How is this different than the scam where they charge you $300 for what would usually be a $30 dinner?
We need to socialize the healthcare in the USA and put a stop to this crazy billing practices. (Maybe send a few execs to jail too) Canada really has the right idea here, as even if you are making $bank here, you can be fired for any reason/no reason and health insurance will end. IMO this is by design, as it is much more difficult to leave a job if insurance will end.
Socialize what part of healthcare? Canada generally doesn’t have socialized healthcare providers, only socialized insurance. So providers could still engage in these sorts of billing practices in the Canadian system. Conversely, whatever rules prevent such billing practices in Canada could be applied in the US without socializing anything.
The concept of “socializing the health system” papers over the really important issues. Countries with universal healthcare don’t actually have a uniform system. They all have quite different systems. The Netherlands, for example has private insurance and private providers. The U.K. has no insurance and public providers (doctors work for the government). Other countries have various things in between. Single payer, like Canada has, isn’t even the most common system. Overlooking these distinctions means you may not fix the relevant problems. You can “socialize” insurance, but if you don’t impose controls on billing it’ll just be a different entity being overcharged.
> Socialize what part of healthcare? Canada generally doesn’t have socialized healthcare providers, only socialized insurance. So providers could still engage in these sorts of billing practices in the Canadian system.
The NHS is going to tell them to get bent, that they're paying the agreed upon price for the act and don't care about the rest of their bullshit, and if they're not happy with it they can close their office.
> Conversely, whatever rules prevent such billing practices in Canada could be applied in the US without socializing anything.
It's not "whatever rules". The NHS can negotiate prices and is interested in balancing keeping costs down with having providers.
Not only is this not a thing which can be "ruled", Congress (the GOP) has literally willed away the one lever the US Government has to do this: the Secretary of Health and Human Services is legally forbidden from negotiating prices on Part D prescription drugs.
And even then that'd only be for Medicare itself (though HR3 intends to not only reverse this but makes this negotiation a binding MSRP): the VA can and does negotiate drug prices, but that doesn't benefit people who are not under VA.
In a single payer system, the single payer in question has both incentive and leverage.
> The NHS is going to tell them to get bent, that they're paying the agreed upon price for the act and don't care about the rest of their bullshit, and if they're not happy with it they can close their office.
The Canadian system has socialized insurance plus price controls. But those are two separate things—you can have one without the other. The Swiss system, for example, has price schedules, but not “socialized” medicine.
As to drug pricing: you’re repeating FUD about Medicare. What should clue you in that this is FUD is that, for the most part, Medicare itself doesn’t cover prescription drugs. (Only drugs you get during a hospital visit.) Prescription drugs are covered by an optional program called Medicare Part D, which is provided through private insurance. So yes, the Secretary of DHHS isn’t permitted to negotiate prescription drug prices for Medicare. That’s because that’s the role of the Prescription Drug Plans under Part D. The private insurance plans that are offered under Part D do negotiate drug prices. See: https://fas.org/sgp/crs/misc/IF11318.pdf
> Determination of Drug Prices in Medicare Part D
To bolster market competition and limit the federal role, the MMA included a non-interference provision (Social Security Act (SSA) §1860D-11(i)), which states that in carrying out the requirements of the Part D program, “the Secretary: (1) may not interfere with the negotiations between drug manufacturers and pharmacies and PDP sponsors; and (2) may not require a particular formulary or institute a price structure for the reimbursement of covered part D drugs.”
> Part D sponsors, working with pharmacy benefit managers (PBMs), negotiate prices with drug manufacturers and contract with pharmacies to dispense drugs to plan enrollees. Negotiated price concessions mainly take the form of rebates (after-sale reductions) from a manufacturer’s list price for brand-name drugs.
I am in Quebec and here the state sets the rate for every single reimbursed act. Doctors can opt out of the public system, but then they can't take any reimbursement from it at all. It's all or nothing. Needless to say that the overwhelming majority of doctors opt to stay in the public system.
I assume it's similar in other provinces and therefore your premise is mostly wrong.
It's called a Medical Cartel run by Physicians through regulatory capture. There's plenty of leeches upstream (pharmas, hospital admins, PBMs, vendors, you name it), but at the base of the funnels are doctors holding keys to supply through state-level licensing regulations.
Physicians are in an incredibly privileged position.
In no other profession can one murder a quarter million Americans annually(1) via chart reading apathy or gross incompetence at multiplying by 10, and not only keep one's job, but get paid for rendering the botched services, as well.
Imagine being a plumber who gets paid after making your customers' leaks ten times worse. That's the life of every doctor in the US.
It’s not irrational. Europe spent decades in economic doldrums before the Thatchers and Merkels and Blairs forced reforms and liberalization. The US largely avoided that. (Though, we’re still stuck with the legacy of FDR, and in many respects Europe is overtaking is on economic liberalization and deregulation.)
