Forcing hospitals to disclose prices:
Though the hospital industry is fighting it, so we'll have to see if the rule survives.
I'm sure "colonoscopy, clear" and "colonoscopy, with removal of polyp and pathology on it" will have different prices, but you won't know which it is until after the procedure.
when they are selling similar procedures for elective or cosmetic surgery, like plastic surgery patients, the prices they ask are much more competitive.
It's baffling how medicine can't produce accurate estimates. Sure, there are edge cases and differences between patients. However, every surgeon has a rough idea of how they're planning to do a procedure. They've been trained and practiced on it many, many times.
I have a torn meniscus. The doctor can happily tell me how easy it is to clean up and exactly what he'll do to fix it. He certainly knows what the risks are and potential complications.
Why he can't document that prior to surgery, I have no clue.
I was given three estimated prices that ranged from $800 to almost $1800, with an expected final cost of $1000 being the most likely outcome. Surgery came out to $975.
And this is with a non-communicative and uncooperative animal, not a human.
Not to belittle what a doctor does, but I totally agree that a doctor should be able to estimate the most likely and most extreme situations and gauge the range.
No one's going to spend a million bucks on a severely premature puppy, but we will for a human, regularly.
"This might be $500, or $250,000" isn't super helpful.
Really, reading all the stories on this thread is insane when I think my wife and I could just walk into a hospital and get out three days later with a baby without having to worry about paying a buck. Same when my father went to the ER and came out over a month later after an emergency heart surgery, a week in the ICU and two weeks of physiotherapy.
And considering that 90 percent of costs are borne in the last year of life by dying patients, it's naive to think there won't be something like death panels in some form, whether it's that explicit or not. Simple economics says price fixing creates shortages.
The USA doesn’t put more value on life. We put more costs on it, but our outcomes aren’t meaningfully better.
By the way the vast majority of people who die in the US are an a socialized medicine system at the time (e.g., medicare).
Either way though, yes, of course there's "death panel" behavior or other cost-controls which effectively lead to the same result (e.g. doing harm through inaction rather than direct action), in any system.
For automotive I'm typically getting a problem diagnosed first, then after diagnosis, I'm agreeing to a price for a fix. This is the norm for that industry.
For a walk in appointment for a rash, I'm agreeing to a fixed visit fee, PLUS signing that I agree to pay any charges my insurance does not agree to pay. The true costs can (and should) be computed by the provider, so the only true unknown in that equation is what Insurance will cover. THEN the provider (wanting to cover their bases) is putting that risk of not getting paid by insurance, back onto the patient.
I like to think we're 1 killer app away from a shift in consumer behavior here to change the expectations
I worked in Australia for a little and had a couple of doctors visits (mole removal, fractured rib). They were able to tell me, on the phone, cost for a consult, removal, xray, check-up, etc. I was able to pay for the mole removal + biopsy with cash...
I'd love to see something like this in the US:
"Assuming a standard hernia surgery, you're looking at $3000 base for the procedure, with another $300-900 for consumables. 91% of surgeries are at or under $3500, 99% are under $4100. Though patients can go home the same day, 24 hour of hospital bed are covered under the fee; additional days in hospital beds are available at [X] rate. In the event of serious complications, consumables, beds, and misc. are billed at [Y]."
One thing is for sure, any improvement to price transparency is a boon to competition.
You probably won’t see this place put a fixed cost on a 26 week preemie like my twins.
Considering that colonoscopies are not urgent you'll likely elect to have your butt probed at the clinic that doesn't have a massive price discrepancy between removing something and not.
I really hope the price transparency rule works as alleged. I'd be totally unsurprising if the entrenched industry finds some way to neuter it but I'm hopeful.
For most people they have insurance and for them to get any kind of help paying they need to be working with an in-network provider. There is no meaningful market here even for elective/non-acute procedures.
Yeah, me too. It definitely seems like more of a way to look like the industry is doing something without actually reducing costs to the end patient.
Our daughter went to the ER and was administered ibuprofen. We got an itemized invoice. Insurance paid $9 for one pill.
So going forward, I guess I'll be able to ask how much the pill will cost, then...haggle? Tell them not to give my daughter medicine?
Just seems like we're going backward...
Which is expected, and kinda ok. At least, if you do a colonoscopy and there's nothing else, no complications, it would be that price.
If you want to see affordable hospital care you have to see the protection removed and competition allowed and encouraged.
