She paid husband's hospital bill. A year after his death, they wanted more money | Hacker News Reader

She paid husband's hospital bill. A year after his death, they wanted more money

text.npr.org

78 pointsrntn142 comments

Exactly the same happened to me & my family, and we've also appeared on NPR for a similar situation:

> https://www.npr.org/sections/health-shots/2022/09/22/1121612...

My daughter died. Our story aired a year later. Another year later, so around 2 years after my daughter's death, I received a hospital bill for a little over $3,000, for her initial few weeks of ICU care. I never acknowledged it. I couldn't bring myself to call the hospital to setup a payment plan, say my daughters name in the same sentence as a dollar amount again. We haven't heard a peep since.

That’s terrible, sorry for your loss. Thanks for sharing.

Sorry for your loss.

> We haven't heard a peep since.

Good. But just to be safe, you should check your credit report from time to time to make sure they didn't send your account to collections.

Here I was thinking I was the only one with insane insurance stories...

The closest experience I can think of to this was when I was a sophomore in college in 2006. In short order, I had a seizure, was taken to a local Trauma ICU, and hours later flown to a Level 1 facility in another part of the state.

The hospital where I stayed billed us without issue, but the Trauma center decided it was the right thing to do when it sent the unadjusted bill to me at my college address. Oh, and the medical transport people who flew me around the state of NJ? Nothing.

Just super.

I also could talk about how earlier this year I spent 23 days in the ICU for an infection related to the same condition, and how an event from April-May still isn't settled as far as insurance goes, but I'm stressed enough at this point.

Score 1 for PTSD!

It occurs to me that I've surely met the deductible and OOP limit for the year, so that might explain why we've been so slow to see things get resolved.

To top off this cavalcade of awfulness, the person who hired me into my current job lost her fight with pancreatic cancer last week.

2023 sucks.

I'm sorry for your loss. Losing a child is a horrible experience and you never really get over it; time moves on but the emptiness persists. I wish you and your family well.

To the hospital systems and insurance companies, the confusion is a feature, not a bug. They assume most patients and their families will just knuckle under and pay what they're told they owe.

Since the health care sector is one of the largest political donors, elected officials have little incentive to fix anything, so they nibble at the edges and call it reform.

It’s not donations. It’s the fact that the largest employer in nearly every congressional district is a healthcare system. Heard this from a guy who worked on the ACA.

I never really thought about it, but you could effectively use sick people to import money into your desolate community.

In the same way that tourists bring tourists dollars, sick people bring government dollars.

There are some poorer countries, which do specialize in excellent health care for economic reasons.

Cuba?

.., Turkey, India

They’re price makers in a local area. They don’t need to import sick people.

Even beyond employment, healthcare represents a ridiculous 18% of the US GDP these days.

That number is ridiculous but it's also the broken window fallacy. If people spent less on healthcare inefficiency they'd have more money and spend it on something else. So it's not like you actually have to preserve the wasteful bureaucracy as though you're gaining something from it -- the jobs would just move to whatever industry supplies the things people would buy if they weren't forced to waste their money on this.

The real problem is the employment, because then you have not just the industry but its unions lobbying to preserve the inefficiency.

I struggle how we can include that into GDP. It should be a number we are attempting to reduce not grow because its a massive tax on the citizens.

It’s a shadow tax that goes to decent-yet-useless $60–90k jobs to buy political influence. There’s no countervailing influence.

I'm reminded of the Terry Gilliam film Brazil.

Yep, the United States spends an outsized portion on it, but has some of the worst outcomes of any developed country.

Good point. Although I still think donations play a decent part.

> largest political donors

You pay politicians, and you get the outcomes you want.

Every other country in the world calls it bribery.

> Every other country in the world calls it bribery.

This is, unfortunately, not true for the majority of "democratic" countries.

They call it "lobby". They avoid to call it "conflict of interest".

In principle, there's nothing wrong with lobbying. Legislators cannot be specialists on everything that needs to be done. Bat conservation charities lobby the government on issues related to bat conservation. Deaf associations lobby the government on issues related to education of Deaf students and Deaf accessibility. Lobbying from commercial interests is infinitely more suspect, of course, but still sometimes reasonable. The trick is to have very strong laws about openness: lobbyists should be registered, and minutes of meetings should be published.

Ireland's Regulation of Lobbying Act (2015) [1] is something of a gold standard, which some other countries are considering using as a model [2].

[1]: https://www.lobbying.ie/help-resources/information-for-lobby... [2]: https://www.politico.eu/article/ireland-lobbying-clampdown-m...