As to ACA, it’s a step toward what’s basically the Dutch or Swiss healthcare model. We don’t need to socialize insurance or healthcare services to have a workable system.
Is that so? By whose standards? Europe is doing fine across the board. There are fewer billionaires but at the same time we don't have medically induced bankruptcies.
> We don’t need to socialize insurance or healthcare services to have a workable system.
You probably do. Simply because disease is distributed randomly (or actually: worse than randomly), unlike wealth.
I could see the case for Blair being a reformer and pushing an agenda of liberalization, much less so for Merkel and Thatcher left the UK in much worse state than she found it even though somewhere in the middle of her rein things were marginally better.
Whose healthcare did the Republicans decimate? People get worked up any time the system changes (e.g. Obamacare caused some people to lose their health insurance plans and in-network doctors); many Democrats were voted out of office after the passage of the ACA. The Republicans realized that and (narrowly) chose not to repeal Obamacare.
The point is - in case that isn't clear yet - that both Obamacare and whatever is the current flavor of the month are both absolutely terrible for the voters and yet they continue to self-flagellate in spite of there being many examples of properly run healthcare systems.
EDIT: I misread the “here” as “Canada”. The US healthcare system has caused me some personal hardships, so I was surprised Canada had something similar. Luckily it’s more sensible.
The U.S., through employer-provided private healthcare, has not just wage slavery, but pseudo medical-slavery. If you quit your job (In the U.S.), you lose health your employer-provided health insurance and could be stuck footing the $28k bill (or at least having to negotiate / deal with it) for a sore throat.
Canada does not have such a system. Canada has taxpayer-funded healthcare. Therefore you have the liberty to quit your job and find more favourable employment without having to deal with the risk of one surprise hospitalization from bankrupting you.
GP is saying Canada did that right. The confusion arises because GP said "here" right after praising Canada, possibly misleading you to think they were referring again to Canada, which they were not.
I was referring to the non-transferability of health insurance in the USA; e.g. you get fired at Microsoft or anywhere with great healthcare and that is only extendable temporarily via COBRA. Then you either have to find another job or get insurance through one of the Obamacare exchanges. What I am arguing is that this reduces the mobility of labor.
Also as someone who has switched jobs in the last year setting up new insurance/dentist/optometrist multiple times is a absolute waste of my time and would be entirely eliminated if we stopped tying insurance to the employer.
Our current system puts a huge time burden on healthcare "consumers" despite being vastly more expensive than any remotely similarly-effective system. This time burden falls largely, though not entirely, on the sick and their families. It's straight-up inhumane, given it's clearly not necessary.
He is asking why is it good for the workers. You're basically advocating for price controls on one field. How would you like if you were only allowed to make $30/hr for writing code?
We already have massive shortages of doctors (and nurses, I think). This will only make it worse.
We don't have massive shortages of Doctors, we have shortages in locality. The same places where there is joblessness (think Apalachian Mining towns), you find a lack of doctors.
There's no shortages of doctors, or nurses in major cities.
AFAIK every single other OECD state has explicit or de-facto (via monopsony) price controls for much of the healthcare sector. Hell, even non-OECD free-marketer-beloved Singapore does.
I would, no kidding, love to see any example of a successful, modern healthcare system that doesn't employ price controls to keep costs from getting out of hand. Allowing "successful" and "modern" to describe the system in the US, it's the only one I know of that doesn't.
... which means you can go look at them to see how it's working out. Again, I am legitimately interested in learning about any healthcare system in a state with an advanced economy that doesn't employ price controls in one form or another, but in the meantime, instead of spitballing about what a disaster it might be, we can just look at, AFAIK, literally any other such state to see how it works out. Dozens of examples.
> You're basically advocating for price controls on one field.
I'm not advocating for anything; it wasn't my comment. I just couldn't be sure what the poster was referring to, as the original comment was convoluted.
> The third reason for the high bill may be the connection between the lab and Kasdan's doctor. Kasdan's bill shows that the lab service was provided by Manhattan Gastroenterology, which has the same phone number and locations as her doctor's office.
They really buried the lede there. This sounds like fraud. She went to her doctor, who, I'm guessing, is in-network since the article says he was her primary care physician. The doctor operates a lab that is not in same network he operates his practice in? Is that some kind of coincidence? Is there any other reason for that except to bilk money out of the insurance company?
It’s weird how the argument in America is always socialised healthcare VS private healthcare. Rather than people just demanding non-insane private healthcare. I have private healthcare here in the UK through work and it costs £150 a month to add my wife too, for one of the best plans around.
Possibly, but there's also the fact that private providers in the UK don't usually cover emergency, ICU, primary care or maternity care. It's more of a top-up service to avoid waiting times on the NHS. They also have a tendency to drop their patients who suffer complications after surgery back into the NHS
It seems like it is not health insurance, but more of a health scam, if you can be dropped when if they find out you really need the money to pay for "complications."
