Total Cost of Her Covid-19 Treatment: $34,927.43
time.com
time.com
It's tougher for people without insurance - my understanding is that you can negotiate with the entity that sent you the bill to get significant reductions, but I don't have first-hand experience doing this. Even so, it sounds exhausting, since a single doctors visit will often result in bills from 2-3 separate entities (doctor, lab, radiologist, etc.), so you'd have to negotiate with each of them individually.
That whole setup is downright cruel & evil. Pretty much guarantees the most vulnerable get fk'd.
Meanwhile people in non-US countries are thinking "I don't have to think about any of this shit, at all."
And even though fake insurance is cheaper than real insurance in this country, it's not cheaper than real insurance in most single-payer countries, which is just nuts.
Yup. And if you opt to buy one they're far more impressive. e.g. the one I'm on has global coverage (except US lol) for like 1.5k a year.
The whole thing is just comical (Yes we'll totally cover you in Iraq...but USA you're on your own there)
Yet when my doctor refers me to a lab for 1 or 2 specific tests, each individual test is billed at $150+ with a $60 copay paid to the lab.
With lab tests in particular, it’s sometimes cheaper to buy them without going through a doctor / without insurance.
I feel like the insurance companies get blamed all the time but it seems like the problem is really the pricing that is set by providers.
Can’t we pass legislation governing these list prices?
But the expectation is that you “negotiate”, which is one the dumbest things I’ve ever heard of. Why can’t my insurance company do that? I already have a ton of stuff to handle, and now I have to worry about negotiating my health bills? It’s a joke.
Total amount billed: $771
Plan discount: $699
Plan paid: $0
You may owe: $73
Because I haven't hit my deductible yet, the plan didn't pay for anything, but I got their negotiated pricing, so I'm only paying ~9.5% of the "billed rate".> But the expectation is that you “negotiate”, which is one the dumbest things I’ve ever heard of. Why can’t my insurance company do that?
If you have insurance, you're not expected to negotiate - the insurance company does that for you. That's the "plan discount" quoted above. You have to negotiate if you don't have insurance.
Not defending the system - I think billing is incomprehensible and hard to stay on top of. Just pointing out that you get significant benefits from being insured even if you never hit your deductible.
I suppose it varies by plan and provider? Regardless, dealing with medical bills is indeed a nightmare in the US. I am not looking forward to doing this all with children in the mix.
"You COULD get a huge discount!!!" is, to first approximation, pure bullshit.
Except when they get screwed.
Friends are middle-class teachers in a good neighbourhood outside LA. Have been so for 18 years, have good health insurance.
She has a baby (should be a joyous time), emergency C section required. The following morning the insurance company says $60k/day is too expensive, and they need to move hospitals this very moment or they won't pay a dime. No transport provided.
A day after a C section he had to drive his wife and <1 day old baby in his own car to another hospital.
That's downright barbaric.
I'm in the UK. My ex considered private C section, and checked prices in the UK. We could have had it done by one of the top specialists in the country for ~12k GBP including the subsequent hospital stay.
In the end we chose not to, and our total costs were ~40 pounds/night for her to get a private room (NHS is allowed to charge for some extras) instead of sharing.
All of the Tomahawk missiles fired since 2001 would have provided 119.000 people with free Corona treatment.
I am thinking that countries with free healthcare care more about keeping their own people healthy than dropping missiles and misery on other countries people.
If you had a straightforward nationally run healthcare system the math would be way more favorable still.
I don't understand how anyone can disagree with that; it's obvious. The German government certainly knows it, which is they allow the Americans to keep 30,000 troops in their country.
A lot of people on HN have an extreme anti-US bias. It's pretty tiring.
> I don't understand how anyone can disagree with that; it's obvious
No, it's far from obvious.
Those troops are now there to serve US interests, not German ones, primarily using Germany as a logistics base for deployments/missions in the Middle East.
Indeed, there's an argument to made that their spend could even reduce, since they might become less of a target.
Also, maybe don't throw out terms like "strawman" when you bizarrely transfigured my innocuous comment:
> The 30,000 US troops stationed in Germany and the existence of NATO are significant factors in European countries spending so little on defense.
into:
> This is a total fallacy - those troops being stationed in Germany does not mean Germany would station 30k of their own should the US troops leave.
edit - It should be clear to anyone reasonable that the way you interpreted my original post evinces anti-American bias. What you don't seem to understand is that US interests and Germany interests have significant overlap. The idea that Germany doesn't benefit from pax Americana is absurd.
That doesn't mean that the US always uses its power responsibility, it just means that things are more complicated than the caricature of US foreign policy that often shows up on this website.
