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What I learned from reading a thousand emergency room bills

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Re: What I learned from reading a thousand emergency room bills

#221

Post by ams6110 »

vec wrote: post #181
bluGill wrote: post #127

Earlier quoted context omitted.

We do not have a free market. Most people get their health insurance from their employer - you cannot reasonably get insurance elsewhere (the same plan I have now for $100/month would cost over $1000/month, but I can't take that $1000/month to anyone else if I don't like my insurance so I accept it). This keeps me from taking a long leave of absence to live off my savings - until I quality for retirement (medicare).…

> We do not have a free market. Most people get their health insurance from their employer - you cannot reasonably get insurance elsewhere What you are describing are in fact the freest parts of the health insurance market. Employers, quite rationally and of their own free will, choose to offer health insurance as a benefit because it attracts and retains talent better than other similarly priced incentives. The fact…

Employers offering health insurance as compensation is a legacy of wage controls from WWII. Employers were prohibited from paying market-level wages so they offered health insurance. It is entirely a result of non-free-market government controls.

Re: What I learned from reading a thousand emergency room bills

#223

Post by krupan »

xixixao wrote: post #182
ThomPete wrote: post #165

Earlier quoted context omitted.

The problem is that neither models work and both have shortcomings. In the US model healthcare is a profit center which allow those who can afford to get help and those who can't various sub-optimal variations of help. In the ex. Scandinavian model healthcare is a cost center and there is a set budget each year which the providers need to function within. This means that prioritization needs to happen and various ill…

Agreeable until the last sentence: > Of course the problem is that the US is such a big country with huge immigration and scandinavian countries arent so it's always hard to compare. US Population: 325 million US Immigration: 1.5 million (2016) EU Population: 512 million EU Immigration: 2 million (2016) (taken from top Google results) It's fairly accurate to say that, compared to the US, the whole of EU has a "Scandi…

There isn't a single EU health care system. Each country still does their own. Maybe each US state could do their own, but there are huge concerns about freeloader problems since we have unrestricted movement between states in the U.S. From what I've read the systems of European countries are being threatened by the freeloader problem that increase immigration as of late has caused.

Re: What I learned from reading a thousand emergency room bills

#224

Post by manfredo »

tangent128 wrote: post #189
manfredo wrote: post #131

Earlier quoted context omitted.

With respect to financial responsibility, if the cost of the delivery is a concern I don't think the couple in question is financially stable enough to start a family anyway. Even if this proposed change does occur there's a good chance it actually makes the procedure in question more expensive. If we start making hospitals list prices beforehand, then they're going to have to raise the base price for an ucomplicated…

> With respect to financial responsibility, if the cost of the delivery is a concern... As the GP noted, if you don't even know the order of magnitude to expect, the cost will always be a concern. The upper bound on the price is in the trillions, after all. > If we start making hospitals list prices beforehand, then they're going to have to raise the base price for an uncomplicated birth in order to subsidize those t…

While the exact prices may not be exposed, estimates from past customers can be found online without much difficulty. If you seriously think that a hospital charging trillions of dollars is a possibility, I don't think you're writing comments in good faith.

Prices negotiated with insurance companies are negotiated under conditions very different from an uninsured patient. For example, risk of non-payment is drastically higher among the uninsured. This had to be offset by charging a higher rate so those losses are made up on patients that do pay. If you offer to pay for medical procedures in cash and immediately then you can usually negotiate the price down to a fraction of the list cost.

Re: What I learned from reading a thousand emergency room bills

#225

Post by bluGill »

vkou wrote: post #209
bluGill wrote: post #171

Earlier quoted context omitted.

Careful there though. If a surgeon is operating on cancer and discovers that the tumor is much larger than expected the operation will take longer - be more expensive - or the surgeon does the operation as planned and then charges even more for the second surgery to remove the rest. Or maybe all operations are estimated as the worst case and so you end up with no more clue about what you will pay than today - in some…

> Which is to say don't propose something until you understand the unintended side effects. You can get your desired result but while making everything worse. I think the American experiment in trying to provide market health care has demonstrated that you can, in fact, have a 'free' market for healthcare, while making almost everything about that healthcare worse.

The american way is not a free market. The employer tax break on health insurance is a significant manipulation.

Re: What I learned from reading a thousand emergency room bills

#226

Post by bjelkeman-again »

ptaipale wrote: post #204
heavyset_go wrote: post #66

Earlier quoted context omitted.

