Forcing hospitals to disclose prices:
Though the hospital industry is fighting it, so we'll have to see if the rule survives.
I'm sure "colonoscopy, clear" and "colonoscopy, with removal of polyp and pathology on it" will have different prices, but you won't know which it is until after the procedure.
when they are selling similar procedures for elective or cosmetic surgery, like plastic surgery patients, the prices they ask are much more competitive.
It's baffling how medicine can't produce accurate estimates. Sure, there are edge cases and differences between patients. However, every surgeon has a rough idea of how they're planning to do a procedure. They've been trained and practiced on it many, many times.
I have a torn meniscus. The doctor can happily tell me how easy it is to clean up and exactly what he'll do to fix it. He certainly knows what the risks are and potential complications.
Why he can't document that prior to surgery, I have no clue.
I was given three estimated prices that ranged from $800 to almost $1800, with an expected final cost of $1000 being the most likely outcome. Surgery came out to $975.
And this is with a non-communicative and uncooperative animal, not a human.
Not to belittle what a doctor does, but I totally agree that a doctor should be able to estimate the most likely and most extreme situations and gauge the range.
No one's going to spend a million bucks on a severely premature puppy, but we will for a human, regularly.
"This might be $500, or $250,000" isn't super helpful.
Really, reading all the stories on this thread is insane when I think my wife and I could just walk into a hospital and get out three days later with a baby without having to worry about paying a buck. Same when my father went to the ER and came out over a month later after an emergency heart surgery, a week in the ICU and two weeks of physiotherapy.
And considering that 90 percent of costs are borne in the last year of life by dying patients, it's naive to think there won't be something like death panels in some form, whether it's that explicit or not. Simple economics says price fixing creates shortages.
The USA doesn’t put more value on life. We put more costs on it, but our outcomes aren’t meaningfully better.
By the way the vast majority of people who die in the US are an a socialized medicine system at the time (e.g., medicare).
Either way though, yes, of course there's "death panel" behavior or other cost-controls which effectively lead to the same result (e.g. doing harm through inaction rather than direct action), in any system.
For automotive I'm typically getting a problem diagnosed first, then after diagnosis, I'm agreeing to a price for a fix. This is the norm for that industry.
For a walk in appointment for a rash, I'm agreeing to a fixed visit fee, PLUS signing that I agree to pay any charges my insurance does not agree to pay. The true costs can (and should) be computed by the provider, so the only true unknown in that equation is what Insurance will cover. THEN the provider (wanting to cover their bases) is putting that risk of not getting paid by insurance, back onto the patient.
I like to think we're 1 killer app away from a shift in consumer behavior here to change the expectations
I worked in Australia for a little and had a couple of doctors visits (mole removal, fractured rib). They were able to tell me, on the phone, cost for a consult, removal, xray, check-up, etc. I was able to pay for the mole removal + biopsy with cash...
I'd love to see something like this in the US:
"Assuming a standard hernia surgery, you're looking at $3000 base for the procedure, with another $300-900 for consumables. 91% of surgeries are at or under $3500, 99% are under $4100. Though patients can go home the same day, 24 hour of hospital bed are covered under the fee; additional days in hospital beds are available at [X] rate. In the event of serious complications, consumables, beds, and misc. are billed at [Y]."
One thing is for sure, any improvement to price transparency is a boon to competition.
You probably won’t see this place put a fixed cost on a 26 week preemie like my twins.
Considering that colonoscopies are not urgent you'll likely elect to have your butt probed at the clinic that doesn't have a massive price discrepancy between removing something and not.
I really hope the price transparency rule works as alleged. I'd be totally unsurprising if the entrenched industry finds some way to neuter it but I'm hopeful.
For most people they have insurance and for them to get any kind of help paying they need to be working with an in-network provider. There is no meaningful market here even for elective/non-acute procedures.
Yeah, me too. It definitely seems like more of a way to look like the industry is doing something without actually reducing costs to the end patient.
Our daughter went to the ER and was administered ibuprofen. We got an itemized invoice. Insurance paid $9 for one pill.
So going forward, I guess I'll be able to ask how much the pill will cost, then...haggle? Tell them not to give my daughter medicine?
Just seems like we're going backward...
Which is expected, and kinda ok. At least, if you do a colonoscopy and there's nothing else, no complications, it would be that price.
If you want to see affordable hospital care you have to see the protection removed and competition allowed and encouraged.
