U.S. health care's widespread overbilling problem • Hacker News Board

Re: U.S. health care's widespread overbilling problem

#31

Post by EvanAnderson » Mon, Jul 10, 2017, 3:31 PM UTC

wvenable wrote: post #25

mfoy_ wrote: post #19

It's also telling when the hospital gives you different bills depending on if you're insured or not. If you're insured they charge waaay more. They give you a more "realistic" bill if you are uninsured. It's a ridiculous system.

It's back-handed socialized medicine. Hospitals cannot turn anyone away so the money has to come from somewhere and this is how they do it. Oddly enough this is what keeps the whole system from collapsing.

This "shadow" socialized system fills me with anger simply because we can't seem to deal with it in a mature and constructive way.

As long as Americans can't stomach the idea of turning away people who cannot pay for emergency care to die we have socialized medicine. I don't understand why we can't, as a society, have a "grown up" conversation about this fact.

Re: U.S. health care's widespread overbilling problem

#32

Post by projectramo » Mon, Jul 10, 2017, 3:31 PM UTC

Retric wrote: post #13

projectramo wrote: post #4

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

Pricing does not solve the root problem which is everything trying to get someone else to pay.

I agree with you in that this is another problem but I think the two are highly related.

Consider:

1. If you don't have insurance, how do you know where to go?

2. If your insurance company wants to reward you for picking lower priced options, how do you comply?

3. If the government wants to lower systematic costs, how do they give you incentives?

Without basic pricing information, all the benefits of a free market are absent, and so are the benefits of any incentive system.

Re: U.S. health care's widespread overbilling problem

#33

Post by bryanlarsen » Mon, Jul 10, 2017, 3:32 PM UTC

wvenable wrote: post #25

mfoy_ wrote: post #19

It's also telling when the hospital gives you different bills depending on if you're insured or not. If you're insured they charge waaay more. They give you a more "realistic" bill if you are uninsured. It's a ridiculous system.

It's back-handed socialized medicine. Hospitals cannot turn anyone away so the money has to come from somewhere and this is how they do it. Oddly enough this is what keeps the whole system from collapsing.

Yet when you try and tell people that it was Ronald Reagan who effectively socialized medicine in the United States they get really angry.

Re: U.S. health care's widespread overbilling problem

#34

Post by firebird84 » Mon, Jul 10, 2017, 3:33 PM UTC

mfoy_ wrote: post #19

It's also telling when the hospital gives you different bills depending on if you're insured or not. If you're insured they charge waaay more. They give you a more "realistic" bill if you are uninsured. It's a ridiculous system.

My experience is the opposite. The uninsured receive absurd bills because the hospital doesn't actually expect them to pay. The sell the debt to collections and get a big tax writeoff with little relation to reality.

Re: U.S. health care's widespread overbilling problem

#35

Post by pancreas » Mon, Jul 10, 2017, 3:34 PM UTC

pragone wrote: post #26

opportune wrote: post #16

Earlier quoted context omitted.

Yep. The AMA/AAMC is essentially screwing the rest of the US so that they can keep doctors' salaries artificially high. There are tons of medical school applicants who get rejected every year, and not because they can't become doctors, but because medical school sizes have remained constant while the country's population (and demand for healthcare) has increased drastically.

The problem is not medical school spots, it's residency spots. Having medical school graduates is useless if they can't get licensed or board certified.

How is that a problem? About 130 medical schools graduate on average 100 MDs every year, that is 13,000. Available residency spots are near 29,000. so, the rest of the spots are filled by FMGs, foreign medical graduates.

Re: U.S. health care's widespread overbilling problem

#36

Post by mfoy_ » Mon, Jul 10, 2017, 3:35 PM UTC

EvanAnderson wrote: post #31

wvenable wrote: post #25

Earlier quoted context omitted.

It's back-handed socialized medicine. Hospitals cannot turn anyone away so the money has to come from somewhere and this is how they do it. Oddly enough this is what keeps the whole system from collapsing.

This "shadow" socialized system fills me with anger simply because we can't seem to deal with it in a mature and constructive way. As long as Americans can't stomach the idea of turning away people who cannot pay for emergency care to die we have socialized medicine. I don't understand why we can't, as a society, have a "grown up" conversation about this fact.

Why not just have proper socialized medicine, such as in Canada?

Instead of this perverse system of "shadow" socialized medicine, fraud, and over-billing, why not just make it come out of everyone's taxes? That way everyone pays a very modest amount in tax and no one has to be financially ruined by flukes of nature.

Also kills a huge amount of overhead in the billing departments, collection agencies, insurance companies, etc.

Re: U.S. health care's widespread overbilling problem

#37

Post by mfoy_ » Mon, Jul 10, 2017, 3:38 PM UTC

firebird84 wrote: post #34

mfoy_ wrote: post #19

It's also telling when the hospital gives you different bills depending on if you're insured or not. If you're insured they charge waaay more. They give you a more "realistic" bill if you are uninsured. It's a ridiculous system.

My experience is the opposite. The uninsured receive absurd bills because the hospital doesn't actually expect them to pay. The sell the debt to collections and get a big tax writeoff with little relation to reality.

Wow, I hadn't even thought of that. The one anecdote I know of was the opposite, but I guess that's because it was clear that the uninsured patient could and would pay a reasonable bill... so presumably they can either get a small bill paid, or a huge bill sent to collections and write-off some tax... ugh, no wonder they need such huge finance departments...

Re: U.S. health care's widespread overbilling problem

#38

Post by skummetmaelk » Mon, Jul 10, 2017, 3:39 PM UTC

EvanAnderson wrote: post #31

wvenable wrote: post #25

Earlier quoted context omitted.

It's back-handed socialized medicine. Hospitals cannot turn anyone away so the money has to come from somewhere and this is how they do it. Oddly enough this is what keeps the whole system from collapsing.

This "shadow" socialized system fills me with anger simply because we can't seem to deal with it in a mature and constructive way. As long as Americans can't stomach the idea of turning away people who cannot pay for emergency care to die we have socialized medicine. I don't understand why we can't, as a society, have a "grown up" conversation about this fact.

Americans cannot stomach the idea of giving anyone anything for "free", without thinking about longer term benefits.

Re: U.S. health care's widespread overbilling problem

#39

Post by alphanumeric0 » Mon, Jul 10, 2017, 3:39 PM UTC

I would like to ditch insurance and find a doctor who would allow me to pay a monthly subscription fee, much like a gym membership, for preventative care.

Isn't the primary purpose of insurance for exceptional and accidental situations? If that's true, then why am I using it for predictable monthly expenses?

Re: U.S. health care's widespread overbilling problem

#40

Post by CoffeeDregs » Mon, Jul 10, 2017, 3:41 PM UTC

projectramo wrote: post #4

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

Amen. There was a great article about this in the The Atlantic a few years ago. https://www.theatlantic.com/magazine/archive/2009/09/how-ame...

Anecdote: my mother-in-law was a smoker, felt dizzy one day, went to the ER and died five days later from a brain tumor. Got the Statement of Benefits (or similar): the cost was $140k; Medicare paid $40k...