This is happening to some degree already. Nowadays we have unprotected, standalone ERs, urgent care clinics, and specialist clinics. But it's not really enough, not yet.
In your example the tail wags the dog. Hospitals are mostly obsolete. You have outpatient surgery in strip malls because hospital beds are capped and reduced, and Medicare began refusing to pay for bad outcomes, which are more common in hospitals.
The government-allowed monopolies are the sprawling health networks the turn medicine into a sales funnel. They are labelled with hospital branding, but the monopolist actions are all about doctors. For example, in my region, 90% of renal doctors work for a single practice.
Urgent care is a whole other animal -- that's all about the reducing standards and addressing supply shortages of primary care doctors caused by restricted supply (there are caps) and higher salaries in specialities.
IIRC in New York, they closed something like 20 hospitals, with 10-12 in NYC. In my area (NY, but not NYC), there has lately there have been a bunch of hospital "mergers", where the lesser hospital gets converted into a sort of outpatient surgery site with urgent care, or an ER without longer term care.
There's only one way to find out.
Indeed, we're finding out as we speak, because all those new ERs and urgent care clinics and specialist clinics and birthing centers, they did not need CONs, so they got built. And they got built by people who risked capital to do it. And it seems to be working out. I know I'm not going to any hospital's ER if something happens to me, and neither is anyone in my family -- we know the score on pricing and billing.
So the free market has found a way around the protectionist regulation of hospital construction. Is that even a surprise to anyone?
Crazy levels of regulation is one of the most sure-fire ways to make monopolies or oligopolies inevitable by creating huge economies of scale. The red tape burden is much easier for larger players than smaller ones. They can keep a staff of dedicated pencil-pushers that know the industry, its regulation, and how to deal with the bureaucrats.
With less regulation and no more "certificate of need" nonsense, it would be not only easier for competitors to start but just as importantly easier and more economical for them to remain independent. The government has created the environment in which monopolists thrive and the free market is stifled; people then complain and turn to the government to fix it? We're in the insurance mess to start with because of wage & price controls. Even the EU makes it easier to try new drugs, at least from a regulatory standpoint. The market is smarter than any pencil-pusher or congressman; let it do its job. Corrupting it is what got us here in the first place.
Pricing transparency is necessary to the process, however. So, the assertion that folks "can't shop around" is exaggerated and about to become less true with the transparency law.
You get some shopping around, but many people will stick with the same dentist for years if not decades.
With respect to your natural monopoly argument, they typically occur when there are very high start-up costs. There are other cases where economies of scale are significant, but very few where they are infinite. Even Amazon, a company that occupies much of the e-commerce market and is well known for its highly-efficient supply chain, is having trouble maintaining them indefinitely. I think we're in violent agreement that the high start-up costs of medical practices and hospitals prevent competition, and I was advocating for removing most of the regulation on the medical field. Another example: the AMA is a horrible gov't-sanctioned monopoly that hugely increases medical costs; most procedures can be done by someone with a few months' training (see the military). Healthcare is one of the few industries that hasn't mastered "mass production" of procedures in spite of the fact that many surgeries are similar.
> healthcare is a natural monopoly due to the fact that a significant portion of the population cannot "shop around"
Except that doesn't mean there is a natural monopoly. If there are a dozen hospitals and you get in an ambulance you'll get rushed to the nearest one that has the right doctors (most major hospitals have most urgent stuff covered). While consumer choice is probably reduced here, it's not as though the ambulances all take patients to a certain place.
The point I think you were getting at is that most people have limited choice because they are often treated in time-sensitive situations. However, about two percent of healthcare spending is on such emergency care . Most procedures give people at least some time to find options, get second opinions, etc.
Natural monopolies (aside from those caused by regulation) are caused by lower long-run average total costs than someone else, industries where economies of scale are nearly infinite. Even those that can't be "disrupted" by building a competitor that sells the same product can be supplanted by newer technology. For instance, many people and companies are exploring setting up solar-powered, battery-backed microgrids that would create serious competition with the government-sanctioned monopolistic utilities. In other words, while high start-up costs will certainly delay competition, they won't prevent it.
> I'll file this one away to remember in the future.
Care to elaborate?
> Care to elaborate?
This was in response to the comment by Retric calling out my idiot behavior. Which, I agreed with.
> Another example: the AMA is a horrible gov't-sanctioned monopoly that hugely increases medical costs; most procedures can be done by someone with a few months' training (see the military). Healthcare is one of the few industries that hasn't mastered "mass production" of procedures in spite of the fact that many surgeries are similar.