There's also a need to stop lobbying being used as a cover for bribery: either openly or as a quiet quid-pro-quo. Your firm's argument for the importance of a regulatory change may be useful, but the associated $10k "donation" is just corruption.

I've been reading vol. 3 of Robert Caro's biography of LBJ and the amount of illegal money routed from various Texas oil tycoons via Johnson in support of various causes is astonishing.

Another technique is to pass the burden of proof onto the consumer. The hospital creates a new charge, and it is up to the patient to prove it should have been covered by insurance. For example, showing something like meeting your yearly out-of-pocket is a difficult task.

Sometimes it's up to the consumer to connect the two departments, insurance and the hospital billing, on the phone at the same time. Seems simple but the wait time between the two parties is high, and either one of them will drop off mysteriously.

If the bill is in dispute for too long, you will be sent to collections, and have your credit score degrade.

C.f. Executive Function Theft

https://hedgehoglibrarian.com/2023/08/14/executive-function-...

Absolutely. I work in HIT for small to medium size practices. We all know how badly insurance is treating us as patients, but what’s not as well known is how much they squeeze medical providers (example [1]). Hospitals and networks have the weight to navigate insurance, but small independent offices don’t and are also getting absolutely fucked over. In addition to staffing issues, rising operational costs, excessive demand, slow turn around in receipts, rising complexity in software and regulatory compliance, a lot of local doctors are selling to networks and hospitals or just straight up closing doors. Large entities absorb all the same problems primarily by economies of scale which can result in poor individual care, increased out of pocket costs, amongst other things.

[1] https://www.npr.org/sections/health-shots/2023/08/15/1193754...

> local doctors are selling to networks and hospitals

My primary care physician did this a couple of years ago. He still works at the practice and I still see him. When I asked him why he sold, he said he wants to do what he loves - practice medicine - not spend most of his time working with insurance companies.

The worst part is all my records from years of visiting him did not transfer to the new system. It’s as if I’ve been seeing him for 2 years instead of 10 because no one can access my old test results and records. So much for continuity of care. Now I download all documents in their portal and save locally.

You’re not joking.

There’s a major dental insurance carrier that finds it perfectly acceptable to “pay” dental offices with prepaid debit/credit cards. Think Greendot, Mastercard, or Visa prepaid cards.

I’m fairly certain my dentistry firm is fighting back in ways I’m not comfortable sharing because I don’t know any facts and would just be speculating, but I do hope they’re sticking it to them.

We simply need a sort of statute of limitations for B2C transactions.

- Your employer can incorrectly pay you for a long time and then demand the money back.

- A hospital bill can come (afaik) anytime in the future

- You can dispute charges, the provider can fail to provide customer service, but your credit score is negatively affected.

Etc.

We need bills that focus on favoring the "little guy" in the fight so that wealth, dominance, and power are mitigated in justice.

EDIT: actually the bit about employer overpay being for "Decades" and demand back was not entirely true, depends on the state, ranges from weeks to 15 years according to my googling.

https://www.forbes.com/advisor/debt-relief/debt-relief-statu...

A lot of health plans consider any bill presented more than a year from the date of service forfeited. Medical billing is notoriously slow, opaque, and fragmented. On the insurance side they tend to be super slow in payment running 120 days behind forcing the hospital to de facto provide vendor credit to insurance companies that are way better capitalized than they are.

What baffles me are these people who constantly show up to defend the US health care system, when there is clearly a plethora of real end user testimony showing how detrimental it is to the health of most United States citizens.

Maybe HN isn't the best site to discuss this on, I'm guessing most of you work for some large tech sector business that offers good insurance. But most of the world is not made up of tech workers.

I think it's very common for Americans with decent insurance to not want universal healthcare, and be afraid they'll pay waaaaay more in tax. They think the system is fine as it is, because they've never put it to the test.

Then they have some catastrophic incident (car crash, cancer, heart attack, etc. etc.) and they're bankrupt in a few years and become very, very strong proponents of universal healthcare.

I think it's exceptionally hard for people to understand the system until it personally impacts their life in a very big way.

I'm not sure what to do about it. Maybe as a start every health insurance provider should be forced to provide facts about customers with the same insurance who had catastrophic events and how that worked out for them over 3-5 years.

If you have a good job and don’t have any chronic medical conditions and have never been hospitalized and no one you care about has experienced those things the US medical-industrial complex is fine.