Exactly! Competition is what makes capitalism work, otherwise you just have a monopoly and then everything turns to crap real quick.
We have a similar problem in a way with our trains. They’ve all been ‘privatised’ but if only one train company runs your route there can’t be any competition, so our trains suck big time and are really expensive.
Competition in the UK railway system isn’t about competition for consumers, but competition for the long-term contracts for operating services. This is a totally valid form of competition and does not mean that a monopoly exists in the sense you seem to think it does.
For a business to be good for customers it needs to be accountable to those customers. These businesses are only accountable to governments and even then only ever X years when the contract comes up for review. Their motivation is therefore to service the government not the customer and the customer suffers.
Not only that, there's also only one Network Rail doing the maintenance. So the local monopoly on passengers relies on another monopoly.
End result is it costs upwards of £4k for an annual pass for a half hour train journey.
Add to that the fact that nobody would ever allow the trains to cease operating, and you have a really big question mark over what the point of privatizing was?
Do you understand what they were like when they were public? Costs have fallen dramatically, prices are actually way down, the govt subsidy is down (although will rise again with HS2), and service quality/output is up.
We know this doesn't work because we tried it and it didn't work.
But it doesn’t hold water. France, Germany, Spain all have cheap, really good government-owned trains - in fact they also operate some of our trains in the UK and use the profit to fund their own trains.
Prices have gone up by the maximum operators are allowed to increase them every year (there’s a 1 year exception where I think they were frozen for political reasons) https://www.bbc.co.uk/news/business-49331238
Just because we tried something before and did it badly doesn’t mean it won’t work in future if done well. Execution is everything, right?
Left out is the specific reason why you think it will work well in the future.
Define really good? They are less safe, the prices charged to consumers may be lower but what is the overall subsidy (I understand that you want other people to subsidise your commute...other people tend not to be happy about this), and it is fair to say that UK trains are less punctual but the difference is not massive (and we do come ahead of the nations you mention some years too).
The discussion on this in the UK is pathetically weak, and largely a function of trade union lobbying (if you didn't know, the TUC pours money into this cause like nothing else...presumably they just really really care about commuters).
The even worse part is that the government funds network rail. So we have privatised the parts that make money and kept public the bit that costs money.
In Israel, I had mandatory healthcare that I paid taxes for (about $100 a month) and additional private coverage for about $5 or $20/month (can't remember how much) and thats all you'd ever spend on anything. Even hospital parking was reimbursed. People in the US act like it's either/or, but why can't it be like USPS and UPS? USPS works fine for 99.9% of all deliveries and you can pay extra for UPS if you want to. Healthcare should be the same - Why would I go to a private doctor for a simple throat culture? Makes absolutely no sense.
People regularly oversimplify this problem as socialized vs private healthcare without considering why American healthcare is so broken. If you look carefully at the problems, you see that they won't go away if the government replaces private insurance and expands Medicare for everyone.
These problems include a tremendous shortage of doctors [0]. Even Canada and the UK have more doctors per capita, and they are known for extremely high wait times (the jokes of the socialized medicine countries, so to speak). There are a number of possible reasons for this, most notably the hassle of occupational licensing (12-14 years of expensive college + 'indentured servitude' residency in the US).
Nonetheless, American healthcare science is still ahead of the curve and subsidizes socialized countries -- ~60% of all new drugs between 2001-2010 were invented in the US, and foreign dignitaries of socialized medicine countries often still get important procedures done in the US [1]. It would be interesting to see how the R&D dynamic plays out if America loses its market incentive to innovate in the space, and no other developed countries have the financial incentive left.
Our medical licensing system isn’t “indentured servitude” in the long run. It is convoluted precisely to benefit medical practitioners by artificially decreasing the supply of labor and reducing competition. Medical organizations largely want our med school and residency status quo to remain. Only recently, after bizarrely warning of an impending doctor surplus in the 90’s, have they stopped lobbying against increases in the number of residency positions.
I've used the Swiss system as well as the NHS and private UK systems.
The Swiss seem to have something right. They have actual competition between insurers, though you are restricted to changing supplier at the annual window. Everyone is obliged to buy basic coverage from somewhere, but you can choose. And the obligatory level is fairly cheap, maybe a few hundred CHF per adult per month (kids cost fractions of an adult, basically nothing). You can then add on perks like guaranteed single rooms and such, costing as much as they can get you to pay.
In return you get a service that seems magical. My colleague crashed his bike and needed stiches. He was at work in the morning only slightly later than the normal time. The time I needed the emergency room I wondered how on earth that could be room, it was empty. When my wife gave birth it was like a hotel stay, they even fed me (the father) three meals a day for the best part of a week.
The NHS these days is super stressed. Everyone seems busy, the halls seem very old and crowded. If you're not bringing in a kid, be prepared to wait. And there's plenty of articles about waiting times and busy staff, which seem believable given I know some of those staff.