Very good point. Reducing costs through other measures definitely are a valid approach. This is one I agree with.
>The point I think you were getting at is that most people have limited choice because they are often treated in time-sensitive situations. However, about two percent of healthcare spending is on such emergency care . Most procedures give people at least some time to find options, get second opinions, etc.
This is true in part. However, mobility and access are often very limited to a significant portion of the population due to ability to travel, lack of time to take off work to travel, as well as the type of insurance a person has. If our society was more inclined to provide the ability for people who financially would struggle if they took a day let alone multiple days off of work to shop around to reduce medical costs this would make sense. But that is not the society we live in.
True enough. I do think allowing a market to develop will give us the tools to shop around with less hassle, e.g. online ratings and comparison based on hard data people will have to disclose to compete in a free market. Similar with transportation, changes in the way we get around will change this and make life a lot easier, hopefully.
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?
I got the bill from the doctor. It was reasonable and I paid promptly. I got the bill for the X-ray and it was ridiculously low to my surprise. It was paid immediately. In my mind, I was done.
Then I started getting phone calls from a broken machine. Please call <actual silence> at <more silence> about your past due amount of <~$4000>. I assumed they were spam, but after about 10 of these calls over three days, the message variables were randomly filled or not on any given message. At no point was the message clearly about my hospital visit identified, but I figured it out by the phone number and the name of the parent company.
At this point I hadn’t even been mailed a bill. And I know they have the right address because the other bills came and I’ve only ever lived at my current house since the first time I went to this hospital.
So I went down to the hospital to sort it out. Well, they don’t have a billing department. They have “financial counseling” or something equally not what I need. And even though it was in the hours they are supposed to be there, everyone had gone home for the day.
I still haven’t paid. I haven’t gotten a bill, and I’m not entirely sure the calls aren’t just a scam someone is running.
Wife cut her hand Thanksgiving night - had to go to ER - bleeding pretty bad. Initial triage was a few minutes, then in to an ER room to 'wait'. Someone came in after about 10 minutes with a portable POS on wheels, saying we had to pay $450 for the ER visit. No explanation about anything, and... I paid, but... I was in no position to 'shop around', nor even be confrontational. If I make a scene, or refuse to pay, or ask for more details, will they make us wait 6 hours? Or 8? I wanted this addresses ASAP, and paid. And... we still ended up getting bills for around $3400 (total of 9 stitches on her hand). This is with 'full insurance', which, we pay $1k/month for for 2 people.
That anyone defends this system as 'the best' is beyond me.
She was certain that she wasn't pregnant, given she had seen her GYN just two weeks prior and was on implanted BC.
We're still fighting the appeal and the hospital regarding the use of an out-of-network lab instead of the in-network lab then used for the rest of tests.
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?
Oh, and my two cents: if you want to end up with larger numbers of under-represented groups in higher-paying fields, maybe making the long-term outcomes clear at that stage would help. Saying, "follow your dreams!" is very, very stupid advice to an eighteen-year-old.
The problem is really at elite publics, which don't have the massive endowments, so cannot subsidize middle class students.
We're at a point where it can be LESS expensive for many middle class students to attend Harvard than UMich or UVA.
1 - https://financialaid.stanford.edu/undergrad/how/parent.html
They are also seevices which means there is no preserved buffering possible. You can't just have a factory of doctors fill a warehouse with 40 hours of medical care each every week. Given the opportunity cost trying to "squeeze in" what they can in a discard free knapsack problem sort of way makes sense given the incentives even if the outcome isn't ideal or fair.
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?
It's price discrimination, in that it's charging people in proportion to what they can pay.
He has quite the "ability to pay".
In the way where you buy the legal definition of fraud from the senate.
I expect a lot of service providers to become untenable after price corrections, go bankrupt, get bought out by more efficient providers who remove all the unproductive staff.
Course this is all premised on Congress doing something useful, so...lol.
How do you motivate these people? Or manage their performance? Or manage a good outcome for the busieness, the payor and the client?
This wasn't a hospital setting. Much lower acuity. Upon joining they measured exactly this: CPT codes, bills, A/R, etc. 95% of the time those metrics correlate with their job: getting your complex insurance to reimburse for a procedure they administered.
It's a) not clear that's what you should measure, but let's assume it's not the worst thing in the world, b) straightforward how you can get the "evil" white board example you mentioned.
Not saying this is good or bad and American healthcare is arguably broken. But just another example to maybe calibrate your view.
