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Majority of debtors to US hospitals now people with health insurance

theguardian.com

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Re: Majority of debtors to US hospitals now people with health insurance

#141

Post by verve_rat »

wolverine876 wrote: post #106
antisthenes wrote: post #90

Earlier quoted context omitted.

The absolutely best (and most impactful) thing you can do as an individual is to _not pay the damn debt_ to the hospital. The illusion of impact by writing to your congressman is really just that, a proverbial carrot in front of the donkey of democracy.

> The illusion of impact by writing to your congressman is really just that, a proverbial carrot in front of the donkey of democracy. This is the hopelessness I'm talking about in the GP. It was edgy and clever to despair, but it's really for losers. Let's get serious; people are dying, democracy is dying; our predecessors managed to achieve great things and there's no excuse for us to sit on the sidelines and whine.

I don't disagree with your fundamental message, but as a non-American watching from the sidelines, what are you doing in a practical sense, other than whining on an internet forum?

Re: Majority of debtors to US hospitals now people with health insurance

#142

Post by duffpkg »

lp0_on_fire wrote: post #105
duffpkg wrote: post #55

This seems like a good thread to mention the book "Never Pay The First Bill" by journalist Marshall Allen. I've worked in healthcare for 20+ years. I've been on the collecting side of many bills, it's a good book for patients. Contrary to popular belief most hospital systems are not evil profit seeking corpratons but just trying to keep the lights on, it's still a business though and as a patient you have the right a…

To be fair, when you see these giant corporations buy up every private medical practice from one side of the state to the other it’s hard not to see them as evil and profit seeking. When you walk into the lobby of the hospital and it’s guilded with marble floors, vaulted ceilings, and chandeliers with large spacious “offices” for the billing departments, it’s hard not to see them as evil and profit seeking. When you…

I want to be clear that I agree there are significant problems. I understand this commonly held perception but more than 29 states make it outright illegal for a regular for-profit corporation to own anything which engages in the practice of medicine. Look up "corporate practice of medicine" laws. That isn't to say there aren't problems. As a former hospital executive I can tell you first hand there is no love lost between hospital systems and insurers. A lot of hospital systems operate with a level of incompetence and dysfunction that it is truly difficult for regular people to appreciate. In many many cases a medical provider may not have a clear picture or be able to get a clear picture of what they will actually be compensated by your insurance for a given procedure. I understand that sounds crazy but it's a real thing. Competent organizations handle that situation a lot better than incompetent ones.

Re: Majority of debtors to US hospitals now people with health insurance

#143

Post by antisthenes »

beaeglebeached wrote: post #120
antisthenes wrote: post #95

Earlier quoted context omitted.

> Profit margins are like 4% on health insurance. If I tell you my cost of a bottle of water is $96,000 and sell it to you for $100,000 in the middle of the desert, my profit margin is only 4%.

You would also get a nice visit from the IRS.

I'd rather pay taxes on $4000 than $0.40

Re: Majority of debtors to US hospitals now people with health insurance

#144

Post by slfnflctd »

Aloisius wrote: post #129
slfnflctd wrote: post #68

Earlier quoted context omitted.

We should've gotten single payer. The insurance lobby is just too strong, I guess. In several recent years, I would've been better off not having insurance and paying out of pocket because I never (or just barely) hit the deductible. Even when my deductible was lower, if you added up my premiums against what was covered I still probably overpaid most years. So all I've been doing is subsidizing someone else's bills w…

Single payer was killed by the healthcare provider lobbies, not the insurance lobby. Doctors have waged a war against single payer anytime it has been suggested for over a century. The power the doctor and the hospital lobbies wield to sway opinion utterly dwarfs that of the health insurance industry.

There are multiple reasons I can imagine why that might be, but I would love to see some citations for this so I have solid data I can confidently adjust my world view with.

My opinion is that insurance companies are middlemen who too frequently rob patients & providers alike, and I would expect any reasonable legislation to include provisions to ensure that being a doctor is still financially attractive.

Coming around full circle, the cost of malpractice insurance is now so high that it's become a significant barrier to entry for anyone trying to start a new medical office, and I think that should be addressed as well.

Re: Majority of debtors to US hospitals now people with health insurance

#145

Post by fn-mote »

slfnflctd wrote: post #68
alwa wrote: post #39

Buried midway down, they mention that the commercial health plans available to people without conventional employers (Obamacare) can (and routinely do) set deductibles as high as $9,450. And that’s in addition to the premium-which, in New York City for example, starts at $618/month for the very worst plan for an individual. Sure, that’s subsidized for lower-income households — but who among those has a spare $10K lyi…

We should've gotten single payer. The insurance lobby is just too strong, I guess. In several recent years, I would've been better off not having insurance and paying out of pocket because I never (or just barely) hit the deductible. Even when my deductible was lower, if you added up my premiums against what was covered I still probably overpaid most years. So all I've been doing is subsidizing someone else's bills w…

In my case, not hitting the deductible is the wrong metric.

