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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

#241

Post by krupan »

SlowRobotAhead wrote: post #50
Arubis wrote: post #45

Earlier quoted context omitted.

The party responsible for payment (the government, in this case) can tell a billing party "I won't pay you more than ___ for that service, and if you don't like it, you can sue me" without taking on the same risk that an individual would. Lawsuits are a pretty inefficient, high-overhead way to bill out, so billing parties are incentivized to not raise accountants and auditors eyebrows.

I must admit I'm skeptical of the claim that "only government can negotiate a better price"... I think anyone that's worked on government systems knows that is not typically the case. Why wouldn't insurers argue for better prices now?

You have hit the fallacy on the head. Our (U.S.) system now is a terrible mess of regulations and tax breaks that drive stupid behavior. Single payer government health care is not the only alternative to what we have now. It would not produce maximums of quality, innovation, efficiency, satisfaction, or freedom. It would provide basic care to everyone.

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

#242

Post by krupan »

dv_dt wrote: post #69
SlowRobotAhead wrote: post #50

Earlier quoted context omitted.

I must admit I'm skeptical of the claim that "only government can negotiate a better price"... I think anyone that's worked on government systems knows that is not typically the case. Why wouldn't insurers argue for better prices now?

It works in 36 out of 37 modern OECD nations, with the US paying the most, and more than double all the other nations which have the government negotiate a better price. Even in our own VA system, their negotiated prices are lower for drugs than the Medicare part D program, barred from negotiating (and with large pieces managed by private companies). I think your skepticism should primarily be directed to wondering i…

Is cost the only measure we want to optimize for?

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

#243

Post by kupiakos »

UnpossibleJim wrote: post #26
vec wrote: post #14

Exhibit A for why "free market healthcare" is an oxymoron. I have yet to hear a coherent explanation for how anyone can reasonably expect for price discovery to even pretend to function in a market where the consumers can't even guess the prices until after they've already purchased and frequently couldn't reasonably be expected to refuse service even if they did believe it was overpriced.

Exactly. It's the same reason we don't have free market police and fire services. You simply don't get to "shop around" for emergency services, which includes privatized ambulance services (which are outrageously expensive, on the order of $12,000 for the ride I took when I had to take one, and it was a relatively benign one... thank god I had insurance). EMS is covered, but that's the Fire Department. After that, it…

> If it's cosmetic, then I could see the argument.

Then there's another problem: who defines what is considered "cosmetic"? Most insurance companies currently don't cover e.g. facial feminization surgeries for transgender women, even though they're considered medically necessary by WPATH, a document drafted largely by insurance companies [0].

[0]: https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_..., p. 58

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

#244

Post by setr »

tcoff91 wrote: post #195
Verdex_3 wrote: post #126

Earlier quoted context omitted.

I think pregnancy and labor is what's going to finally break the camel's back. Having children is a pretty basic part of being human. And the costs are such that even millionaires are going to feel it. When basically nobody can afford to participate in reproduction, something is going to go sideways. With my "good" insurance, I still ended up with a multi-thousand dollar deductible. Which I thought was problematic un…

Usually coinsurance is limited by an 'out of pocket maximum'. So even if something happens where you end up with like 600k in medical bills the most you will pay will be like 8-20k (depending on in-network vs out of network). Which is still insane but not as scary as six-figure medical bills despite being insured.

One issue with describing figures like 600k is that I think the medical industry has a lot of funny money running around. The doctor somewhat arbitrarily charges 10k to the insurance company, insurance disputes, the doctor hires a lawyer who takes 30% of the negotiated outcome, and negotiation finally ends up at $2k.

The patient sees a $10k bill, pays a $300 deductible, and only $2k ever actually materializes in the exchange between doctor/insurance. And afaict, this is the expected operation.

Of course, when you're uninsured, the numbers stop making any sense, because they fail to go through the convoluted process that reduces it. You just get the $10k bill and thats the end of story. But for the insured, a $10k bill is not $10k exchanged.

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

#245

Post by y-c-o-m-b »

sjg007 wrote: post #41
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…

You can try to appeal it.

Appealed twice and both times they denied it stating I didn't require the surgery despite the fact they pre-approved it and paid for all the in-network costs. I ended up paying it because I had the money and I couldn't handle the stress of a legal battle (which given what I've read is an uphill battle).

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

#246

Post by pitaj »

tgsovlerkhgsel wrote: post #62

Want to do something about it? Regulate it. Like literally, have some government body write a table: 1 pill of 400 mg paracetamol ............ $0.50 1 pill of 800 mg paracetamol ............ $0.60 prescribing medicine (once per day) ..... $4.32 base fee for an ER visit .............. $200.00 5 minutes of work by an ER physician ... $27.43 etc. and impose that as the maximum price that can be charged. It's not going t…

Ah yes, price controls. This has never resulted in problems like shortages before.

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

#247

Post by jmulho »

krupan wrote: post #119
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…

This! We have totally forgotten the definition and purpose of insurance.

The purpose of insurance is to pre-pay for a new roof every fifteen years and a teeth cleaning every six months.

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

#248

Post by ttcbj »

rootusrootus wrote: post #80
ttcbj wrote: post #24

Earlier quoted context omitted.

I was not an advocate for gov't health care, but I am now for the same reason you stated. I have a high deductible plan, and have tried to get quotes in advance, but never can. I have been ripped off multiple times, despite trying to do my research, etc. My wife is a doctor, and at this point, I think single-payer is the least bad option.

I find myself in the same boat. I've spent more from my HSA this year than I put into it (and I put in $6900) while I'm nowhere near hitting my deductible ($6K) because for whatever reason the insurance only thinks I've spent $2.7K. During this time I've tried to shop around, find the least expensive option (none of my medical needs this year have been urgent) and it's been impossible. Nobody can tell me. "You'd have…

For the record, this is exactly how I feel. They did it to themselves. I really believe in free markets, and I really see the downsides of gov't intervention, but my direct experience with this particular market says we'd be better off with the gov't.

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

#249

Post by krupan »

vec wrote: post #116
SlowRobotAhead wrote: post #30

Earlier quoted context omitted.

>have tried to get quotes in advance, but never can. >I have been ripped off multiple times, >I think single-payer is the least bad option. Can you help me understand why if everyone is paying for everyone's healthcare in a socialize system - how that reforms the transparency and stops the abuses?

Because it's not everyone paying for everyone's health care, it's one entity paying for everyone's health care (using funds they get from everyone). That one entity can unilaterally refuse to do business with abusive vendors. They can negotiate for lower prices. They can notice and investigate discrepancies in pricing between similar cases. They are in a position to judge which types of care are and are not cost effe…

"That one entity can unilaterally refuse to do business with abusive vendors. They can negotiate for lower prices. They can notice and investigate discrepancies in pricing between similar cases. They are in a position to judge which types of care are and are not cost effective and can refuse to cover the latter."

Having worked for companies that do government contract work (DoD, in particular), this line of reasoning always makes me laugh.

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

#250

Post by ams6110 »

ncallaway wrote: post #219
ams6110 wrote: post #206

Earlier quoted context omitted.

Yes, many people who advocate for "single payer" intend that to mean eliminating any private-pay option.

I don't believe that's true. What serious single payer proposals have been put forward that would eliminate private-pay, private insurance, or private care? I've never seen one. In fact, almost all "single payer" health systems that exist in other countries have private care and private insurance options. For example, such options are available in both the UK with the NHS and in Canada. I've never once spoken with an…

Bernie Sanders, for one, has advocated for the elimination of private health insurance by essentially putting everyone on Medicare.
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