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

Re: Congress is set to ban most surprise medical bills

#301

Post by arcticbull » Mon, Dec 21, 2020, 8:05 PM UTC

winston_smith wrote: post #285

arcticbull wrote: post #273

Earlier quoted context omitted.

> 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 t…

As a Canadian you pay up every time you pay taxes, and you don't negotiate because you take what the government gives you. If they say your orthopedic surgery happens in six months, then that's what you get, or you start shopping south of the border.

Re taxes: I explicitly addressed that. The government negotiates with the drug companies and sets pricing for an efficiently functional health system. I don't have to and shouldn't have to negotiate. The system costs half per capita to operate and covers everyone.

Re: waiting times, take it from the horses' mouth, you've been fed a crock [1]. Of course the system could be better, but on the whole you're just wrong. The insurance lobby has spent a lot of time, money and effort to convince you of that.

The data backs that up. A small handful of Canadians go to the US to "shop for orthopedic surgery" out of millions of visits per year in Canada. After all a hip replacement in America costs one hundred thousand dollars. Just how many Canadians do you think there are with a spare $100K USD ($128,500 CAD) kicking around in the old piggy bank for a new hip that'd be free in a few months? [2]

If you see 50-60,000 ish numbers they tend to be the 'snowbirds' - Canadians living in Florida for half the year who choose to seek care close to their winter homes. These are folks wealthy enough to have winter homes, and also maintain private insurance.

[1] https://www.npr.org/2020/06/27/884307565/after-pushing-lies-...

[2] https://www.vox.com/2016/10/9/13222798/canadians-seeking-med...

Re: Congress is set to ban most surprise medical bills

#302

Post by lostapathy » Mon, Dec 21, 2020, 8:05 PM UTC

lotsofpulp wrote: post #293

lostapathy wrote: post #259

Earlier quoted context omitted.

No - I hadn't hit my out of pocket max, by a long shot, even after the second encounter. They could have happened in either order - and the emergency visit would have been MUCH cheaper out of pocket for me.

Then I don't know what definition of deductible your insurance company is using, but it doesn't match my experience with any insurer ever, health or otherwise.

It's simple - I have a flat $500 copay for an "ER encounter" regardless of what they do in the ER. Just like you have a $40 or whatever copay for a regular doctor visit.

Re: Congress is set to ban most surprise medical bills

#303

Post by nradov » Mon, Dec 21, 2020, 8:05 PM UTC

arcticbull wrote: post #279

winston_smith wrote: post #275

Earlier quoted context omitted.

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-…

That's a non sequitur. Even single payer systems deny certain treatments or force patients to wait in order to control costs. Every healthcare system has some form of rationing.

Re: Congress is set to ban most surprise medical bills

#304

Post by meheleventyone » Mon, Dec 21, 2020, 8:06 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…

It’s also a poverty of imagination that death is the worst thing that can happen.

Further there is also a general societal argument that we all benefit more from having a more healthy population than dealing with the external costs of a less healthy one.

Re: Congress is set to ban most surprise medical bills

#305

Post by Brian_K_White » Mon, Dec 21, 2020, 8:08 PM UTC

oblio wrote: post #146

marcusverus wrote: post #72

Earlier quoted context omitted.

> 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…

I don't understand this. Almost every other developed country has a system that works for healthcare. It's almost always single payer or something where you definitely don't go shopping around for hospitals. Doesn't it start to feel a bit like indoctrination when arguing for a "free market" when no other developed country has a free market for healthcare? Is everyone else stupid? What aren't they seeing? Especially i…

I look forward to the utter absense of any answers to this question, or the entertainingly inventive ones.

Re: Congress is set to ban most surprise medical bills

#306

Post by tomc1985 » Mon, Dec 21, 2020, 8:13 PM UTC

npmaile wrote: post #227

javajosh wrote: post #220

Earlier quoted context omitted.

Yes, it should be "free markets...until the wolves take over the whole system". It's impressive how quickly those profit maximization ideas have caught on, driven by technology (I blame Excel more than anything), and throughout the entire system. The healthcare cash-cow benefits a LOT of people, workers, suppliers, and (especially) administrators at both hospitals and doctors offices. A poor healthcare system is a gr…

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…

> This issue isn't that people are trying to maximize profit leading to issues.

This is exactly the issue. You cannot seriously think that the trainwreck that is US healthcare is what it is solely because of government intereference?

Would Cigna fund and run the tiny little community clinics that serve with sliding-scale pricing? Would Kaiser willingly insure students with preexisting conditions at a fair price? (I know that in my case, they wouldn't)

What "free market" incentive is there for these insurance companies to cover people that would clearly cost them more money than they receive? Those people need help and sickness/viruses do not have any concept of money, and they effect people indiscriminately.