UK private seems to work nicely if you can pay for it. I had a couple of knee operations, and everything was very comfortable. Barely even saw another patient, and there were lots of people attending to me.
I regularly use NHS ER (not personally, fortunately) and it is a joke. The hospital local to me is notorious for fudging waiting time numbers, the longest wait I have had is 36 hours, and even when it is literally deserted it will still be 6-8 hours...I have no idea why or how (there are tons of staff, quite what they are doing is unclear).
Also, I live in Scotland where the NHS has been getting more money for a while...still awful. The NHS drop massive wedges of cash on vanity projects (always over budget, usually issues because of poor project management) but never hit waiting time targets. Definitely, there is an issue with care and old people having to stay in hospital...but there is also something far deeper (my area is rural, total population of 30-40k...the NHS just dropped £75m on a ten-ward hospital...I go there four or five times a week, 75-80% of the people you see walking around are staff).
I don't know what the solution is, I just know that other countries do it better and they have larger private sectors.
>Rather than people just demanding non-insane private healthcare
There is no such thing. A free market for healthcare will end up with people being trapped or simply lacking access. The entire concept of insurance is just a middle-man on a necessary service, one which should be considered a right for a society as rich as ours.
You either massively regulate private companies to force them to cover sick poor people at a big loss and compensate by making healthy people pay more, or you just get rid of the middleman and cover everyone directly (single payer).
Seriously, what value do insurance companies provide? How is it not just rent-seeking on people's health?
Private health insurance in the UK is not comparable to a fully private health system, and you can’t draw any conclusions from the cost of your coverage. Private insurance here mostly covers some specialist referrals, faster access to scans and treatment, and private hospital access. Acute services and long-term conditions are still handled by the NHS.
One third of our healthcare by cost is socialized in the US, and yet people seem to not understand that basic fact. There is no anti-socialism debate, it already is one third socialism.
It is also a little bit more complex than that because, of course, by cost means you underweight the size of the public sector which typically pays far lower prices. As an outside observer, charging the private sector more is a smart way of subsidising the public sector.
(No-one seems to have actually read the article, it says that her insurer would have paid ~$650 if the lab wasn't one owned by the doctor she saw...and, if I understood correctly, the doctor also did a whole bunch of totally unnecessary testing...this looks a bit like plain ol corruption).
This is fraud, they where fleecing the insurance company and the patient just went along for the ride. The whole point of insurance companies is that they are supposed to be motivated by their own financial interest to fight against schemes like this, so it's shocking that they paid up.
Did you read the full article by chance? Saying 'the patient just went along for the ride' insinuates that the patient was complicit when in reality the patient reported the whole incident themselves after they received the bills. They did this even though they didn't have to pay anything. And they told the provider they were going to report them.
> "I made it very clear [to the doctor's office] that I was unhappy about it," Kasdan says. In fact, she told them she would report the doctor to New York state's Office of Professional Medical Conduct.
> Kasdan says she was not told that the throat swab was being sent out of network at the time of her appointment, though it's possible one of the many papers she signed included a broad caveat that some services might not be in network.
No way, this was totally deliberate fraud. The physician likely included all of the accompanying diagnostic codes for ultra rare/serious symptoms/history so it wouldn't get rejected by the insurer. Plus when asked for an explanation by the reporter they didn't opt to fessing up to a mistake or explain why the charge was necessary: they offered no comment whatsoever.
Their fraud relies on insured patients not reading EOBs (because many of us don't).
The system is broken. I think a fundamental issue is that insurance is not really insurance - it is used to cover routine, expected things such as a flu shot (while increasing cost for these and adding complexity, bureaucracy, middlemen). E.g. car insurance does not cover oil changes and home insurance does not cover getting the gutters cleaned - they're there for major events.
Whenever you fill a prescription at your pharmacy, ask what that cash price for the drugs would be. Frequently at my local CVS, they have "coupons" available to cash buyers that makes the cost less than my copayment.
NPR has to be responsible journalists but we can call a spade a spade: this is insurance fraud, plain and simple.
All of the noise in this thread about healthcare system in the US is a good discussion but arguably unrelated to the bill in question. Single payer government run plans can be defrauded too.
By way of comparison, that exact same throat swab test - which some professor was trying to say was excessive - is available at no charge to the patient in Australia, and there are no 'out of network' labs.
I don't know how this nonsense isn't the number one election issue in the USA. Instead everyone just puts up with it.
The comparison is meaningless: the patient did not pay anything in this case, but the cost is astronomical, the problem is with the cost not with who is paying.
By the way of comparison, I just paid approximately $25 for a bit simple test (bacteria, not virii, but it included sensibility to antibiotics) in Europe last week. Out of the pocket, waiting weeks for the free public system was too much to be effective.
