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Your New Medical Credit Score Could Deny You Care (thetoolsweneed.com)
337 points by kaxline 22 days ago | hide | past | web | favorite | 386 comments

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"?

I just learned, to my surprise, that pricing and transparency changes may go into effect next year.

Forcing hospitals to disclose prices:


Though the hospital industry is fighting it, so we'll have to see if the rule survives.

I'm completely onboard with price transparency, but am skeptical as to the utility of it to the consumer. I suspect a lot of people will get "oh, we thought it'd be X, but it turned out to be Y, which is 3x the price" sort of scenarios.

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.

The pricing game in the medical field is not that though, it's just a ridiculous tradition. They give hugely inflated prices then accept a fraction of that from insurance companies because it was their real price anyway. If any uninsured individual (e.g. with good credit they want to protect) gets ensnared by this and ends up paying their 3x number it's totally unfair.

when they are selling similar procedures for elective or cosmetic surgery, like plastic surgery patients, the prices they ask are much more competitive.

i wonder if they inflate the prices to inflate their write offs come tax time.

No they can only write off actual costs.

I'm pretty sure a good accountant can drive semi-truck full of large bills through that.

I dunno, the reality is that we have mark to market accounting https://en.m.wikipedia.org/wiki/Mark-to-market_accounting

Some how automotive repair, general contracting, and many other industries have been able to solve this problem.

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.

Shit... my vet can do that. They saw my cat, estimated the surgery necessary, the length of care in an ideal and not-ideal situation, cost of potential extras based on possible complications or additional needs such as full sedation.

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.

When one of my pets had surgery a few years ago, the surgeon's office actually sent us back a bit over $500 a few weeks afterward since it went smoother than expected.

The extremes are much wider in human medicine, though.

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.

True, but it should be possible to say the average cost is $10,000 according to the last N similar operations. In the event of something abnormal occurring, you might require an extra $25,000 for this and that, and if the shit hits the fan, expect $250,000 for extreme lifesaving effort.

That's why private healthcare makes no sense. You just cannot attach a price tag to human life no matter if it's premature birth or a child with leukemia or routine surgery like an appendicitis. The only sensible way to run healthcare is by socializing it.

Socializing healthcare doesn't eliminate the cost calculus, it just shifts it to a different group of deciders. It feels icky to attach a price tag to human life, but in a world where resources are not infinite, and healthcare requires resources, those decisions have to be made somehow.

Most countries with socialized healthcare and comparable (sometimes lower) GDP per capita to the US have higher life expectancy, lower expenditures for both the state and the citizens, and a better relationship between healthcare and the citizens. It's a fact. No, death panels aren't a thing. You die when your heart stops beating, period.

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.

If a govt decides to restrict the amount of MRI scanners hospitals can have in a region for budgetary reasons, forcing patients to wait longer or only get them when the risk is higher, an economic decision has been made regarding the value of your life. A well-known stat that was already true decades ago was that Orange county california has more MRI scanners than Canada (population difference about 10x). And it isn't just a gimmick, far more imaging is done in the US than other countries. The US probably puts a higher value on life than any other country, which is part of the cost problem.

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.

It’s naive to think the USA doesn’t already have death panels. People die after unsuccessfully fighting their insurers for coverage already.

The USA doesn’t put more value on life. We put more costs on it, but our outcomes aren’t meaningfully better.

I don't see that your case has been made. I see more willingness to perform costly interventions as a clear example of how more value is being placed on lives. As for outcomes, you can argue a CYA approach where they try everything they possibly can isn't necessarily more effective, but I disagree that you can dismiss it as proving less value has been placed on life. I also distrust stats about outcomes given how politically charged the topic is. The most obese country in the developed world comes in with a bias towards worse outcomes already.

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.

I agree. I would say the only reason providers are not cost estimating is because they don't need to in order to get business.

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'm in the Kaiser Permanente system in California where the hospital and insurance are one entity. Since everything is pre-negotiated, most times its just the copay. So under my plan, for example $20 for primary physician visit, $40 for specialist visit, $20 for blood test visit and $100 for emergency visit. Having one entity involved simplifies things.

Kaiser utilizes the Experian program.

They can totally do it. It's only a problem because they want it to be a problem.

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]."

The very existence of insurance allows this insane inflation to occur. It completely obscures the need to to price things accurately.

Not really, insurance must exist because healthcare expenses aree simply too unpredictable. And anyway places with single-payer healthcare spend much less than the US even though they are effectively a state-run insurance. Heck, the same applies to Medicare.

Only in the US, in India, every medical procedure has a cost attached. 90% of the transactions are cash, and it would not work otherwise.

While I understand your healthy skepticism, I would be a bit more bullish given this example from 2013:


One thing is for sure, any improvement to price transparency is a boon to competition.

> Some Hospital administrators accuse the surgery center of cherry-picking the healthiest and wealthiest patients.

You probably won’t see this place put a fixed cost on a 26 week preemie like my twins.

>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.

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.

> 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.

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.

> am skeptical as to the utility of it to the consumer.

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...

> 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.

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.

