, expensive administrators and staff...
remember healthcare.gov? we were pretty glad we had other redundancies from day 1! it takes time to build a system and in my (granted unrelated) experience, big changes are best done in small steps
There is no healthcare system less complicated than "medicare pays for everything"
For example, the healthcare system the USA had for well past the first half of the 20th century was "pay workers a middle class wage and control costs so the average family can afford housing and pay for medical care for their 5 kids. And then send them to college after." Nothing is simpler than to be told the price of the service ahead of time and then pay for it. I know this because my father lived through it. He was the child of dirt poor immigrants, only got a high school diploma thanks to being drafted out of college, and still managed to pay for medical care for a wife and six children. He told me about how insurance started as just catastrophe coverage, and then just grew and grew until the entire system became the morass of red tape, inefficiency, and rent-seeking it is today. Just like with student loans, having the monetary sovereign spend money into existence (directly or through high interest loan guarantees) will inevitably wildly inflate prices in the affected sector. To an extent it already has.
This isn't a simple static system. If it were, then sure "government pays for everything, good to go" would be correct. Unfortunately the reality is that it's a dynamic system, and providing a payment guarantee with politically determined pricing is "government pays for everything, so now every middle-man, lobbyist, special interest, rent-seeker, and every other assorted grifter is going to wet his beak". And that's just the beginning of the higher order consequences. Maybe medicare-for-all is a good choice, I just don't know. And I won't know until I see a cogent, rigorous, and complete analysis of the second order and higher effects of the policy change. I'm not aware of anyone offering that analysis.
Both the situation before ACA and the reaction to it have shown that privatised health insurance is never going to work in the US. Medicare for All looks like the only practical way forward, and it's been gaining a lot of momentum as a result. Medicare itself also still needs some fixes; at the moment the government isn't even allowed to negotiate prices. That's a law that clearly needs to be repealed. But other than that, Medicare for All sounds pretty good, and I'm not aware of any other credible proposal that looks anywhere near as good.
No thank you. I've helped people with medicare and it's the worst health insurance I've ever encountered, with insane rules and brain-twisting billing practices.
I have absolutely no desire to inflict this on the entire country.
When you are promoting medicare - have you actually tried it? Are you speaking from a position of knowledge?
I have, it's terrible.
But worst of all it doesn't fix anything!!! The problems with healthcare in this country are that hospitals and doctors will need to take a pay cut, and we'll need to fire a lot of people in order to save money.
Medicare for all, at current payment rates, will just cause havoc.
This is the part people don't understand when they promote Medicare for all - it's a really really bad plan, that people don't use unless they have no choice.
This should be the death nail in these proposals, except the people proposing it typically don't even realize the difference.
Medicare for all is a horrible idea.
Government funded private health insurance for all is a good idea.
So to add on to what you've said, yes medicare is nightmarish. Hopefully this offers me a new chance to live a life.
And I wouldn't trade my current system. I'd rather have medicare than nothing, and know that the issues it has can be fixed. Just because something has problems doesn't mean that it isn't better than nothing and doesn't mean that it isn't a good starting point.
It might not be so bad being a doctor if we fixed some supply issues: For example, making sure doctors (and everyone else) doesn't have tons of student debt. We can do things about how expensive malpractice insurance is: My dentist here in Norway would like to live in the US, but won't because of the malpractice suits. We can do things to simplify the office work, such as standardising payment scales and coding. We can make good use of nurse practitioners, especially for children who generally have run-of-the-mill infections THese things make it cheaper to be a doctor and cheaper to run an office.
You'd think we might need to fire a lot of people... but not really. Single payer health care means we can do things differently because our resources are pooled. Norway, at least where I live, will send a home nurse to your house for free up to 6 times a day. Even if you are in a cabin in the mountains or living on a little island. This is all because overall, this is cheaper than a nursing home... which costs 80% of your retirement, no matter how much you make.
There is also a private system, which mostly gives bells and whistles. You might get into a non-urgent MRI sooner and so on.
Also my wife is a Dentist. She works 4 days a week and does extremely well. If malpractice and costs were an issue for Dentist's in the US, they would work more. I know a lot of dentists but not a single one that works 5 days a week. And of course no residency required. Its got to be the best career choice in the US today.
As for firing people... I agree probably not. But most Hospitals _do_ run on a tight margin (like 5% or less), and the majority of their costs are staff.
But overall, if you've experienced the system at all, you know how utterly wasteful and unorganized it is. Its difficult to fathom a system with more waste, which is especially ironic since there's so many smart people running around. I think single payer, whatever the flaws, would absolutely be a major change in the right direction.
