Using AI to negotiate a $195k hospital bill down to $33k

Obamacare attempted to make the US healthcare system into a universal system by mandating that people purchase coverage, heavily subsidized to become affordable to every income level, in addition to massive expansion of Medicaid to those with the lowest levels of income or no income at all. Automatic enrollment in health insurance exchanges, even if people did not make their own choices on the health insurance exchanges, is what would make the US system universal health care.

Universal means that everyone has coverage, that the question to the patient is "what insurance plan are you on," rather than "do you have insurance." And making coverage universal has no connection to lowering costs. We need larger structural changes in the logistics of how care is delivered and how the money flows.

Single payer is another choice to be made, but that doesn't necessarily mean that health insurance is cheap, that all the care gets delivered that people want delivered, etc. Medicare is often cited as one direction for this, but most don't realize that private health insurance costs are partially high because they help subsidize the care of those who are covered by Medicare, because Medicare reimbursement rates are far lower than any of the private insurers have been able to negotiate.

Other routes are full decoupling of insurance from employment, full price controls that normalize Medicare and private insurance rates, which either make health care more free market or less free market depending on how you define those terms.

However every year that passes makes any of these reforms more difficult because administration of the costs and billing is getting more complex each year. ICD codes, PLA codes, all that stuff grows in complexity.

HMOs, like Kaiser, may provide a route towards greater simplicity of administration of health and costs.

But implementing any large change will require political buy-in of people, and when we have our current low-trust, high-misinformation political system there's been no way to make any political traction for changing anything. Until we regain a functional democracy or turn to full dictatorship, it seems unlikely that we will see structural changes that improve anything. Hell, we had Republican states actively trying to prevent poor people from receiving coverage from federal dollars. How can we ever come to terms with a change unless that sort of attitude no longer has traction?

But taxing capital gains at the level of ordinary income would be an immense change our tax code. All sorts of things the broader economy would change as a result. If you accept Sanders plan, you're not holding to your original constraint of changing only the health financing system.

I want to be clear that I'm not stipulating that families would be better off under M4A if you didn't do this: I still think your argument has the fuzzy end of this lollipop. I think it's unlikely that you will come up with a set of numbers for any proposed single-payer health system that leaves the median family with private health insurance better off on a take-home basis. I'm making a strong claim, so you should be able to knock it down straightforwardly if I'm wrong, and I'm interested to see if you can.

* Free tele psycho-therapy. Not sure what the limit is but it's >= 2 hours per week. I even cancelled same-day once with no fee. The quality of the care was also very high.

* I developed wrist pain from typing, holding a Steam Deck, starting pull ups. I was able to see a physical therapist at the Google office (through an embedded One Medical) after 1 week. No referral needed. Saw them once per week for 5 weeks paying $20 co-pay each time. They fixed my issues permanently.

* I also occasionally used the Google One Medical locations (and public ones) for injuries from a low speed bike crash, vaccines, etc. Don't think I ever paid more than $20 for anything. On a Google income that amount is completely inconsequential.

Even if they only get to keep up to 20%, doesn't mean they will pay a dime of what they can get away with not paying.