Hospitals are protected businesses in the U.S. To build one you need a "certificate of need" in most jurisdictions in the United States. I.e., they are government-granted monopolies. They behave like government-protected monopolists do: they rent-seek.

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.

> Nowadays we have unprotected, standalone ERs, urgent care clinics, and specialist clinics.

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.

Depending on what you mean by "beds are capped and reduced", the opposite may be true: my understanding is that one of the major inefficiencies in US health care is that we have an unusually high vacancy rate in hospital beds. Addressing that problem is the central argument of Certificate Of Need laws.

Everyone fights hospital closures, so it's really hard to do. It's sort of like how everyone hates Congress, but loves their congressman. Certificate of Need addresses growth.

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.

I'm not even saying that CON laws are good; I have no idea. I'm just saying that the premise behind them appears to be accurate, and the argument that they are nationally responsible for lack of available hospital beds seems flawed (there are regions where there aren't enough vacant beds, but that doesn't seem to correspond to CON laws, and nationally the statistic is in the other direction).

> just saying that the premise behind them appears to be accurate

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?

It's not working out. It obviously isn't. We pay multiples of what other countries do, and one factor in that is the inefficiency of how our health facilities are deployed.

> The government-allowed monopolies are the sprawling health networks the turn medicine into a sales funnel.

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.

This ignores the fact that markets fail under certain circumstances. Removing regulation would not remove the fact that a significant portion of healthcare is a natural monopoly[1] due to the fact that a significant portion of the population cannot "shop around" when incurring medical costs and the starting costs to enter the healthcare market as a provider are high: provide adequate facilities, hiring staff, purchase of equipment

[1] https://en.wikipedia.org/wiki/Natural_monopoly

Medicine is pretty much every economist's go-to example of inelastic demand. And the go-to thing to ignore when saying "markets will fix everything".

Not all medical care is emergency care, and after a while folks learn which provider is a better value. They hear other's outcomes as well. Even if they don't choose perfectly every time, word gets out eventually.

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.

I think US dentistry is probably the best example of US heathcare, but it’s unusual in several ways. Most notably it’s not been part of standard heath insurance coverage and it’s mostly small independent practices. Together that’s keeping prices reasonable and bureaucracy to a minimum.

You get some shopping around, but many people will stick with the same dentist for years if not decades.

Nice, a down-vote without addressing the content and the reference to support said content. But hey, what do actual economists know about markets and monopolies.

The downvotes are flowing freely nowadays on HN. I think the downvote threshold could use a massive increase -_-

Haha, down-vote to that one too. Feel free to address the original criticism, I'm waiting to have an actual debate instead of an naive emotion fueled down-vote fest.

Got it, you're admitting you were wrong through your actions. Thank you for that, it's refreshing to see people that are willing to accept a different viewpoint and adjust their own beliefs when new information is provided.

I upvoted your first comment and downvoted the next 3. It’s not a question of what your saying, but how your saying it. Try actually reading though the guidelines and thinking about what makes a comment worth reading. Ex: Please don't comment about the voting on comments. It never does any good, and it makes boring reading.


You're right I got carried away there. The up/down vote system amuses me a bit too much sometimes. I'll file this one away to remember in the future.

I didn't downmod your original comment; even had I wanted to, I couldn't as it was a reply to my own (same applies to your reply to that one). You really can't believe that more than one person disagrees with you? I did downmod the second two because they were snarky and rude; someone not replying instantly is not an indication of abandoning debate. It's not as though there's a notification system on HN, and people sometimes get busy.

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 [0]. 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?

[0]: https://www.politifact.com/factchecks/2013/oct/28/nick-gille...

First, thank you for responding and second don't take my idiotic self-amusement with the downvote/upvote nonsense as anything other than my own failure in that moment.

> 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 [0]. 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.

> 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.

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.

With first hand knowledge this is correct but much more technically complicated at the ground level than you would ever believe.

“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?

Try being uninsured. I had a woman come into my room (!) during my ER visit and ask for payment. I asked very clearly if this was covering the cost of the visit. I made it clear I understood the doctor and xrays would be billed separately. I paid. It wasn’t cheap.

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.

Even when you're insured this happens. I had a woman come into my ER room and demand payment of my full deductible. They ended up refunding me 2/3 of it about a year later.

yep, same thing happened here. I'd seen pictures, but.. yeah.

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.

I couldn’t even imagine going to a hospital uninsured. It means you are pretty much giving them a blank check to take all the money you have.

I have read and been told repeatedly that if you are not insured, you can typically negotiate any fee down to a reasonable rate, so long as you are diligent about it.

“Reasonable” is relative. Also first try to pull this off yourself. It’s not a pleasant process and takes a long time.

What's your other option? If you're critically ill/injured, the hospital/ER is where you go - that's who can treat your problem immediately.

If you owe a bank thousands, you have a problem; owe a bank millions, the bank has a problem. It isn't in hospitals best interest to have people go bankrupt.

it can work out exactly the same later on if your insurance it decides that they don't agree with doctors about a procedure being necessary, putting you on the hook for whatever.

