The US healthcare system is just a completely broken mess. When things go smooth, you are lucky! However, when you have a major procedure, life event or sickness things can get messy quick.
We had a child 10 months ago, billing was screwed up by the hospital, then by insurance and we are still in process of getting it resolved. I have now spent at least 8 hours on the phone.
I had a surgery, called insurance and verified it was pre-approved and in-network. After procedure I receive $22k bill. I was young and did not care about my credit back then and never paid. 5 years later I received a new bill, for $300 as the provider sued the insurance company.
I hate going to the hospital and AWAITING a shower of bills. This grinds my gears SO hard. Every hospital stay and bills just keep coming for a few months.
As someone who likes to budget and plant expenses, I just cannot stand the US medical system. I never know how much a simple wart removal my cost. $100 or $2000? I'm happy to have good insurance, don't require to use the medical system a lot and have enough money. However, if you are extremely ill you seriously need to move to a "FIRST" world nation or have a good insurance with low max out of pocket. However, you still are going to deal with bills like its your full time job.
I have good insurance through a major company. My SO tripped, and hit their head on a curb on a busy road. I wasn't there, but by happenstance an EMT was there, witnessed the event, and came to offer aid. The EMT was concerned enough my SO ended up going to the hospital.
Several scans, and a few hours later, my SO was discharged.
I then got to spend something like 30 hours on the phone over the course of a couple of months fighting a bill for around $100k because of a typo during the admissions to the hospital.
That's bad enough on the face of it, but there were real Kafkaesque moments. Like where I was explaining to the insurance company that this was not an automobile incident just because there were cars nearby, not once, not twice, but five times, once with a form that asked for pictures of the intersection and made me describe why cars would be stopped at a red light.
That's awful. I hit my head in Thailand and went to the hospital, excellent experience I was in and out in 2 hours, got CT scanned and fully examined by a specialist, then left with a USB drive of my brain scans all for $180 out of pocket.
Up here in Canada I have not gotten a bill yet (including when my daughter had to get brain scans), but one thing is it’s very hard to get the actual scans. I had to no joke steal my own chest xrays to get a copy.
> one thing is it’s very hard to get the actual scans. I had to no joke steal my own chest xrays to get a copy.
unacceptable. In Asia, you have the personal email and cellphone of your dedicated administrative assistant (you won't ever have to talk to another one) who takes care of things like that. You just tell her to obtain your CT and fedex it to your doctor, and they call you back when it's done.
Some providers are getting better at this. The hospital I visit has an online system that gives you tons of details on your results (to be fair, I don't think you see actual scans, but you do see all the notes and observations made on them which are clearly intended to be communicated between doctors and other care providers primarily).
You're not wrong but this is a sign of a very broken system and the people least able to deal with it on even footing are people who may be in extreme pain or delirious from their injury.
I went to an optician for a routine eye test, and they detected something severely wrong with the appearance of my retina and called an ambulance thinking I had a brain aneurysm.
Several hours and CT scans later, I was informed my brain was fine and I just have a strange retina, and will need annual follow up.
I've been sent a letter every year since, inviting me back to the hospital, and every year they tell me it's still fine.
So far I've paid £25 for the eye test (which I completed at a later date!) as I do not get my eye-tests subsidied by the NHS. However my employer reimbursed me for that too...
Should we be upset that people can't afford to provide cures we don't want to pay for?
When I work, I get paid. I expect pharmaceutical companies feel the same way.
And if you look at how the world dealt with the hep c cure, it was pretty much trying as hard as possible to pay as little for a cure because the cost was front loaded.
Ah... the problem here is not that the pharma companies aren't getting paid.. The problem is there's a bunch of banks and government subsidies and a lot of middle-people creating cost on top of enabling the funds flow. I am not sure what's the solution, but there really are a lot of administrative middle-people involved..
Try a web search for the most profitable drugs in pharma. They're not one-off cures. They're drugs the same patient takes repeatedly for decades: insulin, statins, pain-killers, etc.
