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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

#411

Post by mattnewton »

AnthonyMouse wrote: post #382
mattnewton wrote: post #353

Earlier quoted context omitted.

But also doesn't require fire insurance for someone to try pulling you out of a burning building. I think diseases that take longer but are still affecting your quality of life are just as important to consider, but also think they distort decision making and fail to work like a free market as a result. The "free market" has failed to provide affordable dental care outside large insurance policies, which are inaccess…

> But also doesn't require fire insurance for someone to try pulling you out of a burning building. Right, so your city should operate an emergency room funded mostly by taxpayers, and then just charge a fixed deductible (e.g. $1000) for emergency care, which isn't enough to induce bankruptcy in general but is enough to deter people from using it in place of primary care. > The "free market" has failed to provide aff…

> Right, so your city should operate an emergency room funded mostly by taxpayers, and then just charge a fixed deductible (e.g. $1000) for emergency care, which isn't enough to induce bankruptcy in general but is enough to deter people from using it in place of primary care

This is just a public option that covers little and without the bargaining power on price a state has versus a city, right? Why wouldn't the same logic go for a larger entity taking up the mantle? And if we treat only emergencies with the plan, we incentize poor people to ignore cheaper preventative care in the market based system, and to wait until it becomes an emergency that costs many multiples to fix.

> Dental isn't generally a market that requires insurance.

Also from that link, in practice most uninsured americans just don't seek dental care. This matches my personal experience of being uninsured.

Re: Congress is set to ban most surprise medical bills

#412

Post by conanbatt »

three14 wrote: post #395
conanbatt wrote: post #393

Earlier quoted context omitted.

So you think that farmers sell corn at the prices because they fear they will get robbed or plundered otherwise, but hospitals fear no plunder?

No. I think I covered that with "the markets are so large that it's usually hard for a supplier to form a monopoly or a few to form oligopoly."

Healthcare market is really big as well. Why is it easy to build a monopoly there?

Re: Congress is set to ban most surprise medical bills

#413

Post by meowster »

hn_throwaway_99 wrote: post #160
amelius wrote: post #67

Earlier quoted context omitted.

Some people wear a tag with their blood group on it. Perhaps we should be wearing tags with the amount of money we're willing to spend on a hospital visit.

I'm curious, would this even be essentially "accepted" by any hospital in the US? Not just a tag, but if you were going in for a procedure, could you even say "I want to be sure I will not be treated by anyone not covered by my insurance plan"? Because basically all the forms you need to sign upon admittance essentially say "We can charge you whatever we want and you are responsible for paying it."

Whenever I took my vehicles in for service at a dealership, they would always provide a form for me to sign to pre-authorize any work they deem necessary. I always leave those forms blank. Never had an issue.

Whenever I go to a new doctor or medical facility, they always ask for tons of personal information such as my social security number. I always leave most of that blank. Never had a problem.

I've never been asked to write a blank check for a medical operation like I have at a dealership, but perhaps we should just make such practices illegal?

Re: Congress is set to ban most surprise medical bills

#414

Post by meowster »

spaetzleesser wrote: post #376
lordnacho wrote: post #11

> Surprise bills happen when an out-of-network provider is unexpectedly involved in a patient’s care. Patients go to a hospital that accepts their insurance, for example, but get treated there by an emergency room physician who doesn’t. Such doctors often bill those patients for large fees, far higher than what health plans typically pay. How do courts uphold this? You go to a restaurant, they say you can buy the tas…

"How do courts uphold this? You go to a restaurant, they say you can buy the tasting menu for $100, but they have a temp chef working that day which will cost you $50 extra, which you find out as you're paying. " In the US you go to a hospital and basically sign a contract "you can charge me for whatever you feel like". What surprises me is that they get away with often charging for stuff that never happened. When yo…

> I don't understand how they get away with that.

99% of people don't confront them.

Re: Congress is set to ban most surprise medical bills

#415

Post by sershe »

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.…

The reason healthcare is not a free market in the US are not market's fault etc. The govt restricts supply, subsidizes demand directly, and also created the system where insurance is tied to work so the major consumers are completely price insensitive... that is why healthcare is expensive.

Re: Congress is set to ban most surprise medical bills

#416

Post by arcticbull »

conanbatt wrote: post #412
three14 wrote: post #395

Earlier quoted context omitted.

No. I think I covered that with "the markets are so large that it's usually hard for a supplier to form a monopoly or a few to form oligopoly."