Yep. My wife was billed almost $500 for out-of-network pregnancy testing when she went in for an injury, as they needed to confirm before they could give her painkillers.

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.

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?

Somehow doctors and colleges have maneuvered themselves into a position where they act like greedy companies but have a reputation for working for the greater good and should be trusted more than regular companies . Also people still believe that non profits are dogooders which is completely untrue in the case of schools and medical facilities.

This is what I don't get about "financial aid". The "elite schools" name an outrageous figure, charge the rich kids, give money to the poor ones, and ignore the middle class. This is probably intentional: they want either students whose daddies will donate or students who look good on press releases about "diversity". Now that the feds have nationalized student loans, colleges can continue these stupid policies knowing that the bottomless credit card of the American taxpayer has their back. Federal student loans don't consider a student's major, either; there's no way a "xyz studies" or poetry major should get the same loan at the same rate of a stem kid, even if that student has the same financial situation. From an actuarial perspective, it's nuts: one is going to end up a starving artist and the other has a promising career.

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.

That's not 100% accurate (the middle class is NOT ignored at the elite privates). For example, Stanford meets 100% of the tuition for students with family income <=$150k.[1] And the assistance doesn't evaporate completely at $151k. For families with incomes <$65k, tuition and expenses are covered. Most of the Ivies are similar.

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

Colleges and doctors are both decommoditized and competed over by those seeking "quality" and the minimal end up comparatively shunned if at all aware or having an alternative. High stakes breed those sorts of markets - it is no accident that doctors and lawyers are synonymous with highly paid non-management roles.

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.

>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?

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.

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".

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.

No, the generous "financial aid" policies of many universities amount to perfect price discrimination. They meet "one hundred percent of demonstrated need"; their phrase, not mine. This means they calculate how much you can afford to pay and charge you that much. That' is every monopolist's/oligopolist's dream. Oh, and they don't show how they calculate that "demonstrated need". I got prices much higher than what I could afford.

It's not on the level of individual student, but overall market. As ability of whole group of students to pay goes up, the price also goes up.

Just wait until Uncle Sam foots the bill directly.

He has quite the "ability to pay".

Right, but he also then has a lot more incentive to keep costs down and the power to enforce some requirements and controls to keep costs down.

Seems to work OK in every other civilized country on Earth.

In what way is this not fraud?

In the way where you buy the legal definition of fraud from the senate.

Hopefully Congress passes medical price transparency and this game will end, and price competition can truly begin. If a hospital has to publicly announce they charge Blue Cross Blue Shield 20% of what they charge cash patients, they'll be in an untenable position and have to make drastic corrections.

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.

My wife was denied short term disability for a foot operation due to a completely unrelated medical issue. It took 6 months to reverse the idiotic decision, which of exactly what they wanted. Infuriating.

Real world example (slightly annonymized). You have a 50 FTE "billing and collections department". You can outsource, but at a certain scale it makes sense to build your own.

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.

EconTalk recently did an episode on pricing in healthcare that talks about a lot of these issues. Well worth a listen: http://www.econtalk.org/keith-smith-on-free-market-health-ca...

Next time ask for that demand in writing. That's an easily winnable lawsuit. In fact you should just tell your insurance company that they demanded this AND tell your state's attorney general. That nonsense will be squashed immediately.

> 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

That's nuts.

What has changed about healthcare in the last 20yrs to drive up the cost of insurance premiums and pretty much everything?

I'm so happy I don't live in the US and have to deal with private healthcare.

I hope your wife has made a full recovery!

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.

I'm glad I'm not the only one. I just got a signature on a screen for a regular doctor visit and I was like, "What am I signing? There's nothing here."

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."

She called her manager saying, "No one has ever said this before." I asked about their data retention policy, wanted to see their privacy policy. I know this was useless, because they're not going to know. The manager said, "Unless we scan your card, you can't buy alcohol."

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.

"Unless we scan your card, you can't buy alcohol."

PhilosophyTube recently posted a great video essay (Socratic dialogue?) that explores that exact situation.


Typically the attorney fee assignment clauses go both ways, and the prevailing party has their fees paid. In some jurisdictions one sided clauses can be thrown out

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.

> 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?

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

> Power of Attorney

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.

> wanted me to grant them an indefinite Power of Attorney

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.

How does the person in charge of this decision justify that kind of thing to themselves?

> I wounder a judge would actually enforce that clause.

Yes. It's a normal and enforceable clause. It's very common in all kinds of contracts.

Depending on the situation, it could be reasonable to argue that you were under duress or undue influence to sign the contract. This is all situation dependent, of course, but it is probably rare that an individual would have the resources and wherewithal to win such a case anyway (which is another problem).

When you sign the LCD screen without the ability to see what exactly you are agreeing to, that gives you ammunition if needed later in court. When you sign on paper there is less wiggle room for you.

Just sign "No contract provided" and hand it back like it's no problem. If the employees don't care to actually give you a document, what are the chances they are going to scrutinize your "signature?"

A co-worker decided it would be funny to draw penises on the credit card signature forms.

The credit card companies apparently didn't care.

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.

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.

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

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.