Healthy Americans want the payroll deductions for health insurance employee contribution, Medicare, Social Security, income tax to be as small as possible. When we get sick or injured we want no wait highest quality maximum intervention medical care and low co-pays.

There's a lot of willful denial of reality when it comes to health care, but even when that doesn't happen, a lot of discussions just end up being people explaining how things work to others.

The Veterans Health Administration is a huge sprawling thing. A lot of people aren't aware it exists.

It's easy to maintain an unfair political system, as long as your base of support is better off than some underclass. It makes them feel valued and special, all while your hand's in their pocket.

Why should I care about Bob's healthcare problems, I am healthy and have a good job, I'm currently comfortable.

(Observe the recent death of Joe the Plumber, and his family's immediate followup was starting a fundraiser to pay for his accrued medical bills. All for a man who spent his rather low-profile and sad political career campaigning, among other things, against healthcare reform.)

Where are these

> people who constantly show up to defend the US health care system

that you're claiming exist? I don't see any of them.

Check gaulish further down in comments.

OK, that's one commentator in this thread. Not even "people", just n=1. It sure seems like GP is engaging in hyperbole to push an agenda.

I could start keeping tabs of other healthcare threads and the comments defending to make your N robust enough for you to think that more than one person in the US is defending the healthcare system as-is, if you'd like.

Every interaction I have involves checking out, standing before a sign that says, "all fees must be paid at time of service." I pay then, then months later get more bills to be paid well after the time of service.

As far as I can tell, this is the correct way to handle this? I haven’t paid attention to any medical bills sent in the mail since I started working 15 years ago (I generally pay what they ask at the point of service), and I’ve never noticed any consequences (no denial of service anywhere, has never shown up in any way on my credit report, etc) — as far as my experience has shown, any bills sent after the fact are completely optional to pay.

If you are in the US, you are probably often paying for the wrong services as billing errors are quite common.

Maybe? I don’t really care, that sounds like an error for the hospital to fix or get right the first time. Ignoring it seems to have no repercussions.

My experience has been that bills can often be 5X the actual services. It can matter if you have any sort of real interaction. For minor common stuff you're right it is immaterial -- like a doc visit with a copay. But get a frenectomy? Mole removal? Vein ablation? Ortho surgery? I highly, highly recommend reviewing the procedure codes for anyone who recognizes they are their best, and often only, advocate.

I don’t understand why it’s worth doing that work — ignoring and not paying the subsequent bills in the mail seems to have no downside, so why bother reviewing the procedure codes afterwards? Maybe we’re talking past each other.

I think you're interpreting this wrong: they aren't saying that all fees will be presented to you at time of service. They mean any fees which are presented to you at time of service need to be paid, but that isn't all the fees.

The worst experience I've had is one where I interacted with a provider, I paid my co-pay, they billed my insurance, my insurance paid the remainder, and it seemed to be done. Roughly a year later, the insurance company audited the bill, determined that the provider coded something wrong, and (somehow) took back their money. So the provider turned around and billed me 18 months later.

I called the provider, who had no clue what had happened. The insurance company finally told me that they reversed the charges, and told me I was not responsible for the bill, and the provider had to generate a correct bill. That was the last I heard of it, and I'm still expecting a several thousand dollar bill to show up in the mail..

Wow! That is quite a ride. You know there's a problem when an organization has to hire a billing coder in order to decipher what to bill patients. The whole thing just seems sad

Imo one part of the confusion and complexity is pricing. There is no standardized pricing. Many countries with government run healthcare systems solve this by not showing patients the prices and standardizing the price they pay to doctors etc. in the US you have the hospitals / health care providers, insurance companies, and patients all negotiating with each other. Some state governments tried to mandate a defined list of services and costs, but I don’t think it worked. Each provider categorizes things slightly differently. Also it seems the insurance companies and providers are fighting it out around what to pay, leaving the patient in the middle also trying to negotiate. It’s all very exhausting.

> It’s all very exhausting.

Mixing profit with healthcare is bound to lead to trouble. Patients got no choice but to accept the abuses of the system when they are sick. Like agreeing to things under duress.

Imagine if they passed a common sense requirement that is you want any payment it needs to be a single bill, day of service, plain language.

I was thinking we should use the proposition system here in CA to get this through- who wouldn't vote for it.

That sounds like the unintended consequence is you'd be billed the day of service the full cost and you can submit the claim to your insurance for reimbursement.

Maybe ask why UnitedHealth is a $455B company with 400k employees which provides no actual medical care themselves.

