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Congress is set to ban most surprise medical bills

nytimes.com

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Re: Congress is set to ban most surprise medical bills

#41

Post by learc83 »

cdjk wrote: post #33
mehrdadn wrote: post #24

Earlier quoted context omitted.

> I’m always shocked when I get a treatment plant after 5 minutes that outlines exactly what the dentist needs to do, how much insurance will pay, and how much I will need to pay. What you don't know (unless you get 2nd/3rd/4th opinions from good dentists) is how necessary those truly are. Some dentists just work around things by recommending things you don't need. (Fill teeth, taking panorex, etc. unnecessarily)

True, but at least the dentist can tell me how much I will need to pay.

That's because most common dental procedures are relatively straightforward and the mechanical processes of the mouth are relatively well understood compared to most of the rest of the body. Plus most dental procedures are elective in the sense that you can usually just have an offending tooth pulled if it gets too bad, so for most people there's a price ceiling that is much lower than say a lifesaving heart procedure.

Re: Congress is set to ban most surprise medical bills

#42

Post by JacobSuperslav »

bearjaws wrote: post #25

Having gone through cancer treatment here in the USA, I have received over a dozen 'after the fact bills' over the past 5 years, sometimes over 9months after the procedure, mainly involving blood work and CT scans. I missed one bill that came months after chemotherapy for $87 in 2015, it only had a 60 day notice before sending to collections. Mind you I was on disability from my employer that paid well. -80pts on my…

how come in Europe credit score isn't really a thing and everything works fine? that's another thing that needs to go

Re: Congress is set to ban most surprise medical bills

#43

Post by 2Gkashmiri »

In India you have these government run hospitals. Entry is essentially free and so is the emergency / opd treatment. For procedures they charge peanuts compared to private sector. The only thing, there is a waiting list and hygeine is not always a priority.

There is an AIIMS hospital in Delhi and I had the misfortune of taking a relative there for treating surgical infection. It was brutal. We got in line around 9 am. Had to put the patient on a gurney and wait. Around 3 pm slowly our place reached to the inside emergency ward. Around 7 pm we finally were attended by an intern. Took 6 pricks to insert a catather then a senior resident was called in to help. Around an hour later the medication started to do some work. Around 10 pm more medication was administered. We ended up asking the doctor to let us go because it was 12 am and we needed to consume some food, pee.

Never again. This was around 5 years ago and I hope things have improved for the sake of patients.

Re: Congress is set to ban most surprise medical bills

#44

Post by baryphonic »

jsperson wrote: post #13

That it takes such effort to pass a bill like this - 80% public approval, banning a clearly predatory practice, has turned me from a pure free market thinking into a believer in single payer healthcare. The free market just doesn't work when there is very little elasticity in consumption. I've been on the receiving end of a $15K air ambulance bill (thankfully covered by insurance) as well as the out of network specia…

> The free market just doesn't work when there is very little elasticity in consumption.

Should we have single-payer markets for auto repairs, then? Or how about toilet paper, especially in a pandemic? Both of those are very inelastic, yet socialism has a particularly poor record of producing either reliably.

> I've been on the receiving end of a $15K air ambulance bill (thankfully covered by insurance) as well as the out of network specialist at an in-network hospital. The latter is particularly galling. What are you supposed to do, interrogate every person that comes in the room?

Yes, this is frustrating. It also has very little to do with a free market. Health care (and health care billing and insurance and medical devices etc.) have been regulated into oblivion, to the point that the prices make no sense and are more like Monopoly money than anything real.

If I had my way, I'd have a high-deductible (at least $10k) universal single-payer system supplemented by individual private insurance. Most routine costs would be paid directly by patients at the point of care, and providers would have to suck it up to figure out what their prices actually were.

That would actually give us much more of a free market than we have today, despite the large welfare-state component.

