Live data from Hacker News

Congress is set to ban most surprise medical bills

nytimes.com

321–330 of 440 posts

Re: Congress is set to ban most surprise medical bills

#321

Earlier quoted context omitted.

> There's basically no example of a monopoly forming outside of government regulation. That's tautological statement. There is no free market without private property protections which do not exist outside of government regulation either.

Some people view the protection of individual intrinsic rights (freedom from violence, protection of property, the right to move freely about) as a separate thing from regulation. Government protecting people's rights, vs. government protecting people, or government prohibiting consensual business dealings.

Yes, if you want to demonize something you also depend on, it is hard to do so without some rhetorical dodge.

You don't have to fall for it, though.

Re: Congress is set to ban most surprise medical bills

#322
post #84

When we had our first child, we carefully selected a pediatrician that was covered by our insurance. It turns out that doctor was only billable to our insurance for delivery, any follow up visits were not covered by the insurer because that same doctor was not considered part of that hospital org. The org she did routine pediatric work was somehow different, yet in the same building. We discovered this as we were lea…

You make it sound like it's the doctor group that chose not to work with that insurance company. The fault probably goes both ways.

They blacklisted our plan for specific visits. That shouldn't be possible.

Re: Congress is set to ban most surprise medical bills

#323
There is no such thing as a surprise medical bills ban. The only thing that will happen, without a complete overhaul of the way medical services are paid for in the US, is that patients will be given one extra form to sign before being allowed any services by any provider:

  Patient waives any and all rights granted by [anti-surprise laws]
  and agrees to indemnify Provider for any related costs.
You have to understand it's not just about the rules, medical insurance companies will do plenty to stay compliant but they'll still screw you. Sometimes they'll send you a bill for something they already said was covered, then suddenly it's on you to fight a several billion dollar company into just doing what they promised.

Re: Congress is set to ban most surprise medical bills

#324

Earlier quoted context omitted.

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

Where did this happen?

All over the place. Many states have "anti-gouging" laws.

https://www.fmi.org/docs/default-source/gr-state/price-gougi...

Re: Congress is set to ban most surprise medical bills

#325

Earlier quoted context omitted.

I worry that it will lead to much worse treatment on top of that. Even if it's a non-emergency, getting the prices up front will cause a lot of people to chose to either go untreated or to delay treatment until a problem becomes far worse. Just having prices available does nothing to improve the costs. People with type 1 diabetes know the cost of insulin. Has that prevented it's price from moving to levels that many…

Wouldn't that be even more pressure on the pricing system, though? If statistics about refused services were kept, we could see where the various providers are pricing in-demand services out of reach of those who need them. Or conversely, what services were advised above and beyond actual need. We could see pressure on providers to bring costs in line with the benefits of each code/procedure, and the ripple effects c…

> Wouldn't that be even more pressure on the pricing system, though?

Why would it? They can literally just raise the price and those that have insurance are going to get it which ultimately covers the loss in those that refuse service due to price. That ultimately is reflected to the customer in the form of higher premiums which they pay regardless of whether on not they get EKGs.

Further, with less people getting services it really is as simple as cutting nursing, doctor, and lab staff because there isn't as much demand.

It may make a difference if the market was completely unregulated and insurance didn't exist at all. In that case, some guy could do EKGs out of his van at a much lower cost.

However, that's not the market we have. Doctors command high salaries and we've regulated that only those with medical licenses can practice medicine.

Medicine is not a free market and it's a bad idea to ever make it one. There are already major issues with unlicensed quacks selling placebos.

Re: Congress is set to ban most surprise medical bills

#326

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…

What if they don't even come into the room? I experienced this incredible phenomenon a couple years ago after taking my son to the ER while out of state on vacation. We were there for a few hours to have a very horror movie-esc swollen lymph node looked at. He needed a CT scan to confirm that it was not an abscess and some IV antibiotics for strep. The doctor and nurses were great, I paid up front, and additionally provided insurance. Seemed like everything went smoothly. Three months later we received a bill for $2500 from a doctor we had not seen. Insurance had adjusted it from $3800. Perhaps he was the attending physician and the doctor we saw consulted with him. I have no idea and no one told me anything about it.

My wife, being the litigious trial attorney that she is, sent the physician's group a letter disputing the bill, requesting documentation that this doctor did in fact work on my son's case, and putting them on notice that she would fight them on principle over the amount of the bill. A couple of weeks later we got a letter stating that despite the fact that the charges were in fact valid, they would adjust the amount owed to $0.