Kaiser keeps sending me bills for a pair of non-emergency visits that happened 6 months ago. They're small amounts, but it's crazy that it seems to take months for Kaiser's insurance to decide how much they're going to pay for various labs.

My dental insurance tried to make me pay the full cost of my invisalign treatment twice. I've ignored the second bill. Delta Dental can eat shit and see how they like their own insurance plans.

They also dragged their feet paying the part they said they would cover. They split it into two equal payments and said I would get half now and half in the next calendar year as long as I had continuous coverage during that time. Checked EOBs/statements/etc for any hint that they could do this, it was the first time I'd heard about it.

There are two extremes I'm familiar with:

- sticker shock from the bill - like, holy fuck, I was supposed to have insurance. Why is my provider taking back its coverage a year later? (May be called a "takeback" as customer support told me over the phone)

- Called customer support about the bill, and they were mostly supportive and believed what I said about being covered at the time. This was a relief to speak to nice people, but at the same time why make me fight an uphill battle? Why force so much confusion and fear on the patient at once?

I'd like to see a new regulatory regime that allows individual health care providers like doctors, nurses, etc to start their own practices that are cash only. The sense I get is that small strappy businesses like that can't start because of the regulatory regime that's too expensive to comply with.

But yeah in the end all of this machinery that gets between the patient and the provider and affects that relationship negatively needs to be done away with.

> I'd like to see a new regulatory regime that allows individual health care providers like doctors, nurses, etc to start their own practices that are cash only.

We already have that. Medical practices aren't required to take health insurance and can charge cash for services.

Specifically, Googling "Direct Primary Care" in your area will probably find you what you are looking for. Specialists who work this way also exist, but are rarer (and significantly more expensive)

> I'd like to see a new regulatory regime that allows individual health care providers like doctors, nurses, etc to start their own practices that are cash only.

This is a non-starter because older people with Medicare coverage - the people who get sick more often - would have to pay their Medicare premium, supplement premium, and the cash price.

In principle, I agree with you, sort of. Going to an immediate care center in my town for example costs $100 if you pay cash, but if you have insurance, they bill $300 and the insurance pays $100-150 (the rest gets written off). My suspicion, but I don't know this for sure, is that when a hospital bills say $1000 and the insurance pays $300, the hospital gets to take the $700 difference as a loss, ie, it lowers their taxes. So in this case instead of having to pay income taxes on $300, the hospital gets a tax deduction for $400. Anyone know if that is the case?

What happens if people move to a new address, or to a new country? The hospital mails the bills to the old address but nobody will know?

It'll probably go to collections and their credit score will tank for no reason.

The credit score of the dead person, or the spouse?

Spouse under the assumption they either accept ownership of the debt or they already were the owner of the debt.

The US "healthcare system" is a criminal organization. And the US government is in on that con. The USA is such a farce, it's impossible to grasp the totality of it all.

I really don't understand why the US doesn't have a grown up healthcare system. Do you just not see how much better healthcare is in the rest of the developed world?

The healthcare system in the US is much better for a small group of people who make a lot of money from it, and they have bought the entirety of one, and much of another political party to ensure that it stays that way.

This is exactly it. Everyone asks why the American people put up with this, as if our congress actually gives a damn about the average American. Congressional votes are bought and paid for by corporations which benefit from the current, broken system.

I’ve lived in quite a few different countries (including a couple that are frequently praised for their public healthcare systems), and the quality of the healthcare I’ve received in the US is far better than anything I’ve had anywhere else.

The quality of care you did receive in those countries may have been lesser, but what could you have gotten if you paid as much there as you pay in the US?

> but what could you have gotten if you paid as much there as you pay in the US?

If you ignore the fact that I was already paying substantially more for it with higher taxes, the answer is still nothing. Countries with public healthcare don’t have expansive private healthcare systems, and nowhere in the world has a healthcare system that offers the level of service that the US system does. For example my sister was giving birth in New Zealand, and I wanted to just pay out of pocket for a private hospital for her. There are zero private hospitals in the country that offer this service, so her only option was to go to her local (and notoriously bad) hospital. She remained in the maternity ward for nearly a week, because while she was there that hospital had its 15th norovirus outbreak for the year.

Last I checked, Americans already pay more tax for health care than anybody except the Norwegians.

Overall perhaps, but the taxes I paid in NZ were much, much higher than what I paid in the US, even when accounting for health insurance and other out of pocket costs.