Some subsets of the health care industry have price elasticity and seem to work fine in the free market, such as Lasik and liposuction etc. But stuff that gets called medically necessary don't work in a market, there is an entire branch of economics dedicated to it: Health Care Economics. Ironically pioneered by an American, Kenneth Arrow. Won him a Nobel Prize.
In the best case scenario, everything is considered in-network and you are on the hook for up to your annual maximum out of pocket expense.
But for a condition where you can predict a short/medium term future which is going to involve being inundated with medical bills, one thing you absolutely must consider is whether working (earning money) is actually costing you more than not working.
It’s going to vary dramatically depending on the state you live in (and that’s something you need to consider about where you decide to live) particularly if the state expanded Medicaid under ACA.
In cases where there are massive predictable bills, earning a dollar more than the Medicaid eligibility threshold will likely cost you at least $10-$20k per year after tax, but in a failure mode could cost you much, much more. Not to mention there are no premiums - compared to potentially paying the full out of pocket maximum on top of full-bore monthly COBRA premiums after losing a job - if you don’t realize a better option is available.
Getting income down, getting on Medicaid and SNAP, shelters you from any medical bills (you literally never see a bill on Medicaid, and can see a huge network of providers) and that peace of mind can help you focus on healing.
In some states if a medical issue forces you to stop working you can also get short-term disability payments which are entirely tax free, and do not count toward Medicaid eligibility.
It’s important to understand all the options that are possible and under what terms they are accessible, and be willing to do what’s necessary to get access to those benefits when your life depends on it.
This may be the thing that most baffles me about this: how can you be held responsible for costs you never agreed to?
Mysterious medical costs popping up that you were never aware of and never agreed to, sounds like a recipe for fraud and extortion.
I know it's not the subject of this, but this sounds like it's probably illegal? He's seizing money that was supposed to be returned to someone other than the defendant.
Not only do they suffer, but numerous people in progressive states also suffer because right-leaning states like Kansas vote the country towards these types of repressive laws.
The voters do respond, eventually. But the ship is slow to turn. With the wave of rural Kansas hospital closures, farmers going out of business due to the tariffs, and stories like the one linked, Medicaid expansion is very popular with the voters. The pressure is only going to grow.
Democratic side is full of candidates who would be moderate Republicans in any other state. None of them are particularly exciting. Though the most recent entry in the race on the Democratic side is a woman who was a leader in the state legislature as a Republican. She changed parties last year due to both Trump and Brownback. Changing parties in a very red state like this is an act of courage, or a foolish act, or the act of someone who knows what the long term trends are. She's the most interesting so far.
I think there's a struggle to motivate national $$ with a moderate message/candidate. But I think we all might be surprised that the truth, the honest personal story, (and the insider electability politics) might be even more valuable than some liberal issue crusader.
She is courageous to a certain degree. But, her move might be accepted more here than in other red states. Kansas is one of the last red states where truly moderate Republicans can still be found in the wild. The moderates have been willing to endorse Democrats from time to time. Laura Kelly was the beneficiary of such in 2018. Many of them will probably endorse Bollier next year.
2020 should be an interesting election year. Kansas waffles between Trump being above or below water in approval. Kansas is also one of the leading states hit by farmer bankruptcies thanks to the tariffs. On top of that, Kelley has decent approval ratings and has been doing a good job. All this combined might make more people than usual willing to "hold their nose" and vote for a Democrat. Trump is almost certain to win, but the state races could be wild.
“Why have you made me your target? Have I become a burden to you?”
So he's going to continue to waste:
1) his own time. 2) the other guy's time. 3) a judge's time (and therefore taxpayer money).
Aside from the moral implications of the method of debt collection itself (harassing the most helpless), this is basically a crime against everyone. Such a waste.
If several defendants got to the point of committing suicide you would expect at some point one of them breaks and you end up with a mass shooting at the debt collectors office or a hospital or something? They have nowhere to go, totally hopeless situation, and there are a lot of them. So the probability of running into one with a serious mental health issue and a gun are non-zero.
That said, I don't understand why nobody has tried to organize protests outside the courthouse or hospital over this. 90 people in one session are plenty to leverage a pretty big protest. The black eye to the court or hospital in question could definitely lead to some changes. If there are other counties in OK facing the same issues, they could protest at the state level and probably get better protective legislation in place.
I fail to understand how apathy has lead to such passive lack of any kind of action for reform.
What do we do when voting doesn't make a difference?
One of the biggest problems in American politics is that everyone is caught up in the blood sport that is Federal politics while not paying attention to what's going on in lower offices. Yes, healthcare is and will always be a Federal issue, but it's never too late to get involved in politics at any level.