EDIT: Meant to include a link to the classic Arrow paper about health economics.[1] My own comment about it is that third-party payers are the only robust reason for increases in health costs over time. We see that in every market where third parties subsidize transactions between first and second parties: health care/insurance, tuition/student loans, even housing/subsidized mortgages.

[1] http://public.econ.duke.edu/~hf14/teaching/socialinsurance/r...

Re: Congress is set to ban most surprise medical bills

#45

Post by sokoloff »

mehrdadn wrote: post #24
cdjk wrote: post #19

Earlier quoted context omitted.

The existing health insurance industry is far from free market. Try getting a price for a procedure or visit beforehand. Compare that to dental insurance. I’m always shocked when I get a treatment plant after 5 minutes that outlines exactly what the dentist needs to do, how much insurance will pay, and how much I will need to pay. Of course the set of possible treatments for dental work is a lot smaller, but it seems…

> I’m always shocked when I get a treatment plant after 5 minutes that outlines exactly what the dentist needs to do, how much insurance will pay, and how much I will need to pay. What you don't know (unless you get 2nd/3rd/4th opinions from good dentists) is how necessary those truly are. Some dentists just work around things by recommending things you don't need. (Fill teeth, taking panorex, etc. unnecessarily)

I consistently tell my dentist to make treatment decisions as if this were her mouth/teeth. Of course, I'll never know if that gives her a license to "go profitable" over "go optimal", but I'm also extremely unlikely to go chase multiple opinions over a cracked tooth or filling.

Re: Congress is set to ban most surprise medical bills

#46

Post by breck »

leetcrew wrote: post #31
kayodelycaon wrote: post #9

> Some private-equity firms have turned this kind of billing into a robust business model, buying emergency room doctor groups and moving the providers out of network so they could bill larger fees. If this doesn’t describe evil, I don’t know what else would.

I wouldn't reject this out of hand, but I do find that the complexities around healthcare and the obvious political implications lead to a lot of exaggeration and outright falsehoods being propagated. it's my understanding that the affordable care act requires insurers to treat any emergency services (if covered at all) as in-network. can anyone explain either a.) how I am wrong, or b.) how this can be circumvented?

> complexities

This. Does anyone know if the Founding Fathers discussed the evils of complexity in law back during the conventions in Philadelphia? Is that a more modern day problem, or is it as old as parliament itself? I don't remember reading anything that said the dangers of complexity in law was on their radar.

Businesses are guaranteed to take advantage of complexities in law. I don't think this is well enough known. Any and every added complexity will therefore be taken advantage of, and should be considered in passing a law, and every law should have some type of way to "expire" itself, so that it can be removed (and the resulting complexity), when the reasoning for such law is gone.

Complexity around healthcare laws is the textbook example.

Re: Congress is set to ban most surprise medical bills

#47

Post by tehjoker »

cdjk wrote: post #19
jsperson wrote: post #13

That it takes such effort to pass a bill like this - 80% public approval, banning a clearly predatory practice, has turned me from a pure free market thinking into a believer in single payer healthcare. The free market just doesn't work when there is very little elasticity in consumption. I've been on the receiving end of a $15K air ambulance bill (thankfully covered by insurance) as well as the out of network specia…

The existing health insurance industry is far from free market. Try getting a price for a procedure or visit beforehand. Compare that to dental insurance. I’m always shocked when I get a treatment plant after 5 minutes that outlines exactly what the dentist needs to do, how much insurance will pay, and how much I will need to pay. Of course the set of possible treatments for dental work is a lot smaller, but it seems…

Price discovery doesn't help you. If you get knocked out, heart attack, your arm cut off, whatever (i.e. a lot of the expensive stuff) you just go to the nearest hospital, no consumer market finagling is even possible other than trying to live near a good hospital.

Other times with chronic conditions where theoretically price discovery could help, the problem is that you need care badly so all the chronic care providers jack up the prices super high beyond what is needed. Treating this as a market in any way is a crazy system. If the government pays market rate, they jack it up even more. So the solution has to be that the government has to set the prices either directly or by negotiating with an entire population at its back and no competitors (i.e. monopsony in the public interest).

