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I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

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Re: I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

#71

Post by atmavatar »

ip26 wrote: post #46
mmastrac wrote: post #25

The incentives in US health care are so upside-down that Americans pay significantly more for the same results as many of the other western nations. While the public systems of the UK and former colonies aren't perfect, they are still significantly cheaper to run for approximately the same outcomes. Ditto for other European countries. I don't understand why this hasn't become a boil-over issue for Americans yet.

Perhaps because it doesn’t impact you until it does, and we can’t seem to agree on what exactly is causing these outcomes. It’s a legitimately tangled problem, and I do believe how to unwind it is not well understood by anyone. (Ignoring single payer, which is more of a sidestep than a true fix) Many people are also insulated by expensive insurance plans. HDHP are a long term play to generally make the public more fa…

I'll posit single-payer is much closer to a true fix than you give credit for.

A significant fraction of the additional cost in the US is due to all the administrative overhead that comes with negotiating prices with thousands of insurance providers, as well as dealing with not only primary insurance, but secondary, tertiary, and sometimes even quaternary insurance providers for any given patient. And, as mentioned elsewhere, it gets multiplexed over each doctor involved in your care, since each may work with a unique subset of insurance providers.

Re: I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

#72

Post by nradov »

brianwawok wrote: post #36
guyzero wrote: post #30

Earlier quoted context omitted.

"Shop around" is a great capitalist mantra, except that medical emergencies are pretty obviously a situation where you're absolutely not going to shop around.

This is the obvious case. What is even more shocking is the happy case. You have a week to make an appointment for an outpatient procedure. Call around. No one can even give you a price. Doctor doesn’t know; sends you to some billing department. They don’t know. You will spend a month to find the actual price at 5 places, and it’s not even locked in price. Bill come for another amount? Tough

Some of this has improved under the No Surprises Act. In certain situations the provider may be legally required to give you a "good faith estimate", or at least not send you excessive bills after treatment.

https://www.cms.gov/medical-bill-rights/know-your-rights

Re: I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

#73

Post by nradov »

dzhiurgis wrote: post #69
from-nibly wrote: post #66

Earlier quoted context omitted.

The problem is that the solution is subtractive not additive. Its, at the very least, a lot harder to make a business where people stop doing stuff. What do we need to stop doing? All of the billing shenanigans with insurance. We need to stop insuring regular healthcare, and go back to insuring catestrophic healthcare. What we do now with healthcare is like buying car insurance that pays for oil changes.

> We need to stop insuring regular healthcare, and go back to insuring catestrophic healthcare. Good point. In NZ we are covered for accidents, infections, heart attacks, etc. But get lung cancer from smoking and you are paying yourself. It's not perfect, but sets priorities to live healthy.

If a patient is diagnosed with lung cancer there is no reliable way to determine whether the root cause was smoking, radon exposure, or some random mutation.

https://www.cnn.com/2023/10/13/health/lung-cancer-young-and-...

Re: I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

#74

Post by dools »

didacticBuffalo wrote: post #29
dools wrote: post #17

Earlier quoted context omitted.

Greetings from Australia. My brother has MS and gets a monthly infusion of Tysabri. All he does is show his Medicare card and it doesn't cost him anything.

I looked at leaving the US years ago. Australia was on my short list after spending some time in Melbourne. Alas MS is one of those things that makes immigration harder nearly everywhere because it "puts an undue burden on the health system". Never found a way around that aside from maybe marrying a local; it's been a while. Glad he's getting the treatment he needs!! Drugs have made incredible advances in the last de…

Yeah that's a bummer :(

And yes drugs have made incredible advances -- my aunt (and hence my brother's aunt) had MS and her life was ruined by it.

Pretty amazing to see something advance that quickly with such a stark difference in outcomes between 2 of my own family members.

When my brother told me it was relatively benign given they caught it early and he had access to treatment I was like "I read 10 books for the MS Readathon in Year 1... You're welcome!"

Re: I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

#75

Post by dzhiurgis »

nradov wrote: post #73
dzhiurgis wrote: post #69

Earlier quoted context omitted.

> We need to stop insuring regular healthcare, and go back to insuring catestrophic healthcare. Good point. In NZ we are covered for accidents, infections, heart attacks, etc. But get lung cancer from smoking and you are paying yourself. It's not perfect, but sets priorities to live healthy.

If a patient is diagnosed with lung cancer there is no reliable way to determine whether the root cause was smoking, radon exposure, or some random mutation. https://www.cnn.com/2023/10/13/health/lung-cancer-young-and-...

Oh no doubt. But it’s more fair than otherwise.

Re: I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

#76

Post by nunez »

spondylosaurus wrote: post #31
giantg2 wrote: post #8

There are some good points in here. However, it feels disingenuous with the author being a former surgeon general. "the onus of the entire amount still fell on me due to my high-deductible health plan (HDHP)." I mean, yeah, that's how HDHP works. Anyone in healthcare should understand that.

