
Your New Medical Credit Score Could Deny You Care - kaxline
https://thetoolsweneed.com/poorly-secured-medical-credit-score-could-deny-you-care/
======
Zooper
To give a real-world example of why this is problematic: my wife recently had
surgery, and they had a follow-up a month later to remove a stent. Even though
she was insured, a slew of wholly unintelligible bills from various
departments at the hospital followed. When she showed up to have her stent
removed, the director of the hospital's billing department told her that all
past bills must be payed before they are able to remove the stent: this was a
blatant lie, and the doctor overrode the decision in about 30min. Now after
speaking with the nurses about this, one reveals that the collections
department has a whiteboard game going on in the office where they write up
their names and have an ongoing competition over who can extract the most
money from patients. The hospital and its services are under no obligation to
provide accurate pricing until ipso facto, and the pricing can often be
changed because it doesn't stand up when placed under scrutiny. Does anyone
believe a system like this is capable of producing an accurate "score"?

~~~
Ididntdothis
“The hospital and its services are under no obligation to provide accurate
pricing until ipso facto, and the pricing can often be changed because it
doesn't stand up when placed under scrutiny”

That’s what’s driving me crazy. No other business can make up charges
repeatedly and when found out, say “oops” and change them a little. In what
way is this not fraud?

~~~
gotoeleven
College prices are kind of like this, in that they follow the simple formula

tuition cost = how much you can borrow + how much you can pay

What is strange is why do we stand for huge price discrimination in college
and medical care, but not for buying a candy bar?

~~~
Loughla
>tuition cost = how much you can borrow + how much you can pay

I need this flushed out a little bit more. I have worked in higher ed for
decades, and have never encountered a college that charges in that manner.
They have a flat tuition, and the student fills that payment however they are
able. But it's not like it changes based on how much capital they have access
to.

Can you please explain that statement?

~~~
jefftk
It sounds to me like your parent is describing financial aid at high end
colleges. The college has a sticker price, say $50k/y, and for people that
can't afford it they have need-based financial aid. They ask you lots of
details about your family's income and assets, and come up with a number that
they think is the most you can pay.

It's price discrimination, in that it's charging people in proportion to what
they can pay.

~~~
apta
Are you referring to the loan-based "financial aid"? This is one of the most
hypocritical terms I came across. It's a loan, not an aid. An aid would
directly reduce the amount of money you have to pay (discounts, scholarships,
grants, etc.). A loan is not an "aid".

~~~
jefftk
I'm primarily talking about grants, not loans, since that's where the price
discrimination is clearest. They're effectively setting the price at exactly
what they calculate you can pay.

------
pdkl95
Speaking of medical billing insanity...

I recently had a MRI, and in the process of filling out the usual new-patient
form at the imaging center, they wanted me to sign a blank LCD touchscreen. No
indication whatsoever what I would be signing. Is it even a contract if you
never saw the offer and thus no "meeting of the minds"?

After explaining that I wasn't going to sign a "blank check" contract (and
would always need to read the entire contract before first), they eventually
figured out how print the actual document. After several minutes reading the 8
page (!) contract, I found a clause I haven't seen before. After more or less
normal stuff about agreeing to pay for the service, in a section about sending
the bill to a collection agency if I didn't pay, they wanted me to agree to 1)
pay for the collection agency and any other fees associated with recovering
the debt, and 2) _pay their attorney fees_ if they decided to take me to court
over the debt.

I wounder a judge would actually enforce that clause. Agreeing to pay someone
to sue yourself seems unconscionable. I told them I wouldn't sign their
unreasonable contract (that wasn't the only problem) and they sent me off to
have the MRI scan anyway.

~~~
sidewndr46
Recently had an MRI as well. I was given an iPad with lots of documents to
sign. Most of it was what you'd expect. Just poorly scrawl your name &
initials where indicated.

The one that really jumped out to me was the Power of Attorney. Yes, the
provider wanted me to grant them an indefinite Power of Attorney as part of
being a patient. I asked if I had to complete this and was told I could skip
it. I was really glad to see that about 1/2 the people in the waiting room had
the same question.

