Hacker News Reader

Comment by p1mrx | Hacker News Reader

Under this system, what would be the reason to pay your medical bills?

I mean, getting sent to collections sucks regardless of whether it affects your credit score - see, e.g., patio11’s recent blog post[0]. If you don’t pay, chances are you will still regret it.

[0] https://www.bitsaboutmoney.com/archive/the-waste-stream-of-c...

Only emergency rooms are legally obligated to treat you to the point of stabilization.

As most doctors are now part of hospital ran conglomerates, a failure to pay your bill for an orthopedic consult can still be recorded in the hospitals system and you could be denied an appointment by your OBGYN.

That's true from an EMTALA standpoint. But in certain circumstances once a doctor-patient relationship has been established and a course of treatment has started the doctor may be legally and/or ethically bound to either continue that treatment or pass the patient over to another willing doctor. They aren't necessarily always allowed to immediately drop a patient for failure to pay.

Keyword: “abandonment.”

The obvious consequence would be that people go to the emergency room for any kind of healthcare. That’s a much worse outcome for hospitals so I doubt they would deny people primary care.

Emergency rooms are already the treatment of last resort for the uninsured. Visit any ER on a Tuesday afternoon in a major city and you'll be stuck in a two hour queue behind what are 95% primary care issues.

The $400 Tylenol people love to complain about in the hospital is a direct result of the government mandate to treat thousands of patients a day effectively for free because we can't get our shit together and provide universal healthcare.

It’s terrible for a hospital’s business to have their ER clogged by people who don’t have emergencies and can’t pay. It means they see a much lower volume of people who can pay.

So they aren’t going to deny people primary care because doing so will just cause them to wind up in the ER.

> It’s terrible for a hospital’s business to have their ER clogged by people who don’t have emergencies and can’t pay.

It is already a big enough problem they don't seem to care. Hospitals in less affluent areas are getting interest free loans from the state to keep emergency care from bankrupting them: https://calmatters.org/health/2023/08/california-hospitals-b...

> So they aren’t going to deny people primary care because doing so will just cause them to wind up in the ER.

You seem to be confused that I am speaking to some hypothetical future situation. Hospital networks require you to either pay outstanding balances or meet with someone to arrange a payment plan before you can be seen. Taking away the ability to report to credit is only going to make them more aggressive in this practice.

I have a company that sells to hospitals, they absolutely care about keeping the wrong people out of the emergency room.

“ Hospital networks require you to either pay outstanding balances or meet with someone to arrange a payment plan before you can be seen.”

Putting them on a payment plan is not the same thing as forcing them to pay. I believe they would force payment for elective care, not preventative.

Have you been to an "emergency" room lately?

Nope, and almost everyone reading this hasn’t either. This is not a helpful or productive comment. Instead consider saying “at my last visit to the ER, I encountered many people seeking treatment for XYZ which I do not think should be considered an emergency” or something similar so others can learn from your experience that they don’t have.

It's interesting that we just assume it makes sense for the patient to self assess what level of care they need.

I wonder if there are sensible reasons to not have a single point of contact for unscheduled care, or if it is just dumb inertia?

I know there are some hospitals that have provided urgent care type services at urgent care type prices in their emergency rooms, I haven't looked to see if it worked well or if they are still doing it.

Spelling out what I implied - my experience has been the exact opposite of how OP is insisting that it should be. I'm not interested in typing up a report of my various experiences with the medical industry and scrubbing it of the right amount of identifying information merely to refute some prognostication that's so abstract it's not even wrong.

Yes and I have a company that sells to health systems.

Hospitals and doctors don’t do this. It’s unethical to deny someone treatment because you’re not sure they can pay.

It may be unethical, but it happens all the time. My father got cancer in 2020 and died earlier this year. During that time, I was continuously shocked at the delays in tests and treatments that he experienced because specialists wouldn't see him until he had approval from Medicare. Without those delays, I think there's a good chance that we'd be looking forward to another Christmas with him.

(We live in the US if this anecdote didn't make it obvious).