What has changed about healthcare in the last 20yrs to drive up the cost of insurance premiums and pretty much everything?
I hope your wife has made a full recovery!
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.
She gave me a laminated card; three pages. I think she was kinda shocked I read it.
Kinda unrelated ... I was at a Wal-Greens and the checkout person wanted to scan my ID. I was like, "NO! I do not consent."
So I turned my bag upside down, emptied everything out and said goodbye. I no longer buy alcohol at Wal-greens (or anyone who scans my ID), and I find it disturbing I was the first person who asked.
Most people don't care about their privacy or what they're signing. It's fucking insane.
PhilosophyTube recently posted a great video essay (Socratic dialogue?) that explores that exact situation.
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.
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?
If I remember correctly, there might have been something about PoA in my contract. I already hand several reasons to not sign it, so I only skimmed the last ~1/3 of the document.
For comparison, I had a minor surgery (ulnar nerve release) in the surgical center across the hallway from the imaging center. I think they are part of the same umbrella healthcare company? The surgery center only wanted me to sign a short, concise contract that was mainly standard stuff (surgery always has some risk). I don't understand why an MRI (very safe, short) needs 3x-4x longer contract than surgery (always has some risk, involves a lot more people). This seems backwards.
Surely this should be reported to someone that could do something about it. I would hope so anyway, as that seems like a dark pattern that could be litigated.
Yes. It's a normal and enforceable clause. It's very common in all kinds of contracts.
The credit card companies apparently didn't care.
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?
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.
Really, it's disgusting.
credit unions are one of the few pro-consumer entities in the financial world, it would be a shame to smear them
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.
And given that it’s now a US requirement to have medical insurance, I’m still struggling to understand what this medical credit score is accomplishing.
It became a "requirement" in 2014 with Obamacare, but since the repeal of the individual mandate in 2019, there is no financial punishment (except well, the increased possibility of medical bankruptcy) for not having insurance:
Similarly, if the insurance company for any reason disputes a hospital claim for any reason, up to and including disagreeing with the hospital that the issued treatment was appropriate in lieu of a cheaper treatment, the hospital goes to the patient to foot the bill.
So it is entirely possible to be fully insured and still be forced into unpayable medical debt through factors completely outside of one's control.
It's frustrating to me that this point is very often overlooked in the discussions about health insurance in the US. A lot of people who go bankrupt over medical bills are fully insured and suffer for reasons entirely beyond their control like the hospital an ambulance decides to route them to when they're unconscious.
A Bronze family plan will typically have a $13k deductible. You pay that entire amount out of pocket before insurance kicks in, and it resets annually... so if you're in the hospital December 31 through Jan 1, you might be on the hook for $26k.
There's also nightmare scenarios where the hospital is in-network, but the doctor isn't. https://www.reuters.com/article/us-health-insurance-surprise...
Many states have surprise billing laws to limit what bills you can receive from out of network providers.
There are a lot of subsidized folks on the Bronze plans with zero ability to pay an unexpected $400 bill, let alone a $13k deductible. They're insured, but only technically.
> Also almost all bronze plans cover the first 3 doctor visits with a normal copay, and any preventive care has no copay.
Sure, but I'm referring to the sorts of bills that bankrupt people, not an annual physical.
"There is good evidence to support the idea that acne and associated scarring negatively affect a person's psychological state, worsen mood, lower self-esteem, and are associated with a higher risk of anxiety disorders, depression, and suicidal thoughts."
While Acne probably won't kill you, it certainly won't make you happier and could contribute to suicide if left untreated. We are lucky that acne meds are cheap, but there is nothing stopping those companies from shooting up their prices tomorrow.
Also by the way, the requirement to provide care to any walk-in patient only applies to ER's, and only until they have stabilized the patient.
> “Emergent” properly means “emerging” and normally refers to events that are just beginning—barely noticeable rather than catastrophic. “Emergency” is an adjective as well as a noun, so rather than writing “emergent care,” use the homely “emergency care.”
Medical debt can still be added to your credit report.
Moves like this erode my opposition to nationalizing the entire US health-care sector. If they're going to cartelize or confederate, patients--which is to say everyone in the country that lives and breathes--will also want a seat at the table.
From a more generous perspective, this may be a tool for price discrimination. Hospitals will charge based on what they think the patient can pay, rather than the actual costs of providing the care. When you receive care, you will be billed for a number that is calculated to make you sigh, flinch, or wince, but not call a bankruptcy lawyer.