That's not the only factor, though. If someone else is avoiding selling a cure to do something more profitable, you can compete with them by selling the cure and still make enough.
There simply isn't a "cure for pain" to replace painkillers, but statins and co could be avoided if we taught people actual good diet advice.
I mean that any system that has money or power as it’s underlying motivation probably cannot reach the kind of level that is possible since there will be people who are gaming and manipulating it to take extra for themselves.
My actual point is that we (human beings) have the technology, the knowledge, and the capacity for compassion required to live beautifully vibrant lives free of most of the health problems that we see in our societies. And we can have all that when we get out of our own way.
Im not sure your last statement is true or makes sense. Healthcare provision is not solar power bogged down by a specific technological or policy barrier. It's a complex service industry that requires a lot of human touch as well the capacity for innovation has no bounds on cost.
Nobody wants to spend 100% of their income on healthcare, which means saying no has to become a habit.
I'm not talking about Healthcare provision, or the complexity of the current service industry (the whole industrial complex around healthcare is
I'm saying: pretend we could sweep everything 'off the table' and start over. Not just the industries and the political systems, not just fiscal structures, not just the concept of money itself, but the mindsets of every human being.
And let me be clear: I do not think that this is realistically possible in any sort of reasonable time frame (I'm not even going to argue that it's possible at all).
But, now that we've hypothetically swept everything off the table, my point is that we have the building blocks to build a society where the majority of people are effortlessly healthy.
With a clean starting point, there's no reason to build in a way that companies gain by keeping people sick.
We as a planet know how to be healthy.
We as a planet know how to keep the environment healthy.
We as a planet know how to be emotionally, physically, and spiritually vibrant.
We as a planet know how to treat many diseases cheaply and effectively. (Not all. There's definitely still a need for medical R&D so don't @ me on that)
Yes, we could argue all day about how these ideas are not profitable or realistic or 'how things are done' in our current societies, but none of those arguments matter against the fact that we have more varied understanding and capabilities now than we ever have in the past.
Framing it this way is probably inaccurate, and if inaccurate, unhelpful.
From decades of observing the system, it seems extremely unlikely to me that it was deliberately engineered to be this way. Rather, different parts of it grew and changed organically and the parts and changes that benefitted moneyed interests in power stayed, while those that did not were discarded.
It does not take a deliberate will behind something for it to be pulled toward this sort of inequality, and presenting it as if that's what's happened suggests that if we could only defeat the Evil People who "engineered" it this way, we could make it better. It's a very compelling idea, and it makes for a nice dramatic narrative, and humans love good stories.
Unfortunately, it's not the case. In order to make it better, we need to take a good, comprehensive look at many aspects of our systems of economics and government, and redesign them deliberately and with a strong intention to inhibit the flow of money upward from the 99% to the 1%. It's hard, it will take a long time, the people with the most wealth and power will fight us every step of the way, and there's no silver bullet, but there's also very little that's more worth doing.
Agree in part — but there has been some engineering due to the moneyed interests. Few other industries have the perverse incentive structure where you cannot “shop around” to keep costs low. Also, the tax code was most assuredly engineered: tax code, as insurance that pays for medical procedures is tax-free to workers. But if they want to pay for the same procedure out of pocket, they have to pay tax on it. This leads to more insurance coverage and less consumer control.
It does seem like it’s engineered towards making profits in extremely unethical ways?
I get they need to make money, but many times it seems like hospitals/doctors sent out bills just hoping people will pay.
Me, and my father used to have great union insurance (Cadillac plans). For years their were no problems. That started to change in the late 90’s.
1. I once got a $900 lab test from a hospital. They knew I had insurance. I called multiple times, and told don’t worry about it, but I still got the bills. Lather I saw what the the hospital charged my insurance company, and it was $90 for the test. I paid $9 for my premium. Isn’t in the hospitals interest to send out bills just hoping I might pay $900?
2. My mom is sent so many bills even though she has the same plan.
My point is there are no laws against sending out bills. Hospitals/doctors might not have it written down anywhere, but just send out a bill, and let the patient clean up the mess with their insurance company seems like a good strategy—for the heathens?