The article tries to make the sub-point that the swab was somehow an excessive test - I was trying to highlight that this is not the case, which makes the overcharging even more egregious.
Also to clarify, in Australia there is no cost to anyone with permanent residency status, whether they are insured or not.
Also to clarify, there is no cost for anyone (EU residents) here too if you use the public health system, but if you cannot wait till you're dead then you can use the (optional) private system and pay for that.
Last time I went to Slovenia I got strep throat. I went to the public doctor, on a Sunday, waited about 25 minutes and got a throat swab and a prescription for $14. And I was a tourist!
Well for one thing our population is over 12x that of Australia, harder to govern on a federal level. For another we are likely much less healthy than Australia. Thirdly, medical lobbying by the AMA and doctors being treated like holy men and getting a pass for said lobbying.
Can you imagine if Amazon never let you choose how they deliver your orders and purposely decided to charter a commercial jet to route your package though Antarctica? Because thats basically what happened here.
No part of medical billing whatsoever would fly most anywhere else. It's batshit crazy, top to bottom. Go get service at one place, get fifteen damn bills from five people & companies spread out over three months plus a pile of mail that looks like bills but may say it's not a bill, and then several will have errors requiring back & forth to correct, you'll get a refund then have to pay more, pay more then get a refund, all kinds of nonsense, you're acting as a go-between for insurance and the providers because they're all friggin' incompetent and that means hours and hours on hold, finally six months later it's all settled but you're guaranteed to have missed something in all that mess and now you've got a letter from a collection agency for a $48 bill out of thousands paid.
Fuck the whole thing, I hope it all burns to the ground. It makes me so very unhappy every time I have to deal with it.
Sir, you are choking and dying would you like the premium $500 intubation tube or the discount $10 one? Oh thats riiiight he cant talk lets just assume he values his life and give him the good one.
Oh, sincere apologies about not trying to save you money.
It's awful that you have access to a premium life saving service which gets better every year, beyond the immagination of years prior? Or is it awful that the price for said service is high? What exactly is awful to you?
> Jim McManus, director of public relations for BCBS of Minnesota, says the company has a process to flag excessive charges. "Unfortunately, those necessary reviews did not happen in this case," he wrote in an email.
The reason it wasn't flagged is that both the insurer and the provider are incentivized to make this as expensive as possible. Insurers cannot make more than 10% in profit, so if they want to make an extra $1000, they need to take in $10,000. Next, providers are paid fee-for-service, so they want to bill as many services as possible and charge the highest rate for each one. Ultimately our insurance premiums go up to cover this, but the whole thing is a racket.
And single payer will not solve this. All we do is subsidize demand and decrease supply in a never ending fashion in the medical industry. We need to 1) Make it easier to supply services (allow doctors to be imported from other countries, easier to start facilities, allow people with less credentials than an MD to perform services) and 2) Stop subsidizing demand (Medicare for All = Use as much as you want).
My ideal health insurance model is catastrophic insurance provided by the government for any bills over $50,000, Health Savings Accounts to allow you to save for procedures beneath 50k, and a total free-for-all of insurance companies beneath the 50k mark. This would radically reduce insurance rates while preventing people from becoming bankrupt. Catastrophic insurance covers you from cancer and being hit by a bus, but for 99% of all health issues the bill would not exceed that.
If there is only one payer, and they refuse to pay your outrageous prices, you either lower your prices or you go out of business. Since a government-run payer does not have to make a profit, it is very easy to incentivize it to keep costs low.
If you don’t forcibly ban doctors from opening up private, non-governmental clinics - and that means radically restricting individual freedom through the threat of violent force, which I assume would be unconstitutional - then doctors (or at least the good doctors) will decamp to the private sector only.
Doesnt single payer "solve" this by having negotiating power. As a provider, You can choose not to take it but you are keeping yourself out of 95% of the market.
Medical care is a product like any other. When it's 100% free, you have no disincentive to use it. Unfortunately, there is not a single thing in the economy that is immune from the laws of supply and demand. So if you want to have the government pay 100% of all medical bills and do nothing to prevent using it, you'll have never-ending increases is costs.
The chronic lack of price transparency in U.S. healthcare is the single biggest cause of runaway healthcare spending.
Medicare for All would preempt the lack of price transparency: participating doctors get what the government says they will receive. Period. They can opt out and only serve non-M4A payees, but that will shrink their customer pool. Healthcare spending would plummet across the board.
The U.S. healthcare industry operates outside of the capitalist system. We can either try to make it more market-based, or, acknowledging the high value of life and astronomical bargaining power of medical practitioners in wealthy nations, we can socialize the provision of necessary healthcare. Almost every other developed nation has done this successfully.
Engineer: I will charge X for this project because that’s what competitive projects of equal value go for.
Gas station owner: I charge $1 for a Hershey’s bar because that’s what the convenience store next door charges for a Hershey’s bar, and my customers can just bail or hop over there if I charge too much.