Medical debt is regarded less harshly in FICO 9. I am not sure how widespread the use of FICO 9 is currently among credit bureaus but it is the latest standard.

It is not exactly the same. The bill cannot go into collections for 180 days. This is different from regular debt.

180 days is generally how long it takes their system to adjust the charges and send you a semi-fraudulent bill instead of the fully-fraudulent one.

It is possible that in non-emergency situations, the vast majority of situations, a hospital may deny or change the quality of care based off of your likelihood of paying it off. No one knows the difference between a "medical" credit score and a normal credit score, but we do know that this special, secret credit score is being used to calculate patient treatment.

Wouldn’t the easier solution be to not accept patients without insurance (and low co-pays).

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.

>And given that it’s now a US requirement to have medical insurance

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:


I'm glad the requirement is gone. I had trouble affording insurance under the marketplace plans when I returned to the US:


Medical insurance only covers treatment from specific medical practitioners, of which an entire hospital may contain a wide array of medical practitioners under and also not under any specific patient's insurance company. Having a routine surgery from a surgeon that is covered can still rack up an intense medical bill from an anesthesiologist who is not covered.

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.

> 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.

Which sometimes makes me wonder, why pay for insurance at all? Sure sounds like a racket, "pay us and you may get into medical debt, don't pay us and we'll make sure that you do"

Precisely because "pay us and you may get into medical debt, don't pay us and we'll make sure that you do".

This depends on the state. Many states have passed surprise billing laws, and limit what an out of network provider can charge

It's a requirement to have medical insurance, but the cheaper qualifying plans have enormous deductibles.

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...

The high deductible plans were originally for healthy young individuals with an health savings account to pay for the occasional deductible. These plans could be used as tax free investments if you got lucky. These days families end up getting the high deductible plans because that is all they can afford. And they do it without savings to back it up.

This is incomplete. A bronze family plan will typically have a deductible of $6k for an individual, and 13k for the family, but it also has an out of pocket max of slightly over that, so once you meet the deductible that is all you pay. Also almost all bronze plans cover the first 3 doctor visits with a normal copay, and any preventive care has no copay. Gold and above plans typically do not have a deductible, and the out of pocket max is lower.

Many states have surprise billing laws to limit what bills you can receive from out of network providers.

> so once you meet the deductible that is all you pay

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.

Also the deductible fiscal year conveniently restarts halfway through flu season.

There are laws against denial of service.

Only in life-threatening circumstances.

Which is kind of funny: all medical problems are life threatening. The only differentiator is how long it'll take them to kill you.

Well, the requirement is more specific: the hospital must treat you if you are in immediate danger of dying. They only have to treat to enough to stabilize you, though, then their legal responsibility is complete.

I agree with the OP in a stronger spirit. It’s in society’s own best interest to ensure a basic level of quality of life to its members. There are many illnesses out there which can severely, negatively affect a persons life but otherwise aren’t always treated because of mitigating factors. Sleep apnea is a good example. Many can get by without treatment, but eventually complications from it or side effects of it can lead to chronic fatigue/reduced productivity at work, and even lead to death. Back pain can do similar. It’s not life threatening but can lead to reduced work productivity which could contribute to being terminated.

Yes, I agree as well. I was just describing how things are, not how they should be.

That's patently not true. Acne is a medical problem faced by a substantial portion of the population at one time or another. In all but the rarest of cases it is not life threatening.

From the acne Wikipedia page:

"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."[1]

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.

[1] https://en.wikipedia.org/wiki/Acne#Prognosis

In that case depression is the life-threatening ailment, not the acne. Just like pneumonia is the reason you go to the ER, not a common cold on the off-chance it might later become pneumonia.

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.

Standard Credit scores are more lenient for medical debt. It takes 6 months for unpaid debt to show up and fully removed if paid in full even after it is sent to collections.

Nit pick, but I think the word you two are looking for is “emergency” rather than “emergent”.

Since you're nit picking already and because it's a "today I learned" opportunity, parent's usage fits one of the definitions of emergent, the first one here: https://www.merriam-webster.com/dictionary/emergent.

TIL indeed. Must be industry jargon or trade usage as another reply put it. As a lay person I’ve only ever heard it referred to as “emergency services”.

"Emergent" is the term used in the trade. Webster has this to say:

> “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.”

I have corrected this, despite some discussion back and forth, for clarity.

I believe medical debt is no longer allowed on credit reports now. Maybe this is to get around that?

"Specifically, the NCAP prohibits adding medical debt to credit reports until after 180 days from the time the account was reported to the credit reporting agency. It also mandates the removal of previously reported medical collections that have been or are being paid by insurance." [1]

Medical debt can still be added to your credit report.

[1] https://www.creditkarma.com/advice/i/how-to-remove-medical-c...

They might want people to be afraid that if they don't pay their bills, they might die. Since the threat of debtors' prison is no longer viable, I guess.

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.

I bet 'Likely to be litigious' score is part of that Score. Physicians and hospitals would kill to see such a score before they start treating new patients

> 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.

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.

