I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

Like the proverbial crabs in a bucket, only pulling each other down. https://x.com/JeromeAdamsMD/status/1761375417351430595

Last go around, the hospital coded the drug as coming from their supply instead of CVS so I got a surprise bill for $130,000+

Luckily, I've been through the process so there's records of the normal billing path. I fought the Hospital billing department and 5 months later I'm billed $700 which was about the expected amount.

It was still stressful and time consuming to figure out if I screwed up to the tune of 6 figures.

There is $2.25T per year of savings to be had. We can eliminate our national debt in 15 years, and with that also eliminate the $1T going to $1.5T of interest payments we pay each year on the debt, so a total savings down the road of about $3.5T per year.

To put that in perspective, our entire national budget was a bit less than $4T pr year pre pandemic.

There is absolutely nothing else that comes close to the potential savings on healthcare. All of the schemes I have seen whether they are tax increases or cutbacks in other programs, even the extreme ones, *might* save $2T over 10 years.

If you do not have the agency to select an in-network provider (because you are mortally wounded / incapacitated / etc.), then the out-of-network provider should be legally transmuted into an in-network one. The insurer should be compelled to pay, and the provider compelled to accept it.

I knew full well the ER visit was going to sting, but I had no idea how much. The amount after insurance was almost exactly what was quoted in this article (almost like they plan that). That pretty much maxed out his OOP max, but I'm not wealthy enough that 5k doesn't make me mad. It shouldn't matter, but it feels worse that it was just a stomach bug, so $2 worth of anti nausea meds (that the hospital charged $150 for) was all we got out of it.

Rationally, I don't really see a way out for (possible) emergencies. That care is expensive, and HDHPs are a bit of a gamble that usually pay off if you're healthy. The OOP max ensures you won't be financially ruined, and 'cadillac plans' or gov care just means you pay far more in premiums or taxes for the majority of the years.

The problem is the current system is basically a giant jobs program. Healthcare spending is approximately 17% of US GDP. Politicians are terrified of rocking the boat on this, so the system will always remain broken.

HDHP plus great price transparency (especially pre service, where one can potentially cross-shop providers, vs. being in a facility and given only one option) would be good for cost reduction; if you can't surface and measure the costs, you won't have any incentive to lower them.

I personally have a fairly mediocre $230/mo blue cross plan in Puerto Rico which largely only covers care within Puerto Rico (and which I've never actually used for anything), and rely on medical tourism where I pay 100% out of pocket, and until Amazon bought them, OneMedical for cheap clinic care which I also paid 100% out of pocket. I previously had a WA state HDHP for $100-200/mo pre-ACA which was great but ACA killed those/insurers left the state.

I don't understand why this hasn't become a boil-over issue for Americans yet.

It seems to me that the costs for treatment in the USA are actually more than covered by the deductible. The rest is holiday money for the criminals running the system.

> Enhance transparency in healthcare pricing

So after you're in an emergency room, and a posted sign shows that to see any medical professional there, you'll be charged X plus a facilities fee Y. After you wait k hours to be seen, you're told that the treatment they think you need will cost Z. If you think that's too high, during an emergency do you try to go to a different hospital to see if they have the same treatment for W < Z?

> Institute arbitration for billing disputes

I mean, better than no arbitration, but if you're dealing with a serious illness , trying to recover from an injury or whatever, while getting time from work, bouncing between specialists for follow-up visits, still foggy from pain meds, etc should you need to navigate an arbitration process? Are you equipped to?

> Advocate for consumer protections: Educate and empower patients to advocate for themselves through measures such as the right to appeal surprise bills and negotiate payment plans with providers.

... so again, placing the burden on patients to defend themselves during what already may be a very challenging time in their life.

I think the highest level bit is that the most predictable cost for health care would be under a free-at-point-of-care, single-payer system, that lets us cut all the medical billing and medical insurance overhead out. Everyone pays the same (nothing!) for their care, and every earner pays a predictable amount for the system overall. Even if the exact same "amount" of health care was provided, we'd collectively pay less for it. But if we also went all-in on value-based/outcome-based care rather than fee-for-service, we might also be able to get people to live healthier longer lives with less total care (and costs). And no one who's sick or recovering from a medical crisis needs to spend their energy "advocating" for themselves, or in dispute arbitration, or researching which provider has the best prices for their needed service.

...or even $100k: https://abc7news.com/rabies-shot-hospital-bill-vacaville-ca-...

Anecdotally, I recently got a simple blood test to keep an eye on something that’s been borderline in the past. Unbeknownst to me, my doctor ordered nearly 30 things to be checked in the blood panel, at $50-$100 a piece. Luckily my insurance negotiated a much lower price and covered most of it, but I can’t imagine paying $2,000+ just to check e.g. your cholesterol level.

I think the problem is alignment of incentives: for a doctor, over-testing has little to no negative consequences, but under-testing could lead to guilt due to a patient dying, loss of reputation because something was missed, lawsuits, etc.

As a society, is this how we should be using our limited medical resources? What if we made fewer xray machines and instead spent more on something like cancer screening? How many net lives could we save?

"the onus of the entire amount still fell on me due to my high-deductible health plan (HDHP)."

I mean, yeah, that's how HDHP works. Anyone in healthcare should understand that.