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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

#311

Post by amanaplanacanal »

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’m very much a free marketer for most things, as it seems to work well. It’s possible that it might work for health care too, but I don’t think we really know. For a lot of folks the free market is an article of faith, and I think that’s where a lot of support for this idea comes from.

Even if a free market could work in the US, I have no idea how we could get from here to there without making things worse along the way.

Re: Congress is set to ban most surprise medical bills

#312

Post by kaibee »

gregario wrote: post #192
kstrauser wrote: post #168

Earlier quoted context omitted.

I've that this before, but I like my markets free as in GPL, not free as in BSD. That is, I want the markets themselves to be free, even if that means that participants in the market have limitations put on them to keep them from capturing the market, forming monopolies, etc.

It's the regulations / limitations you are proposing that make it possible/likely that a monopoly will form. See Milton Friedman on this. There's basically no example of a monopoly forming outside of government regulation.

> There's basically no example of a monopoly forming outside of government regulation.

Facebook has a monopoly on the social network.

Re: Congress is set to ban most surprise medical bills

#313

Post by magila »

tyoma wrote: post #14
standardUser wrote: post #3

The 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.

This can be regulated at the state and local level; current state solutions had no ability to regulate air transit fees. However even local government is getting in on this revenue stream. The last ambulance bill I saw (for a relative) was from the city’s fire department, which is already funded by (fairly high) property taxes.

I had an ambulance ride earlier this year and got hit with a four figure bill despite having good insurance. I did some digging and found that the ambulance company has an agreement with the county granting them a monopoly on emergency ambulance service. The agreement includes a set fee schedule, but it is very aggressive such that almost all rides will cost over $2000. The company is of course out-of-network for most insurance providers and they bill people for the remaining balance after insurance pays (balance billing). I wouldn't be at all surprised if there was some form of kick-back going on between the company and the county government.

Re: Congress is set to ban most surprise medical bills

#314

Post by arcticbull »

nradov wrote: post #303
arcticbull wrote: post #279

Earlier quoted context omitted.

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.

I said denied in bad faith - not due to capacity constraints - which roughly amounts to claims denied with the intent of maximizing profit instead of upholding the duty of care.

Re: Congress is set to ban most surprise medical bills

#315

Post by amanaplanacanal »

throwaway201103 wrote: post #258
billpg wrote: post #65

Earlier quoted context omitted.

Toilet paper shortages this year occurred in capitalist economies.

Only because retailers were not allowed to raise prices to meet demand.

Where did this happen?

Re: Congress is set to ban most surprise medical bills

#316

Post by busyant »

y-c-o-m-b wrote: post #309

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 e…

I had a similar experience.

* I paid $20K out of pocket for a surgery that my insurer wouldn't cover.

* This was supposed to pay for everything (surgery, anesthesia, hospital stay, etc.).

* About 2 weeks post surgery, I got ANOTHER $20K bill from the hospital AND ANOTHER $1800 bill from the anesthesia group.

* At the same time, I developed a complication from the surgery that put me in EXCRUCIATING pain.

* Wife said I should go to the ER for the complication.

* I said, "NO WAY. We're gonna get hit with ANOTHER $20K bill because I developed a complication from a procedure that my insurer doesn't cover. I will ride this out."

* After 2 weeks of horrific pain, I broke down and went back to the surgical group.

* They told me that the bills that I received were probably an error.

* I calmly explained to the physician's assistant that I had neglected dealing with the complication as a DIRECT result of receiving those bills and I not-so-subtly implied that there might be a lawsuit coming their way.

* Within 20 minutes of leaving the surgical group, I got 3 phone calls from different people at the hospital expressing deep apologies and rescinding the bill.

Re: Congress is set to ban most surprise medical bills

#317

Post by unishark »

arcticbull wrote: post #310
unishark wrote: post #296

Earlier quoted context omitted.

> 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.

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

Because one is coercion and the other is simply an economic system. Which by the way is also used for all the other necessities of life too. How about food?