The legal obligation hospitals have is that they must treat you if you are have a life-threatening emergency happening. That treatment can be the minimal amount needed to stabilize you so that you aren't at immediate risk of death. There is no obligation to treat you beyond that, nor to engage in follow-up care.

Yes, that is the current legal obligation. This is not enough, and important life-sustaining healthcare (such as cancer treatment) should be available to everyone, even if it is not an immediate emergency.

I agree, but we're a long way away from that in the US.

In Switzerland private hospitals will calculate the possibility of success in your case and if it is too low you will not be accepted, because they want to keep their success rates high... Maybe such "Medical Credit Scores" could be used for the same reasons...

I believe medical bills over $100 no longer count against your credit score so of course that created an opportunity to break them out and market them specifically

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.

There is also an increasing issue in Canada of minor operations being delayed to the point where major surgical intervention is eventually needed.

With the medical system over-burdened, the system is now fundamentally reactionary in many specialties; delaying anything that can possibly be delayed.

It's saving a penny today to pay a dollar (or a loonie, I should say) tomorrow. It's economically burdensome and, obviously, creates a great deal of unnecessary hardship for those in line.

Nearly every Canadian has anecdotal stories of elderly relatively who had a minor ailment that needed surgery - were delayed for months because they were low priority - and then needed a larger intervention as the problem compounded over said months.

Where does this show up in the data? How do you measure and value up to a year - which can be more than 10% of an elderly persons remaining life - being mired in uncertainty, discomfort, and pain waiting for a procedure? How do you measure medical efficiency and patient outcomes in this context?

The best way to describe the current system is that doctors (surgeons, in particular) are forced not to look out for the individual patient's best interest, but the best interest of their entire surgical waiting list in aggregate (and this can be dozens of names long).

So, yes, it is in the best interest of Patient X to have the minor operation done this week as there is a strong likelihood of further complications and a worse patient outcome if delayed. However, Patient Y needs a major surgery this week so Patient Y, rationally, gets the higher priority.

Yes, it's a different problem with universal health care. Here (Canada) the problem isn't oriented around the question of are you rich enough but there's a trade off in wait times. From the Fraser Institute[1]:

> There is also a great deal of variation among specialties. Patients wait longest between a GP referral and orthopaedic surgery (39.0 weeks), while those waiting for medical oncology begin treatment in 3.8 weeks.

Still, the Canadian system is demonstrably better when it comes to outcomes. Canadians live longer than Americans, and have lower infant mortality rates for instance. Canadians also pay half of what Americans do for health care, when everything is accounted for. My partner is diabetic; like most medicines its a fraction of the cost of in the US. A universal system brings with it purchasing power. No system is perfect, but this one seems much better than the American one for the average person.

It's a choice. In my case, I'd much rather the Canadian system over the American. Even when it comes to surgery, I had a vaginoplasty (took 8 months between GP consultation and surgery; $25k surgery paid for by govt). My friend got her tubes tied (took a month; paid for by govt). My other friend was in the hospital for a month (admitted immediately; paid for by govt). My uncle had heart surgery. He did not have to lose his house. My step-dad had hip surgery (took 4 months; paid for by govt). Not to mention all the doctor's visits and tests accrued over a lifetime.

[1]: https://www.fraserinstitute.org/studies/waiting-your-turn-wa...

The speed of the health-care system really depends on the specific area of Canada you're in. Health-care is managed by the provinces, and the amount of funding they pour into it can vary wildly. Add to that the fact that medical infrastructures are far from uniform across the provinces, and you get very different results.

I lived for a few years in southern Québec, and I was amazed at the quality of care there. My wife had some pancreatic stones, and it all got dealt with (including 2 surgeries, multiple scans and a 2-week hospital stay) within a couple weeks. No bill. My daughter fell and had a concussion, we were scared about possible brain damage so I took her to the hospital at around 8PM. We were out of there at 6AM after an X-ray, an MRI scan and a few hours of observation. Again, no bill. I had four kids, and I think in total I paid less than $100 for their births, and that was for the food I ate or for parking.

Right now I'm more in central Québec, and the quality of care is a bit lower. It's a pretty rural area, so the budget is probably lower and the points of service are more spread out. Still, I like to know that a medical issue will never bankrupt me.

> 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.

I'm in one the largest and wealthiest metro areas of the US, and there is a 6+ month waiting list to see mental health professionals.

> "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.

When I lived in Manhattan, despite living right down the street from some of the best paid surgeons in the country, my wealthy clients would fly overseas to France and Israel for their surgeries.

The fact is that countries with universal health care have better health outcomes, better quality of care, shorter wait times for care, pay half of what the US does and manage to cover all of their citizens. Each of those statements of fact can be cited here[1].

[1] https://www.healthsystemtracker.org/chart-collection/quality...

Yeah that sounds a lot like American propaganda about the Canadian healthcare system. All of my family has had their surgeries done in Canada, and while there is a needs-based component the wait times aren't ridiculous.

Publicly funded healthcare may not solve all issues, but it removes the perverse incentive to refuse or reduce care quality because you don't have access to insurance or cash. Free market means shit to me if I'm mid-heart attack, I don't have the time to review pamphlets about why ABC hospital has the best care for the low-low price of $4999!

