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Congress is set to ban most surprise medical bills

nytimes.com

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Re: Congress is set to ban most surprise medical bills

#381
post #100

Earlier quoted context omitted.

> has turned me from a pure free market thinking into a believer in single payer healthcare The current trend in 'free-market economics' is to call captured markets free and then argue for the relatively lax regulation. Most markets are not free markets and the healthcare definitely isn't. There's very little true choice, participants are typically under duress when seeking expensive services, and prices are hidden.…

In practice, "free market" as a historically implemented policy has meant "remove all oversight and revoke any protections or governing laws and thus legalize all business practices (such as scams, collusion, price fixing, market manipulations) regardless of ethics and hand the legislative pen to the business leaders to write their own laws. Ban all forms of community governance, municipal ownership, or a people doin…

> In practice, "free market" as a historically implemented policy has meant "remove all oversight and revoke any protections or governing laws and thus legalize all business practices (such as scams, collusion, price fixing, market manipulations) regardless of ethics and hand the legislative pen to the business leaders to write their own laws.

The rule of law is important for free markets and breach of contracts needs to be punished to have a vibrant market.

Re: Congress is set to ban most surprise medical bills

#382

Earlier quoted context omitted.

That would only apply to the 10% of medical costs spent on emergency care. It makes little sense to operate the other 90% based on requirements that don't exist in those cases. Emergency care is also inherently local. You could operate emergency rooms under the same framework as you do fire departments. Which doesn't require a national fire department to manufacture the fire extinguishers you buy for your house or re…

But also doesn't require fire insurance for someone to try pulling you out of a burning building. I think diseases that take longer but are still affecting your quality of life are just as important to consider, but also think they distort decision making and fail to work like a free market as a result. The "free market" has failed to provide affordable dental care outside large insurance policies, which are inaccess…

> But also doesn't require fire insurance for someone to try pulling you out of a burning building.

Right, so your city should operate an emergency room funded mostly by taxpayers, and then just charge a fixed deductible (e.g. $1000) for emergency care, which isn't enough to induce bankruptcy in general but is enough to deter people from using it in place of primary care.

> The "free market" has failed to provide affordable dental care outside large insurance policies, which are inaccessible to almost a quarter of americans, for example.

Your link is to the promotional material of a dental insurance company.

Dental isn't generally a market that requires insurance. You need health insurance because heart surgery or chemotherapy is a six figure expense that would bankrupt nearly everyone. Paying $1500 for dental work doesn't require insurance, it requires a payment plan. It isn't an expense large enough to require insuring against.

Re: Congress is set to ban most surprise medical bills

#383

Earlier quoted context omitted.

I want a comprehensible restaurant-like menu. Likely not going to happen purely out of complexity if nothing else. Look at the list of ICD procedure codes[1] and imagine all of these with a price attached. Comprehensive, sure, but comprehensible? Ehhh.. pushing it. [1]: https://www.icd10data.com/ICD10PCS/Codes

Yup! And what will you do about it anyways? Like "Oh, you need xyz, it will cost $1000" Ok. Now that I know that, what am I supposed to do? Shop around? What if I'm in the emergency room, what then? Are they supposed to give me a price menu for every single drug or treatment they need to perform against me? "Hey, we'll do CPR, but that'll will be $100, please sign here so we can save your life". The ala cart method s…

For some perspective, I’m pretty sure there are a lot of non-Americans reading this thread amazed at just how comical current US thinking around healthcare has become.

Re: Congress is set to ban most surprise medical bills

#384

Earlier quoted context omitted.

A dentist office is more comparable to an urgent care clinic than a hospital. And in many cases an urgent care clinic can tell you what simple procedures will cost. There are imaging services companies that can tell you upfront how much diagnostic tests are going to cost as well. A broken tooth is a much less complex injury than a broken arm. In many cases you don't even need to be a dentist to diagnose it. Try walki…

I don't understand how this answers the question about X-ray cost.