~~~
jasonjayr
> Power of Attorney

Isn't this similar to the same trick those business loan sharks employ? They
ask you to sign a "Notice Of Default" or similar document upfront, that they
present to the court to get an instant summary judgement if anything goes
wrong with repayment?

~~~
sidewndr46
It can't ascribe the same attitude to the provider of medical services, but it
certainly stinks.

------
alberth
I’m confused, so what exactly do the hospitals want to gain from this
“medical” credit score?

If the hospitals simply want to gain insight on your ability to pay your
medical bills, wouldn’t your “normal” credit score be able to provide that
insight.

What’s different between your “medical” credit score and your normal credit
score?

Edit: Additionally, there are laws in place in the US that state in emergent
situations, no hospital (public or private) can deny care - regardless if you
can pay or not. So the article title might be a bit sensationalized.

~~~
pbrb
I'm with you, not paying medical bills affects your credit score the same way
as any other bill. To me, it seems like it's just another service for the
credit unions to make money on, while giving private hospitals some legal
protection.

Really, it's disgusting.

~~~
metalliqaz
s/credit unions/credit reporting agencies/

credit unions are one of the few pro-consumer entities in the financial world,
it would be a shame to smear them

~~~
throwaway_tech
I will add credit unions are chartered banks...but unlike "banks" they are not
owned by shareholders, they are non-profits made up of the members (account
holders).

Ideally in 2008 all the "banks" should have gone bankrupt and the vacuum
should have been filled with credit unions, instead lawmakers gave the banks
$2T as a reward for ruining the US economy so they could float their own debts
instead of declaring bankruptcy and enough so they could buy up their
competitors to further consolidate the marketplace.

------
hedora
I’m surprised this doesn’t violate HIPPA or CCPA.

Every time you visit the doctor, the hospital tells experian (by querying the
experian system) and then experian resells this information for profit.

~~~
throwaway5752
Minor point, but it's HIPAA with two A's, not two P's.

HIPAA pertains to PHI and PII (protected health information and personally
identifiable information, respectively). The fact of your office visit is not
either of those if it's not linked to health information (labs, medical
records, notes, itemized bills).

Further, it may be allowed under permitted uses and disclosures as-is, without
authorization under the language for payments. I couldn't tell from the
article, but the health systems could simply decline to treat you without your
authorization for the credit check.

Separately, people love to make healthcare into the bad guy, but it's not a
monolith and there are hospitals closing down because they are losing money.
There is a systemic problem in the US here, and I bet this is those 2nd/3rd
tier markets in smaller systems that can't absorb defaults like nationals can.

~~~
jdmichal
> HIPAA pertains to PHI and PII (protected health information and personally
> identifiable information, respectively). The fact of your office visit is
> not either of those if it's not linked to health information (labs, medical
> records, notes, itemized bills).

False. Directly from HHS, emphasis mine:

[https://www.hhs.gov/hipaa/for-professionals/privacy/laws-
reg...](https://www.hhs.gov/hipaa/for-professionals/privacy/laws-
regulations/index.html)

“Individually identifiable health information” is information, including
demographic data, that relates to:

* the individual’s past, present or future physical or mental health or condition,

* _the provision of health care to the individual_ , or

* the past, present, or future payment for the provision of health care to the individual,

~~~
throwaway5752
I do deal with this stuff, but got sloppy with boundaries of entities covered
by BAAs. Thank you for the correction.

------
young_blood
I recently received treatment for Hodgkin's Lymphoma and have been trudging
through bills for the past 3 years. I've found that most if not all of my
medical bills contained errors, which had I not looked into, would've cost me
in excess of $10k+. The most common error was the billing department
submitting a bill to my insurance company months after the date I received the
services. I wrote a post explaining how I used python OCR to look for these
discrepancies.

My father is also a pharmacist (and now owns a pharmacy) and he constantly
tells me horror stories about the cat and mouse game that insurers play with
patients, where they have doctors prescribe and offer discounts on specific
drugs, depending on what is most profitable. He pointed to an interesting bit
of software [1] that uses machine learning to find the best margins.

I could seriously go on and on about all the insanity that is our healthcare
system. These problems runs deep, from top to bottom.

[1] - [https://amplicare.com/](https://amplicare.com/)

------
JohnFen
The medical system in the US is so awful that I already avoid getting medical
care unless it's absolutely unavoidable. I guess I need to add "never go to a
private hospital" to that habit.

~~~
Ididntdothis
Same here. Just went to an emergency room with a fever and was charged $700
for 5 minutes with a doctor who told me to go home and stay in bed. I have
insurance and had to spend several hours on the phone to get charges reduced
to 240.

~~~
rhexs
Why did you go to an emergency room for a fever instead of urgent care or a
nurse practitioner working out of a grocery store?

