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Insured, but Still Owing $109K for a Heart Attack

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Re: Insured, but Still Owing $109K for a Heart Attack

#131

Post by acomar »

lotsofpulp wrote: post #94
treyfitty wrote: post #68

My father had a heart attack 4 months ago, and he’s been in and out of the ICU for 3 of those months. Everyone likes to think “oh, I’m insured. I’ll be fine.” But let me tell you, you won’t be fine. 3 months of ICU at Robert Wood Johnson was billed for $4Mn. BCBS-NJ only paid out $750k. The headache begins there- from a personal financial standpoint, and Tri-party incentive standpoint. Ignoring the difference of $3.2…

Health insurance companies' profit margins are restricted by law, whereas Robert Wood Johnson and its executives and doctors profit margins are not restricted. If anyone is on the patient's side from a cost perspective, it's insurance, and the ones benefiting from higher pricing and unnecessary procedures are the providers.

I've suddenly started seeing this take all over the place and I have no idea where it comes from because it doesn't make sense. That the insurance companies profit margins are restricted means rather little because executive pay isn't capped: if they earn too much money, they can simply pay bonuses to raise their expenses. Or cut shareholders a check. Or. Or. Or. Tangentially, this is why "non-profit" doesn't mean what people think it means.

And despite what caps exist (can you point me to resources on this topic?), the industry is enjoying record profits right now. That's not to say hospitals aren't as well, but I'm puzzled that so many people seem to want to point the fingers at doctors. Doctors and nurses actually provide the care. If there's anyone I'm less worried about making a little more, it's the people actually doing the work. The administrators and the corporations that set and negotiate prices with the insurance companies though... I'm with you there.

Lastly, the incentives of insurance companies do not align with the patients unless you ignore most of how the industry works. Insurance companies make money when they're able to deny you coverage or require you to pay more out of pocket (in vs out of network). That doesn't align with patients at all.

There should not be a profit incentive in health insurance.

Re: Insured, but Still Owing $109K for a Heart Attack

#132

Post by wang_li »

citrablue wrote: post #111
lotsofpulp wrote: post #94

Earlier quoted context omitted.

Health insurance companies' profit margins are restricted by law, whereas Robert Wood Johnson and its executives and doctors profit margins are not restricted. If anyone is on the patient's side from a cost perspective, it's insurance, and the ones benefiting from higher pricing and unnecessary procedures are the providers.

I don't think this follows. Insurance profit margins are restricted, but they're a percentage of overall payments to hospitals. If the total charge goes up, their total profit also increases.

Insurance companies are required to pay out 80%/85% of the collected premiums on medical care. Which means the remaining 20%/15% has to cover all the insurance company costs and any profit they can manage. If premiums are raised then their portion also will increase as a percentage. But if the medical costs increase without a corresponding premium increase, the insurance company won't see any profits.

Re: Insured, but Still Owing $109K for a Heart Attack

#133

Post by bmmayer1 »

lacker wrote: post #36
jhayward wrote: post #11

Earlier quoted context omitted.

> Sounds all fine and dandy until you realize that these charges will just be made up for by people that aren't able to get NPR to publish a story about them. No, St. David's has already fully recouped their costs and then some. They were simply trying to extract as much money as the stone could bleed.

I was going to respond saying that most hospitals are nonprofits and aren't actually making a great profit margin off this sort of overcharging. But then I looked it up and St. David's, despite having a religious nonprofit-sounding name, is actually owned by HCA Healthcare, which is a for-profit that has almost 4x'd its stock price over the past five years while acquiring more hospitals to grow. So, yeah, this one is…

> squeezing money out of insurance companies because they can

FTFY.

But seriously, how can it possibly be the hospital's fault for doing exactly what the law and market incentives give them every reason to do? There's almost no downward pressure on prices: little competition, no transparent pricing, huge barriers to market entry, and third party payers.

Re: Insured, but Still Owing $109K for a Heart Attack

#134

Post by acomar »

PurpleBoxDragon wrote: post #116
acomar wrote: post #95

Earlier quoted context omitted.

For what? Lay out a business plan in this area for me that doesn't take money from the worst off.

If you make money off them but save them more money than you costs, it is still towards their benefit. The only problem occurs when you start working with the hospital to create even more arcane bills that you get into immoral territory.