My mom had a bad tooth a few years ago. Went to her dentist, and he demanded cash upfront—conveniently on a Friday, and he knew she had great insurance. She paid because of the pain. She called up a few weeks later, and asked for a refund. She gave $2500, and insurance (Delta Dental) paid 90% of the bill. She kept calling the dr’s office, but always was told we need to contact the insurance company. I finally got on to a Delta Dental worker, and started to explain the situation. The work seemed to know exactly what I was trying to say. In thirty minutes, after Delta called the doctor, a highly apologetic money manger said we are sending off your check today. (I won’t publicly saw what the representative implied here of the doctor here.)
3. My father once went to Marin General for a routine hernia surgery. My father was beyond a hardened man. I saw him close to crying once, and it over taxes. Well he woke up after the surgery, and their was a Teddy Bear, and bouquet of flowers waiting for him. It wasn’t me, I told him. Anyways it was a mystery until he got his bill. Beyond the typical $12 Tylenol’s, there was a $330 psychological enrichment fee. Yes—that was the hospital charging my father, and insurance for the unasked for gift.
So it is it seems like it’s in their best financial interest to overcharge, do unethical things, and hope people just pay?
No one argues that the California or Texas power grids were geared to be unreliable and fail, but they were deliberately engineered over the years in specific ways for specific reasons.
Our medical system is no different. Insurers developed byzantine claims departments and custom plans as a way to make medical coding complicated and error prone for the purpose of denying claims due to error. They setup private panels and doctors to reviews claims and treatment plans with the explicit purpose of denying claims as not medically necessary.
The system is designed to intimidate, overwhelm, and confuse and it's stacked against both the customer and the medical provider.
There are three heads to this beast: hospitals, insurance companies, and drug companies. Each swears it is innocent and points to the other two and calls them the problem, but they are all guilty.
You've covered the evil tactics of insurers, but providers absolutely engage in intentional opaqueness, overbilling, and as much screwball behavior as the market will bear. No, the insurance company did not force them to charge $500 for an aspirin and "accidentally" bill in full for a procedure that was discussed as a hypothetical but never actually happened. "Look over there!" isn't going to cut it as an excuse forever.
Over billing is a result of the complexity of the system. Care providers have to hire full-time staff trained to deal with insurance and file claims. Insurers negotiate rates with care providers that put them in a position of having no customers or ones they're paid poorly for. They have responded by playing games with billing and insurance to make ends meet.
Is it fair or honest? No but if they suddenly became fair and honest it would solve nothing because they're a symptom of the problem, not a source.
Same goes for insurance companies: just letting providers overbill would not solve the problem.
I'm sure the overbilling and weaponized opaqueness are plausibly deniable, but I'm just as sure that providers don't mind one bit when they work, just as an insurance company doesn't mind when they discover an excuse to deny coverage. Providers are not "making ends meet," they are testing the limits of how far they can exploit the blank checks they have been written. They are not solely responsible for this mess, but they have a full share of moral and systemic culpability.
Sure, nobody sat down 50 years ago and said this is how we want things to happen, but each individual part was created and the direct interactions are intentional.
For example insurance pays for procedures not the process of doctors filling out insurance forms. That’s by design and ends up having horrifying implications for the healthcare system as doctors often spend more time dealing with insurance than the patient actually needing treatment.
The intent is to maintain status-quo despite evidence that it's a broken system for medical users. Profits are being made based on the system we have. It's boards & c-suite executives keeping their fiduciary responsibility to their investors by lobbying against structural change. The intent is clearly there.
The intent is socially entrenched though - it's not just c-level executives calling for keeping the government out of healthcare. America has a real problem with anything that even smells like socialism or egalitarianism.
> It does not take a deliberate will behind something for it to be pulled toward this sort of inequality, and presenting it as if that's what's happened suggests that if we could only defeat the Evil People who "engineered" it this way, we could make it better.