~~~
Ididntdothis
Because I called the insurance and they told me to go to the emergency room.

~~~
djsumdog
Did they give you a cost? That's fucking shitty they would encourage you to do
something that just earns them money. I fucking hate private insurance (and I
worked in it for ~3 years)

~~~
Ididntdothis
Of course they don’t give you a cost. You are essentially signing a blank
check. The hospital can charge whatever they feel like and the insurance can
pay whatever share they feel like and you are in the middle trying to figure
it out.

------
rcar
I've worked extensively with credit bureau data, and there's a fair bit of
misinformation both in the article and the comments.

First, bureaus get very little detailed information about the episode of care
that led to the medical bill: essentially, they'll just get info on when the
bill was due and what amount on it is still overdue, plus enough info on the
patient to match it to the right person (name, address, phone, SSN if
available). HIPAA and similar legislation allows the sharing of billing data
like this, and no other PII (or any PHI) gets shared in the process.

Second, medical debts have been a part of bureau data for a while now. What's
new here is that Experian is trying to build a machine learning model on it to
try to sell the model as a new product. I've never worked for any of the
bureaus before but know many people who do, and in general, these specialized
scores seldom sell well, but since the marginal cost to Experian is low (let a
few data scientists at it for a few weeks), they still put out new ones
anyway. Even things like new FICO/Vantage scores like the new FICO that's been
in the news lately tend to take a while (on the order of years) to make it out
into the wild since lenders like to have consistency in their processes as
long as possible.

Third, it's actually beneficial to most consumers to have medical debts split
out of the bureau data explicitly. Most big lenders use raw bureau data much
more than the aggregated credit scores, and since the US medical system has so
many distortions that correspond more to broken processes rather than a
person's creditworthiness, many exclude medical debts from consideration
explicitly, and others implicitly as models they build don't often find those
attributes as useful as others.

All in all, it's good to be thoughtful about how information like this is
disseminated and used, but the dire warnings of the article are really not
warranted in this case.

------
petilon
Great. Now Experian gets to decide whether you can the surgery you need. They
also decide whether you can get a job, rent an apartment, and whether you
should remain in police custody [1].

[1] [https://bigbrotherwatch.org.uk/all-media/police-use-
experian...](https://bigbrotherwatch.org.uk/all-media/police-use-experian-
marketing-data-for-ai-custody-decisions/)

------
mayneack
I usually don't give medical providers my social security number. It's on all
their forms, but I just skip that section and no one has ever come back to
clarify that it's required.

I have no idea if they can require it or not, but I always assumed it was
optional because they wouldn't turn away foreigners without SSNs.

~~~
ceejayoz
Refusing to give your SSN doesn't prevent things from showing up on your
credit report.

[https://www.experian.com/blogs/ask-experian/accounts-may-
be-...](https://www.experian.com/blogs/ask-experian/accounts-may-be-reported-
even-without-social-security-number/)

> Experian doesn't match information to a person's credit history using only
> the Social Security number. Experian matches information using all of the
> identification information provided by the lender, so the account will be
> accurately shown in your report, even if no Social Security number is
> provided.

~~~
mayneack
I guess that makes sense. I have been doing it just because I figure it's an
easy way to limit my potential data breach exposure. Didn't know about this
medical credit score thing.

------
filereaper
As a Californian resident, how does stuff like this not violate CCPA?

Brokers reselling my health info is far more critical to me than my buying
habits.