Hospital/Surgeon/Doctor/Pharma exec: Well, it’s complicated. You know there are insurance companies and PBMs, they’re the real villains, what can I do? Look, let me ask you, what’s the value of life? We charge a small portion of that. Do you really want to cut back on something so vital? We save lives, respect our profession. Feel free to go to my competition, they will all tell you the same thing. Stop trying to haggle like we’re spice merchants at the Grand Bazaar.
(Of course, thousands of medical practitioners support socialized medicine, the above is simply a generalization used to illustrate my points on price transparency, crony non-capitalism, and bargaining power)
No it's not. Medical care is a process people don't want to go through to make them healthy.
> When it's 100% free, you have no disincentive to use it.
1. that's just plain bullshit, as demonstrated by the NHS and other single-payer free-at-point-of-use systems, people don't hang out at their GPs office just because it's free
2. you actually want to incentivise people to use medical system preventively, it's way cheaper than having to use them curatively
> So if you want to have the government pay 100% of all medical bills and do nothing to prevent using it, you'll have never-ending increases is costs.
Literally every other healthcare system is cheaper than america's, despite the US healthcare system being by far the one most disincentivising use.
> there is not a single thing in the economy that is immune from the laws of supply and demand
As a sibling comment noted, this doesn't happen in countries where there are existing single payer systems, so your analysis is trivially disproven by example.
Additionally, this presumes the content of "the laws of supply and demand" -- what's the nature of supply when consumers cannot choose between competing providers? What's the nature of demand for a product that people require to survive? These are not standard parameters, and to assert that they can be understood with simple demand curves is disingenuous at best.
As demonstrated in every single-payer system where this… doesn't happen because the single-payer entity decides what they're going to pay for medical acts and if you don't like it tough tits, the gravy train of high-marging acts only works until the next revision where the single payer auditors realise you're making 90% on something and… just slash down what they're paying by 90%. That was pretty widely reported on with japanese neck MRIs a decade or so back, manufacturers created small cheap MRI machines, every doctor's office equipped themselves to feed at the through, review time arrived and neck/head MRI prices were slashed to $100 or so.
> 2) Stop subsidizing demand (Medicare for All = Use as much as you want).
This is the exact same lie as the voter fraud scare-mongering: not an actual issue. Most people have to be pushed to see their docs, the vast majority just want to get better and would rather be anywhere than an md’s office.
> Patient emergency room visits rose to a record high of 141.4 million in 2014, the same year the Affordable Care Act's insurance expansion went into effect, according to new data from the Centers for Disease Control and Prevention.
The results contradict policy experts' assertions that unnecessary ER use would decline as more people gained access to health insurance under the ACA.
People get insurance, they use healthcare more. This is not a surprising result.
Thank you. But also - measuring this after first short years of just introducing a new rule is a bit disingenuous, IMHO. How many of these people that went to an ER immediately after they could afford it, actually went there from complications of simple things that could've been relatively easy (aka cheaper) fixed if they would've just gone to a doctor years ago? How many of these who went now and fixed something simple that would be a financial disaster to fix couple years later?
PS. Sorry, I hope I did not mess up previous sentences too much to make it completely opposite of what I am trying to say.
Markets created this mess. Markets will not solve it. Single payer takes insurance out of the game entirely, just run the entire industry out of town and be done with it. Doctors fix people, Doctors are paid by the Government what is reliably determined to be going rates for their services.
We (the United States) are the SOLE western country that does not have state sponsored healthcare, and it shows and it's ridiculous. I don't know how anyone can feel we are the greatest or great in any capacity when a car accident can send a family into poverty.
Markets are not responsible for insane health care regulation that restrict competition. Those exist locally and by state for insurances and providers. I could go on a whole list of all of these insane regulation that exist in the US. The US law going back to World War 2 that essentially forces people to get health insurance threw your employer is one one example of one of the dumbest ever laws and incredibly harmful to people.
The point is that everything that's outside of the regulated insurance market, such as plastic or lasik surgery and a whole list of other things are actually getting consistently cheaper while operations that are captured in a totally degenerate insurance market go the opposite direction.
We don't have many western countries that have ever even tried a more market style of health care. Singapore is the most market oriented system in the world and its by far the cheapest when looking at % of GDP.
This is insurance fraud and abuse. Over-billing is very common in the American medical world. As long as there is no oversite, nor competition, it will continue and grow worse over time.
Speaking of competition, it would be interesting if the major political parties competed on improving results instead of sabotaging results or preventing the other side from getting a win.
Both parties have symbiotic relationships with profiteers that stifle progress and innovation.
Trump signed an exec order* (thx for correction folks!) requiring hospitals to dramatically improve price transparency for patients. A huge win. But of course you'll never hear much about it for obvious reasons.