Denmark’s population is that of Wisconsin.
The least populated state (Wyoming) would have a larger risk pool than Iceland, which seems to be doing fine.
But it is just math - bigger pools have more resources over a larger population, and so are better positioned to survive shocks.
My point is that you can have adequate risk pools at a lower administrative level (the states), while not having to deal with having to build up political will among a large, heterogenous polity.
It is a complex topic, and the variety of "solutions" to the problem give us a lot to chew on.
I don't personally think that's optimal - there are a number of problems US states have that nation-states don't. (Deficit financing, exclusion and latitude to make its own rules being larger ones.) Also, one cost of running "laboratories of democracy" is that some of them fail, and some of them are run incompetently or corruptly or cruelly.
But if you like the idea of state level fixes, by all means pull for that. There is no single right answer.
That is true of nation states as well, and yet we trust them with sovereignty.
In our Union, states have to abide by a baseline set of rules per the Federal Constitution (free speech, right to a fair trial, equal protection before the law, etc). US States aren’t run by Kings and Queens, they’re democracies with checks and balances, state Constitutions, judiciaries, legislatures, and executive agencies.
Insofar as a state would be run corruptly or cruelly, it would be the will of the people of those states.
Being poor is illegal ;)
The bigger problem in this case is that the people being sent to court probably cannot easily walk there, because they are unhealthy.
It’s effectively criminalizing illness.
There are so many reasons poor people find it difficult to appear in court. A huge, and very easy to imagine, issue is that poor people tend not to have time flexibility; with everyone screaming at them to pick up another job, how could they possibly appear in court as well?
Another very easy to imagine issue is getting healthcare outside of this “town” everyone seems to live in in the above argument, could make appearing in court difficult as well.
The argument that “all poor people are fat and ill” is not just lazy, but outright ridiculous.
If you happen to live in town and that town happens to be where the State put the courthouse for that county.
Plenty of counties in this country are bigger than Rhode Island -- not just in the middle of nowhere, either.
[1] For the record, Palm Beach County, Fl (main city: West Palm Beach) and Broward County, Fl (main city: Ft. Lauderale), respectively.
But yes, people looking for a reason to blame the victim will use process arguments like that to ignore the reality of what is happening.
[1] We're talking about people with medical issues and no money; that can mean no car or no house or no personal mobility.
[2] As anecdata, someone I know was sued for nonpayment of a loan. Papers were served by mail and arrived the day of the hearing; postal carrier timing meant it arrived right as she would have had to appear, even if she hadn't been at work. Default judgement, and she didn't have the money to hire a lawyer to contest it. See how that works?
> He made sure no one was arrested unless they’d been reached by personal service or certified mail.
> As long as the defendant had been properly served, the judge’s answer was always yes.
I'm not trying to justify anything else, but the experience of being arrested without being properly served does not align with the article in question.
You can't make this up!
I believe you. Nothing really surprises me anymore...
This is beyond outrageous!
Edit: I couldnt find the term but now I did. You become a lawyer by becoming an apprentice of another lawyer. I assume these people become judges. In some states the only requirement to become a judge is to have been a lawyer. My original point was to take the comment from the article with a grain of salt. It requires a citation.
In Cali, the pass rate for the bar exam (3 days long) was around 45% when my wife took it (and passed it on first go! Yay!). So, sure, in CA you can sit for the bar exam after reading the law, and hang out your own shingle, and maybe become a judge. If you pass the bar exam, you are, and in IMHO deserve to be, good to go.
That may be part of why you don't get a lot of these kinds of stories in AZ. Of course there are many other issues at play. Such as most political candidates don't show their political party in ads. The term limits set a couple decades ago cause a large shuffling of where political candidates land after term limits (state house/senate/boards).
I've seen so much corruption from inside and out, and even creative ideas of dealing with it, only to see it shuffled differently every time. I'm not sure there really is any other solution than limiting govt as much as possible, and by extension limiting corporate protections as well. Many today lean towards Communism/Socialism as the answer, and from my understanding, I can only see that as escalating the problems in the long run.
The law is supposed to be human and obvious. Any case that "requires" a JD and ten years experience is likely full of trash.
There's a great New Yorker cartoon about this. https://www.newyorker.com/cartoon/a20630
It'd be funny if it wasn't something that actually happened.