1. Dental x-rays are more straightforward and involve fewer people, so the price is easier to calculate.

2. Dental x-rays are more often than not elective procedures. It's much easier to comparison shop elective procedures than emergency procedures. Therefore market forces frequently compel the dentist to come up with an up front cost for an x-ray.

The same market forces don't apply to hospitals because you can't wait a week or more while you shop around for treatment for a shattered hip.

Re: Congress is set to ban most surprise medical bills

#385

> Surprise bills happen when an out-of-network provider is unexpectedly involved in a patient’s care. Patients go to a hospital that accepts their insurance, for example, but get treated there by an emergency room physician who doesn’t. Such doctors often bill those patients for large fees, far higher than what health plans typically pay. How do courts uphold this? You go to a restaurant, they say you can buy the tas…

> and tipping to pay

Tipping is demeaning and derogatory to the person being tipped, especially in the manner it is done. Also, it can be reason for discrimination against the expected tipper. It always astounds me how people (mostly a lot of Americans) defend this practice just calling it "custom" and that it helps the receiver.

Re: Congress is set to ban most surprise medical bills

#386

> Surprise bills happen when an out-of-network provider is unexpectedly involved in a patient’s care. Patients go to a hospital that accepts their insurance, for example, but get treated there by an emergency room physician who doesn’t. Such doctors often bill those patients for large fees, far higher than what health plans typically pay. How do courts uphold this? You go to a restaurant, they say you can buy the tas…

> and tipping to pay Tipping is demeaning and derogatory to the person being tipped, especially in the manner it is done. Also, it can be reason for discrimination against the expected tipper. It always astounds me how people (mostly a lot of Americans) defend this practice just calling it "custom" and that it helps the receiver.

> Tipping is demeaning and derogatory to the person being tipped, especially in the manner it is done.

Why?

Re: Congress is set to ban most surprise medical bills

#387

Earlier quoted context omitted.

> Yes it is. No it isn't. Speaking of dodging the point. The US didn't remain in the private system, it half-socialized it. And you must know Canada's system has been increasing in cost like everyone else's. And speaking of magic single-payer economics for the good of all, what's up with that "socialized" army you mentioned? Most expensive in the world also. I expect the very same wanton mishandling of other people's…

> The way a market works is people find ways to serve people at a price they can afford. When you always force others to pay for the cadillac service for them, no one bothers to find cheap ways to provide healthcare. How can you be so twisted up about this? Americas system is the expensive one, everyone else's is cheap, and controlling costs better. Medicare may not be doing a perfect job but again it's controlling c…

> R&D spending? Guess which healthcare companies spend the most on R&D? It's not the American ones. It's all the European ones. #1 is Switzerland's Roche. #4 is Switzerland's Novartis. #6 is France's Sanofi. #9 is the UK's AstraZeneca. #10 is the UK's GlaxoSmithKlein. [1] This is yet another failed talking point.

Roche has over 8000 employees in the US. https://www.roche.com/careers/our-locations/americas/usa.htm

A handful of giant international companies who obviously make a big fraction of their money in the US market (selling at higher prices due to the lack of price fixing) do not provide a useful metric. Try overall stats, such as here: https://efpia.eu/publications/data-center/the-pharma-industr...

And that'd just pharmaceuticals. The US has far greater dominance over other areas of biotech.

But you're right, I do need to move on. This immature flaming behavior is why I avoid toxic places like reddit.

Re: Congress is set to ban most surprise medical bills

#388

Earlier quoted context omitted.

"People love their insurance!" Is a dead giveaway that a politician is a sock puppet. Biden kept saying it during the primaries.

I'm not a politician and I will say: I love my insurance. Because it's actually pretty great.

My insurance is good, but I wouldn't need it if we had a sensible alternative, and neither would you. And many other less fortunate people (including those in my immediate family) wouldn't need it either. Not wanting to give up your insurance because you "love" it (fucking gag me) is "fuck you I got mine" energy. Cancerous to a society.