Is there a "do not sell my health info" checkbox?

~~~
jhart99
According to Experian, it looks like they claim they do not collect medical or
health information on California Consumers.
[https://www.experian.com/privacy/ccpa-privacy-
policy.html](https://www.experian.com/privacy/ccpa-privacy-policy.html) I
would love to send them a request to see if that is in fact true.

------
Ididntdothis
A lot of people say you should just not pay crazy charges from hospitals and
wait until they reduce or drop them. I bet hospitals want to track people who
do that. They want patients who will pay whatever kind of charges hospitals
dream without questioning anything.

------
cft
I have been traveling in Latin America for the past 2.5 years. In Mexico, life
expectancy is 77 years, pretty much the same as in the US. An American retiree
expat told me that his MRI cost him $200 here, versus $3500 in the US. I have
been to doctors too. A typical payment for a doctor visit is $30 cash, less
than my copay in the US. I had a stomach parasite from Guatemala when I flew
back to the US. My PCP scheduled tests, then more tests, copays, bills and
finally a $200 medication. While doing all this, I simply took a Mexican anti
parasitic medication that I bought for $1 (one dollar) in Arrilaga, and it
went away, _before_ I got the $200 medication!

I think the medical field here in Mexico is much more affordable because it's
cash based, with real competition between doctors

------
adrr
In 2017 financial bureaus changed their scoring system to be more lenient on
medical debt and also remove collection reports if paid in full. This stemmed
from a state Attorney General settlement against the hospitals that were
extorting patients with threats of ruining their credit when disputes between
hospitals and insurance companies arouse. Hospitals would just collect from
the patients and let the patient deal with the insurance company to recover
funds.

Hospitals want this leverage again so they built their own credit system.

------
IHLayman
It’s not just Experian... TransUnion has it too, with the same name as a
matter of fact. Although it looks to be a report and not a score just yet,
unless I didn’t read it correctly:
[https://www.transunion.com/product/patient-financial-
clearan...](https://www.transunion.com/product/patient-financial-clearance)

------
tptacek
It's not clear from this article how people are being "denied care" based on
this Experian product; the video example provided appears to be about a
special need-based admission offering at a provider, not a normal admissions
process. In other words: a check that you're _poor enough_ to require the
special service.

~~~
jerry1979
She mentions that the product helps screen for the patient's "propensity to
pay". From that I gather that if the patient has a low propensity to pay, then
they get denied by the hospital.

This is from the product's lit:

"Predict propensity to pay using our proprietary Healthcare Financial Risk
Score, which factors in historical healthcare payment outcomes and the
patient’s credit history"

She mentions that the product also lets them pull "FPL", which in this case I
imagine means "Federal Poverty Level", in addition to household size.
Cincinnati Childrens has some info that might put that info into context:
[https://www.cincinnatichildrens.org/patients/resources/finan...](https://www.cincinnatichildrens.org/patients/resources/financial-
assistance)

~~~
tptacek
She says explicitly that she's pulling that information in the context of
eligibility for "the charity program".

Further, unstated, perhaps speculative context: most people who go to the
hospital pay through insurance and out of pocket. But if you go to the
hospital without insurance, or can't cover your out of pocket component, most
(every?) hospital will negotiate a lower rate; almost nobody pays rack rate
out of pocket. So what they're calling "charity" might just as likely be the
name they give the program where they come up with their real rate on the fly
(I've been through this process with a large hospital chain in Chicagoland).

Either way: it doesn't support the post's claim that Experian's health score
--- which I'm disinclined to trust, just like everyone else --- is being used
to "deny care". That's an argument the article does not appear to marshal
evidence to support.

~~~
jerry1979
Maybe you are right, but what difference does it make if the program is used
to screen out people who can't pay?

------
nojvek
You walk into to a supermarket to buy a bottle of milk. None of the items have
prices. There isn’t even milk on the shelves. You present your supermarket
card to someone and then talk to a consultant who then does a bunch of tests
and gets you milk plus some other items (which have high margins - like a
special green bottle cap)

Then you go home and receive separate bills that trickle over several months.
One from milk consultant, one from the doorman, one from the cleaner and other
folks you never even met. The total bill could buy you a truck of milk in
other countries but you’re glad you have supermarket insurance and you only
pay the price of 10 gallons of milk out of pocket.

------
marklacey
> The Financial Clearance system combines medical records along with the
> financial records Experian already has on you to calculate the score.

How is this not a complete violation of HIPAA?

Are they working around it by having very general HIPAA release forms?

~~~
ceejayoz
The law explicitly permits sharing with other entities for billing purposes.

[https://www.hhs.gov/hipaa/for-professionals/faq/268/does-
the...](https://www.hhs.gov/hipaa/for-professionals/faq/268/does-the-hipaa-
privacy-rule-prevent-health-care-providers-from-using-debt-collection-
agencies/index.html)

> The Privacy Rule permits covered entities to continue to use the services of
> debt collection agencies. Debt collection is recognized as a payment
> activity within the “payment” definition. See the definition of “payment” at
> 45 CFR 164.501. Through a business associate arrangement, the covered entity
> may engage a debt collection agency to perform this function on its behalf.
> Disclosures to collection agencies are governed by other provisions of the
> Privacy Rule, such as the business associate and minimum necessary
> requirements.

------
tantalor
> So wealthy people get access to better care and everyone else has to take
> whatever is available.

That's how Canada's healthcare system works, too.

> Government health insurance plans give you access to basic medical services.
> You may also need private insurance to pay for things that government plans
> don’t fully cover.

[https://www.canada.ca/en/immigration-refugees-
citizenship/se...](https://www.canada.ca/en/immigration-refugees-
citizenship/services/new-immigrants/new-life-canada/health-care-card.html)

~~~
altcognito
This is not how Canada's system "works" by definition as their definition of
basic health care is a lot wider than the US.