The history of private firefighting is a particularly dirty one. In the past, fire companies would show up and demand payment before putting out fires. If a payment couldn't be made, the company might negotiate the purchase of the burning property at a steep discount. Later, insurance companies hired brigades to only put out fires on insured properties. Fire companies might have fought or sabotaged one another in ord…

Not everywhere, though. In Denmark, private operators have been handling emergency services since 1926; currently one company (Falck) is handling 65 percent of municipal fire brigades and 85 percent of ambulance services. No particular nastiness has been reported afaik.

I think this is because the culture is quite different in DK compared to the US. There is an expectation of how it will work which is very different by everyone involved.

Re: What I learned from reading a thousand emergency room bills

#227

Post by justtopost »

neurotrace wrote: post #98
cabaalis wrote: post #57

Earlier quoted context omitted.

> You simply don't get to "shop around" for emergency services You do actually, by where you choose to live and also by the services as detailed in [1]. I think there's merit to investigating public health care. That line stops for me in eliminating private care. 1] https://www.theatlantic.com/technology/archive/2018/11/kim-k...

A lot of people don't get much choice in where they live.

Are they on felony probation? I have moved a few times with little money for better opprotunities. It seems like most people are just psychologically conditioned to die near where they were born. Most people just think the hardship is worth it, which is very much a choice. It is literally cheaper to move to most of the USA than live another month in places like california or nyc.

Re: What I learned from reading a thousand emergency room bills

#228

Post by jessaustin »

ddebernardy wrote: post #139
y-c-o-m-b wrote: post #28

I was a victim of the surprise out of network bill in the Portland, OR area. I did all my research before hand: hospital in network, surgeon in network, etc. but ONE person in that operating room was not in network and SURPRISE i'm out thousands of dollars. The worst part about this is my state passed a bill to stop this prior to my surgery, but the bill's effective date was roughly 3 months later. Talk about bad tim…

I'm at a loss as to why the US is still dead set to have no meaningful health coverage. I got burned by this in California a decade ago. A dentist charged me $4,500 to fix a broken tooth (panic!) and fill in a cavity on a Sunday. Had I known then what it might have cost I'd have simply flown back to Europe in the next flight ($600-800 at the time) and get the same thing done for under $100-200 with a full refund from…

USA dentists don't work on Sunday. If you had waited until Monday you would have had many more options. Besides what could she have possibly done to "fix a broken tooth" in one day? Nobody was milling crowns in the office a decade ago. If it was really just a filling, wow.

Do dentists in Europe work on Sunday? In my experience the grocery stores aren't even open...

Re: What I learned from reading a thousand emergency room bills

#229

Post by ams6110 »

ncallaway wrote: post #117
pitaj wrote: post #60

Earlier quoted context omitted.

Emergency situations are exactly what insurance is for. Emergencies account for a minority ( Nobody advocating for free market healthcare is expecting people to shop around in emergencies. People are expected to shop around for good insurance plans which will cover emergency situations to their satisfaction. That is why many free market healthcare supporters also support removing the incentives for employer-provided…

But, as described in the article that system does not function . Acquiring insurance does nothing to ensure that the facility you visit will accept that insurance. Further, even if the facility you visit does accept the insurance, that's no guarantee that all doctors within that facility accept that insurance. Even further, there's no guarantee you'll be conscious to validate that you go to a facility that accepts yo…

Proper insurance pays you for insured losses you incur.

When my car is damaged in an accident, I take it wherever I want to have it repaired. I don't have to think about whether the shop is "in network" or not. My insurance pays for the cost of the repair, up to the limits of my coverage. Simple.

Re: What I learned from reading a thousand emergency room bills

#230

Post by vec »

bluGill wrote: post #213
vec wrote: post #181

Earlier quoted context omitted.

> We do not have a free market. Most people get their health insurance from their employer - you cannot reasonably get insurance elsewhere What you are describing are in fact the freest parts of the health insurance market. Employers, quite rationally and of their own free will, choose to offer health insurance as a benefit because it attracts and retains talent better than other similarly priced incentives. The fact…

You are missing one critical point though: If I through my own free will decide that I want a different plan I need to come up with that $1000 difference that my employer is kicking in for me. If I could get that $1000 back to spend on my own I'd have the ability to choose a $1300 plan instead of the $1200 plan (for $1100 because of the factors you sight), that extra $200 out of pocket is much more affordable than th…

Gee, that sure does sound like a private dispute between you and your employer to me. If you want to opt out of your company's health care plan then you're more than welcome to go attempt to negotiate with your manager about raising your salary by the amount of their health care contribution. Best of luck to you.
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