First, no he didn't. He issued an EO directing CMS to implement the rule, which doesn't go into effect until 2021 and is facing pretty significant legal challenges. The fact that it's an EO and not a bill is likely part of the reason why its vulnerable to lawsuits.
Second, health care experts don't seem to think much of the new rules, since there's little evidence anyone price shops for care, especially since, regardless of published prices, they're not the ones paying for them; they pay indirectly, through premiums. I think price transparency is a good thing and the rule is a good thing, but I don't think this is "huge".
Third, the "obvious reasons" snark at the end of your comment poisons what would otherwise have been a valuable contribution to the thread.
It is neither a big win nor a great improvement. At the time of need of essential goods/services price transparency is not as helpful as you make it seem. The American health system is so complex, has so many competing interests, and so many negative externalities that I doubt any one new regulation can be anything more than superficially beneficial to patients.
I suggest the obvious reason this new regulation doesn’t get as much press attention as you’d like has less to do with Trump and more to do with its futility.
I think you should assume incompetence instead of malice.
> Fathollahi, the Manhattan Specialty Care physician, didn't answer our questions about the bill. Neither did Dr. Shawn Khodadadian, listed in state records as the CEO of Manhattan Gastroenterology.
Because they CAN'T. Why didn't NPR publish their response, which is likely along the lines of how they are forbidden to discuss patient charges and procedures?
It's far more likely this was a mistake that will end up costing the doctor 25k when the insurance company hires someone who checks for things like this, which they will.
Similar to Diagnostic Imaging - firms will aggressively market MRI/CT/PET ownership/co-ownership schemes to physicians, which become a license to print money very quickly.
Such doctors who participate in schemes, entirely unsurprisingly, order multiple standard deviations above their expected imaging needs.
Are insurance companies' take of the pie still defined as a percentage of total spending? If so, they have little reason not to look the other way, especially if fighting the problem in a systemic fashion (rather than just every now and then, or when someone notices and says something) would be tough and expensive and wouldn't be likely to capture its benefits for them in particular (rather than spreading out the benefits over "defector" insurers who don't bother to work on enforcement, too).
No, the ACA maxes out total profit payers can take home at 15% for large groups and 20% for small groups respectively throughout a year, so it's not a commission based system like you are imagining. There are severe penalties for improper billing including prison. No one likes insurance, but HMOs are not at fault here, it was due to overcomplexity and lack of regulation within private practice.
You're missing the point. It doesn't need to be commission based, it becomes so implicitly. If my allowable profit is a function of how much I pay out, then I have an incentive to make prices as high as possible, just like in a commission based system.
The trouble with a comment like this is that it doesn't contain any real information. If you know more, please share some of what you know so the rest of us can learn something.
No, because there are extreme penalties and disincentives to overbill. Also, payers are not strictly payers in the US, they are what is known as HMOs, they are incentivized to bring healthcare costs down or at least slow the rise.
Healthcare costs will inevitably rise in the US however, as labor is scarce, practioners are scarce, people are increasingly unhealthy and older...we are in for a massive healthcare cost spike due to economic conditions and blaming HMOs is emotional and politician inspired at best. Its like blaming insurance companies for a rise in car crashes.
Ah, pretty sure I've never been under nor been close to anyone under an HMO so I'm not familiar with how those operate.
Given how common stuff like in TFA is, plus so much more on smaller and less eye-popping scales, and seeming endless ability for providers to say "oops our bad now it's fixed" when caught and avoid punishment, I'm skeptical that these extreme penalties kick in often enough to counteract incentives to let prices creep higher.
[EDIT] from my personal experience, it's mostly up to individuals to burn tons of time investigating irregularities and escalate them to elected officials & regulators when insurers or providers dig in their heels, to which the officials' and regulators' response is usually a strongly worded letter that makes your particular problem go away, with no follow up, presumably because pursuing it will be difficult, expensive, and unlikely to yield results that help anyone with their next election or promotion. That's kinda how it looks like this one's going, in fact, though maybe there'll be some regulatory follow-up with something resembling teeth, since it got press. It's like the Twitter-complaint model of customer support, but way worse.
The US healthcare system is just fundamentally broken. Its not even about private or public. Even if they made it public, it would probably still be far and a away the most expensive system in the world.
People who believe that making it public will massively lower the cost because other socialized systems are cheaper are up for a rude awakening.
No matter in what direction the US system evolved those problems need some amount of addressing and those questions are more practically important then the question about public or not.
Insurers have to create networks so they can negotiate fair rates with doctors and hospitals. These rates often end up being more than medicare would have paid, but not wildly more. Sounds pretty fair. But what to do if the patient goes to an out-of-network doctor? Insurance might say "we won't pay unless it was an emergency," but then the patient gets stuck with a $30k bill. He'll get angry, tell the media, write his Congressman, etc. Somehow the blame will always fall on the insurer (who had no way to prevent this from happening) and not the doctor (who was engaged in price gouging.)