...but then also this:
> ...to inhibit the flow of money upward from the 99% to the 1%. It's hard, it will take a long time, the people with the most wealth and power will fight us every step of the way...
So maybe there are "evil" people and deliberation at work, and it's not just emergent complexity?
There can be "evil" people who will work to prevent the dismantling of a system, even if those people did not deliberately design and build that system. All that is required is that they recognize that the status quo benefits them, and that's a very common situation for those among the elite.
The Social Transformation of American Medicine is an illuminating read. Much of how we got here came in the form of, essentially, patches on top of patches, some of which were for good reasons, some of which were not.
Non for profit is a nice smokescreen. Nonprofit status is a nice little windfall fir the permanent bureaucrat class at payors and hospitals.
Starting from cancer children's hospitals that do all kinds of tricks to energize fundraisers and draw donations.. which amount to a paltry 30% of their CEO's salary....
Is it any surprise that admins then balk at putting prices online, with an argument that can be summed up as "OMG, you make us put online the price from 2000 contracts!! Its too hard! "
Here is a little nugget. Nonprofit designation for hospital is a recent development. It didn't exist before 1900. The designation was effectively "compensation" by the government to hospitals, so the latter would agree to admit patients regardless of ability to pay. Quid pro quo.
Dont feel bad for hospitals and their "curse" of nonpaying patients. They got their pound of flesh.
Nonprofit status its not just federal exemption.. its ALL Taxes (state, local, real estate, commercial, etc).
Imagine your life if you didn't have to pay sale tax? Property tax? State tax ? FICA, FUTA SDI?
I've come to the conclusion the past couple years is we need to get rid of non-profit status. There is too much room for grift and I'm afraid narrowing requirements would just make more loop holes and continue the process. I don't think that would be a popular opinion but I really don't see another solution to the problems caused by non profits.
The executives, board members, and middle management at all of these companies. I've worked with some of the companies you named, they have lavish offices and gravy train jobs for everyone and their crony friends. Yes, they're "not for profit", but that doesn't mean no one gets (insane) bonuses. Checkout their 990s sometime to get an idea at the excess of cash being pocketed.
Employers and owners of practices, hospitals, clinics etc. Shareholders of pharmaceutical and medical device companies. Executives and administrative roles are paid well, too.
Our first daughter was born right as the hospital was changing ownership. They billed the c-section as a natural birth. Cool. Then a year later they called and told us we had to pay the full cost because they’d messed up the paperwork. My wife said that was their problem and she wasn’t going to pay. The hospital maternity ward closed down, and the bill vanished and has never shown up on our credit report six years later, so that’s cool I guess. Telling people you won’t pay and to gleaned you alone works sometimes.
I was unemployed for our second daughters birth (I started a new job a week after she was born) and her birth and subsequent care was all covered by Medicaid. So I guess the best financial decision is to time job changes for births, which really shows how messed up the system is.
Forget the hospital, let’s talk doctors office. I saw a PA for barely ten minutes, I got a $326 bill.
When my wife takes our baby in for a visit, we wait 2-4 hours and get a $200 bill for a routine visit. We get charged if we cancel an appointment with notice or late.
They are always fumbling around with bills. Pay $150 at the visit and get a $80 bill in the mail, and then they bring up a $60 charge from last time.
Once I paid a bill that came the usual 3-6 months after the appointment. A few months later they send me a check in the mail for the same amount as that bill. Then a few months after that, another bill for the same amount as the check.
I just got a $3k bill in the mail for my 6 month old son’s delivery. This is about 4 months after they incorrectly billed us for part of it.
I have the money, but am thinking of fighting it even though it’s such a small sum.
Either their accounting is incompetent or fraudulent, but either way, I’m annoyed enough to push back. I suspect they are trying to fleece as many people as possible to make up for the 2020 budget hit they took.
Always always always challenge it. In the American medical system is that the first bill is a first position. Expect to negotiate down, even with insurance, by at least 20%.
It’s time consuming, and confusing, and people will fob you off. But it’s necessary unless you want to get taken for a ride.