You are still benefitting from the insurer's negotiation of lower rates for all procedures. For example, your insurer may have negotiated $0 for standard bloodwork.

The parent's acknowledgement that "this is how insurance works" doesn't change the fact: that IS how insurance works. Coverage of a risk has a value, even if that risk does not materialize. (This is easier to understand from the point of view of the finance markets, but it's the same everywhere.)

Re: Majority of debtors to US hospitals now people with health insurance

#146

Post by beaeglebeached »

antisthenes wrote: post #143
beaeglebeached wrote: post #120

Earlier quoted context omitted.

You would also get a nice visit from the IRS.

I'd rather pay taxes on $4000 than $0.40

I honestly thought the jig here was lying about the 96k. If the bottle actually costs 96k then I don't begrudge the 4% risk for hauling to the desert.

Re: Majority of debtors to US hospitals now people with health insurance

#147

Post by rayiner »

charlie0 wrote: post #133
rayiner wrote: post #99

Earlier quoted context omitted.

> What do you expect me to do about it? I live in a reliably blue area and it's Republicans who are blocking things like a single-payer system. So why did single payer healthcare fail in Vermont and California? European countries the size of Maryland manage to run their own universal healthcare systems. Why can’t states where democrats outnumber republicans 2:1 do the same?

Because you'll get the same issue as with the homeless, people from other states will come over to mooch on the better services. This has to be handled at a national level in order for it to succeed.

Legally, I’m not sure that’s true. I think discriminating against out of staters for health insurance could well meet the compelling interest standard of Shapiro v. Johnson, similarly to how states are allowed to discriminate against out of state students for public universities. And if it were challenged, I suspect the current Supreme Court wouldn’t be so inclined to further extend the broad “right of travel” found in Shapiro.

Putting that aside, the theoretical prospect that states would have to accommodate out of state moochers doesn’t seem to be the actual reason that the California and Vermont universal healthcare efforts failed. It seems like those programs failed because voters don’t want to pay for it.

Re: Majority of debtors to US hospitals now people with health insurance

#148

Post by tumsfestival »

trynumber9 wrote: post #111
itronitron wrote: post #62

At some point I hope Americans realize the extent to which they are being taken advantage of by the politicians they elect, and the companies that lobby them.

Americans do dislike their politicians. They also find them corrupt and ineffectual (possibly that's better than corrupt and effective). https://www.pewresearch.org/politics/2023/09/19/americans-di...

Clearly not enough, otherwise they'd do something about it.

Re: Majority of debtors to US hospitals now people with health insurance

#149

Post by rayiner »

charlie0 wrote: post #131
theonething wrote: post #124

Earlier quoted context omitted.

I like Kaiser in that sense. None of this separate bills monkey business. In fact, for my plan, no bills at all. Just upfront co-pays and then you're done paying.

I really like Kaiser as well, but afaik, they are one of the most expensive providers out there. I've only had Kaiser once, many years ago and the company dropped them because the cost to insure each person was significantly more expensive per person than everyone else. This was in a place where the average age was less than 35. I can only imagine what it costs now, especially for companies with a higher age average.

> I really like Kaiser as well, but afaik, they are one of the most expensive providers out there.

Yeah, but what would you pay in taxes in a country with universal healthcare? In Maryland, I pay a similar total tax rate on a top 1% income as our German au pair did at her entry level desk job. Germany’s tax to gdp ratio is 39%. Ours is just 28%.

Re: Majority of debtors to US hospitals now people with health insurance

#150

Post by mindslight »

devilbunny wrote: post #30
AlecSchueler wrote: post #15

Earlier quoted context omitted.

But why is done that way? Lots of freelance chefs move between restaurants but the bill is always between the restaurant and the people who dine there.

Because historically doctors were in private practices. I still am, as an anesthesiologist. Many of the surgeons I work with are also private. So, since neither of us is employed by the hospital, we do our own billing. If we were hospital employees, we could indeed do unified billing. That's a better analogy; your chefs are expecting to be paid by the restaurant, so it collects the bill. I am not paid by the hospital…

Your explanation doesn't seem like anything but a well polished justification for what is ultimately a dubious shakedown. Without actually consulting with a patient and agreeing upon pricing well ahead of a scheduled surgery, you have absolutely no business requesting any payment directly from them. These billing charades revolve around some utterly perverse idea that obtaining someone's identifying information somehow confers some right to unilaterally bill them arbitrary amounts. For sanity's sake, everyone else can only hope this broken and illogical system is on borrowed time and will get stamped out hard. And you can most certainly retain your legal independence and work for multiple vendors as a subcontractor, like in any other industry.
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