This is a symptom of illness in the system, and leaving it untreated seems like a bad idea.
This is true, but many life-saving treatments (such as chemo or radiation treatment for cancer) are not "emergency" treatments, despite being necessary and somewhat urgent.
It’s probably more profitable for them to send a small bill to a poor person than a large bill that is never collected. It’s definitely more profitable to throw the most ludicrous bill at those who can and will pay whatever cost is sent at them. You can also adjust the kinds of treatments given according to likelihood of profit.
I wouldn’t be surprised if the latter case is illegal (or happening or not). I’m pretty sure the former case is perfectly legal, though symptomatic of a bigger problem.
Every time you visit the doctor, the hospital tells experian (by querying the experian system) and then experian resells this information for profit.
This article talks about how Experian have SOC-2 issues, which is a cause for concern, but smaller hospitals with tighter budgets could be inclined to look past it.
In general, it's important to understand that HIPPA doesn't prevent data from being shared, it gives it a legal framework to be shared within. When things go bad, the HIPPA-associated paperwork provides a roadmap for assigning liability.
Liability does get assigned, and companies (providers, insurers, network providers) are held responsible, despite the popular imagination: https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf
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.
False. Directly from HHS, emphasis mine:
“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,
"As needed" is a definition that most patients would disagree with
Your prescriptions, hospital admissions, radiology orders, etc are in the hands of any of a dozen third parties before your claim is processed. It is trivial to un-anonymize the data.
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  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.
 - https://amplicare.com/
If you look really bad, they'll refuse to check you in.
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.
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.
> 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.
Usually the only time they'll fail to ID you is when you show up to the front desk with no identification and lie about your personal details, which I don't particularly recommend doing.
Bear in mind this fact when working on systems that make use of SSNs.
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?
Yeah, except, sadly, it'll most likely be "You're welcome to try the hospital across town if you'd like...".
I think the medical field here in Mexico is much more affordable because it's cash based, with real competition between doctors
Hospitals want this leverage again so they built their own credit system.
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...
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.
For context, hospitals are only likely to lose money on very complex patient cases, i.e. the kinds of program described in the video. In those situations, it makes sense that hospitals will want to make sure that either (1) the patient will be able to pay or (2) charities or government programs will cover them, once they apply.
Experian's system claims to helps them make that assessment. Will that lead to patients being turned away? Maybe, but it's not a straightforward conclusion, like you imply. The comparison to Uber ratings holds no water.
The reality is that American healthcare is a complicated market with many sources of revenue that aren't patients' bank accounts (charities, govt subsidies, insurance), and it doesn't lend itself well to this kind of oversimplifying analysis.
Even though they're determining eligibility for "their own" charity, they're likely determining eligibility for "other charities", if you follow the money.
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.
How is this not a complete violation of HIPAA?
Are they working around it by having very general HIPAA release forms?
> 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.
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.
The above aspect of "wealthy people get to buy nice things" really doesn't contribute anything interesting to the conversation.
Their Standard for basic care is much higher though. You can’t compare that.
In Canada, you get Medicare-like primary care, benefit from price controls on drugs, and can buy secondary coverage to get more. In the US, you get to subsidize drug development for the world and enrich a variety of different cartels.
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?
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.
While on vacation recently I ended up listening to the Bear Brooks podcast . 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 .
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.
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.
Edit: Technically oligopoly, not monopoly, though it may tend towards one.
Second, what exactly do you mean by "an otherwise public service?" Are you simply saying, in the absence of private medical care, that "medical care" would be purely owned by the government? This seems uninformatively tautological and I get the feeling some other meaning or implication is meant to be attached but I cannot pin it down.
Those 2 are conflated because Citizens United permits lobbyists to sidestep campaign donation limits by allowing industry groups to effectively spend unlimited amounts of money on behalf of or in opposition to candidates.
At the core of this problem is that speech can be amplified with money. Even if we ban selling of speech to others, organizations can still spend the money to host/print/post/billboard/telecast their own messages. Those with money will out message those without.
Is there a way to fix this that doesn't result in government control of political speech?
The first amendment has only been loosely upheld throughout our history. There are many types of speech that are regulated in spite of it.
>Is there a way to fix this that doesn't result in government control of political speech?
We had a system in place prior to Citizens United that didn't turn into government control of political speech. Many other developed countries have limitations on spending money on political speech that don't turn into complete government control of political speech.
There's no reason to assume that a few men in the 1780s got everything right. And a slippery slope argument is no reason to throw up our hands and stop trying to advance egalitarianism.