Re: Congress is set to ban most surprise medical bills

#389

Earlier quoted context omitted.

Free markets generally work better the less leverage one party has over another. When the negotiation is "pay up or die" then it's de facto not a free market [1] and the government has a responsibility to step in and address it. The minimum viable remediation is a two-tier system in which the government takes the "or die" out of the conversation. The best approach IMO is single-payer where the government takes the "p…

Why doesn't the pay-up-or die model apply to food or shelter?

If you found yourself in a situation where getting food or shelter now was a matter of life and death, and you effectively had only one supplier, it would. But you usually have time to find alternatives, and usually can skip the shelter altogether, and the markets are so large that it's usually hard for a supplier to form a monopoly or a few to form oligopoly.

On top of that, even "pay-up-or-die" doesn't mean that the price will be a billion dollars. Instead, it means that it's the price that maximizes total profits. Suppose that no one could ever pay more than $30,000 for the medical helicopter. Then the helicopter people would set a price that prompts people to pay as close to $30,000 as they can. Perhaps if patients see a bill for $50,000 they negotiate down to $30,000, but if they see $500,000, they go to court and only at the end pay $30,000. Similar dynamics can limit food prices in areas that really only have one food supplier - there's only so much you can charge, and if you charge more than that, you won't succeed in squeezing more out of them, but you may attract all kinds of trouble - violence, or legislation, or competitors, etc.

Re: Congress is set to ban most surprise medical bills

#390

Earlier quoted context omitted.

In practice, "free market" as a historically implemented policy has meant "remove all oversight and revoke any protections or governing laws and thus legalize all business practices (such as scams, collusion, price fixing, market manipulations) regardless of ethics and hand the legislative pen to the business leaders to write their own laws. Ban all forms of community governance, municipal ownership, or a people doin…

> In practice, "free market" as a historically implemented policy has meant "remove all oversight and revoke any protections or governing laws and thus legalize all business practices (such as scams, collusion, price fixing, market manipulations) regardless of ethics and hand the legislative pen to the business leaders to write their own laws. The rule of law is important for free markets and breach of contracts need…

Historically, those who legislate and wield power have not invoked it in that way.

That's the point. "Deregulation" is code for taking hundreds of laws and dumping them in a garbage bin. "Privatization" is code for stealing tax dollars and hiding it in offshore accounts.

I only care about the actual, real world material reality that has historically factually happened. The champions politic in a way that tends strongly away from rule of law as quickly as possible.

It's a framework that gets invoked to go both ways. It's a vendor's "freedom" to not have to label, say, gmo, but then it's the vendor's "rights" to prohibit soy milk from using the label "milk".

"Freedoms" and "rights" get interchanged to rationalize the preconfigured results. The dogma is a general tool.

It was the "freedom" of agrobusiness to flood mexico with corn after NAFTA and run the local farmers out of business and then it was their "rights" to the marketplace when mexico pushed back. The farmers didn't have that same right to the marketplace, they didn't have the same freedoms, only international capital does. How convenient.

That's why the zealots always think it's the right answer - it can be reshaped like a mound of clay to justify and rationalize whatever they want.

For instance the sanctity of contract matters when it's with the gas pipeline company but not when it's with the american tribes

When instead it's a pipeline of people via a subway through a wealthy neighborhood like the purple line extension in Beverly hills, all of a sudden the free market gets invoked to guess what? Reach the opposite conclusion.

It's fundamentally a convenient power tool of capital. They used to use the Bible, now they use Friedrich Hayek. Skullduggery with the purest, most heavenly goals. Sure...

In practice, free markets are lawless raw power that bend the state to do their bidding like some feudal king, but now it's wearing a bowtie and a cardigan instead of a sceptre and a robe.

Same thing, different era.

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