Congress is set to ban most surprise medical bills • Hacker News Board

Re: Congress is set to ban most surprise medical bills

#271

Post by drawkbox » Mon, Dec 21, 2020, 7:32 PM UTC

hodgesrm wrote: post #132

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.

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-...

Yeah most people when they say "free market" they want a fair market.

Capitalism works but the top and bottom and excessive cases need to be contained, usually those happen when there is monopoly, oligopoly, duopolies, collusion or massive wealth advantages resulting in a fixed leveraged market that is almost mafia state like.

The market is a garden, the large overgrown plants taking all resources need to be trimmed back and the seedlings need more support, this allows the garden to flourish for all when the edge cases and extremes are tuned.

Right now the mafia state oligarchy markets, disaster capitalists and state backed whole industries are fixed markets to the chagrin of fair market capitalists.

The game design needs to be tweaked, some overpowered ones nerfed, underpowered ones helped.

We like a game that is easy to approach and difficult to master, not difficult to approach and easy to master buying out competition with all that wealth leverage.

We would do better to say we want fair markets not free markets, because a fair market is more free to all participants, players want to play and can.

Re: Congress is set to ban most surprise medical bills

#272

Post by Brian_K_White » Mon, Dec 21, 2020, 7:32 PM UTC

curtainsforus wrote: post #213

lvs wrote: post #200

Earlier quoted context omitted.

That is a completely bizarre claim. What is Google? A highly regulated search monopoly? I think not.

DMCA

DMCA? Let's see...

Does this example of a bad government regulation come from the government? Or the people voting and demanding it from the government?

No, it comes from business. DMCA is an example of the badness of private business if allowed to do what it wants.

That was a purchased law. The failure on the governments part was in allowing itself to be for sale.

So you are right, even though I bet this is just about the opposite of the conclusion you thought citing the DMCA resolves out to, we should definitely stop allowing the government to be influenced by the private sector.

Re: Congress is set to ban most surprise medical bills

#273

Post by arcticbull » Mon, Dec 21, 2020, 7:33 PM UTC

unishark wrote: post #261

arcticbull wrote: post #232

Earlier quoted context omitted.

Free markets generally work better the less leverage one party has over another. When the negotiation is "pay up or die" then it's de facto not a free market [1] and the government has a responsibility to step in and address it. The minimum viable remediation is a two-tier system in which the government takes the "or die" out of the conversation. The best approach IMO is single-payer where the government takes the "p…

Personally I've never been told to pay up before receiving treatment at a hospital. Especially when I arrive there unconscious. And Herb Cohen would say once you've received the service, you're actually in a great negotiating position. People actually negotiate hospital bills all the time. Especially in those crazy stories you hear about. And you need a citation for your claim about when free markets do and don't wor…

> Personally I've never been told to pay up before receiving treatment at a hospital.

Of course you have. The first thing you did when you walked in was hand them your ID and coverage info. You think hospitals operate on the honor system?

As a Canadian I've never been asked to pay up before or after receiving treatment [edit: at the point of care].

And before you jump into taxation, Canadians pay less per capita in taxes than Americans ($13K vs $14K), and that's before you factor in the $600 per month in private tax you directly (or indirectly via employer) have to pay your insurers.

> Especially when I arrive there unconscious.

You either have insurance or you're driven into Chapter 11. Further I suspect this is not due to good will but rather government intervention.

> And Herb Cohen would say once you've received the service, you're actually in a great negotiating position.

The debt was incurred once the service was rendered, and you are now liable. 66.5% of all bankruptcies in the US are medical -- are they just bad negotiators? I'm not sure what point you're trying to make but it's not in good faith.

> People actually negotiate hospital bills all the time. Especially in those crazy stories you hear about.

That sounds the worst.

> And you need a citation for your claim about when free markets do and don't work.

Voluntary contractual exchange is one of the undisputed key pillars to a free market economy. If you're being told you will die without the service it is a coercive exchange and therefore violates one of the key tenets. [1]

If I hold a gun to your head and tell you to buy my oranges for $1000 or I kill you, is the free market price of oranges $1000? If I tell you that you have cancer and you'll die unless you get $48,000 worth of chemotherapy, is that a free market? [2]

A free market requires both the voluntary production and voluntary consumption of services.

[1] https://en.wikipedia.org/wiki/Free_market

[2] https://www.asbestos.com/featured-stories/high-cost-of-cance...

Re: Congress is set to ban most surprise medical bills

#274

Post by lawn » Mon, Dec 21, 2020, 7:34 PM UTC

erlapso wrote: post #40

> 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..

How come it covers air ambulances but not ground ambulances?

I know the answer is probably that the ambulance companies lobbied (bribed) the hell out of these laws, but with the ambulance costs this is comical.