That's exactly the circumstance I outlined previously. This plan has you taking the debts of somebody who cannot afford to pay, reducing them to something above the actual cost, then asking them to pay the higher amount. You are making money from the least able to pay and profiting from a system driving people into bankruptcy. I cannot imagine starting such a company without serious empathy issues.

Re: Insured, but Still Owing $109K for a Heart Attack

#135

Post by wang_li »

PeekPoke wrote: post #48
aaroninsf wrote: post #43

Here is a reminder that in the US, we pay much more and receive far worse outcomes than any other first world nation, by any metric you care about: life expectancy; infant mortality; incidence of chronic disease; obesity; incidence of addiction; etc. Then consider we are the only first-world nation in which medical bankruptcy is not just a thing, but a profound source of anxiety and genuine risk. What do we get in ex…

This is why it's good to be English - our national health service fixes you up and sends you on your way without providing you with a bill.

Unless the NHS has no approved treatment, in which case you die instead of being able to go abroad for care.

Re: Insured, but Still Owing $109K for a Heart Attack

#136

Post by ubernostrum »

lotsofpulp wrote: post #105
acomar wrote: post #91

Earlier quoted context omitted.

> Why the fuck isn't there a law against this kind of shit? There's a pretty clear answer to this question almost every single time it's asked... the people who benefit are wealthy and the people hurt are poor. The latter structurally lack the ability to fight it or lobby their congresspeople to change the law to help them. Until a mass movement steps forward to say "no, we will not tolerate this", nothing can possib…

Based on voting demographics, the poorest are the ones who are voting for politicians who hate the government and are opposed to any kind of subsidized healthcare.

Mostly because they believe and have been encouraged to believe that any protections/benefits would go to people who "don't deserve it" (also known as: whichever racial/ethnic demographic those voters have been raised to hate the most). They're very much in favor of discriminatory special-treatment programs that help them and only them, but very much against broad safety nets because they've been told such programs would only benefit the bad other people.

Re: Insured, but Still Owing $109K for a Heart Attack

#137

Post by BLanen »

jtokoph wrote: post #7

> UPDATE: Monday, shortly after publication and broadcast of this story by Kaiser Health News and NPR, St. David’s said it was now willing to accept $782.29 to resolve the $108,951 balance because Drew Calver qualifies for its “financial assistance discount.” Sounds all fine and dandy until you realize that these charges will just be made up for by people that aren't able to get NPR to publish a story about them.

Can you stop blaming individuals and start blaming the people who set up and keep the current system?

Re: Insured, but Still Owing $109K for a Heart Attack

#138

Post by krupan »

lotsofpulp wrote: post #120
dragonwriter wrote: post #107

Earlier quoted context omitted.

> Health insurance companies' profit margins are restricted by law, whereas Robert Wood Johnson and its executives and doctors profit margins are not restricted. If anyone is on the patient's side from a cost perspective, it's insurance, and the ones benefiting from higher pricing and unnecessary procedures are the providers. Untrue, because health insurers profits are limited by law, sure, but to a specified fractio…

How does that make it untrue? Health insurance companies are supposed to compete with each other based on their premium prices, and the insurance companies with lower premiums (and hence lower costs) will win more customers.

Except the insurance market doesn't work like that. You get a job, that job determines your insurance. There's no shopping around for the best rates.

Re: Insured, but Still Owing $109K for a Heart Attack

#139

Post by h4b4n3r0 »

TomVDB wrote: post #115
cabaalis wrote: post #39

Earlier quoted context omitted.

There are different horror stories from different systems. Bottom line is that access to health care professionals and equipment is a scarce resource, and any resource management process whether through governmental regulation, or individual funding, insurance program, etc will be faced with managing access to that resource one way or another.

And in some systems, horror stories are way more common than others. The simple fact is that I don't know anybody from my European family or friends who would willingly switch their system to the US one. And as a very well insured employee in the US, if, hypothetically, I had the option to use my European health care in the US, I'd switch immediately a well.

>> I'd switch immediately a well

I doubt it. Someone needs to pay for it, so this switch would have to imply a 20% tax increase. Unless you’re paid peanuts, it’s not worth the tradeoff.

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