The whole point of a free market is competition, so if you were at least arguing for emergency situations there's be something to talk about since it's rather hard to shop around. But we'd still need to compare it to how well the government handles economics of emergencies. So far we have the govt driving up the cost of emergency care by requiring the ER to provide primary care for everyone without insurance.

Re: Congress is set to ban most surprise medical bills

#318

Post by arcticbull »

unishark wrote: post #308
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…

> 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, h…

I've lived in the US for more than 10 years. What you're saying there is a mix of half-truths.

One is of course that "I suppose you can call it a kind of honor system," no, you can't, it's enforceable by law and actively collected upon. That's not an 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.

Yes, the bare minimum, then ejecting them out the back door as soon as they possibly can. Of course by waiting until they require emergency care you're fleecing everyone. Minor issues that could have been addressed earlier for pennies on the dollar are instead allowed to fester until they become life-threatening, then when the poor can't pay, it's socialized across those who can at the worst possible time for the highest possible price.

Not to mention, this is an argument against the free market approach which would just be to refuse service. This is actually bolstering my case that healthcare is not a free market because of a lack of ability to form a voluntary contract.

> One's ability to pay is not a factor.

Oh come on now. Who doesn't have health insurance? The poor. Who's going to get the bare minimum treatment required be law and getting booted out the back door? The poor. Who's then going to get a bill for it forcing them to declare bankruptcy? The poor.

This is strictly about one's ability to pay.

Re: Congress is set to ban most surprise medical bills

#319

Post by henrikschroder »

Moodles wrote: post #202

As an immigrant coming to America, honestly the most shocking and surprising thing (apart from the state of homeless in San Francisco being tolerated as normal) is the medical care expenses. How on Earth is it that I can walk into a doctor's office or hospital to get medical treatment and have no idea how much it's going to cost? $10? $100? $1000? Who knows. I had an ear infection once, went to the doctor who looked…

It's pretty tragic that there are so many people like you and me, immigrants who have experienced several different healthcare systems, and we can all testify that the US system sucks on every level compared to other systems.

And yet, there's a huge amount of Americans who have only ever lived in the US, who are certain the US system is the best in the world, and who believe all the scary stories that are designed to make you think so.

You could listen to the people who have actual real-world experience, or you can listen to the lobbyists who are paid to preserve the lucrative US system. How is this even a thing?

Re: Congress is set to ban most surprise medical bills

#320

Post by roenxi »

telchar wrote: post #155
bfieidhbrjr wrote: post #57

Earlier quoted context omitted.

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…

Free market principles fail for healthcare for reasons entirely unrelated to those things, as has been pointed out up-thread. You're advocating for regulations to be eliminated as if that would fix unrelated problems. Do you care if healthcare is improved, or do you just want to see free-market-style reforms for their own sake?

In 2013, 64% of health spending was paid for by the government [0]. The non-profit hospitals share of total hospital capacity has remained relatively stable (about 70%) for decades [0]. The regulation section of Wikipedia is a litany of anti-free-market policies [0].

You can argue that free market principles fail in healthcare, and I will happily disagree and we can all have a cheerful time. But the US hasn't tried a free market approach to healthcare in at least decades. The free marketeers lost the argument; all the dials were set to non-free market and people argued that the quality/access to healthcare would rise to offset the cost of regulation. I'm not totally sure why people keep buying that argument.

In a free market:

1) Employment status would be irrelevant to healthcare.

2) People would be legally allowed to provide healthcare as long as treatment met whatever minimum quality standards the government sets on healthcare.

Saying "it became illegal to open a hospital" is unrelated to high costs is a serious failure of imagination. A ban on allowing people to provide competing services is a serious concern.

Also, people arguing for socialised healthcare aren't arguing to bring down the absurd costs, they are mostly arguing that the absurd costs should be shouldered by the middle & upper classes instead of the people consuming healthcare. It is unfair to first being in policies that inflate the costs, then dump the costs on taxpayers. If the argument is dump the costs on someone else then a decent effort should be made to reduce those costs.

[0] https://en.wikipedia.org/wiki/Health_care_in_the_United_Stat...

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