As an aside, do we expect the rise of medical tourism options to put downward pressure on pricing for medical procedures in the US?
Congress is set to ban most surprise medical bills
131–140 of 440 posts
Re: Congress is set to ban most surprise medical bills
#132> 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.
It's hard to see how anyone could extol the virtues of a "free market system" where behavior like this exists. It is pervasive in American health care. Just search for "orphan drugs" if you are insufficiently outraged. [1]
[1] https://www.washingtonpost.com/news/wonk/wp/2017/12/18/this-...
Re: Congress is set to ban most surprise medical bills
#133That 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…
There's no "market" in healthcare in the US. Long ago, it became illegal to open a hospital without a 'certificate of need' from the State. That's why so many towns have only one hospital - it's a government granted monopoly like cable companies in the 80s. Differential pricing is also illegal. You fly cheap on Sunday at 3am, expensive on Monday at 9am. Healthcare providers are not allowed to charge less when it's ch…
I find this idea interesting, but I'm extremely skeptical. If we are thinking about this as being a startup, how can we outsource the cost of building the hospital to the doctors and nurses? That way you might be able to build a billion dollar business by tricking people into owning all the downsides while you own all of the profits?
I'm just joking of course... the idea that the market can optimise every problem is simply incorrect. There isn't a move fast and break things for doing startup hospitals, it's simply a problem that central planning can organise effectively. Unfortunately, the American allergy to government means your healthcare system costs twice as much per capita for the same outcomes.
Re: Congress is set to ban most surprise medical bills
#134Earlier quoted context omitted.
> has turned me from a pure free market thinking into a believer in single payer healthcare The current trend in 'free-market economics' is to call captured markets free and then argue for the relatively lax regulation. Most markets are not free markets and the healthcare definitely isn't. There's very little true choice, participants are typically under duress when seeking expensive services, and prices are hidden.…
> and prices are hidden I believe the Trump administration is addressing this: https://www.hhs.gov/about/news/2019/11/15/trump-administrati... https://www.hhs.gov/about/news/2020/10/29/trump-administrati... > The rule requires that most health plans and health insurers not only provide easy-to-understand personalized information on enrollee cost-sharing for healthcare services, but must also publicly disclose the rat…
We still need up-front transparency on what codes will be billed to whom, from whom, and for how much. I want a comprehensible restaurant-like menu. And we need to break up regional monopolies so that there's actually a choice of provider. Further, agreements to pay whatever, whenever, before any diagnosis need to be banned as contracts under duress.
If we want the free market approach to work, we need to make it possible, easy even, to make informed decisions among competitors.
But fixing this is increasingly feeling intractable, and this pushes me further and further towards believing a single-payer (maybe not exactly, but that's the buzzword) system is the better fix.
Re: Congress is set to ban most surprise medical bills
#135I was working on a health insurance related startup for awhile so I would say I know more than the average person about the space, and even I get surprised on a regular basis by the absurdity in this field. For example, I was finishing up an advanced degree program between September and January and my University decided to terminate my health insurance in September. Without telling me. In the middle of a pandemic. Wh…
Just as a heads up in case you or anyone else reading this is in this position. For the uninsured, if your treatment is directly related to Covid-19, you would be covered under the Covid-19 HRSA program described here. https://www.hrsa.gov/CovidUninsuredClaim
Re: Congress is set to ban most surprise medical bills
#136That 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…
there seem to be alternatives for e.g. non emergency surgeries. this organization has prices listed which include follow ups, anesthesiologist, etc.
https://surgerycenterok.com/pricing/
they also seem to have a lower risk of infection compared to the national average:
https://surgerycenterok.com/faqs/
i'm not sure what could account for that. i was thinking that maybe because they are incentivized to provide the procedure at the baked in rate that there's a strong incentive to get patients out of surgery successfully as best as possible (to free up another bed, etc), but i'm not sure what their demand is like.
a more macabre hypothesis is that hospitals don't care much about patients who end up in their own ICU as it's just additional billable coverage, so the precautions aren't as strict.
Re: Congress is set to ban most surprise medical bills
#137Earlier quoted context omitted.
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 procedur…
Why can't a hospital tell me how much an xray costs then? If I come in with a broken arm, why can't they tell me how much it will cost to get it xrayed yet the dentist can do the exact same thing with a broken tooth?
Re: Congress is set to ban most surprise medical bills
#138I feel most comments here fail to separate hospitals and insurance. And that could be separated even more (pharmaceuticals, for example as a separate category).
Re: Congress is set to ban most surprise medical bills
#139> The new changes will take effect in 2022, and will apply to doctors, hospitals and air ambulances, though not ground ambulances. From 2022 and no ambulances. This is a joke..
Optimists here would claim that this is slightly less of a joke than the status quo.
Re: Congress is set to ban most surprise medical bills
#140The change does not apply to ambulances (except for air ambulances), ensuring the United States remains one of the few places in the world where a seriously ill person needs to debate if they're willing to risk their health and life to avoid a financially crippling trip to the hospital.
When our youngest was born the nurses (incorrectly) thought his blood sugar was low and had him transferred to a different hospital via ambulance. We were able to fight and get the $2000 bill waived on account of the fact that it was a needless trip. Unfortunately my wife spent the night alone as I was with our son. On a somewhat related note in the span of 10 years the cost to us to deliver our kids doubled. Same ho…
This was a serious discussion my wife and I had when we were deciding to have a kid. The maximum out of pocket for both of us could easily wipe out my savings.
It felt really fucked up to have this discussion in what is supposed to be a first-world country. Like we were talking about alternatives like hiring a midwife or a doula because it would be cheaper. I don't even think that would be a discussion in most second-world countries.
The whole system is outrageous.