Healthcare market is really big as well. Why is it easy to build a monopoly there?

It's really not. Generally you're limited to two or three insurance providers in a state and in range of your car accident, about one hospital.

Re: Congress is set to ban most surprise medical bills

#417

Post by arcticbull »

unishark wrote: post #387
arcticbull wrote: post #370

Earlier quoted context omitted.

> The way a market works is people find ways to serve people at a price they can afford. When you always force others to pay for the cadillac service for them, no one bothers to find cheap ways to provide healthcare. How can you be so twisted up about this? Americas system is the expensive one, everyone else's is cheap, and controlling costs better. Medicare may not be doing a perfect job but again it's controlling c…

> R&D spending? Guess which healthcare companies spend the most on R&D? It's not the American ones. It's all the European ones. #1 is Switzerland's Roche. #4 is Switzerland's Novartis. #6 is France's Sanofi. #9 is the UK's AstraZeneca. #10 is the UK's GlaxoSmithKlein. [1] This is yet another failed talking point. Roche has over 8000 employees in the US. https://www.roche.com/careers/our-locations/americas/usa.htm A h…

Just as a final note, that chart of EU vs US spending paints a very incomplete picture.

1. That's in "millions of national currency units" (except in Japan which is in "hundred millions of national currency units") so the Japan bar is in 100M JPY, the Europe bar is in 1M EUR, and the US bar is in 1M USD. It was clearly not meant for comparison against regions, just over time.

2. Not only is the currency inconsistent the values weren't adjusted for purchasing power parity, i.e. how far a national currency unit goes in that country relatively.

If we convert the values to USD adjust for PPP the picture changes completely. All values in USD, PPP adjusted:

2016 - USA: $52.4B

2016 - Europe: $46.16B (PPP factor 1.225, EUR:USD factor 1.11)

This is about a 13% delta, not the seemingly 53% delta represented on the chart. Also, this is limited to EFPIA member companies.

Re: Congress is set to ban most surprise medical bills

#418

Post by sershe »

mattnewton wrote: post #411
AnthonyMouse wrote: post #382

Earlier quoted context omitted.

> But also doesn't require fire insurance for someone to try pulling you out of a burning building. Right, so your city should operate an emergency room funded mostly by taxpayers, and then just charge a fixed deductible (e.g. $1000) for emergency care, which isn't enough to induce bankruptcy in general but is enough to deter people from using it in place of primary care. > The "free market" has failed to provide aff…

> Right, so your city should operate an emergency room funded mostly by taxpayers, and then just charge a fixed deductible (e.g. $1000) for emergency care, which isn't enough to induce bankruptcy in general but is enough to deter people from using it in place of primary care This is just a public option that covers little and without the bargaining power on price a state has versus a city, right? Why wouldn't the sam…

The latter is probably not causal - poor Americans have no money for either insurance or dental care, whereas non-poor would pay for retail dental anyway, but they also mostly have insurance.

Re: Congress is set to ban most surprise medical bills

#419

Post by jdmichal »

meowster wrote: post #413
hn_throwaway_99 wrote: post #160

Earlier quoted context omitted.

I'm curious, would this even be essentially "accepted" by any hospital in the US? Not just a tag, but if you were going in for a procedure, could you even say "I want to be sure I will not be treated by anyone not covered by my insurance plan"? Because basically all the forms you need to sign upon admittance essentially say "We can charge you whatever we want and you are responsible for paying it."

Whenever I took my vehicles in for service at a dealership, they would always provide a form for me to sign to pre-authorize any work they deem necessary. I always leave those forms blank. Never had an issue. Whenever I go to a new doctor or medical facility, they always ask for tons of personal information such as my social security number. I always leave most of that blank. Never had a problem. I've never been aske…

That's interesting. My mechanic always provides an estimate, then I sign something authorizing up to that estimate and that requires them to separately approve any further funding.

Re: Congress is set to ban most surprise medical bills

#420

Post by conanbatt »

8note wrote: post #401
conanbatt wrote: post #379

Earlier quoted context omitted.

A handy guide to check if healthcare is a free market: 1) Can you buy medicine from whoever sells it cheapest? 2) Can you hire the healthcare provider you want? 3) Are you financially punished for choosing your own health insurance? 4) Can you opt-out of government health services? 5) Can you waiver or partially waiver your right to sue the medical professional in exchange for cheaper services?

6) can you pay any odd person off the street to open you up and take out your appendix?

What a nice world that would be, wouldn't it.
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