And what proportion of the time are you having a heart attack when you see a doctor?

There are enough heart attacks (and other issues of an emergency nature where it's difficult to go do comparison shopping) that the health care system clearly needs to account for that sort of situation.

This is anecdotal evidence. I have friends in Canada who are incredibly proud of their healthcare system. They see the US system as archaic.

Maybe rich Canadians think differently, but universal healthcare will always be better for the general population.

Same with the NHS that's often derided. Cancer, heart attack, stroke? You'll be treated very quickly with the very best treatments.

Need some physio, but delaying it isn't going to cause ongoing problems? You're going to wait.

If you want to skip the queues then there's affordable private healthcare as well for non-urgent issues ... my plan with BUPA costs my employer £1,600 per year.

> 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.

>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... (2019)

And that number is decreasing under the current administration while the rate of medical bankruptcy (even for those with insurance) is also increasing.

Insurance != Healthcare or the financial capacity to see a doctor.

I have excellent insurance through my employer and still pay several hundred a month to cover my and my partners medical needs, on top of the insurance premiums in my paycheck. We are extremely lucky to be able to afford that but it's still nearly $500 a month that could be going to savings, retirement, a safer car, or more. Instead we spend about $6k a year to an inefficient system that doesn't produce better outcomes than universal systems like in Canada.

"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.

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

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.

"Sub-par" in this context meaning significantly higher chance of dying.


Government run care is different in one massive way: It's not a profit seeking entity.

Private insurance, even those run as non-profit, still turn a profit. Does the head of the DHS make 15 Million dollars in year? No? That's the average compensation for private insurance CEOs. Bernard Tyson CEO of non-profit Kaiser Permanente made 16 Million in 2017.[0]

Is that really "all the same"?


It also spreads the risk pool over an entire nation, rather than who happens to be insured by insurance corp A in state B.

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

There is no reason to have it exclusively. Having single-payer healthcare with mandatory participation for residents does not preclude existence of healtcare providers that are outside of that system.

Although it is likely that such providers would be just a small part, as for patients it would have zero monetary marginal cost to use providers that are part of system, so they would likely use providers outside of the system as a last resort or if there are significant non-monetary cost.

Can you be more specific? Which procedures would they have to wait years for? And how many relatives do you have? All of your relatives doesn't say much if you only have one living relative in Canada.

I waited 8 months to see a Neurologist in Toronto for a slipped disk in my neck (he was in disbelief and shocked). By the time he saw me, it had healed on it's own. If you are dying the Canadian medical system is great (most of the time). If you suffer from things like back pain, injuries, condition, etc, it will be a long and arduous journey before you get the attention or treatment you need.

I have many more stories, (family member being sent home with an Abdominal aortic aneurysm on the verge of happening (Friday) because the Surgeon didn't have time to perform the surgery until Monday. Guess what happened on Sunday? Guess what else happened a couple of days later?

Wife almost died because she had to wait a month for a specialist. She just couldn't get anyone to take her seriously. Finally got the treatment in an Emergency room (she went septic).

I live in the USA now and have the best medical care in the world for my family.

All this happens in the USA, too.


> At the beginning of the year, the wait to see a cardiologist at three of Vermont’s rural hospitals was more than 100 days, according to data from state regulators.

> At Southwestern Vermont Medical Center in Bennington, hospital officials reported patients would need to wait nearly 200 days to see a dermatologist.

> As of March, some of the hospital’s specialists, including cardiologists, ear nose and throat doctors, gastroenterologists and psychiatrists could only see between 20% and 30% of patients requesting appointments within 10 days.

I live in the US.

I had a relatively minor injury (wrist) from a car accident. Nevertheless, it needed some interventions and I was advised to start PT right away. Was given a referral and a list of in-network providers (for a large insurer). In my (metropolitan) area, I could not find a provider with a less than 3-4 month waiting period within 30 miles.

My step daughter wants counseling - 2 month wait. All three of my closest options for a PCP are "not accepting new patients".

This isn't a problem of socialized medicine. I grew up in Australia, and I know that much.

> I waited 8 months to see a Neurologist in Toronto for a slipped disk in my neck

In my part of the US, that is about the normal wait for that sort of surgery as well. Unless, of course, you're a millionaire.

> I waited 8 months to see a Neurologist in Toronto for a slipped disk in my neck (he was in disbelief and shocked). By the time he saw me, it had healed on it's own.

There are plenty of multi-month waitlists in the US for common medical procedure. My wife sees a sleep doctor. Our insurance is fantastic. He has a nice, expensive office in an upscale regional medical center. I don't know which car in the parking lot is his, but there's a lot of nice cars in that parking lot.

It is a ----ing nightmare. Multi-month waiting lists to first see him. Month-long waits for scheduling anything. Three-month wait to schedule a minor surgery. [1] He screws up her prescription changes, the pharmacy won't dispense because he didn't tick some box on a form, and he goes on holiday for a few weeks. His on-calls aren't able to fix the problem, because, well, they aren't on-call for his sleep practice. Guess who can't get her prescription?