Granted, all of this is pretty much meaningless when you have a government overstepping its bounds and doing what it wants. In that case, it seems the blame of the corrupted system would fall on those corrupting it (the corrupt government allowing itself to be bribed in exchange for monopolies).
Those laws exist because capitalist forces incentivize healthcare providers to limit competition.
> which is likely impossible to keep from being corrupt (easy to believe if you've ever met an actual human being).
Have you met any human beings? Try not to be so cynical, damn.
This is peak political corruption.
And of course even where the govt is not funding the product, they are stipulating in detail what it must include. E.g. insurance must include a long list of things from mental health care to nicotine patches, forcing people to go through their insurance rather than through a market where they would negotiate prices.
Instead health plans market to EMPLOYERS (not the consumers of the actual product). Trust me - the service there is pretty amazing! Tax law is designed to in many cases benefit these employer negotiated plans.
Buying people off is the essence of capitalism.
Sadly, no. It's been all of them, including Experian. This seems flat-out mad to me.
Periodic reminder that there are more bureaus than just Equifax, Experian, and TransUnion, and all of them buy and sell your data every day. One of them  even sells your salary data to prospective employers so that they can negotiate against you more effectively.
All in all, we spend about half the median household income each year in health care. When my wife got pneumonia after the flu, we had to drop thousands on an ER visit.
If I wasn't well paid, between our allergies and asthma, we'd probably dead.
In other words, it's the same as a tax to pay for healthcare for the country, except it goes to insurance companies, and you have to deal with in network and out of network. Except this tax goes up the older you get (but capped at 3x what youngest/healthiest person pays).
Presumably, if you add up all the insurance premiums paid for every year of a person's life, it should theoretically add up to close to how much the insurance company expects to spend on you (plus some profit, capped at 20% by ACA).
There's always the anecdata that floats around the internet claiming that you can fly to Spain, live their for 6 months, get a hip replacement, and fly back to the US for the same amount as the outpatient surgery costs in the US. It's basically true, though the numbers may have drifted slightly since it first started making the rounds.
> it's the same as a tax to pay for healthcare for the country, except it goes to insurance companies, and you have to deal with in network and out of network
I think this is one of the strongest ways to frame government-provided healthcare. It's no different paying a tax vs paying the company directly, and in the former case you have the whole US government bargaining on your behalf for reasonable healthcare costs (in the case of single-payer a la M4A).
> capped at 20% by ACA
20% is a lot when we're talking about these outrageous numbers.
It’s not 20% net income, it’s 80% of premiums have to be paid out to healthcare providers. There’s still all the costs of operating the insurance organization, and financials of publicly listed health insurance companies show net income in the 3% to 6% range.
For my high wage, my NHS fee would be just under £7k for the year, my taxes just about at 30%.
Granted here in the US, my taxes are ONLY 25%, but my healthcare costs are close to $30k/year.
That $20k difference is ridiculous ($11k more than in the UK when comparing tax+health), and I HAVEN'T gone to the hospital for a heart attack or premature baby or hemophilia, but if my wife did have a baby, it would cost us out of pocket around $8k (according to the likely VERY skewed numbers in my insurance packet).
A colleague I know is 54, he is single, has only catastrophic coverage and pays $1200/mo. Nothing is covered except 40% of any emergency hospitalizations. The bronze plan was $2000 and had a $15k deductible, and also was basically only co-insurance with $30 generics.
The way we are doing this here in the US is literally killing people. Medical debt is increasing.
My little sister-in-law was on vacation and walking along a path on a jetty with handrails, and benches, and dozens of other people. A rogue wave came and hit her and her friend. She was taken under, knocked unconscious and drowned (and died), until a random stranger who was standing near her finally found her and resuscitated her. She was medivaced to a hospital by helicopter that insurance only covered 10% of because she was out of network, she was then treated by a dozen or so doctors for multiple days as she got pneumonia and broken bones, and head trauma, all out of network. She ended up owing close to $100k with her insurance only covering the first $25k. In any other first-world country, she'd be out of pocket maybe a few hundred bucks. Not in collections for being unable to pay $75k for a freak accident.
I'm no fan of insurance/hospital bureaucracy, but at least I can go to any specialist doctor I want without having to see a GP first. And I pick the job and insurance provider I want to reduce the amount my family pays each year.