You are promoting a healthcare system for the wealthy and privileged, which is exactly what we have right now and what needs to be torn down.

Re: Congress is set to ban most surprise medical bills

#307

Post by AdrianB1 » Mon, Dec 21, 2020, 8:14 PM UTC

gotostatement wrote: post #297

AdrianB1 wrote: post #268

Earlier quoted context omitted.

I have no great job and I am paying more than 50% in taxes, including health care (not an insurance, but a payroll tax) that I get almost nothing from. That great change described in the article is bringing poor services to everyone, that is the end of it - I saw it in Eastern Europe, I saw it in Western Europe, but people don't want to talk about it. I live in Eastern Europe, decades in a socialist country and decad…

> socialized healthcare and that dream of free healthcare for all is an impossible utopia, you just need to think about it to realize I can't understand this argument when Canada, England, France, Israel, and many other countries already have healthcare that is totally free to people at the point of service, and people rave about it. Can you explain why you still think it's utopian when it already exists?

Because of limited resources in Canada they had waiting times of several years (Google can point to multiple sources), UK or Nederlands a few months (I have friends working as doctors in these countries) or, in Eastern Europe, you need to get your own drugs from home because the hospital does not have it. With the perceived "free healthcare" the use increases a lot and the limited resources cannot scale up to infinite, so you either have a very long wait time or get the almost nothing left.

This is the situation in most of countries with this system. It is mathematically impossible to get what you dream of. In countries like USA the demand is heavily filtered by prices, so people get what they afford to, if you take the filters out you will be left with nothing very fast. I hate the system in US, but at least it gives a chance to people who can afford it; here, everybody is equally screwed. The only thing that works well here is giving birth, that is free, you can cover that by the state or federal in US too, but that's about the limit.

Re: Congress is set to ban most surprise medical bills

#308

Post by unishark » Mon, Dec 21, 2020, 8:14 PM UTC

arcticbull wrote: post #273

unishark wrote: post #261

Earlier quoted context omitted.

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 t…

> 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?

They mail you these paper forms known as "bills". I have examples I can show you. Insurance only pays a portion. I suppose you can call it a kind of honor system.

And given your examples, you apparently aren't aware that when it comes to emergence care in the US, hospitals which have an emergency department are required by law to provide emergency care as needed to make sure a patient is stable. One's ability to pay is not a factor.

Re: Congress is set to ban most surprise medical bills

#309

Post by y-c-o-m-b » Mon, Dec 21, 2020, 8:14 PM UTC

My state (Oregon) has protection against this. Unfortunately my emergency spinal operation was 2 months prior to the bill going into effect, so I got hit by this.

The part that pissed me off was I KNEW about the practice and specifically made a fuss about making sure everyone in that OR was IN NETWORK. I went to an in network facility, my surgeon was in network, and so was the anesthesiologist and every person that entered my hospital room I asked if the OR staff was in network (the answer was always yes). 1 month later I get a bill for a neuro-monitoring team and an assistant-surgeon that were both out of network.

The assistant surgeon charged me about $500. The neuro-monitoring team sent a ~$20,000 bill with the promise that they'd lower it to a reasonable value when I called to pay. Furthermore Blue Cross sent me a letter saying it wasn't pre-approved (even though the procedure was) and they would not cover a cent of it. Imagine the feeling of doom wondering just how low could these shysters possibly go from 20k. Thankfully that turned out to be true, the final bill was $800. Which still made me furious because I made such a huge deal out of not getting into this situation.

So that was $1300 total out of pocket that I was not expecting to pay. Luckily I'm a software developer with a huge savings, but I made several angry calls anyway and even sent an appeal twice to blue cross (which they denied both times). I'm so glad this crap is finally coming to an end, but the right-leaning supreme court makes me afraid some of these laws will get reversed.

Re: Congress is set to ban most surprise medical bills

#310

Post by arcticbull » Mon, Dec 21, 2020, 8:14 PM UTC

unishark wrote: post #296

arcticbull wrote: post #273

Earlier quoted context omitted.

> 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 t…

> 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? The overwhelming vast majority of people have health insurance. However, due to taxation of privately-purchased insurance but not insurance that's a work benefit, people are driven to get insurance through their job. This was the government's fault, by the wa…

> For the cancer one, possibly.

Do go on. Why is dying due to an explicit action any more of a free choice than dying of an explicit inaction? Why is one any more coercive than the other?

The only point I'm making is that healthcare is not a free market due to lack of voluntary agreement between buyer and seller. Once you accept that it's not a big jump to say the system should be remediated.