The above aspect of "wealthy people get to buy nice things" really doesn't
contribute anything interesting to the conversation.

------
SolaceQuantum
_" Private hospitals are now consulting a secret medical credit score from
Experian before you even see a doctor. As a patient you do not have access to
this score, nor can you see how it is generated. All you know is that you may
be denied care, or receive different care, because of it."_

Could we classify 'not being able to afford, either time wise, emotional labor
wise, or money wise, to deal with the messed up medical billing system' as a
pre-existing condition?

------
Kelli77653
I had my credit increased from 420 to 800 within a short time with the help of
bbirdeye1@gmail.com some from here linked me up with them, at first I was
skeptical about it but I contacted him because I needed to get a loan, now my
family is happy and grateful to bbirdeye1@gmail.com. I have recommended him to
few of my friends and you can contact them through email if you need your
credit fixed too...

------
jiveturkey
It's too bad TFA doesn't mention either way whether a credit freeze will
prevent hospitals from obtaining information on you. A bing search reveals
nothing.

OT: I left google and use bing now. Interesting, google's search results for
my query were absolutely horrible. obvious spam and various detritus. and all
the results had the little ad icon ^W^W favicon! I thought they backtracked
from that? oh well.

------
Analemma_
The one bright spot to this is that, since it's a ratchet that can only go in
one direction and find more reasons to deny people as it gets more data,
privatized health care will eventually be its own undoing when enough people
are frozen out of coverage that they can form a voting bloc and give this
system the bullet to the head it deserves.

~~~
magduf
Considering how much of the population keeps voting for this system, I don't
see that happening for decades at the least.

------
mnm1
Here's another version, besides the private insurance companies themselves, of
the death panels opponents of universal healthcare always blabber on about.
Now we have two branches of death panels, each one slightly differently evil.
Yet another issue that would be solved by universal healthcare.

------
ycombonator
Maybe congress should actually focus on privacy legislations than being
obsessed with orange man.

------
briffle
The video they show in the page has nothing to do with what the article is
about. The person is talking about finding eligibility information for
patients for things like worker comp, medicare, etc.

------
jorblumesea
As if the US healthcare system couldn't get more dystopian..

------
LatteLazy
I mean, in a for-profit system you can't blame them. But at the same time,
this seems insane to me. Thank god we (still, just) have the NHS...

------
rglover
[https://www.youtube.com/watch?v=EcwyOaYyu7Y](https://www.youtube.com/watch?v=EcwyOaYyu7Y)

------
cletus
So I've come to the conclusion that the US model of private health care is
ultimately doomed and nothing will save it. Of course it's going to kill
people in the meantime but it is doomed.

While on vacation recently I ended up listening to the Bear Brooks podcast
[1]. It's a little longwinded at times (but it is aimed at non-technical
people) but is not a bad way to spend a long drive.

The interesting thing about this story is how advancements in DNA testing have
taken us from the simple case of is or is not a match (used in paternity
testing and for forensics) to figuring out how much of a match you are. This
has created a new field of genetic genealogy that famously led to the
identification of the Golden State Killer [2].

So there's a lot of talk about privacy and your DNA but much like having your
contact information uploaded by someone else, this is showing that that will
be insufficient as your DNA will ultimately be inferred (at least in
probability terms) by people who aren't you. There's really no putting this
genie back in the bottle.

So take a disease like Cystic Fibrosis. Currently this requires life long
medication and care. Depending on the severity, you may require one (or more)
lung transplants. All of this is expensive.

So if you have CF and want to get private insurance in the US this may well be
a pre-existing condition and excluded. Now this disease is usually quite
apparent from birth but there are other diseases that are not (eg
Huntington's). If you'd had a test and know you have it the insurance company
has a "right" to know it (if you accept the premise of the US health insurance
system, which I, of course, do not).

But this is only going to get worse. Ultimately health insurers will able to
figure out if you're much more likely to have certain expensive conditions by
knowing, say, that a sibling is a carrier (which greatly increases the chances
you have it).

Taken to its natural conclusion, the system of private health insurance cannot
survive. The only workable solution is group health insurance. Sufficiently
large groups statistically even out. That's how insurance is meant to work.
This could be a fully public health system or something in between (eg state-
level).

So back to the medical credit score. There will be fights over this. At some
point you'll have a right to see it and get corrections. This will probably be
championed by states since the Federal government seems to have forfeited,
well, governing. But all this is just arranging the deck chairs on the
Titanic.

Of course there's still the separate issue of costs (in the US) to deal with
but one step at a time.

[1]: [https://www.bearbrookpodcast.com/](https://www.bearbrookpodcast.com/)

[2]:
[https://en.wikipedia.org/wiki/Golden_State_Killer](https://en.wikipedia.org/wiki/Golden_State_Killer)

------
vkaku
The medical system in the US needs more regulations, and people should push
their politicians to fix this, or vote them out.

------
alpineidyll3
Great to see healthcare sector innovating in new levels of depravity. These
people put the Marquis de Sade to shame.

------
nixass
One mention of universal healthcare and all McCarthys of the world unite in
uninformed shit talk against it.

------
rainhacker
I wonder Experian will buy fitness trackers/apps data now and use it in
ratings.

------
r00fus
Yet another reason for single-payer.