Emergency situations like the last one you mentioned, if they are out of network, are still covered at in network rates, thanks to my insurance plan specifically stating that in their plan documentation. I feel bad for your sister-in-law and am glad she survived, but she did have a not so great insurance plan. I would strongly consider getting a different job or lobbying hard with my workplace HR if I had a plan that would only pay 10% in true emergency situations.
Look at what it would cost to cover you and your family on the individual market without government or employer subsidies. As a contractor, I pay double what you do on the individual market, and that is only coverage for myself.
And everyone would get a different job with nice health insurance offerings, if they could.
If my math is correct, employer + employee national health fee for £140k salaried employee is a few quid short of £10k which is still half of my annual health care expense, so my original point still stands.
Being forced to ruin your credit because you got sick or had an accident is sociopathic.
And to that I say: fine. I will happily subsidize, through my tax dollars, health care to pregnant women, addicts, the obese, down-and-outers, whoever, so long as it means that everyone has access to doctors and hospitals when they need it.
I am far less worried about paying a few bucks a year to support someone whose condition I will never have, than I am about sustaining this spider's web of private health insurance, with its unaffordable deductibles and an endless list of shady practices. America doesn't need health insurance companies to act as intermediaries between us and our doctors. They add nothing.
Replace "male" with "child free" and this makes sense but suggesting men are subsidizing childbirth is ridiculous.
> and other women specific costs.
> Men die younger than women, and they are more burdened by illness during life. They fall ill at a younger age and have more chronic illnesses than women. For example, men are nearly 10 times more likely to get inguinal hernias than women, and five times more likely to have aortic aneurysms. American men are about four times more likely to be hit by gout; they are more than three times more likely than women to develop kidney stones, to become alcoholics, or to have bladder cancer. And they are about twice as likely to suffer from emphysema or a duodenal ulcer. Although women see doctors more often than men, men cost our society much more for medical care beyond age 65.
I assumed that because before ACA, childbirth was not covered by insurance and insurance pricing based on gender was allowed, and post ACA, childbirth was mandatory and insurance pricing based on gender disallowed, that it must mean that, in general, healthcare costs more for women than it did for men.
But perhaps that's only true for young men and women, if true at all?
Good luck if you fall outside of that list.
Oligarchs know that money has to be spent to keep the plebs just well enough to prevent revolt.
There was a survey that went around a few years, asking Republican voters something along the lines of:
"Would you vote for an Affordable Care Act if it was offered as an alternative to Obamacare?"
A significant amount said "Yes".
Can't revolt if you're disabled and untreated, tied to your job to keep your kids healthy, incapacitated by treatable illness or weak from hunger.
like I said, they'll call it something else. repeal obamacare and make something new that will basically be medicare for all in some shape or form. it will be a handout to the big insurance, drug, and healthcare companies, I'm sure.
I didn't specify before but I'm talking like 8-12 years down the line.
Or are we more the token outlier with a "worst of all worlds" system?
Around the world, it appears that low costs lead to universal healthcare, not the other way around.
What America needs to do is make it cheaper and easier to become a medical practitioner without taking on half a million dollars in debt and wasting half of one's pre-retirement life. No fancy government program will work without first addressing that issue.
And Medicaid, Medicare, and the Veterans Administration (the three big government run healthcare systems here) all run more efficiently by every measure than any private health insurance system.
Note that I fully recognize the problems that the VA has had, but when you really look at it fairly, they have many parallels to problems in the commercial side of the system, we just don't tolerate that when it comes to government (nor should we).
After Canada implemented universal healthcare, costs rose rapidly before stabilizing: https://www.ncbi.nlm.nih.gov/pubmed/379054
Both private insurance and taxpayer-subsidized programs pay astronomically high prices for healthcare; I haven't seen any examples of Medicare paying European-level prices for services.
I know this feels true because laissez-faire and commie-bashing rhetoric is still common in the Western world, but there have been numerous studies recently showing that the US is the most costly per capita. The next 3 countries (by 2016 numbers) are all places where most things are more expensive because the country and its citizens are relatively rich: Switzerland, Luxembourg, and Norway.
There's even a Wikipedia article about it: https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
Of particular interest is this graph, which breaks it down by public vs private spending: https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
I feel like you didn't read and fully understand my comment.
"Please don't submit comments saying that HN is turning into Reddit. It's a semi-noob illusion, as old as the hills."
Yes, I can see that your account was created in 2011 :)
Regardless, I don't think silent downvotes really cut it anymore either - nowadays I tend to run out of them after reading only a couple submissions with active comment threads.
