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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

#361

Post by dalore »

HamSession wrote: post #201
dalore wrote: post #180

Earlier quoted context omitted.

There is a faulty assumption that higher cholesterol leads to higher risk of heart disease, but the fact the opposite is true. http://www.zoeharcombe.com/2016/11/familial-hypercholesterol... A few of the other facts/assumptions you make are outdated. Statins do very little to improve mortality. Inflammation can be reduced by cutting out carbs and sugar. Eating more saturated fats and omega 3 also reduces your risk of…

I wouldn't put much faith into the non ldl hypothesis we have extensive studies that show that lower cholesterol (total and ldl) cause less myocardial infarctions. [1] https://www.nejm.org/doi/pdf/10.1056/NEJMoa1405386 People with a gene that naturally produces lower ldl levels lead to less Hard CD events. [2] https://www.thelancet.com/journals/lancet/article/PIIS0140-6... Statins cause less heart disease and strokes…

[1] This study makes the assumption that lower ldl is less risk and then looks for mutations in genes that lower ldl. It's putting the cart before the horse.

> e. In each study, we estimated the odds ratio for disease among carriers of any NPC1L1 inactivating mutation, as compared with noncarriers. We then calculated the summary odds ratios and 95% confidence intervals for coronary heart disease among carriers, using a Mantel–Haenszel fixed-effects meta-analysis without continuity correction

[2] This starts off by saying that if we gave statins to 10000 people who are at risk that it would help 1000 and 500 people only. In addition 100 people might have adverse effects. If you ask me, an expensive drug that barely helps and only increases mortality by 5 days on average isn't worth it, and it comes with chances of adverse affects. If we just eat foods high in saturated fats and raise our HDL that is far better.

[3] a meta analysis of randomized trials. Says 11 out of 1000 patients had a reduction of major vascular events. So that is saying out of 90 or so people who take statins, only 1 of them will see any benefits.

Basically statins are poison that give hardly any benefit and treat an assumption that lower ldl leads to less heart attacks.

Try this one https://bmjopen.bmj.com/content/5/9/e007118.full

> The median postponement of death for primary and secondary prevention trials were 3.2 and 4.1 days, respectively.

The average life increase of taking statins is 4 days!

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

#362

Post by Sohcahtoa82 »

defen wrote: post #326
Sohcahtoa82 wrote: post #313

Earlier quoted context omitted.

Nope. Wage garnishments and liens only happen with debts to the government such as unpaid taxes, child support, or fines.

Ok but can't the hospital (or the collections agency) take you to court? Let's say you have 100k bill from the hospital that you just ignore. They sell it to a collections agency for 60k. You refuse to pay the collections agency. Now what happens?

Did some more research on this...

Yes, the hospital or collections agency can sue you to try to garnish your wages. If they win, you're boned.

If they lose, or they never sue for garnishment, it's unclear what happens if you refuse to pay. From what I can tell, the debt disappears from your credit report after seven years, but the debt is still valid and they can still try to recover the money from you, but they won't be able to use the courts to do it.

However, there's always the option of declaring bankruptcy. Even if they garnish wages, declaring bankruptcy will wipe it away. Obviously, that's the nuclear option and will destroy your credit rating for seven years.

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

#363

Post by freeone3000 »

h4b4n3r0 wrote: post #196
freeone3000 wrote: post #176

Earlier quoted context omitted.

Huh? Tax rates are not 20% higher in Canada than in the US, and we somehow muddle through.

That’s why I deliberately did not say income tax rates. They ream you in other ways. Canada’s taxes as percentage of GDP are 31.7%. US is 26%. And on top of that I was referring to Western Europe, where they are close to or above 50% GDP.

That's still 6%, not 20%. (It also pays for college tuition, childcare, and parental leave.) It's also a bit weird to do it as gdp percentage instead of individual percentage, which obscures the individual/business split.

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

#364

Post by sigvirt »

Propublica [1][2] has done some investigation into the amount of waste, beginning with a 2012 report by the Institute of Medicine of the National Academies. The unnecessary costs amount to roughly 5% of US GDP. For comparison: the defense budget is about 4.5% of GDP, and Social Security Disability Insurance outlays are about 5% of GDP. NASA's budget is about 0.1% of GDP.

A number of other commenters have castigated politicians on suspicion of being in the pocket of insurance companies or health care companies. Sure such things may happen occasionally. More certainly, politicians and bureaucrates are regularly attentive to the budget and financing of the government.

If medical care was cost efficient, it would 1) reduce GDP and the appearance of economic growth, and 2) wreck the back office math concerning whether the federal government can afford the deficit and the interest on the national debt. Elimination of mass incarceration and criminalization would cause a similar dilema. US economic growth has been 2-3 percent in recent years. If that were negated by substantial reduction of waste-masquerading-as-productivity, then the federal budget could not be financed without massive cuts or dramatic manipulation of interest and inflation rates.

There are others who potentially benefit from denial of treatment or claims beside the insurance company. Beside the doctors, medical institutions, and insurance companies are another set of actors: the benefits management and payment processing companies, who often profit per transaction. Some of the calculus in this camp can be seen in [3]. This part of the system (and others) can benefit when a patient is denied or discouraged from or uninformed of curative treatment and manipulated into some ongoing palliatve therapy - despite the possibility of greater overall long-term cost. The cash-flow gets distributed differently than curative treatment, and there are more smaller on-going transactions enabling a higher percentage of skim.