~~~
djsumdog
I really hate it when people response to single payer with "I don't trust the
Government to..."

First, Medicare/Medicate are contracted out to all the same health care
companies that currently do employer insurance. They're given tighter money
constraints and can't waste as much.

A singler payer would mean contracting out. Private companies wouldn't go
away, they'd become government contractors, would need to reduce waste, stop
useless advertising and probably layoff a ton of useless people.

I agree though, we desperately need fully universal healthcare .. where
everyone gets the exact same level of care because they're a citizen or tax
paying legal permanent-resident.

------
doubleunplussed
Vote for Sanders or Warren, folks.

~~~
djsumdog
It doesn't matter if they believe in standard health care, they have to be
able to implement it, which is going to be very difficult for anyone, no
matter if they have a D or an R behind their name.

------
sysbin
I'm starting to think it's better to not be born (into society today) unless
born into a rich family. The sociopaths have no checks & balances and everyone
can just watch everything get worse.

~~~
djsumdog
I'm pretty much an anti-natalist. I don't want kids personally. I'm still fine
with other people having them, but I can't morally justify bringing people
into this world just to suffer.

------
alexfromapex
Here we go killing people over money again

------
aldoushuxley001
Well that's terrifying

------
uoaei
You may not like it, but this is what peak private-markets-for-public-goods
looks like.

~~~
marriedWpt
Can we call it a cartel market instead of private markets?

The various healthcare leaders use their wealth to strengthen their position
through laws.

Most sectors cannot operate like US medical, they are their own beast.

~~~
cwzwarich
Isn't it natural to want to only "sell" to "customers" that are profitable?
This is a natural function of other markets.

~~~
pfarrell
Is there anything that shouldn’t be treated like a market?

Street lights? Police and Fire protection? Water access?

~~~
cwzwarich
I don't think that health care (or the things you mention) should be treated
as a market. I was only responding to the claim that this is a "cartel market"
and not basic market behavior.

~~~
pfarrell
Gotcha. I've asked myself those questions to probe my feelings. I think things
are going to get pretty ugly as the US starts to grapple with this again.

------
planetzero
Universal care is no different. If your surgery is deemed unnecessary, you
really have no chance at getting it.

All of my relatives in Canada come over to the US for any major surgery. The
reason? The wait time is in years, instead of weeks and some can't get the
surgery at all.

"Once you start running a hospital like a business, you create an environment
of perverse incentives. Care is no longer solely based on what's best for the
patient, but how that patient's care relates to the hospital's finances."

Government-run care is no different. It doesn't magically solve the issue of
treating patients as a number.

"So wealthy people get access to better care and everyone else has to take
whatever is available"

The alternative is that everyone gets access to sub-par care.

The answer is an actual free market, rather than another, large middleman
monopoly over our health care. We need to get rid of all insurance companies,
allow hospitals and doctors to compete over price (which will reduce prices
for everything to true values (instead of $80 Aspirin), and only have
insurance for surgeries that are rare and can't benefit from the free market.

Monopolies are bad for everyone, whether it's big business or the government.