This is happening to some degree already. Nowadays we have unprotected, standalone ERs, urgent care clinics, and specialist clinics. But it's not really enough, not yet.
In your example the tail wags the dog. Hospitals are mostly obsolete. You have outpatient surgery in strip malls because hospital beds are capped and reduced, and Medicare began refusing to pay for bad outcomes, which are more common in hospitals.
The government-allowed monopolies are the sprawling health networks the turn medicine into a sales funnel. They are labelled with hospital branding, but the monopolist actions are all about doctors. For example, in my region, 90% of renal doctors work for a single practice.
Urgent care is a whole other animal -- that's all about the reducing standards and addressing supply shortages of primary care doctors caused by restricted supply (there are caps) and higher salaries in specialities.
IIRC in New York, they closed something like 20 hospitals, with 10-12 in NYC. In my area (NY, but not NYC), there has lately there have been a bunch of hospital "mergers", where the lesser hospital gets converted into a sort of outpatient surgery site with urgent care, or an ER without longer term care.
There's only one way to find out.
Indeed, we're finding out as we speak, because all those new ERs and urgent care clinics and specialist clinics and birthing centers, they did not need CONs, so they got built. And they got built by people who risked capital to do it. And it seems to be working out. I know I'm not going to any hospital's ER if something happens to me, and neither is anyone in my family -- we know the score on pricing and billing.
So the free market has found a way around the protectionist regulation of hospital construction. Is that even a surprise to anyone?
Crazy levels of regulation is one of the most sure-fire ways to make monopolies or oligopolies inevitable by creating huge economies of scale. The red tape burden is much easier for larger players than smaller ones. They can keep a staff of dedicated pencil-pushers that know the industry, its regulation, and how to deal with the bureaucrats.
With less regulation and no more "certificate of need" nonsense, it would be not only easier for competitors to start but just as importantly easier and more economical for them to remain independent. The government has created the environment in which monopolists thrive and the free market is stifled; people then complain and turn to the government to fix it? We're in the insurance mess to start with because of wage & price controls. Even the EU makes it easier to try new drugs, at least from a regulatory standpoint. The market is smarter than any pencil-pusher or congressman; let it do its job. Corrupting it is what got us here in the first place.
Pricing transparency is necessary to the process, however. So, the assertion that folks "can't shop around" is exaggerated and about to become less true with the transparency law.
You get some shopping around, but many people will stick with the same dentist for years if not decades.
With respect to your natural monopoly argument, they typically occur when there are very high start-up costs. There are other cases where economies of scale are significant, but very few where they are infinite. Even Amazon, a company that occupies much of the e-commerce market and is well known for its highly-efficient supply chain, is having trouble maintaining them indefinitely. I think we're in violent agreement that the high start-up costs of medical practices and hospitals prevent competition, and I was advocating for removing most of the regulation on the medical field. Another example: the AMA is a horrible gov't-sanctioned monopoly that hugely increases medical costs; most procedures can be done by someone with a few months' training (see the military). Healthcare is one of the few industries that hasn't mastered "mass production" of procedures in spite of the fact that many surgeries are similar.
> healthcare is a natural monopoly due to the fact that a significant portion of the population cannot "shop around"
Except that doesn't mean there is a natural monopoly. If there are a dozen hospitals and you get in an ambulance you'll get rushed to the nearest one that has the right doctors (most major hospitals have most urgent stuff covered). While consumer choice is probably reduced here, it's not as though the ambulances all take patients to a certain place.
The point I think you were getting at is that most people have limited choice because they are often treated in time-sensitive situations. However, about two percent of healthcare spending is on such emergency care . Most procedures give people at least some time to find options, get second opinions, etc.
Natural monopolies (aside from those caused by regulation) are caused by lower long-run average total costs than someone else, industries where economies of scale are nearly infinite. Even those that can't be "disrupted" by building a competitor that sells the same product can be supplanted by newer technology. For instance, many people and companies are exploring setting up solar-powered, battery-backed microgrids that would create serious competition with the government-sanctioned monopolistic utilities. In other words, while high start-up costs will certainly delay competition, they won't prevent it.
> I'll file this one away to remember in the future.
Care to elaborate?
> Care to elaborate?
This was in response to the comment by Retric calling out my idiot behavior. Which, I agreed with.
> Another example: the AMA is a horrible gov't-sanctioned monopoly that hugely increases medical costs; most procedures can be done by someone with a few months' training (see the military). Healthcare is one of the few industries that hasn't mastered "mass production" of procedures in spite of the fact that many surgeries are similar.