Funny that you mention wart removal. I once got a $450 bill for wart removal cryosurgery. “Cryosurgery” meant a one second spray of the wart with liquid nitrogen. Outrageous.
Like when you go for a normal doctor's appointment, pay on your way out the door and the other get three bills in the mail "because they didn't know how much the insurance would cover when you paid". I have great insurance, this is pure bullshit.
I don't mean to blame you, but for the sake of anyone reading this -- you could absolutely have negotiated this down with the hospital by pleading financial hardship.
I'm not trying to justify the system overall, but please don't take a $150k bill at face value, if you can't reasonably afford to pay it.
It's true you can negotiate, but it's also true their bar for "reasonably afford to pay it" absolutely can include emptying your savings and other assets.
Hospitals' bar for reasonably afford is low, in my experience. They want proof that you make poverty line wages or below to write it off, below 300% of poverty line (around 38k) for reductions.
Similar here. Had a baby 9 months ago, the doctor took the insurance, but it turned out later the hospital didn't. Bill was over 100K and it wasn't covered at all.
I knew about that little caveat/scam going in. So I spoke with hospital billing and confirmed that the hospital did accept our insurance. But I also discovered that any other doctor that works on you during the birth will bill separately and will need to accept your insurance.
I asked the hospital who the anesthesiologist would be and they said they had no way of knowing because you use whoever is on duty when you give birth.
So there was literally no way to figure out if all of the birth would be covered. And it turns out, the anesthesiologist that happened to be working that day was not accepted on our plan. They billed us for $4k (even though he botched the epidural, causing us to need an emergency c section.)
We had to decline to pay it a few times before they said they would work it out and accept the lower amount from our insurance.
> The US healthcare system is just a completely broken mess.
That's why I got hospitalization-only insurance as soon as Trump allowed it... Obama-care was a joke... except for the pre-existing condition clause, maybe.
There is a very valid reason that hospitalization only insurance was not allowed.
The whole point of requiring everyone to get insurance is so that you don't have just the sickliest and oldest people getting insurance. Insurance is meant to spread the risk amongst everyone who pays premiums.
Additionally, not having insurance for primary and non-emergency care will make it much less likely that people will even end up in the emergency room. (No checkups, no outpatient)
Even worse, having emergency room coverage only encourages people to use the emergency room more often than they should.
Though I wouldn't expect our last president to have much of a handle on economics and business, considering his track record. Either that, or he was purposely trying to destroy the program (he was, but it was probably both reasons).
> The whole point of requiring everyone to get insurance is so that you don't have just the sickliest and oldest people getting insurance. Insurance is meant to spread the risk amongst everyone who pays premiums.
Well another provision of the ACA was the 80/20 rule, Insurance Companies have to spend 80% of premiums on care or refund the customers. So their overhead, salaries, etc was limit to the remaining 20%. Sounds great until you think it through a bit and realize that for them to increase their profits they need to increase premiums, they also then have to increase the payouts and the Hospitals, Doctors, Anesthesiologists, etc.. are all fine with getting paid more. So there you go higher premiums to cover their increased $ value of their 20%. Everyone in the system except the patient benefits from increasing prices.
We had a child 10 months ago, billing was screwed up by the hospital, then by insurance and we are still in process of getting it resolved. I have now spent at least 8 hours on the phone.
I had a surgery, called insurance and verified it was pre-approved and in-network. After procedure I receive $22k bill. I was young and did not care about my credit back then and never paid. 5 years later I received a new bill, for $300 as the provider sued the insurance company.
I hate going to the hospital and AWAITING a shower of bills. This grinds my gears SO hard. Every hospital stay and bills just keep coming for a few months.
As someone who likes to budget and plant expenses, I just cannot stand the US medical system. I never know how much a simple wart removal my cost. $100 or $2000? I'm happy to have good insurance, don't require to use the medical system a lot and have enough money. However, if you are extremely ill you seriously need to move to a "FIRST" world nation or have a good insurance with low max out of pocket. However, you still are going to deal with bills like its your full time job.