Banks and hospitals are cashing in when patients can't pay for health care
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And yet, this is not enough, and people need private health insurance. Then you look at the prices of common medications, and most of them (mind you, a lot of them made in India or China) are sometimes ten times more expensive than the SAME medications in any other developed country and even more expensive for the same medications in Under Developed countries.
It looks like the invisible hand of markets is not working here. But at the same, the political process is also blind to the real issues.
We also had a president who said he wanted to implement this once. Not that he was perfect but amoung other things they fabricated evidence of some weird pee fetish and attached a narrative that Tom Clancy would consider too unrealistic to publish and repeated it on the major news networks non-stop. When you control a 1/5th of the GDP all sorts of funny little things like that seem to happen.
Every new medicine, every name brand medicine, every generic is paid at an exorbitant rate in the US which allows companies to provide cheaper medications to other countries. Every new surgery, every new technique, literally every part of the medical process is subsidized IN FULL by Americans.
Put it simply - if the US decided collectively we will not pay any more than cost for generic medication the entire world's healthcare system would collapse overnight. Most of the west would no longer be able to socialize their healthcare. 3rd world nations would likely halve their life expectancy. This is why, in my opinion, the US will never be able to do a medicare-for-all type situation. It's already unaffordable on the current tax basis strictly to take care of Americans. The unmentionable cost of subsidizing literally the entire planet's medical system through paying insane prices for everything makes it unaffordable even in some fever dream scenario.
When you're getting your cheap healthcare and free medicines take the time to thank your nearest American. They are dying so that you can afford to live. Your insulin is only cheap/free because some poor sap in America is paying quite literally 1400x your cost. The taxes other countries pay into their medical system pales in comparison to the amount of money Americans pour into their healthcare to keep it cheap everywhere else. There is simply no comparison to how badly Americans get bent over.
A father got a call from his daughter that she went to the emergency room, because she had a vitamin C pill stuck in her throat and she was scared. In NY, they are required to give an estimate of costs, and estimated $1600 for the exam and the can of ginger ale they gave her to drink so she could swallow it.
Fast forward a few weeks, and they got the bill. They ended up charging his insurance $2,200, and the insurance company valued the trip at $3,500 (presumably to bump up his co-pay? not sure).
The radio host (a lawyer) recommended reporting both the hospital and insurance company to the state regulators who oversee hospitals and insurance companies. Obviously, this is an instance of price gouging and abuse.
The question I have is, are state regulators sufficiently empowered to take action here, not only to help this family, but prevent such abuse in the future? I think the answer is likely not- part of the benefit of being so heavily regulated is they seem to get more leeway.
Personally, my wife went into an ER for a migraine that had lasted 3 days. A few drugs, an hour stay in a dark room, and we were sent on our way. This was not a busy ER; I think there was maybe one other patient there the entire time we were. After whatever the insurance covered, I was expected to pay $900. One of the drugs was given intravenously so it acted faster, but... if these had been available OTC or if doctors could operate out of pharmacies and prescribe something on the spot, it would have been so, so much cheaper.
The joys of regulatory capture, I guess.
This makes no sense. Insurance companies NEVER pay more than they are asked to pay. It's half the reason why medical billing is such a royal pain. A doctor or pharmacy knows they've left money on the table if they get exactly what they ask for from the insurance company.
And there's no way that increasing the coinsurance for the patient (co-pays are fixed dollar amounts so there's no "bumping it up") does anything for the insurance company. If your coinsurance is 20%, the insurance company is still paying paying 80% whether that's 80% of the $2200 or the $3500. Even if the person had an HDHP plan and was paying all of that out of pocket, all the insurance company raising the the cost from 2200 to 3500 would have done was move the patient $1300 closer to their deductible and out of pocket limits and make it more likely the insurance company is paying out more money in the future.
More likely is that the ER billed $3500 and the insurance's allowed amount was $2200.
It's possible that the (clearly upset) father on the phone had the story mixed up, but I'm not sure that NY law would allow an estimate for a medical bill to end up being billed at more than double the original estimate. Hell, in my state car repairs can't exceed 10% of the original estimate without approval from the customer. Either way it shakes out, if the story is real the state commissioners are going to have fun with it.
Billed Amount - what the provider/health system tags as the “billed amount” Allowed Amount - what the insurer sets as the actual total $ allowed to change hands for the visit Patient Responsibility - the portion the patient is responsible for.
The Billed Amount is supposed to exceed the Allowed Amount by 2.5-5x typically so that the Allowed Amount the insurer/provider has negotiated “saves” money thanks to Insurance ostensibly in how the bill is displayed.
Put differently, your provider/health system is supposed to per the billing contract put in an inflated value well in excess of expected payment so your insurance company can reduce it so you can “save money” superficially on your bill. It is as smoke and mirrors as it sounds. Sounds like your provider / HS forgot healthcare billing 101 in this case.
The Billed - Allowed Amount value is also usually called Contractual Adjustment
Just a tip for future cases, a lot of those pharmacies have small clinic in them staffed by a nurse practitioner. They can prescribe most things in most states. If it happens again, you can probably take her and her discharge paperwork and have the nurse write out prescriptions for whatever it is. Should be way cheaper unless the meds are something exotic that only a hospital pharmacy would carry.