Here's an interesting chart on the matter: https://www.oecd-ilibrary.org/sites/154e8143-en/index.html?i...

Per capita statistics have no affect on me personally given the level of taxes I paid in the US and NZ was substantially higher than their respective per capita averages.

The maternal mortality rate for the US is 4.7 times higher than New Zealand's. The infant mortality rate is 61% higher.

I could also cherry-pick some statistics to try prove a point. But the point I’m actually making is that the healthcare I had access to in the US was far better than the healthcare I had access to in New Zealand (or anywhere else), regardless of how much I was willing to pay.

Complaints about systemic issue of healthcare costs in the US are perfectly valid (and there are other somewhat unique problems with it as well). But are completely seperate from the fact that the best healthcare facilities, and most qualified healthcare professionals in the world are generally located in the US.

the healthcare I had access to in the US was far better than the healthcare I had access to in New Zealand (or anywhere else), regardless of how much I was willing to pay.

Can you back that up with data?

You mean like my healthcare records?…

The numbers I've seen do not support your position. If your opinion is based on evidence, show me that evidence. I'm willing to change my mind, but not based simply on "trust me bro".

The US has some of the best healthcare providers in the world. They also have some very bad ones. But gains are harder to achieve than losses in healthcare, so when you average in the bottom of the barrel you get some bad numbers even if both the median and the best available provider is above the international average.

Basically, healthcare quality in places that are both very rural and very poor (e.g. West Virginia and Mississippi) can be awful and it brings down the average even though the system provides better outcomes for most people in most other parts of the US.

>the healthcare I had access to in the US was far better than the healthcare I had access to in New Zealand

No, it wasn't.

Factually, your sister is 4.7 times more likely to die giving birth in the US than in New Zealand.

The outcomes in US healthcare are terrible, and it's extremely expensive.

> Factually, your sister is 4.7 times more likely to die giving birth in the US than in New Zealand.

Factually, that’s completely wrong, and I don’t think you know what maternal mortality is. It’s any death that occurs during pregnancy, during or with 42 days of childbirth. There’s a lot of reason that the number is so high in the US (including unequal access to healthcare in the first place), but the quality of the healthcare provided isn’t one of them.

> There’s a lot of reason that the number is so high in the US... but the quality of the healthcare provided isn’t one of them.

In one sentence you acknowledge that the US has a VASTLY higher maternal mortality rate than developed countries, then you say that has nothing to do with the quality of healthcare provided.

That's.... impressive.

Lots of countries with universal healthcare have private insurance and healthcare. Public healthcare is pretty rare, Britain and Canada are the main examples, and Canada is only one that bans private healthcare. Switzerland is good example of country with required private health insurance. France is mostly public insurance but healthcare is mostly private.

....If you can afford it. Which, you having lived in multiple countries, sounds like you can.

If you cant afford it, you're fucked in hundreds of different ways, including basically signing for any care "i agree to pay whatever im told for the rest of my life" blank check.

And healthcare is the leading cause of bankruptcy. This sort of crap doesn't happen in a decent country.

https://www.forbes.com/2010/03/25/why-people-go-bankrupt-per...

US healthcare system works for people with money, and people with money make up most of the voting base.

No, it's that congress generally only cares about those that donate to their campaign, and that just so happens to be the corporations that benefit from the current broken system.

No, it doesn't even work (the most) for them. And they don't find out until that critical time that they're not covered.

What it does is give the illusion of high-level coverage so those profitable users keep paying the dole and keep supporting the industry politically.

Sure, let's say they believe it works for them so they don't politically support reworking it.

If you can afford it the healthcare in the States can be quite good. And there's a massive number of Americans who can afford it. I can't say off the cuff what share of the population is that but Americans being ever on the verge of bankruptcy is mostly a cliche.

I mean, in France we have a 'life expectancy' metric (82.5) and a 'life expectancy with good health', which is on average, the age someone born in 2023 will reach before getting daily pain or start loosing independence. The number is 76.5 year old (10th in Europe).

What's 'funny' is that our life expectancy with good health match USA life expectancy this year.

Maybe because on average in USA you die from your first illness. Yes, I'm sarcastic.

American culture places a lot of importance on individualism. This means people are free to make choices that will lower their life expectancy without fear of judgement. So Americans don't live as long. Doesn't really prove anything about the quality of health care.