Also crazy you can be a judge without a law degree, even if you want to a be a lawyer there's a long process without going to law school, like years of a apprenticeship. Feel like that opens up the judge to being manipulated by lawyers. Just seems like more evidence that the so called justice system isn't really just. Then the whole private prisons and prisons not really focused on rehabilitation, people get released and don't know what to do on the outside so they reoffend and get comfortable with prison. I guess in prison at least you get food and probably warmer than being cold on the streets homeless. There's some books I've been wanting to read on these topics, but haven't got around to it yet. Apparently people unknowingly commits three felonies a day, and of course being ignorant is a excuse either as you must memorize and understand thousands of pages of legal gibberish.
Feel like our nation has veered so far off course than our original principles and ideals, and then if you watch the news... Very disturbing stuff happening all over the place. Really saddening. Plus I feel like our education system is dumbing people down, but that's an entire other topic. But not sure if any other countries are that much better, seems like everywhere has it's problems.
That one is really shocking. I don’t even understand how this can work if the judge isn’t highly trained.
If things are really this dire sign up for platinum coverage under a total in-network HMO like Kaiser. Platinum 90 0/10 as an example.
If you have serious medical costs these plans are MAJORLY subsidized because they don't discriminate on pre-existing conditions.
You CANNOT go out of network.
Also, there are no Platinum plans where I live (western WA), some counties, especially rural, low-density areas, sometimes only have one plan provider for individuals for people who don’t qualify for Medicaid - and they aren’t obligated to provide even a Gold-level plan.
We need universal coverage, now.
[1]https://www.healthcare.gov/glossary/pre-existing-condition/
[1] https://www.commonwealthfund.org/blog/2019/short-term-plans-...
The other 10% actually wound up having to use it, and discovered why the ACA said they don't count as insurance.
You CANNOT go out if network though - that's really the deal / tradeoff.
If you travel a lot, have a fav specialist etc may not be a good fit - a national ppo may work better or us within us coverage for specific trips. Generally you can get $100K coverage for trips > 100 miles away from your home + 1 night away from home as part of your insurance package (exceptions related to traveling for medical work, getting drunk and hurting yourself etc).
I would like to see some billing revisions take place and make the majority of collections susceptible to review. Also, limit the rates that a facility can charge limited to no more than a 20% variance. Of course now that insurance companies don't act with a fiduciary responsibility, this also needs to change. Obamacare, as well intended as it is/was, has introduced some fierce unintended consequences.
As someone who was saddled with a $138k set of bills (after insurance, before Obamacare), it's rough. I make decent money and still had to spend the better part of a decade working 60-70 hour weeks with a day job and side work to pay it off. If they made medical debt a tax credit, it isn't even a deduction most of the time, I'd bet there'd be more interest in actually adjusting the course.
I would like to see the collective coverage for Medicare, Medicaid, VA Medical, and Federal Employee coverage combined into a non-profit medical insurance anyone can get a policy from with a single policy that can and does negotiate with fiduciary responsibility. Of course, then the congress would handcuff such an organization and make it unable to wield its' negotiating ability.
ACA has been yet another screwup on top of the cluster-Fsck that is the US health care healthcare system. Medicare can’t even force payment restrIctions or transparency. It’s not in politicians interest to fix it - they raise all their money by either running on medical reform(fixing it would take that issue and revenue stream off the money) or protecting it. Why else do you think that a supermajority under Obama made the problem worse?
It’s time to form a separate states controlled mechanism for doing this. The federal government has proven to be either completely and totally inept, or corrupt beyond all imagination.
Also note that hospitals is one of the very few businesses that you have to get permission from other hospitals to open. It's a cartel.
For a lot of people? A few days off means they lose their job and everything else. So they work through the pain or the illness until it becomes a severe medical emergency.
Another horror storie from america. This rare gem mix otherwise common issues of debt, failling healthcare and jailing.
It's 3 year and half I take interest of the inner working of american society, since Trump declared he didn't understand why the US didn't use its nuke more often.
I think at every article I have reached the bottom... Yet everytime I learn something worse from another story.
America is on the decline. Corruption, greed and madness is literaly ruining the country from the inside.
No country will defeat you ; you will defeat yourself.
The reason I say burn it all down is medical billing would be considered outright criminal fraud and extortion in any other industry.
Imagine your mechanic engaging in surprise billing. Well yes my bill of $2500 was just for removing and installing the transmission. The $15,000 is the independent transmission rebuilders fee.
www.nytimes.com/2018/05/22/opinion/alabama-poverty-sewers.amp.html
I'm a fan of people being allowed to sell medical services regardless of qualifications, BUT being required to explicitly state and advertise their (lack of) qualifications. Have more continuous rather than binary qualifications too.
That would drive prices down for the poorest, allowing them to purchase healthcare, while not really affecting the rest of us who can afford the inflated prices.
somehow "socialism" is a dirty word in the US, even though the US citizens absolutely love their socialism when they get it.