Re: Congress is set to ban most surprise medical bills

#275

Post by winston_smith » Mon, Dec 21, 2020, 7:34 PM UTC

arcticbull wrote: post #232

npmaile wrote: post #227

Earlier quoted context omitted.

I think the argument you are responding to is not the one the previous user presented. This issue isn't that people are trying to maximize profit leading to issues. The problem is that there is undue government interference in the market leading to all of the negatives that come from people selfishly trying to maximize profit in a cynical way with none of the benefits of people trying to maximize profits by providing…

Free markets generally work better the less leverage one party has over another. When the negotiation is "pay up or die" then it's de facto not a free market [1] and the government has a responsibility to step in and address it. The minimum viable remediation is a two-tier system in which the government takes the "or die" out of the conversation. The best approach IMO is single-payer where the government takes the "p…

Ironically the proposed solution is usually to put the government in charge, which is far larger and more violent than any private company.

Re: Congress is set to ban most surprise medical bills

#276

Post by zaroth » Mon, Dec 21, 2020, 7:36 PM UTC

thesimon wrote: post #185

zaroth wrote: post #87

This essentially takes the patient out of the loop if one of the providers is not in-network / being directly reimbursed by insurance. Now the provider and insurance company have to work together to resolve the bill. Most importantly it would be charged against the patient’s in-network deductible. It’s really too bad that this bill was watered down in one particular way. The Senate version of the bill would have set…

I guess a version that would make them pay what Medicare would pay wouldn't fly?

No, that’s significantly less than the in-network rate.

Re: Congress is set to ban most surprise medical bills

#277

Post by wmeredith » Mon, Dec 21, 2020, 7:36 PM UTC

uberdru wrote: post #222

Imagine buying a car when the salesman cannot tell you the price, and the lender cannot tell you the interest rate, until after you have driven the car off the lot.

Now imagine you'll die or be permanently maimed if you don't buy the car in the next 15 minutes.

Re: Congress is set to ban most surprise medical bills

#278

Post by throwaway201103 » Mon, Dec 21, 2020, 7:36 PM UTC

EvanAnderson wrote: post #207

mrlala wrote: post #164

Earlier quoted context omitted.

How any of you snakes on here can downvote this is beyond me. I mean, I know who you are. People who have a great job and don't really have to worry about insurance. Or maybe at a university where insurance is probably covered well. So f everyone else, right? I am self employed so I have to worry about paying all this shit myself; 11k family deductible with 40% co-insurance for $1200. Every time my young kids have ha…

I found, being self-employed for a long time, that hardly anybody inside or outside the medical establishment understands how much health insurance costs for the self-employed (and what little you actually get for it). My first thoughts re: anything health-related are always costs. The treatment one receives from medical provider when they ask about costs is really degrading, too. (Try asking what a procedure for you…

I was employed for about 5 years by a small tech firm that did not have a health plan (this was pre-ACA). They did pay a salary that was commensurately higher. I was able to buy an Anthem individual plan (family coverage) and it was reasonable. It was essentially equivalent to any other employer plan I've ever had except notably it did not cover maternity but that was OK as we were not having any more kids at that point.

The absolute best plan I was ever on was an HMO in the 1990s. No out of pocket for anything as long as you were referred by your primary care provider. Our first kid was born via emergency C-section and we never saw a bill for any of it.

Re: Congress is set to ban most surprise medical bills

#279

Post by arcticbull » Mon, Dec 21, 2020, 7:41 PM UTC

winston_smith wrote: post #275

arcticbull wrote: post #232

Earlier quoted context omitted.

Free markets generally work better the less leverage one party has over another. When the negotiation is "pay up or die" then it's de facto not a free market [1] and the government has a responsibility to step in and address it. The minimum viable remediation is a two-tier system in which the government takes the "or die" out of the conversation. The best approach IMO is single-payer where the government takes the "p…

Ironically the proposed solution is usually to put the government in charge, which is far larger and more violent than any private company.

Every medical insurance claim denied in bad faith is an assault if it leads to delay in care, and if it leads to death, is a murder. I suspect if you take that lens, you will see that the government insurance is not the violent one here.

45,000 people die each year in the US without care. Ending that would go a long way to reducing government violence. [1]

[1] https://news.harvard.edu/gazette/story/2009/09/new-study-fin...

Re: Congress is set to ban most surprise medical bills

#280

Post by mbesto » Mon, Dec 21, 2020, 7:43 PM UTC

iaw wrote: post #100

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…

> 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.…

If they do actually exist - free markets only work when there is a clear distinction between the buyers and sellers of the good and services.

This just doesn't exist in healthcare in the US.

IMHO, healthcare should either be full retail or single payer - nothing in between. Even if you are a "free market advocate", the current system doesn't reward the customer (unless you rightfully deem Carrier's as the customers).