I can assure you that eating and drinking yourself to death is entirely possible in France too :-)

Us obesity rate 36%, france 17%

The case presented by the article is of an American who can afford it, yet I would still call it legalized abuse. Just like the other cases here in the comments, none of them of Americans on the verge of bankruptcy. And either way: the real possibility of getting bankrupted by your health bills signals systemic disinterest towards the (even when poorer) tax-payers. Maybe you agree with it, state models can be different and I guess there are advantages and disadvantages to each, but at least let's call it for what it is.

I love my quality of care in the US. My insurance is quite reasonable compared to what my increased tax burden might look like overseas. I can’t imagine living in a nation that would make me wait months for something like an MRI, I love living in a nation where I can get an MRI for myself and my dog in the same day. I also enjoy living in a nation that doesn’t suggest I kill myself over trivial situations and backlogs, let alone suggest I kill myself at all.

The only thing I hate is dealing with Byzantine clerical processes in the occasions they make a mistake. Have to waste 3 hours on back and forth phone calls because a low-level nurse made a typo is obnoxious.

> I love living in a nation where I can get an MRI for myself and my dog in the same day

You love living in a nation where millions of people can't afford basic healthcare for themselves but your dog can get an MRI same day.

The reason you have those things is because others don't have access to them.

You being able to get an MRI in a week might have the social cost of 3 people not being able to get an MRI at all.

> I love my quality of care in the US. My insurance is quite reasonable

Does it matter to you that 27.6 million of your countrymen have no insurance? [1]

Does it matter to you that 66.5% of all bankruptcies are due to medical bills [2] and that Almost 1 in 5 adults with health care debt either lose their homes or declare bankruptcy ? [2]

Do you simply not care that the people in your community and society struggle to get the bare minimum?

[1] https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2023/...

[2] https://www.retireguide.com/retirement-planning/risks/medica...

I'm very dissatisfied with the quality of the replies to your post so far, a lot of them are deepities about corruption and class. The actual reasons involve a whole bunch of factors:

- principal-agent problems - health-insurance and hidden cost mean the people paying aren't the people getting the product

- concentrated benefits, diffuse costs. There are tons of actors (pharmas, hospitals, insurers, doctors, etc.) each skimming off the top. Each of these is a small enough effect that it's not worth anybody's time to stop it, especially when it's worth it for the skimmer to fight to the death to protect their cut, and together they all add up to massive amounts of waste.

- the US healthcare system is a Frankenstein's monster of public and private elements, and has ended up with the worst parts of both

- the US healthcare system probably would be better (at least in terms of cost-effectiveness) if it become either more libertarian or more socialized, but since moving a little in either direction would be seen by half the population as the top of a slippery slope towards a dystopia they hate, everybody fights hard to keep it in the local minimum

Corporate regulatory capture.

And the institutionalization and legal enshrining[1] of work ethic.

Basically the two tier healthcare system has a legal basis for it's existence and structural support in the form of economic incentives to continue in perpetuity, and sustain itself.

This is going to seem either extremely obvious or completely bonkers depending on your point of view. so it makes an interesting scissor statement.

Furthermore one component of the system is the foundational belief that "work is virtuous," and healthcare is a boon based in reaping rewards of that virtue.

1. I wanted to say legalization. It's the right word, but it has the wrong meaning.

That’s not quite true. It is true that we often see work as virtuous, but it’s not enshrined in law. It’s just a side effect that health insurance (not health _care_, just health _insurance_) is a perk offered by your employer.

During WWII, Congress enacted price and wage controls that have caused us a lot of problems. With millions of men out of the labor force (because they were conscripted), and no way to compete with other employers by raising salaries, employers started offering perks instead. Things like tipping in restaurants and health insurance paid for by your employer became common and eventually ubiquitous. Before WWII, only a few percent of the population used health insurance. Everyone paid for health care out of pocket, and overall it was such a low percentage of people’s incomes that nobody worried much about it. You could trivially compare prices between doctors, for one thing.

Yep, we're all well aware of the origins of employer healthcare in the United States.

However, I don't want to confuse the etiology of employer healthcare and the social reproduction of employer healthcare as it exists today. In other words, just because a thing has an origin, doesn't mean that the original cause continues to exist nor can we avoid examining proximal causes.

I'm a bit confused what you meant by "it's not enshrined in law." I think we both agree that there doesn't exist a statement of law like "Employer healthcare is a benefit of virtuous employment." Rather, the motivating factors for the ACA compliance[1] are congruent in the minds of a contingent with the idea that a work ethic justifies rewards.

There are many such programs that are congruent with work ethic such as Earned Income Tax Credit(EITC)[2], unemployment benefit requirements(looking for work[3]), and FMLA requirements(work >12 months)[4].

