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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

#71

Post by vidarh »

jdlyga wrote: post #6

The current US medical system reminds me a lot of very important legacy code that's become unmaintainable. Maybe the best way of rolling out universal healthcare is to take a refactoring approach. Get more and more people onto medicare, lowering the age limit and raising the maximum income threshold. Eventually, it would only be the wealthy who were still on the private insurance only system. Then employers can gradu…

You need to reform regulations as well.

Medicare + Medicaid cost US tax payers more per capita as the UK NHS costs UK taxpayers per capita. The UK NHS provides universal coverage.

Part of the problem is that Medicare is actively prevented from being cost-effective. E.g. there are restrictions on its ability to negotiate prices in many instances, whereas the NHS will actively use all the leverage it has by coordinating purchases across the board. I'm sure that alone would not solve the issue, but it's unnecessary hard to get support for universal healthcare as long as Medicare is as expensive as it is.

Fixing that would make it harder to argue against Medicare expansion. To start with you could expand coverage substantially simply by allowing any savings to go towards expanding coverage.

> Eventually, it would only be the wealthy who were still on the private insurance only system. Then employers can gradually replace health coverage with other benefits.

It's worth noting that this is pretty much how it is in the UK. We do have private cover, but only about 10% of the population uses it. Notably it's generally "add on" coverage in that almost all policies expect you to rely on the NHS for basics, but lets you pretty much use the policy to queue jump to private hospitals if the NHS is "too slow" or for services above and beyond what the NHS offers. As such that's 10% despite UK policies being generally far cheaper, since they don't need to cover things like ambulances and ER/A&E (whenever anyone complains about the NHS this is a pretty essential point: the NHS is good enough that there isn't a sustainable market sufficient to compete with it; it's not perfect, but as long as private cover is as limited both in takeup and what it provides as it is, that's a pretty good indicator)

Re: Congress is set to ban most surprise medical bills

#72

Post by marcusverus »

jsperson wrote: post #48
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…

> 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 si…

> 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.

The government is perfectly capable of ensuring access to a market without regulating it to death. The SNAP program (Food Stamps) is a great example of how this works in a separate market with very little elasticity in demand.

Re: Congress is set to ban most surprise medical bills

#73

Post by claudeganon »

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…

This is hilarious sentiment to me because I’ve found it harder to find an honest dentist than an honest doctor. My experience is that they’re always trying to upsell you or perform unnecessary procedures.

The only good dentist I’ve had was a guy that specifically served working class people. He knew there was little upside in trying to screw people over (they’d either skip necessary work or just not pay the bills) and was completely open about everything from treatment options to their respective costs.

Re: Congress is set to ban most surprise medical bills

#74

Post by dx87 »

nottorp wrote: post #27
lordnacho wrote: post #11

> Surprise bills happen when an out-of-network provider is unexpectedly involved in a patient’s care. Patients go to a hospital that accepts their insurance, for example, but get treated there by an emergency room physician who doesn’t. Such doctors often bill those patients for large fees, far higher than what health plans typically pay. How do courts uphold this? You go to a restaurant, they say you can buy the tas…

From what I know about the US even your restaurant example has hidden service fees and mandatory tips and taxes that aren't on the menu?

Every restaurant I've been to with mandatory tips or fees has it written on the bottom of each page. The only shady thing I've seen them do is add the mandatory tip, then give you the bill with an option for an additional tip, hoping people will forget that the tip was already included in the bill.

Re: Congress is set to ban most surprise medical bills

#76

Post by lacker »

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…

We don't have a free market in health care at all. In a free market you would be able to buy a coronavirus vaccine right now, instead of waiting months to get it for free. We haven't had a "free market" in health care in my lifetime.

Re: Congress is set to ban most surprise medical bills

#77

Post by frankbreetz »

jdlyga wrote: post #6

The current US medical system reminds me a lot of very important legacy code that's become unmaintainable. Maybe the best way of rolling out universal healthcare is to take a refactoring approach. Get more and more people onto medicare, lowering the age limit and raising the maximum income threshold. Eventually, it would only be the wealthy who were still on the private insurance only system. Then employers can gradu…

Not a bad idea, but I would like to point out one of the arguments of getting rid of private insurance is that wealthy would need an incentive to not degrade the system. Like it or not the wealthy have have much more political power then common folk and allowing them to have them own system outside of the general public gives them incentive to cut cost with no effect on themselves.

Re: Congress is set to ban most surprise medical bills

#78

Post by lacker »

jrumbut wrote: post #52
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…

It's worse than that, my wife got one of these bills from a provider who was never in her hospital room. The bill ended up getting waived but it was for more than the rest of the stay.

Yeah, we got a bill from the hospital once with a footnote saying, some of these procedures may have actually been for another patient, not for you, we don't have complete records. But your insurance agreed to pay it, so we recommend you don't worry about it.

Re: Congress is set to ban most surprise medical bills

#79

Post by newen »

cpuguy83 wrote: post #58
tehjoker wrote: post #47

Earlier quoted context omitted.

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 provid…

The sad thing is, as expensive as healthcare is they probably have to jack up those rates because they are getting screwed everywhere else. In the end, though, the consumer is always the one who ends up getting the ultimate screw... exactly why healthcare shouldn't be seen as a service to consume.

You don't really need anyone else screwing over the hospital to have for-profit hospitals be incentivized to screw the patient by jacking up prices on demand inelastic goods. Not to even mention that many times the patient chooses these procedures while not thinking clearly, when under duress, etc.

Re: Congress is set to ban most surprise medical bills

#80

Post by aamar »

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?

See here[1] for a pretty good explanation. Importantly, your insurer treating the visit as in-network does not force the provider to treat it as in-network; surprise bills come from the provider, not the insurer. From that post:

If the insurer pays less than the out-of-network emergency room bills, the emergency room can send you a balance bill for the difference, over and above the deductible and coinsurance amounts you pay.

That “if” condition is usually going to hold, so a lot of surprise bills come out even despite the ACA rule.

[1] https://www.verywellhealth.com/get-in-network-rates-out-of-n...

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