~~~
nexuist
> The alternative is that everyone gets access to sub-par care.

Sub-par care is _excellent_ when the _current reality is that most people don
't get access to any care at all._

You must understand that the vast, vast majority of people don't go to
doctors. They don't have dentists. When a poor person is in pain they will
continue to be in pain until the pain goes away or they die.

When given that versus a shitty but free healthcare system, who wouldn't want
to see a doctor? To get $5 prescriptions to medicine that can help them?

And remember, this is assuming the healthcare system will be shitty -
universal healthcare _has never been repealed in a country that has
implemented it._ Don't you think if the citizens of these countries were so
fed up with free care, they would be protesting and electing candidates that
promise to dismantle it? Even Boris Johnson has to tiptoe around privatizing
the NHS because he knows how wildly unpopular that would be, even among his
conservative constituents.

~~~
homonculus1
>Sub-par care is excellent when the current reality is that most people don't
get access to any care at all.

>You must understand that the vast, vast majority of people don't go to
doctors. They don't have dentists.

Uhh… what? This sounds either out of scope for the US or just wildly
inaccurate. Over 90% of Americans have insurance.

Edit: I do not live in a bubble. I stand by this comment, "only" 1/3 delay
medical treatment [0]. The claim that the _vast, vast majority_ of people
never get it at all is simply false. Fact checks do not bear counterargument
in a healthy discussion unless the fact check itself is lie.

[0][https://news.gallup.com/poll/269138/americans-delaying-
medic...](https://news.gallup.com/poll/269138/americans-delaying-medical-
treatment-due-cost.aspx) (2019)

~~~
philjohn
"Having insurance" != having good insurance that doesn't have eye-watering co-
pays and excesses.

If your out of pocket excess is $1000 and you need $900 of treatment, but you
also need to make rent, buy gas, feed your family ... well, you don't get the
treatment (or you do, can't pay, and are made bankrupt). I think you might
live in a slight bubble.

~~~
throwaway2048
out of pocket limit to $1000 is still a very good plan, out of pocket limits
on the plans most people have (usually termed "bronze plans") is well north of
$5000

~~~
philjohn
Whereas my yearly out of pocket on my top up private plan in the UK is £100,
the entire plan (me + family) costs the company £1600.

Yes, I pay a lot more tax, but then again, public transport, healthcare free
at the point of need etc. etc. are worth it to me.

------
exdsq
I like how they reference this post alongside their Reddit posts but as of now
it's just people commenting saying the author has it wrong. Awkward.

~~~
alexpetralia
To be fair, isn't that type of criticism exactly the thing an open discussion
board is meant to encourage?

~~~
gatherhunterer
He’s lying. There is only one such comment and it is laughably obtuse.
Influencing opinion without addressing the topic is exactly what Reddit is
for.

~~~
exdsq
I wasn’t lying, I commented when that was the only comment with upvotes and
the only comment here was also upvoted. My point was true at that point in
time.

------
thathndude
The score would almost certainly qualify as a credit report that you are
guaranteed access to buy the fair credit reporting act. Pretty much, this
article gets the facts wrong in the first two sentences.

~~~
hedora
I doubt it. The hospital isn’t extending an offer for credit, so the law
probably doesn’t apply.

Also, from personal experience, the FCRA reports are useless.

The credit reporting agencies report completely different scores to consumers
than banks, and give false information about how to increase your real score.

In particular, doing things that benefit banks (such as opening more credit
cards) increases the consumer visible scores, but not the scores used in many
real estate transactions.

The entire credit reporting industry should be outlawed.

If I owe you money and won’t pay, sue me. If you want to gauge my credit
worthiness, look at my income, and check for court decisions against me.

~~~
tialaramex
Two things, having worked for a big Credit Reference Agency although not
specifically on consumer credit.

1\. The commercial customers can (for a fee of course) arbitrarily customize
the metrics they care about. If you're looking for customers for your high APR
"accept anyone" card you don't actually want the person with a squeaky clean
history who'll never incur interest. But the recommendations do correlate
pretty well with getting what most of us would consider better credit. Lower
rates, better terms.

2\. The CRAs grew naturally out of what happened before this data was
available. Experian, for example, is essentially spun out from a mail order
catalog company. So what your plan does is just waste everybody's time for a
decade or two and then we're back here again but meanwhile the poorest people
have no access to credit.