I want to be transparent and stress that this is much more in line with a critical analysis of the US legal code and policy than a logical argument, and carries with it all of the nuance and assumptions that any critical legal analysis does.

1. "ACA, employers with 50 or more full-time employees (or the equivalent in part-time employees) must provide health insurance to 95% of their full-time employees or pay a penalty to the IRS." https://www.nolo.com/legal-encyclopedia/is-my-employer-requi...

2. "Encouraging work" https://obamawhitehouse.archives.gov/blog/2016/01/29/earned-...

3. https://www.usa.gov/unemployment-benefits

4. https://www.dol.gov/general/topic/benefits-leave/fmla

The problem in the US is that each of the parties wants to solve it in a different way, so neither has broad enough political support to easily pass, but both of them have strong opposition from a different constituency.

The Democrats keep proposing some kind of single payer system, but without addressing any of the causes of the existing high prices (because that would gore the ox of all those healthcare providers, who have a lot of political power), so in practice the result would be to move the absurdly high cost fully onto the taxpayer, but they can't get through a tax increase that high. There are also some aspects of the US heathcare system (certainly not the price) that people do like, and their proposals would tend to make those parts worse.

The Republicans are mostly content to do nothing, but their main proposal when they have one is to push things like price transparency and regulatory reform. Those proposals have a lot of potential, but they would come entirely out of the margins of the aforementioned healthcare providers, so they can't get any meaningful support from across the aisle or even within their own party. Which is why they're mostly content to do nothing.

It also doesn't help that most of the reform efforts have been attempts to do the first one, which doesn't reduce the cost, but consumes activism resources to promote a proposal that either doesn't work or doesn't pass.

Clarification.

US health is great if you are employed, have a good income or are retired and on medicare. If you don't fall into those categories it is pretty tough

This. Which is why US averages are so bad, on average folks have shitty insurance and thus healthcare.

But if you purchase, or negotiate excellent coverage you can get excellent care. (You still have to do some research to find the best providers)

US healthcare isn't great regardless of what metric you choose to use.

It's mid-tier all the way around except for cost, where it far exceeds any other system in the world.

Never being able to access the healthcare you're paying for because you can't afford the insane deductibles is even worse than not having healthcare at all, because when you DO have an emergency that you need to see a doctor for, your rates would often be lower out of pocket with the money you could have saved.

I have great insurance through my employer. Last week my spouse was suppose to go in for a surgery that multiple doctors made it clear she needed. We were on the books for months for the surgery. Insurance denied it the day before, throwing all our plans up into the air. The surgeon suggested getting a different surgery that wouldn't fix the problem. The idea is that when it didn't work it would act as evidence to convince insurance to pay for the original one.

We have a terrible, stupid, inefficient system. It's drowning in its own chaos and bureaucracy.

Insane ;(

Get the surgery, get notarized items from multiple docs, talk to a lawyer.

Healthcare insurance doesn't get to dictate your healthcare directly. They aren't doctors, and open themselves up to liability if we don't push back.

.. and if that doesn't work out, go bankrupt.

Nah, you have rights in this situation[0]

[0] https://www.healthcare.gov/appeal-insurance-company-decision...

... and if that doesn't work, spend years in a stressful and time consuming legal battle.

Perhaps, at a pessimistic extreme. Exercise of rights is important. It's worth consulting a lawyer for assistance. Organizations occasionally need to be compelled to do the right thing.

Life isn't always easy or fair, but standing up for yourself is important as you are your best advocate.

Woooofftt. That's bad advice and in an even worse order. There are a bunch of steps in between getting denied and just YOLOing it out of pocket. It looks like going through the insurance company's peer to peer process is probably going to work out. It is still a bit up in the air but its looking positive. We'd already started down the route of getting connected to lawyers in case it doesn't.

I don't think "do it out of pocket and try and claw the money out of them after the fact" was ever on our list of options. I wouldn't consider that unless the lawyers suggested it. We were looking into going overseas to have to done, which honestly its another big indictment of this system.

The point still stands about how insanely inefficient this whole system is at the macro level. The fact that lawyers are getting involved in routine medical procedures or doctors are suggesting what they know is incorrect treatment is a sign of deep inefficiencies. We aren't an outlier either. It is profitable for the insurance companies to jerk you around, fight you, try and sneak past denials were they can.

Have yall looked into external review?

https://www.healthcare.gov/appeal-insurance-company-decision...