I'm perfectly "reasonable", and it's rationale to question whether German military spend would increase just because some US troops leave.
I understand perfectly well that some US and German interests overlap, but certainly not all. It's also the case that the US does many things that there would be absolutely no appetite for in Germany (I'm not judging those actions here, just making a reasoned point).
However, the world has significantly changed since December 1991. I agree with the grandparent that today the primary usage of the large US bases in Germany are for staging people and material to the middle east. I also think that it's a reasonable opinion that these wars (or their scale and length) were unnecessary. Is that opinion evidence of "anti-american bias"? I believe that is an unreasonable conclusion.
So - from the 50's to the 90's did the US "subsidize" European economies to some amount by providing common defense from the USSR? Sure. It also served US interests as the policy was to "fight over there" instead of in the US.
Since then, the US has spent upwards of $3T on the GWOT, while declining in every health statistic year over year.
If we're tossing around charges of "anti-american'ism" - I counter than anyone who wants to continue on with an unchanged healthcare system is "anti-american" - as in literally in favor of a system that causes more children to die at birth, for people to live shorter, less predictable and more brutal lives.
Why? What if they are happy with their defence spending as it is? Its an unproven American trope that their defence would HAVE to increase.
Who, pray tell, is going to invade nuclear armed France and the UK?
It's a price we pay for favourable trade arrangements, not something Europe would maintain on its own.
- Sebastian Junger
Much like people's sudden views on UBI, especially those claiming that the upcoming stimulus is somehow proof that we need UBI or that it works - we're in a national emergency where hundreds of millions of livelihoods are threatened, any experiment we do now won't necessarily translate back to peacetime life.
Fun Related Fact: I donated a kidney to my Dad in 2000. The Affordable Care Act is what finally made it so it was no longer a "pre-existing condition" that insurance companies could use to deny me coverage for anything semi-related to kidneys.
Look, I think shelter in place is a great idea for humans. But this is a case of doing the right thing for the masses hurts the individual. Sad times.
The health system in the US is only accessible to those with money. It doesn’t have to be this way. I am not saying socialized healthcare will cure all ailments, but it would definitely be better than the current privatized system.
In Germany you are required by law to have it.
Because that's the case in the US.
https://www.cm.be/lid-worden/cm-bijdrage
Eg. Going to a doctor for a blood check costs 1€, 14€ is paid by the insurer
God I wish, it's about double that [0]: 162€ (health insurance) + 32€ (statutory nursing care insurance) for those making ~1k€/month or less. Not counting any gov support. Btw ~870€ seems to be the max, if you earn ~4700€/month or more.
And from what I remember there is a way to opt out of the public system and switch to private insurance, but this is kind of discouraged by being hard to switch back and requiring significant income in the first place.
> (german) https://www.tk.de/techniker/leistungen-und-mitgliedschaft/in...
It is always reasonable and affordable.
There are upper limits for the national health insurance which is based on a fixed percentage of your monthly income. I've passed that border this year (earning around 66 k€/year) and from now on, I will not have to pay more, so my procentual share actually goes down from now on.
If I'd marry now, my wife and any children would also be covered by my percentage, it's called "family insurance". Pretty fair after all. (Some limitations apply, but if my wife would stop working, she would be covered through my insurance.)
So it doesn't matter if you pay the pemiums or not - you get massive surprise bills.
“Out of network” doesn’t mean your health insurance plan doesn’t pay for anything. It usually just changes coinsurance rate. Anyone who has a major expensive hospital event while insured will just hit their maximum annual out of pocket amount and that coinsurance rate won’t matter. That’s not a good thing but it also means that this comment is misleading, implying that being out of network means that the insured person just has to foot the bill and that their insurance company dips out.
The whole point of the insurance network is that your health insurance company is encouraging you to take your routine doctor’s visits and scheduled non-emergency procedures to a place where they negotiate.
And acne and pregnancy aren’t disqualifying. What are you even saying they’re disqualified for? That’s a vast exaggeration.
https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...
1. Even in the event of Emergency visits to in network hospitals, one is often charged out of network fees if one of the doctors present is out of network. Which one is not notified of and has no say over, regardless. So going to an in nerwork hospital (which is the best one can do to align to their plan) means nothing.
2. When charged out of network, it most certainly does not mean only the coinsurance rate changes, you are also charged 10 to 50× more. So you are charged say 40% of $5000 rather than 20% of $300. Again, at an in network hospital.
3. Out of pocket max differs dramatically in network to out of network, in some plans going away completely in out of network scenario.