A friend I related this to commented, "yup, they just wrote you off because there are so many more people that they can go after and not fight with that it just isn't worth it to them."

What a sad commentary on healthcare in America.

Re: Congress is set to ban most surprise medical bills

#327

Earlier quoted context omitted.

> 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 infinit…

> I hate the system in US, but at least it gives a chance to people who can afford it;

This is the temporarily embarrassed millionaire argument.

The system absolutely sucks for you right now, but you're putting up with that, because one day, ONE GLORIOUS DAY, in the future, when you are filthy rich, you want to be able to skip all the queues.

(There are plenty of countries with socialized healthcare that has a parallel private healthcare system that allows you to pay more to receive better/faster/customized care, so that's not actually an argument.)

Re: Congress is set to ban most surprise medical bills

#328

Earlier quoted context omitted.

> 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'…

I provided two examples of a coercive economic system. Just because it's an economic system doesn't make it any less coercive. The dictate is clear. A free market requires a voluntary participation of both the buyer and the seller. Threat of death is not voluntary participation, so it is not a free market. In a car crash you are not in a position to negotiate or make providers compete for your business.

In functioning systems the government drives down the cost of emergency care by setting the price and insuring everyone, and the results are clear. Canada's health care system costs $5447 USD, and Americas costs $10224. That's basically all I'll say about that.

Other necessities like food are in fact subsidized or socialized.

- The freeways? Socialized.

- The schools? Socialized.

- The police? Socialized.

- The fire stations? Socialized.

- The army? Socialized.

- The post office? Socialized.

- Healthcare for 40% of Americans? Socialized. (Medicare, Medicaid, VA). Medicare is socialized medicine. [1]

Food is also very much provided for if needed. SNAP and food banks provide socialized food to the poor. Americans pay less for food than anyone else on earth in no small part because the Farm Bill subsidizes production of corn and soy to the point these staples are sold at below cost to end users.

Either way that's a distraction and a red herring. Americans pay less for food than anyone else and more for medicine than anyone else. Eyes on the prize here, and stop carrying water for the insurance companies taking advantage of you :) All we're talking about doing is moving the percent of Americans covered by socialized medicine up from 40% to 100%.

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

Re: Congress is set to ban most surprise medical bills

#329

Earlier quoted context omitted.

> 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 req…

If you're already poor, bankruptcy isn't really the biggest of your worries. You can't get blood out of a turnip, as the saying goes.

Re: Congress is set to ban most surprise medical bills

#330
This is being made out as a win for patients, but it actually IS NOT. I'd describe it more as a win for insurance companies and potentially patients, with the losers being the out-of-network doctors, depending on the situation. This does have the possibility of reducing the quality of care around trauma in the US.

We have a few competing forces involved in surprise medical bills (really, out-of-network bills).

Insurance companies that negotiate to obtain in-network rates with medical providers (Doctors mainly). Insurance companies regularly negotiate based on a multiple, or fraction of medicare and medicaid rates.

Doctors, and practices providing care. Most doctors are either hospital employed (RVU compensation), or in a private practice. Doctors want to get paid fairly for their services, and there are some with extortionary rates, normally because they are handling the shit work that is not profitable with an in-network model.

Hospitals that are the locus for much of it via ERs. Hospitals don't want to employ doctors because they are overstaffed on administrators already, and, RVU based compensation does not equal financial viability. They prefer to punt to contracted practices that handle parts of the care, leaving the hospitals with the fat facility fees that provide much of their income.

My wife's practice has negotiated in-network rates with every major insurance (and they try to be in-network with everyone) for a multiple between 100% and 200% of medicare. The practice is clearly geared towards reconstructive in-network care and the surgeons work 9 - 8 regularly. One of the nearby plastic surgeons' practice is focused on trauma plastic surgery, and they are completely out of network. They charge between 500 and 2000% of medicare and they don't have regular hours since their trauma plastic surgery work is based on car accidents and workplace injuries which regularly come in at night and odd hours.

Whereas the compensation for an 8-5 cancer surgery via medicare rates would have most practices in the red if 100% of the practice, performing them at multiples of medicare rates are sufficient. For a trauma practice though, the regular compensation (based on codes and billing) for a nighttime surgery don't actually reward the surgeon well enough to gear their practice around performing that service.

I think what would be a better approach would be to cap out-of-network practices at 500% of in-network rates and call it quits. This would disincentivize the practices shooting for 2000%, and also, not reward the insurance companies that would shoot for a 50% to 75% of Medicaid, not Medicare, if they could get away with it.

Post reply on HN