It's those long chains that end up being an out-of-order recital of some famous TV/movie scene that really irk me, personally. Those and similar are cases where the value is only in recognizing the source and getting that dopamine hit, and not in any further contribution to the discussion.
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.
Everyone who can does that. Laws and politics aren't a separate magisterium from business; there are no hard borders here.
That one difference is all that matters.
As a businessman, as much as you can direct the behavior of both your customers and your employees, you can influence the lawmakers. After all, they too want money or things that money can buy.
Violence is just one side of the coin that is power. The other side is voluntary (or technically voluntary but not quite) participation, which is primarily controlled by money. That's what makes politics and markets intertwined.
The doctor runs credit on you before providing treatment, and because of this erroneous bankruptcy that you may not even know about(credit reports can only be reviewed once per year), you are placed in the hallway instead of being given a private bay despite the increased risk of infection. The hospital wanted to make room for paying customers, you see.
So while it's natural to want to "sell" to "profitable customers" in this case applying free market principals to this makes a complete mockery of our health care system. And given the credit bureaus' track records of high inaccuracy and difficulty in disputing the reports, you're likely to get poorer treatment inexplicably, and entirely by accident.
Street lights? Police and Fire protection? Water access?
I remember there was a big outrage about Martin Shkreli's actions. Meanwhile the CEOs of these companies probably get lauded in business magazines.
Calling these miserable, greedy, selfish bastards out for what they are could be a first step. God, how I'm hoping for a socialist revolution to take place within my lifetime...
We've seen that this is something that absolutely doesn't work. They (that's the people who matter) just find a scapegoat and everyone else carries on just as before. Shkreli ended up in prison, but Valeant is still busy making profit off the backs of patients, and despite Hillary Clinton's professed outrage prices for such drugs as Syprine haven't gone down a penny. Netflix has a documentary on the case.
Where is the revolution? Where is single-payer healthcare?
Americans are getting exactly what they voted for.
Also, let's be clear about one more thing. Martin Shkreli is not a free market capitalist, he's a crony. Leveraging state patent systems to create abusive monopolies is not free market capitalism, that is textbook crony capitalism and the enemy of a free market. Without arbitrary state enforcement of medical patents on insulin and epipens, do you think that these would be exceedingly expensive items? Are you being bankrupted by Benadryl? Hardly.
There are absolutely elements of healthcare that are far better serviced by a command economy than a free market, and I think the weird hybrid system in the US is the worst of both worlds in many such cases. But a socialist revolution? Socialism is an authoritarian nightmare that cannot suitably answer any question related to scarcity or competence.
As for "socialism", again you're disagreeing on definitions. To most Americans, Sweden, Norway, Canada, etc. are "socialist".
As far as definitions go, my definition of "socialism" is actual socialism, not social democracy. This quote is overused at this point, but Danish PM Rasmussen explicitly clarifies "I know that some people in the US associate the Nordic model with some sort of socialism. Therefore I would like to make one thing clear. Denmark is far from a socialist planned economy. Denmark is a market economy." Adding central planning to ameliorate some of the rough edges of market economies does not create a socialist state.
Again, most Americans will disagree with you. The definition of a word is whatever most people agree it is.
>This quote is overused at this point, but Danish PM Rasmussen explicitly clarifies
No one in Denmark has any authority to define a word in the English language as used by Americans.
>Adding central planning to ameliorate some of the rough edges of market economies does not create a socialist state.
According to Americans, it absolutely does.
>So no, free market capitalism is not indistinguishable from crony capitalism.
Again, according to many Americans it is.
Here's a challenge for you: pick out 100 different rural counties across America. Go to each county, and take a poll, asking them, "Is Denmark a socialist country?" I guarantee you that a clear majority of those polled will answer "yes".
Just try having a conversation with the average American voter (esp. in rural districts) about "socialism" vs. "social democracy" vs. whatever, and see how far you get. They're probably going to say Denmark is "socialist" because they saw it on Fox News. But these are the people electing the leadership here (or about half of it anyway). We have two "sides", and even many on your side probably would have a hard time with these concepts. It's no wonder things are so broken here, and I don't see how it can get better any time soon when the two sides can't even have a rational discussion because they can't even agree on basic language or concepts.
"In economics, a public good is a good that is both non-excludable and non-rivalrous"
"A good is considered non-rivalrous ... if, for any level of production, the cost of providing it to a marginal (additional) individual is zero"
"... a good or service is non-excludable if non-paying consumers cannot be prevented from accessing it."