Or maybe the insurer can say "we'll only pay the same rate we would have paid an in-network provider." No problem, says the doctor-- we have the patient's signature on this huge contract that says we can bill them for the remainder. Now the patient gets a $29.5k bill instead of a $30k bill. Still no good.
I'd love to say "just socialize medicine and be done with it", but this worries me too. The US already runs two 100% socialized healthcare systems: the VA for veterans, and IHS for Native Americans. Both are absolute nightmares where people sometimes wait years to see a barely-competent doctor. Many IHS doctors only work there because no private hospital would hire them[1].
Is it hard? Just eliminate insurance networks. Healthcare providers can set whatever prices they want for procedures. But, they must offer the same price to all customers. Insurance, medicare, cash, whatever. They must also publish the prices publicly. That would put a swift end to this nonsense.
It says that the bill was 20X more expensive than it shouldn’t have been. I can’t even imagine having to pay that when I go to the doctor. The NHS isn’t perfect, but it’s damn good.
Reading the article, the trick here is exploiting a loophole that exists specifically within private healthcare.
The doctor part owns/is associated with an "out-of-network" lab where the tests were sent. Healthcare providers have default listings which are typically outrageously high, and negotiate with insurers for their "actual" rates. But by the in-network doctor quietly sending the tests "out-of-network", the insurer could be charged the outrageous fee.
With single payer, the price is the price. No bullshit, shady multilateral private negotiations in a marketplace where people's health is what is being wagered.
We already have socialized medicine in the US and you can go ahead and compare average billing rates to calculate the insanity ratio by using Medicare and VA.
It's not always clear to be in these types of stories if the money actually changed hands. Just because it was invoiced, doesn't mean that's actually what was transacted.
Remember folks, physicians are the root of the problem. Don't let anybody fool you into thinking otherwise.
It's easier politically to blame corporations and whatnot. And it's true - there's plenty of leeching downstream by pharmas, PBMs, hospital admins, device makers, insurance companies, vendors, labs, and many others. But at the base of the supply funnel sit the doctors (and numerous associations like AMA, ACR, ABP, AHA, AAMC, etc) who control the entire supply through licensing and state-level regulations, and are entirely responsible for all of the atrocities. It's effectively a cartel.
There's a reason why any time there's a talk about pro-consumer regulation on the Hill like anti-surprise billing, pro-price transparency, and Medicare for All, each of these association is blasting their members with calls to contact their representatives and resist at all cost. Their argument is easy to understand emotionally - doctors will protect you from the harm, and hence there should be more licensing and supply restrictions. But this is the root of all problems in US healthcare.
But the vote for recommending the imaging change was 3-2 in favor, with two physicians on the panel, Sens. Ben Watson (R-Savannah) and Kay Kirkpatrick (R-Marietta), voting against.
the American Academy of Pediatrics declared that retail health clinics are “an inappropriate source of primary care for pediatric patients, as they fragment medical care and are detrimental to the medical home concept of longitudinal and coordinated care.”
Stanford University researchers found that from 2010 through 2016, 39% of 13.6 million trips to the ED at an in-network hospital by privately insured patients resulted in an out-of-network bill. That figure increased during the study period from about a third of ED visits nationwide in 2010 to 42.8% in 2016.
All non-emergency medical bills should be legally null.
That is, if you go to a doctor's office, they can try to collect payment upfront, but if they send you a random bill after the fact without your explicit price consent, it doesn't have to be paid. Similarly to how I can send a bill to y'all for the privilege of reading my post (and justify by saying it took me years of expensive training to obtain this knowledge), but you shouldn't be required to actually pay me, of course.
Emergency medicine OTOH should be socialized - everybody is covered in the US by Medicare. For every emergency admission facility can charge Medicare for all up to $X (say $300 in Kansas and $500 in San Francisco) and have to make do with that money. Patient gets between 0% and 30% copay depending on whether they are trying to abuse the system or came with a legit reason. This is the same as Kaiser today, but on a National scale.
The problem with emergency care being free and non-emergency being paid is that people will try to make things into emergencies and it discourages preventative care.
But we do need upfront pricing. It should be mandatory in non-emergency situations.
Could you please stop posting unsubstantive comments to Hacker News? You've done it a lot, and we're trying for something a bit better than internet default here. If you wouldn't mind reading the site guidelines and using HN as intended, we'd be grateful.
Could you please stop posting unsubstantive comments to Hacker News? You've been doing it repeatedly, and we ban such accounts. The site guidelines explain the intended use of the site: https://news.ycombinator.com/newsguidelines.html.
We need to socialize the healthcare in the USA and put a stop to this crazy billing practices. (Maybe send a few execs to jail too) Canada really has the right idea here, as even if you are making $bank here, you can be fired for any reason/no reason and health insurance will end. IMO this is by design, as it is much more difficult to leave a job if insurance will end.