Re: Congress is set to ban most surprise medical bills

#48

Post by jsperson »

cdjk wrote: post #19
jsperson wrote: post #13

That it takes such effort to pass a bill like this - 80% public approval, banning a clearly predatory practice, has turned me from a pure free market thinking into a believer in single payer healthcare. The free market just doesn't work when there is very little elasticity in consumption. I've been on the receiving end of a $15K air ambulance bill (thankfully covered by insurance) as well as the out of network specia…

The existing health insurance industry is far from free market. Try getting a price for a procedure or visit beforehand. Compare that to dental insurance. I’m always shocked when I get a treatment plant after 5 minutes that outlines exactly what the dentist needs to do, how much insurance will pay, and how much I will need to pay. Of course the set of possible treatments for dental work is a lot smaller, but it seems…

> The existing health insurance industry is far from free market. Try getting a price for a procedure or visit beforehand.

Oh, I know. I've tried getting prices in the past. Traditional providers can't do it. One thing that has opened my eyes is using a Direct Primary Care (DPC) provider. I pay $75 a month for direct access to my doctor (email, text message, cell phone etc.). The access is great, but an unexpected side benefit is that a large percentage of their patients are un/underinsured. They can quote the prices for most common procedures from memory.

The other day I was getting a blood test and they asked if I wanted to bill my insurance or pay cash for it. I asked about the cost and they said "two-sixty". My response: "For two hundred sixty bucks we better bill the insurance. They laughed: no, $2.60 (it was an add on to another test for my physical). When I got home I googled pricing - the exact same test normally bills for around $65.

We do not have a free market. Other countries seem to have solid solutions for "socializing" medicine. I can't think of any highly functional system that is a free market. I don't even think that one is possible without people dying in the streets. Thus the best way forward is to try what has been successful elsewhere.

Re: Congress is set to ban most surprise medical bills

#49

Post by daveFNbuck »

mehrdadn wrote: post #24
cdjk wrote: post #19

Earlier quoted context omitted.

The existing health insurance industry is far from free market. Try getting a price for a procedure or visit beforehand. Compare that to dental insurance. I’m always shocked when I get a treatment plant after 5 minutes that outlines exactly what the dentist needs to do, how much insurance will pay, and how much I will need to pay. Of course the set of possible treatments for dental work is a lot smaller, but it seems…

> I’m always shocked when I get a treatment plant after 5 minutes that outlines exactly what the dentist needs to do, how much insurance will pay, and how much I will need to pay. What you don't know (unless you get 2nd/3rd/4th opinions from good dentists) is how necessary those truly are. Some dentists just work around things by recommending things you don't need. (Fill teeth, taking panorex, etc. unnecessarily)

Doctors disagree about medical treatment too. At least with the dentist you'll know how much each opinion costs.

Re: Congress is set to ban most surprise medical bills

#50

Post by OkGoDoIt »

cdjk wrote: post #19
jsperson wrote: post #13

That it takes such effort to pass a bill like this - 80% public approval, banning a clearly predatory practice, has turned me from a pure free market thinking into a believer in single payer healthcare. The free market just doesn't work when there is very little elasticity in consumption. I've been on the receiving end of a $15K air ambulance bill (thankfully covered by insurance) as well as the out of network specia…

The existing health insurance industry is far from free market. Try getting a price for a procedure or visit beforehand. Compare that to dental insurance. I’m always shocked when I get a treatment plant after 5 minutes that outlines exactly what the dentist needs to do, how much insurance will pay, and how much I will need to pay. Of course the set of possible treatments for dental work is a lot smaller, but it seems…

On the other hand, try calling ahead to various dentists in order to find the one that has the cheapest price for the procedure you need to have done. Surprisingly difficult. Not as impossible as in other aspects of healthcare, but I spent hours and hours and mostly didn’t get the details I wanted
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