[1] Sep 2012 - https://www.propublica.org/article/a-costly-equation-medical...

[2] Nov. 2017 - https://www.propublica.org/article/a-hospital-charged-to-pie...?

[3] Nov. 2017 - https://www.bnymellon.com/us/en/what-we-do/business-insights...

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

#365

Post by loeg »

Marazan wrote: post #250
loeg wrote: post #211

Earlier quoted context omitted.

> Hospitals should be legally mandated to accept replacement of materials in lieu of payment. > If I can source the same stents for cheaper than the hospital bills me, they should be required to erase them from the bill and accept them as material replacement. Meh. The only reason they inflate supply costs is because that's where insurance negotiations let them. Mandating supplies must be available at-cost to consume…

Health care is not a regular market. You can't shop around for emergency care when your leg is severed or you are unconscious in a car accident. Healthcare can and should be heavily regulated, its not like buying a hammer.

Emergency care is not a great market to be a buyer in, but that does not change that market economics apply. And it is beside the point. The vast majority of healthcare is boring, predictable, non-emergency expenses that can be shopped around.

I agree that regulation makes sense, just not with the extremely specific proposal that medical devices be sold at cost (or whatever slightly higher unit cost is available to consumers).

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

#366

Post by loeg »

antisthenes wrote: post #215
loeg wrote: post #211

Earlier quoted context omitted.

> Hospitals should be legally mandated to accept replacement of materials in lieu of payment. > If I can source the same stents for cheaper than the hospital bills me, they should be required to erase them from the bill and accept them as material replacement. Meh. The only reason they inflate supply costs is because that's where insurance negotiations let them. Mandating supplies must be available at-cost to consume…

Trivially disproven by UK's health care system, which consistently ranks #1 in the world by outcomes and employs price caps for health care suppliers. https://www.commonwealthfund.org/press-release/2017/new-11-c... > Mandating supplies must be available at-cost to consumers is just a stupid cost-shifting game. That's not what I suggested in my post at all. Also, if it reduces costs for the end consumer, what's the ha…

NHS is a single-payer system, which is one of the solutions I proposed.

Yes, mandating supplies be sold at-cost is exactly what you proposed:

> Hospitals should be legally mandated to accept replacement of materials in lieu of payment.

> If I can source the same stents for cheaper than the hospital bills me, they should be required to erase them from the bill and accept them as material replacement.

And to address:

> Also, if it reduces costs for the end consumer, what's the harm?

The problem is in the condition. At the end of the day, ineffective regulation increases costs for the consumer.

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

#367

Post by loeg »

logfromblammo wrote: post #263
antisthenes wrote: post #165

Earlier quoted context omitted.

Hospitals should be legally mandated to accept replacement of materials in lieu of payment. If I can source the same stents for cheaper than the hospital bills me, they should be required to erase them from the bill and accept them as material replacement. It's not as if medical supplies are unavailable to the end consumer. https://www.esutures.com/product/0-in-date/41-boston-scienti... Here are the stents available…

Nope. No way. Have we learned nothing from "fulfilled by Amazon" counterfeits? The supply chain has to be verifiable as genuine goods from the factory to the hospital floor. Trying to verify the authenticity of patient-supplied replacements would be a nightmare.

Yes. It would be expensive, and that cost would be pushed onto consumers in some other way.

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

#368

Post by chrisbennet »

sturgill wrote: post #254
rdtsc wrote: post #52

> St. David’s HealthCare defended its handling of Calver’s bill and sought to blame the school district and Aetna for offering such a narrow network. So while dying of a heart attack he should have been negotiating with the ambulance driver, the paramedics, the nurses, each intern and doctor to make sure they are "in-network". > St. David’s said it was now willing to accept $782.29 to resolve the $108,951 balance bec…

I once got cut by a skate playing hockey. Showed up at the hospital pulsing blood from my leg. My first question to them, “Do you take X insurance?” Only after they assured me that my insurance would be accepted did I drag my bloody leg into the care room. Turns out the doctor that the hospital assigned to me did _not_ take my insurance. I got billed the full amount, yelled very loudly at lots of people, and when I “…

”But next time I need stitches I think I’ll just opt for the super glue in my workshop...”

Super glue aka “Dermabond” https://emedicine.medscape.com/article/874047-overview

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

#369

Post by DesiLurker »

whamlastxmas wrote: post #289
DesiLurker wrote: post #143

Earlier quoted context omitted.

whats amazing to me is how little money it takes to sway a politicians vote. yes there are big numbers in the list but most of them are 10s of thousands. its just amazing that they are willing to put their conscience aside and condemn people to bankruptcy or worse for that little. for the worshipers of free market they sure are selling themselves off cheap.

The problem isn't that they're bought with $10k. They're approached and told "Take this money or we'll give your competitor $5 million to campaign and take your place". And they know they follow through with the threats, so they take the $10k.

but even that should ultimately bid-up the bribes after all its a 'free market'!

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

#370

Post by bmmayer1 »

lacker wrote: post #330
bmmayer1 wrote: post #133

Earlier quoted context omitted.

> 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.

For what it's worth, I'm not interested in blaming the corporation for trying to raise profits. I just think that clearly the system is not ideal, and the right way to fix the system is probably different depending on whether the diagnosis is 1/ inefficiently-operating nonprofits or 2/ non-consumer-happiness-optimizing corporations.

Right, I definitely agree with you. My only point was that it's easy to point to villains but real solutions are structural.
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