And for this privilege, we and my employer pay ~$20,000/year. I suppose we could fire his ass, and switch doctors, with no guarantee that the next one won't be any worse. [3]

[1] Cherry on top - despite being fully covered for the procedure, and paying what they asked for at the time of the operation, the surgery center started calling us, demanding money. Guess who gets to untangle billing? [2] We do. Guess who, once the dust settled, turned out to have overcharged us, and eventually cut us a cheque? The surgery center.

[2] Double-whammy - my wife dropped her old insurance two years ago, to switch to mine. Guess who started sending us bills last month? Her primary care provider, because at some point his office realized that she is no longer on her old insurance. Somehow, it's taken them two years to realize this. I'm assuming that the new provider has been paying them all this time, but who even knows at this point?

[3] I must say, my best interaction with the US healthcare system so far has been at a walk-in clinic located in a crummy office with peeling wallpaper, patient examination rooms that doubled as storerooms, a broken water cooler, and a bathroom with a door that mostly closed, located above a laundromat in an, ah, common part of town. The staff consisted of the doctor, who was cycling through patients, and his assistant, who was translating to and from Spanish, juggling papers and photocopies, and doing vaccinations and blood draws. I was in, I had what I needed done, and I was out, with zero billing bullshit. I didn't see any Teslas in the parking lot, though.

Canada's system is deeply imperfect (it falls short of France in most measures), and arguably underfunded, however such a finite limitation in resources is a reality in every country and every system. Such anecdotes about a condition being misdiagnosed exist everywhere.

The US is certainly not immune from this reality.

I could see a specialist in less than a few days in DFW or immediately if necessary.

I live in the US and had to wait months and months for endoscopy, and even a referral to a gastroenterologist who could order an upper endoscopy. I was losing weight rapidly and in moderate pain for 90% of every day. It had nothing to do with what insurance I had. The only way around that was to pay cash... Regular appointment, 6 weeks plus a month for the GI. Cash? Scheduled within a week.

Eight months is not years though.

>>By the time he saw me, it had healed on it's own.

In other words, you didn't actually need surgery. The system worked as intended.

No, he needed surgery to avoid being in excruciating pain and incapacitated for months.

If you look at it in terms of economic productivity, the inability of the doctors to schedule this properly was taking some useful out of the workforce and jeopardizing their continued employment and financial stability.

I was in such incredible pain for so long that I finally realized why people kill themselves. I had asked my wife to cut my arm off with an axe at one point.

A free market requires informed buyers, there is no way 98% of people can be sufficiently informed about medical issues, nor do they have time to research them. The closest option is to hire an agent of equal ability (i.e. a doctor) to verify the claims of your doctor. Obviously, that's too expensive, so the next closest alternative is to use health insurance companies who do employ many doctors to verify proper treatment options (aka prior authorizations).

I have thought and thought about this and I have to say that I agree. Right now though, I am ready to shake things up in the US healthcare system and anyone offering a different solution is worth a look. So I am looking at "Medicare for all". I am sick and tired of the current system. So lets try something different even though I would ideally like a free market system where the poor are covered by the Govt and the middle class and rich folks pay out of pocket for MOST things. The moment you remove middlemen like the mafia insurance and overheads like billing companies etc and allow doctors to work directly with patients, watch how prices drop. I guarantee. I mean I pay like $22,000/Year premium for a family of 4. So even if I don't go see a doctor all year, I have paid 22,000. Don't even get me started on deductibles, in/out network , co-pays and all that other crap. Instead, I would prefer going to a doctor and receiving say a $200 bill for a regular visit. np. pay out of pocket. If I don't like that, I go to google and compare prices across other similar practices.

I have a relative who needed emergency surgery in the States. Unfortunately, the billing department would not let her have the surgery, because she was Canadian, and it was Friday, and they didn't have time to deal with it. The surgery had to be rescheduled for the next week, even though the doctor wanted it done immediately. This, despite pleas and offers to pay in cash, in advance – whatever it took.

So, instead the of the rushed surgery, my relative waited. After a day of waiting, she decided to go straight to Vancouver, B.C., where the issue was taken care of immediately, with no wait times.

However, because of the delay, her outcome was significantly worse than it would have been.

Basically, she lost much of her eyesight because of the "billing department."

That's the States for you.

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

Highly disagreed. I had several unnecessary surgeries as a child in canada. I had some swollen drainage things in my sinuses removed, and the only danger is that I was really sniffly all the time!

"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."

Does this mean that the free market means hospitals can choose not to treat patients that are too sick, too black, too gay, etc?

The wait time for an uninsured person for "unnecessary" surgery in the USA is infinite, which needs to be factored into your calculations here.

> which will reduce prices for everything to true values

wishful thinking.

we already see this with ambulance service. there is an overabundance of supply, but it has not reduced price. in fact, the opposite as all the companies run much less efficiently (less billable time).

people aren't going to shop and buy on price for hospital care. they are going to shop and buy on local presence. for regular doctor visits, the costs are already low.

If a person has no insurance and no money, do you think they should be denied treatment?