It's pretty close to having a doctor in the pharmacy for anything you'd feel okay not going to the hospital for.
This is the chart of what they can prescribe per state (you'll have to look up what schedule the particular meds she needs are): https://www.ama-assn.org/sites/ama-assn.org/files/corp/media...
Nothing happened after that.
I've rarely gotten an accurate medical bill (vastly inflating the time I was seen by the doctor is the most common mistake), and if it's inaccurate I just don't pay.
They may not be able to beat back the general case, but if you get them involved the hospital and the insurance company will almost instantly fold.
And it's worth doing, because regulator offices work off of accumulated data - so the more complaints they get, the more they have to go on.
When our first child was born, in the States, it was in a birthing center associated with the local hospital. This was in its own building, but in that building they have a room they call the "ER" -- this is where they decide whether to admit you, in terms of being ready to give birth. The entire function of that room, though, is just to charge exorbitant ER rates for admitting into the birthing center. (A 10 minute dilation exam.) This is completely fraudulent, of course, but they've been getting away with it for many, many years.
But all of this means you're probably gonna lose the equivalent of a work week or two of hours playing go-between with everyone involved, largely sitting on hold on hospital billing department and insurer phone lines. Record everything because they all have a habit of "losing" their own fucking records. Reference numbers aren't enough, they'll say they can't find it—record the calls (check your state laws and make sure you comply, which may require nothing in some states, or may require your notifying each person who comes on the line in others)
My point is -- almost none of those things should have exorbitantly high prices, because they don't actually cost that much.
Do urgent care centers actually use an exorbitant amount of resources to provide health care services? They do not. Does getting any MRI actually consume thousands of dollars of resources, even counting labor? It does not.
To me, the main reason we still have not had meaningful healthcare reform in this country is that Americans have seen the made up numbers on those ridiculous works of fiction called "medical bills" and "statements of benefits" for long enough, that they think they are real. They are not.
(Ads for meds are so odd: I spent a couple of years in Canada and they don't do that there and it was bizarre coming back to the US and hearing them.)
Another reason for this is that Americans are so litigious: tests are ordered because otherwise the patient can sue. Which in turn is the case because the only way to hold companies/professionals accountable is to sue them. I'm not sure what the answer is.
Also there's probably less resorting to suing in the UK since people whose doctors mess up can get the resulting problems treated. In the US, if a doctor fucks up and you need more treatment, it can bankrupt you and the only way to recoup the costs is to sue.
It's a giant feeding trough for the subsidized industries. They get rich. The people who make the feeding trough run get power and influence. Taxpayers get poor results per dollar to the detriment of all the other things society could have spent that money doing. And idiots who are hoodwinked by the veneer of plausible deniability defend the system.
Either massively socialize it or massively deregulate it, I don't care which. Neither can be worse than what we have.
How much better will things become?
With a choice to pay $1k "with a small probability of surprise bill" or $5k all-included most patients will prefer the former.
Why would information asymmetry prevent a free market? The free market works for all manner of highly specialized goods and services, for which there is (almost as a rule) a large information asymmetry between buyers and sellers.
If you cannot get equivalent care nearby "in network" then you can go out of network and get covered. They won't like it and it can take negotiation but you have that option. All emergency care for example operates this way.
This is why the ACA stuff uses your zip code to offer plans. Remember most of these are State and Federal partnerships with private companies. The companies are just offering up their "networks". You and the State are paying the premiums.. One way to think about it is that the state is paying the employer portion.
This is way better than how it use to be...
I can get the care, but nothing in what you're describing sounds like what my paperwork details say. It indicates that any non-emergency services undertaken outside of their network will not be dealt with at all. I'm not sure how this is 'better' than what it used to be, with 'used to be' being last year's plan that would, at least, deal with services delivered out of network, with some % split up to a deductible.
No one is helping the ordinary personal with a high deductible - and don't forget the huge deterrent it is to seeking medical care.
Holy crap - Fan or no fan, the "invisible hand" isn't a factor in that environment. Healthcare is highly regulated, the market for drugs (for instance) highly rigged by federal reimbursement commitments, the third-party payer system obscures all costs from the consumer rendering them incapable of making informed choices. If you wanted the market to sort out health care, you'd need to get rid of state-level 'certificates of need' to introduce competition on the supply-side, actually achieve price transparency for consumers to avoid price fixing, and massively overhaul medicate part D to bring costs for drugs down. This is in addition to allowing insurance markets to cross state lines.
Total facepalm when I hear people say, "look at healthcare - guess the free market doesn't work". Nobody needs to argue that it should be a total free and open market devoid of regulation - that's a dumb retort, but to not understand how regulation has served to facilitate self-dealing, instituted market barriers, and create a money-go-round, is equally as daft.
The fraction of the population that is eligible for Medicare skews much, much older than the overall population and so is exactly the population that I'd expect to be more costly.
This is another reason to decouple insurance from our employment. These plans are cheaper because the pool of people is all reasonably healthy, and able to work.