No offense, I appreciate the idea, but I'm not looking for suggestions. I only posted this here as an example of how the system is failing even for people with high quality insurance.

And I appreciate your story and empathize, which is why I am ensuring both you and others reading your story remember that folks finding themselves in your situation have rights that are less commonly exercised.

But I appreciate that it's a tough topic and not engage further. Good luck with it.

> Healthcare insurance doesn't get to dictate your healthcare directly.

They aren't supposed to, but in reality, of course they do. They just have an on staff doctor who rubber stamps the decision.

With expensive procedures, they have a financial incentive to find a way to say no.

I work as a developer in Silicon Valley, and my wife also works. So we probably have a better insurance (and better income) than 95% of Americans.

My wife probably burned 10+ hours of her life making phone calls that amount to "No no, I've already called the insurance company and they say the record is wrong on your side! I have to call your other office? No, I already called them! Why am I still getting a bill when it must be covered by the insurance ...!!!"

And none in our family is even badly sick. Don't want to imagine what will happen if one of us actually gets sick.

US healthcare system fucking sucks.

A really great trick I learned is to use the 3 way calling feature of your phone. Call the insurance company, go through the please go away don't bother us menu system (now with voice recognition!), wait on hold for an agent, speak with the agent and tell them you are going to conference in your doctor's billing department, and call your doctor. Have them speak directly with each other.

This is also usually necessary to find out if something will be covered.

That's a great tip/trick! Thanks for sharing!

No, it's great if you don't get sick. I'm employed and have a good income. I probably spend of average 4 hours a week (sometimes much, much more) on the phone with my insurance company, pharmacies, and doctors. I suppose I do have the alternative of just breaking down and paying everything out of pocket.

No it's really not, regardless of the financial aspects. Doctors' time is parceled out into nearly-useless 15 minute chunks, appointments are booked full months out, "insurance" companies demand unnecessary paperwork and add more delays to run your clock out, inpatient rehabs (nursing homes) are understaffed death camps, and everyone generally operates in "not my job" cover their ass mode, including things like referring you to the "emergency" room (many hour wait!) at the drop of a hat.

Some of these change when you're truly end of life and in the ICU, and otherwise there are brief flashes of doctors actually giving you attention. But for the most part trying to receive healthcare in the US is like squeezing blood from a stone, independent of the soul crushing billing shakedowns.

It's more like you can imagine US healthcare is great if you don't need it, or don't proactively think about what needs to be done. Of course that's a great way for something to go unaddressed and kicked down the road until the next appointment (or ER visit).

I can't speak to other country's failings, but I can say this bogeyman narrative about "government run health care" is utterly fallacious. We already have the equivalent in the form of corporate-bureaucracy-first health care.

Clarification - not true.

I can point you to several people who have great jobs, great insurance, and tens of thousands of dollars in medical expenses. Nowhere else in the civilized world does this happen.

Right, then you get cancer and lose your job, savings, retirement, and start from zero.

It's not. Name another industry/market where you can't know the price of what you're buying (even an estimate) before you buy it.

Every other developed country has a better system than ours. Every one.

And for those who say "oh, well wait times are so much higher" - well you can get supplemental insurance in many of those countries as well - so the baseline isn't abysmal, but wealthy can get even better.

Canadian chiming in here. Sorry, but it's just not true of at least Canada that the single payer&provider system is working or working well. We get better _average_ outcomes because we do some preventative work, but if you're really sick you get far better care in the US if you can afford it.

There's probably some nice middle ground around having a national preventative program (screening, weight loss, nutritionists etc), and allow insurance to cover "you're fucked" scenarios like Cancer, Heart attacks, car wrecks, Gun shot wounds etc.

Are you sure you're canadian? You talk about having insurance for US Healthcare here: https://news.ycombinator.com/item?id=36818747#36819112

Nice attempt.

Canadian, former resident of Canada (for decades), and lately in the USA on a visa. Plenty of connections and family in Canada who can vouch first hand for what I'm saying, both as patients and as care providers.

Last year, maerF0x0 said they were $age years old. This year, they said they were $age+1.

Which is it, maerF0x0? Where do the lies end?

nice attempt.

Do you really not understand? Powerful people are making tons of money at the expense of everyone else. Isn't that how the system is designed? What's confusing about it?

I really can not understand how fucked up us health care is.

The American healthcare system is so broken, this exact thing has happened to everyone I know including myself

The mistake was paying anything. If you paid anything on it, it then becomes collectable.

Reply on news.ycombinator.com