How does that work for a heart attack? How do you negotiate an emergency open bypass surgery?

No. In Canada, they just take you into surgery and treat you. Then you leave without a bill.

Contrast that to the US which could leave a person bankrupt for the same emergency.

> Contrast that to the US which could leave a person bankrupt for the same emergency.

Indeed. Even if you have good insurance, getting something like a heart attack, cancer, etc. in the US makes it likely that you'll be bankrupt in the end. I know three people that this has happened to.

medical procedures, for people with insurance, is the leading cause of bankruptcy in the US.

I strongly support your line of thinking, but there's a number of issues with this viewpoint that I've identified, and I'm not entirely sure how to solve.

The main one is, the (expected) medical costs are different for different populations. In particular, the expensive sub-populations are (1) the elderly (because aging & death), (2) women (because pregnancy) and (3) some children (born with genetic diseases, birth deficiencies etc. but having no income/wealth to pay for them).

If we argue that medicine should be driven by the free markets, we should also allow the free market to take over other things, but we as a society (currently) refuse to do that (IMO for good reasons).

What's the value of old age? Retirees are almost completely non-productive, a drain on the society... you could argue about saving for retirement (it's "free market") but that's a bit of a lie, you can't "save" labour or energy, so there's always a transfer of value from the working population to the non-working population, and as the non-working retired population increases and the working population shrinks, that's going to become a problem one way or another (both in socialized and in individualistic retirement systems). Old age awaits everyone, a populace would probably be feeling very uncomfortable about their own future if they saw poor old people dying on the streets, refused medical care.

What's the value of bearing children? It's kind of parallel to the above, children are an investment into the future (future workers), currently it's on the individual to pay for this investment (pregnancy, career income loss, more housing, education costs) but the society benefits (extracting taxes / parts of the value produced by this future worker). Should women also bear the cost of medical care? You could say there's always a father in the picture, but some people also claim that fathers should have the option of financial abortion (given that they have no say in physical abortion). Generally I argue that there should be incentives for people to have kids (correlated with their income, so that high-income, usually highly educated people, have more of an incentive to have kids - e.g. some kind of negative tax rate).

And finally, what's the value of a human life? Should we condemn a kid to a short life full of suffering just because s/he was born with some mistake in their body? I mean, resources are limited so we always have to make trade-offs, but refusing medical care to kids born to poor parents seems particularly evil.

I'm not sure what the solution is... personally, I'm leaning towards a "highest highs, highest lows" kind of a society - having some kind of social net (regarding medicine, jobs, ...) while also allowing private markets for those who can afford them (i.e. if you want to buy private surgery, you can, if you're wealthy enough). But this needs to be carefully managed so the whole system kind-of works.

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.

IANAL. It is not a HIPPA violation if Experian has signed a BAA with the hospital. It's on the hospital to perform the due diligence checks, to verify that Experian's capable of upholding the terms of the BAA.

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

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.

> 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:


“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,

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

HIPAA does not preclude hospitals from sharing data with business partners as needed to conduct their business affairs, assuming those partners likewise comply .

> sharing data with business partners as needed

"As needed" is a definition that most patients would disagree with

HIPPA protects you from gossipy front desk people. The rest is a joke.

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.


While I agree that the current leadership is probably the worst we've had in this regard (at least in recent memory), there's no way this all just started in 2017.

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/

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.

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.

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?

At this time of the year the urgent care will decide you have the flu, and if your BP is elevated (You have a fever, so it will) they will send you to the ER as a legal liability mitigation.

If you look really bad, they'll refuse to check you in.

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

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)

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.

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.

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...

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.

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


> 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.

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.

It's common for people to not give SSN, but they don't need it. A name and date of birth is enough to match you to existing records the overwhelming majority of the time. Phone, address, insurance, and so forth, resolves the majority of what remains.

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.

Additionally, some American citizens do not have a Social Security number.


Bear in mind this fact when working on systems that make use of SSNs.

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?

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 I would love to send them a request to see if that is in fact true.

> 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...".

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.

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

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.

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...

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.

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...

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.

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

Tacking on to your comment, it's important to realize that hospitals do not usually lose money on patients that can not pay for routine procedures (because of generous government subsidies). The substance of this article certainly smells funny (experian is known to be shady), but it is not as nefarious as the author makes it out to be.

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.

To be clear: the impression I got from the video was that this was a charity that the provider was offering, not that they were using Experian to validate eligibility for other charities.

The revenue for their charity is most likely dependent on government subsidies that are contingent on the financial status of the patients they're helping.

Even though they're determining eligibility for "their own" charity, they're likely determining eligibility for "other charities", if you follow the money.

I don't know what this has to do with my point; you can do this "follow the money" analysis to take any argument anywhere. On message boards, at least, it seems to turn out that it's almost never a good idea to just "follow the money".

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.

> 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?

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


> 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.

> 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.


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.

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

Their Standard for basic care is much higher though. You can’t compare that.

Not really. In the US, you get medical coverage if you are old, an honorably discharged veteran, or indigent (either through ER or Medicaid).

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.

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"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?

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.

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.

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

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.

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

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.

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

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