What you are saying above is not just a minimization its completely misleading and wrong.
the person who replied to you is wrong about out-of-network services though. they seem to be describing a ppo plan. my high deductible plan is quite clear on the fact that out-of-network is not covered at all. doesn't even count towards the out-of-pocket max.
This is not true. Premiums and coverage are only allowed to vary by age and location, not preexisting conditions.
https://affordablecareactlitigation.files.wordpress.com/2019...
https://affordablecareactlitigation.files.wordpress.com/2019...
here are summary articles explaining trump's DOJ's efforts
https://www.brookings.edu/blog/usc-brookings-schaeffer-on-he...
https://www.cbpp.org/research/health/trump-administrations-a...
so what is your point other than to mislead?
Absolutely none of this is true in the US.
Someone who is insured in the US is not allowed to negotiate.
This person can call the billing department and say “I can’t pay” and watch that bill plummet.
The 50% or so of Americans who get their healthcare from solid employers will exhaust their deductible but otherwise be generally fine. Then there’s another chunk of people on Medicaid and Medicare (government healthcare for elderly or poor) who would be fine in this situation.
The group of people in the United States who are screwed fall into a few categories: hourly workers who aren’t offered insurance or who are offered bad insurance from their employers, or business owners that have to self insure.
The ACA (Obamacare) attempted to help this situation by making health insurance mandatory and essentially going the route of Germany, but the mandate has been handicapped by numerous compromises in the bill itself, court rulings, and political turmoil. Also the high unregulated cost of drugs doesn’t help. It was not able to defeat the for-profit health insurance industry.
It’s wild to me that these political parties that claim to be pro-business don’t support separating healthcare coverage from employment. This is probably because of status-quo lobbying and a desire to keep people wage enslaved until retirement age.
I don't think it works this way that often. It might just get sent to a debt collector. They might give you a lower fee, but it won't be by that much.
But I can tell you this: there aren’t a lot of ways in which that debt collector can collect. They can’t take your home, they can’t take your car (as if the uninsured person even owns their car outright), and I don’t even think they can garnish wages.
The statue of limitations on debt is as short as 3 years in some states, and it won’t even affect your credit score beyond 7 years.
If that person never answers the phone and never admits to the debt, it basically just goes away on its own from my understanding.
Even if they decide to settle, that debt collector purchased the debt for pennies on the dollar. That person settling is not paying anything close to the full cost. The hospitals know that a bill going to collections is already a lost cause, and is basically written off as charity care.
Many people frame this as a "say this magic phrase to get your bill reduced" and I just don't think it's that simple any more. Some of the consequences from not paying just come back down the road.
The US healthcare system is messed up in a lot of ways.
I’m just saying that many people who are uninsured at the emergency room will end up with a lower total than people who are insured with unsubsidized low quality insurance.
Obama basically made this happen, but the net result was that all of healthy young adults (the kind that least needed insurance) were forced to start paying for insurance to subsidize the unhealthy older adults (or pay a penalty).
So basically it was just a disguised tax targeting the young and healthy.
This is literally insurance.
Obama's plan failed because the public option was removed, employers and states refused to play along, and the Supreme Court undermined even the part you're complaining about. It was also not a great plan begin with, compared to European programs.
Isn’t the whole point of insurance to have everyone (sick and healthy) pay for the few?
To me it sounds very similar to social security tax - the young being forced to pay to subsidize the old.
Maybe Americans are missing something to understand that, but it's not socialism or communism if you actually care about all people in the state, no matter how healthy or old they are.
Maybe Americans will understand one day.
(What? Too much?)
Trump getting rid of that mandate is one of the few things I'm grateful for in his presidency. No longer am I forced to pay for terrible insurance that had high copays and ridiculous deductibles.
I'm a low income worker and in exchange for almost 7% of my income I get 1 free doctor checkup a year and catastrophic coverage.
Sorry but $2000 cash is worth a lot more to me than an imaginary $100,000 hospital bill. Anything less than $2000 I spend on my health in a year is cash money in my pocket. Being "rational" about insurance is a luxury for wealthy. I would rather dispute the cost with my hospital and let the debt go to collections where I can reduce it even further.
Not sure how you get 2k?
Look at what other countries are doing, do you hear them having "obamacare?"
Stop comparing your current medical system to worse systems. Start comparing it to other, better systems. Look at Canada and the UK.
You would pay EVEN LESS than you do now.
Being uninsured is actually something of a blessing in the United States in this situation. If you have health insurance (often with bad coverage and high deductibles), you’ve agreed to waive your ability to negotiate and to pay whatever bill they’ve sent you.
Not so for the uninsured.
The whole billing system in the United States is beyond fucked up.
We both know that the price is to be negotiated, it's just a joke price.
But healthcare is not a joke even there.