The purpose of insurance is to amortize costs over time and population, but the industry has successfully dumped the highest cost patients onto the government plan.
If the U.S. paid what the rest of world did for drugs there would be a 90% less drug research.
I guess it's hard to defect and run a smaller office, because of the demands of dealing with insurance, as well as doctor licensure, but afaik the AMA isn't a governmental agency so much as a professional organization interested in keeping doctor salaries elevated by restricting the entry of new doctors into the field, and they seem to be one of the major problems.
Many hospitals are viscous for-profit machines that fraudulently maintain a non-profit status. They employ CFOs and business analysts to maximize profits unrelated to care quality. They hire “medical coders” whose entire job is to find the highest price way to legally bill you for services. (Is a surgery followed by stitches from a second doctor one procedure or two? Can we bill higher for medication if we can’t bill more for surgery? Can we charge a “room fee”?). And medical coder fees often show up on hospital bills sent to patients! The non profit mission of hospitals has long ago been lost to maximizing profits.
no, not every hospital is run this way. Many are, of course.. how can constructive engagement get past these shrill and urgent criticisms, and make positive change?
If the vast majority of bank tellers sucker punch you in the face after completing a transaction, the correct response is to implement a sweeping reform of bank tellers - not to do a deep dive root analysis on the positives and negatives that bank tellers add to the banking experience.
It is structurally and functionally evil.
We're sabotaging critical infrastructure in order to insert more middle men to pay.
Hint: the people who work in a hospital are an expense.
There are protections that vary significantly by state, and it's interesting to look through the variations in policy. Some states exempt a single firearm (regardless of value).
If memory serves right, 401k's are protected by ERISA rules, but many states have IRA protections as well. Iowa exempts the entire homestead up to 1/4 acre in a city, regardless of its value.
Having to deal with all of those items while battling a terrible disease puts someone in a disadvantaged position, but if you're ever in a position to help someone, it is good to be aware what exemptions exist. If your house is exempted, don't do a HELOC to pay medical bills.
https://www.nolo.com/legal-encyclopedia/california-bankruptc...
That won't properly highlight the issue. It's just a financial shell game of bailouts and buying and selling of paper. It doesn't impact the patients. It's not ideal but the only solution is for the patient to be rejected for insufficient funds/inability to pay. Then, when people finally realize they can't get a doctor appointment because they literally can not afford healthcare in our current system, they will expect the government to provide it.
What's funny/ironic to me is that people that are against single payor in the US always like to point to other non-US countries and say how care is restricted or people with cancer/needing surgery are on a long waiting list, etc. I don't know if that's even true but we've all heard it somewhere by now and it becomes a part of their truth (not unlike like politics). And it's what they're most afraid of, being cut out... when not being able to afford something is the very definition of being cut out.
Hundreds of thousands of people publicly begging for help with medical bills should be a national embarrassment.
Overall, people are pretty vocal about wanting a living wage, affordable healthcare, affordable education, housing, etc. yet we seem to constantly move in the opposite direction. IMO - our political machine has become too dysfunctional and no longer serves the people, or even make meaningful incremental progress. It's quite a damning time for our country and seems like some large correction would be in order at some point.
So yes, they say they want a living wage, but get really really really upset if you suggest that means the guy scanning your groceries makes as much as they do.
Then you have organizations like the AMA who have a monopoly control over how many doctors can be created. There were lawsuits in the past because they would not let medical schools open. This reduced supply and kept wages sky high.
People need to hit these profiteering practices right in the wallet.
I'll take bad credit over actual bankruptcy any day.
>People need to hit these profiteering practices right in the wallet.
Here in Arizona there is a hospital system that appears to be using false smuggling accusations as a racket in connection with CBP officers. "Patients" are forcibly taken in, rack up huge medical bills, and then when nothing is found they're dumped back on the street with the debt.
Keep getting the bills. Can't wait for them to actually sue so I can discovery them for any shred of evidence what they did was legal.
Can we really? Wouldn't that require that our income tracks inflation? Because that's not true for perhaps most people in the US. Only executive-level income is beating inflation.
I think the option most available is to die poor and have your pitiful assets distributed to your creditors.
At least if you don't pay the medical bills, you'll have a little bit more money while you live, making it less miserable.
If it costs money to get healthcare, and there's value in being able to delay paying for it, then it makes sense that there will be interest. It also makes sense that the amount of interest scales with the risk. If a hospital did all of their own bookkeeping and debt collection, I would expect it to converge to the same kinds of policies and costs that a separate debt collection agency has.
The unfortunate result is that the people with less ability to pay (i.e., higher risk) end up paying more, as with anything else. That's the real problem. But as long as it costs money, and there's a time/risk value to money, I don't see it getting fixed.
https://newsnetwork.mayoclinic.org/discussion/nearly-7-in-10...
You don't go there for health
Wealth breeds health :)
[1] https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...
"Just because all of the other kids do it" is more relevant today than ever :p
https://www.toledoblade.com/a-e/food/2015/06/23/70-of-Americ...
Edit: I didn't make the stats :)
But this really could -- and yet they are silent...
No they're not.