Emergency rooms don’t do this. Non-emergency health providers of all sorts will deny you services if you have an outstanding balance.

I assume you live outside the United States. Healthcare here is... special.

Medical “debts” are almost always unilateral fees you never agreed to. No provider will state upfront what the fees will be! I got billed after the birth of my first child for services that had not been rendered by a physician who wasn’t even present, which my attorney characterized as “fraud” in a stern letter but that the hospital viewed as “debt”. I prevailed obviously but imagine the range of outcomes.

The other people to contact there are your insurers. Despicable as some of them may be, they too hate provider fraud. Even if they don't appear to do something to censure the provider, it is on their file, and enough complaints will be problematic.

I had a similar situation with a kidney stone. Transferred from my hospital to another by ambulance - I was moved from the ambulance gurney to the surgery bed in the hallway of the ER, and was billed for a ER visit among everything else, though no care had been rendered, no ER staff had been involved (hospital transport techs), it just happened to happen in the ER, and not even in a room.

Why should people pay their medical debt that only exists because Congress refuses to implement a functioning national healthcare delivery system?

If Congress refuses to act, the executive branch can sidestep them providing temporary relief until Congressional reps turn over enough to pass material legislation to fix the system.

Why should people pay for food when Congress refuses to hand out free food for everyone?

> when Congress refuses to hand out free food for everyone?

Can you say that when USDA food security and nutrition assistance benefits are around $183B a year? Certainly, it isn't for everyone, but for those in need. Why would we not extend similar policy to healthcare in a more efficient manner? No one is arguing for free healthcare (although that phrase is used colloquially), but a more efficient payer and delivery system, versus all of the bloat between patients and providers as exists today (insurance companies, pharmacy benefit managers, etc). Sibling comment by willcipriano touches on this bloat.

https://www.ers.usda.gov/data-products/ag-and-food-statistic...

> Certainly, [free food] isn't for everyone, but for those in need. Why would we not extend similar policy to healthcare in a more efficient manner?

But we do have a similar system for healthcare! If you're poor enough you qualify for Medicaid [1], and if you don't qualify for Medicaid but your income is too low to afford the full price plans the ACA provides pro-rated subsidies.

It's not that different from SNAP, and both are a mix of working well and poorly.

[1] Unless you live in Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, Wyoming, which opted out of Medicaid expansion. Even though expansion had the federal government covering >90% of costs...

Note that Medicare and Medicaid budget dwarfs federal food budget

It's like literally an order of magnitude more spending

> versus all of the bloat between patients and providers as exists

bloat and illegal monopolization: https://www.reuters.com/legal/us-accuses-investment-firm-ane...

US citizens, per captia, spend more on socialized medicine than any other nation. Then we pay again for the private system. With those facts in mind I see no moral reason to pay, we already did.

https://data.oecd.org/healthres/health-spending.htm

Food is the only thing congress has happened to manage. Prices have been low and stable for generations due to agricultural policies. Everything else has spiraled out of control.

Agriculture can be mechanized. Diagnosis and treatment of disease and injury has not yet been automated. America has an awful medical financing system where a hospital sends a bill for 10x the market price and then the health insurance boasts that they got you a 90% discount.

My understanding is that medical debt would still be collectible and could be sold to third party debt collectors. It just couldn't hurt your credit report.

Civil action could be started against you in court. If you don’t show up the other party would win a default judgement. If you did you could and likely would still lose and have to pay. At that point your assets could be legally taken from you and wages garnished.

I haven't paid a medical bill under $1k in years ... it never goes into collections and I never hear about it after the 2nd or 3rd letter in the mail. My providers never mention it, my insurance company never mentions it.

Your wages can still be garnished.

One thing’s for sure, the lawyers and finance professionals at the CFPB aren’t going to remove your legal defense fees and delinquent mortgage payments from your credit report, even though being in jail and being homeless also massively increase your mortality.

They can sue you.

Presumably an actual legal judgement against you would still go on your credit report, as it does today.

Reply on news.ycombinator.com