A physician of mine has said that he thinks HDHPs are predatory and (in his opinion) should be illegal. They sound attractive until the moment you actually need to get medical care.

HDHPs are awesome if the deductible and OOP max is low-ish (less than $2000/$4000) AND you either don't see doctors very often or you see them all of the time AND your employer contributes. That is the only combination with which I'd ever recommend a HDHP. Just about everyone is better off with a PPO.

I had a HDHP for a few years. $1500 deductible/$2500 OOP max; employer contributed $750/year. I loved the concept and contributed myself, but basically any doctors appointment I'd have would wipe out my contributions. I saw many doctors in 2021 due to random stomach issues that were ultimately GERD. I landed up paying out of pocket before hitting the deductible. I now have a PPO.

The issue is that they are often the cheapest plan to get (because of the HD part) and many HDHPs have crazy high deductibles and astronomical OOP maxes (with out of network deductibles and OOP maxes that are of this solar system), so that + people (understandably) not understanding medical insurance = a very bad time

Re: I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

#77

Post by ip26 »

atmavatar wrote: post #71
ip26 wrote: post #46

Earlier quoted context omitted.

Perhaps because it doesn’t impact you until it does, and we can’t seem to agree on what exactly is causing these outcomes. It’s a legitimately tangled problem, and I do believe how to unwind it is not well understood by anyone. (Ignoring single payer, which is more of a sidestep than a true fix) Many people are also insulated by expensive insurance plans. HDHP are a long term play to generally make the public more fa…

I'll posit single-payer is much closer to a true fix than you give credit for. A significant fraction of the additional cost in the US is due to all the administrative overhead that comes with negotiating prices with thousands of insurance providers, as well as dealing with not only primary insurance, but secondary, tertiary, and sometimes even quaternary insurance providers for any given patient. And, as mentioned e…

You don’t have to have single payer to get more transparency in pricing, for example.

Re: I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

#78

Post by xtiansimon »

brianwawok wrote: post #36
guyzero wrote: post #30

Earlier quoted context omitted.

"Shop around" is a great capitalist mantra, except that medical emergencies are pretty obviously a situation where you're absolutely not going to shop around.

This is the obvious case. What is even more shocking is the happy case. You have a week to make an appointment for an outpatient procedure. Call around. No one can even give you a price. Doctor doesn’t know; sends you to some billing department. They don’t know. You will spend a month to find the actual price at 5 places, and it’s not even locked in price. Bill come for another amount? Tough

“No one can even give you a price.”

Ha!

I needed to visit a sports therapist. Called an office near me and asked the cost to see the doctor.

> We can’t say, we don’t know what procedures the doctor might order.

I understand, I say. Just tell me how much for the consultation. Walk in the door and see the doctor.

> [repeat]

Let’s take the most common case. Say the doctor orders cortisone shot, but I decline this care. Then how much?

> Don’t you have insurance?

Yes. As I stated earlier I do have insurance, but I don’t have a co-pay plan. I have a deductible plan—-i don’t know why I need to explain the difference—-that means I pay full price until I reach my high yearly deductible. Since I haven’t been sick, I’m at $0 right now.

> Where did you get our number?

From my health insurance’s web site.

> I don’t think this is the doctor’s office for you. Click.

Re: I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

#79

Post by rdl »

I didn't realize HDHPs were still available in the US post-ACA, due to requirements that all plans cover certain minimum services 100% from the first dollar, making them kind of silly (it basically means there's a doughnut of approximately $2k-$6k in cost where someone might be personally liable in a given year).

HDHP plus great price transparency (especially pre service, where one can potentially cross-shop providers, vs. being in a facility and given only one option) would be good for cost reduction; if you can't surface and measure the costs, you won't have any incentive to lower them.

I personally have a fairly mediocre $230/mo blue cross plan in Puerto Rico which largely only covers care within Puerto Rico (and which I've never actually used for anything), and rely on medical tourism where I pay 100% out of pocket, and until Amazon bought them, OneMedical for cheap clinic care which I also paid 100% out of pocket. I previously had a WA state HDHP for $100-200/mo pre-ACA which was great but ACA killed those/insurers left the state.

Re: I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

#80

Post by mkoubaa »

from-nibly wrote: post #66
whodidntante wrote: post #41

We spend $14K per person, or $4.5T on healthcare in the US. The typical cost for healthcare in comparable countries is 1/2 of that per person. There is $2.25T per year of savings to be had. We can eliminate our national debt in 15 years, and with that also eliminate the $1T going to $1.5T of interest payments we pay each year on the debt, so a total savings down the road of about $3.5T per year. To put that in perspe…

The problem is that the solution is subtractive not additive. Its, at the very least, a lot harder to make a business where people stop doing stuff. What do we need to stop doing? All of the billing shenanigans with insurance. We need to stop insuring regular healthcare, and go back to insuring catestrophic healthcare. What we do now with healthcare is like buying car insurance that pays for oil changes.

I disagree. The development of petroleum made people stop whaling
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