Very good point. Reducing costs through other measures definitely are a valid approach. This is one I agree with.
>The point I think you were getting at is that most people have limited choice because they are often treated in time-sensitive situations. However, about two percent of healthcare spending is on such emergency care . Most procedures give people at least some time to find options, get second opinions, etc.
This is true in part. However, mobility and access are often very limited to a significant portion of the population due to ability to travel, lack of time to take off work to travel, as well as the type of insurance a person has. If our society was more inclined to provide the ability for people who financially would struggle if they took a day let alone multiple days off of work to shop around to reduce medical costs this would make sense. But that is not the society we live in.
True enough. I do think allowing a market to develop will give us the tools to shop around with less hassle, e.g. online ratings and comparison based on hard data people will have to disclose to compete in a free market. Similar with transportation, changes in the way we get around will change this and make life a lot easier, hopefully.
That’s what’s driving me crazy. No other business can make up charges repeatedly and when found out, say “oops” and change them a little. In what way is this not fraud?
I got the bill from the doctor. It was reasonable and I paid promptly. I got the bill for the X-ray and it was ridiculously low to my surprise. It was paid immediately. In my mind, I was done.
Then I started getting phone calls from a broken machine. Please call <actual silence> at <more silence> about your past due amount of <~$4000>. I assumed they were spam, but after about 10 of these calls over three days, the message variables were randomly filled or not on any given message. At no point was the message clearly about my hospital visit identified, but I figured it out by the phone number and the name of the parent company.
At this point I hadn’t even been mailed a bill. And I know they have the right address because the other bills came and I’ve only ever lived at my current house since the first time I went to this hospital.
So I went down to the hospital to sort it out. Well, they don’t have a billing department. They have “financial counseling” or something equally not what I need. And even though it was in the hours they are supposed to be there, everyone had gone home for the day.
I still haven’t paid. I haven’t gotten a bill, and I’m not entirely sure the calls aren’t just a scam someone is running.
Wife cut her hand Thanksgiving night - had to go to ER - bleeding pretty bad. Initial triage was a few minutes, then in to an ER room to 'wait'. Someone came in after about 10 minutes with a portable POS on wheels, saying we had to pay $450 for the ER visit. No explanation about anything, and... I paid, but... I was in no position to 'shop around', nor even be confrontational. If I make a scene, or refuse to pay, or ask for more details, will they make us wait 6 hours? Or 8? I wanted this addresses ASAP, and paid. And... we still ended up getting bills for around $3400 (total of 9 stitches on her hand). This is with 'full insurance', which, we pay $1k/month for for 2 people.
That anyone defends this system as 'the best' is beyond me.
She was certain that she wasn't pregnant, given she had seen her GYN just two weeks prior and was on implanted BC.
We're still fighting the appeal and the hospital regarding the use of an out-of-network lab instead of the in-network lab then used for the rest of tests.
tuition cost = how much you can borrow + how much you can pay
What is strange is why do we stand for huge price discrimination in college and medical care, but not for buying a candy bar?
Oh, and my two cents: if you want to end up with larger numbers of under-represented groups in higher-paying fields, maybe making the long-term outcomes clear at that stage would help. Saying, "follow your dreams!" is very, very stupid advice to an eighteen-year-old.
The problem is really at elite publics, which don't have the massive endowments, so cannot subsidize middle class students.
We're at a point where it can be LESS expensive for many middle class students to attend Harvard than UMich or UVA.
1 - https://financialaid.stanford.edu/undergrad/how/parent.html
They are also seevices which means there is no preserved buffering possible. You can't just have a factory of doctors fill a warehouse with 40 hours of medical care each every week. Given the opportunity cost trying to "squeeze in" what they can in a discard free knapsack problem sort of way makes sense given the incentives even if the outcome isn't ideal or fair.
I need this flushed out a little bit more. I have worked in higher ed for decades, and have never encountered a college that charges in that manner. They have a flat tuition, and the student fills that payment however they are able. But it's not like it changes based on how much capital they have access to.
Can you please explain that statement?
It's price discrimination, in that it's charging people in proportion to what they can pay.
He has quite the "ability to pay".
In the way where you buy the legal definition of fraud from the senate.
I expect a lot of service providers to become untenable after price corrections, go bankrupt, get bought out by more efficient providers who remove all the unproductive staff.
Course this is all premised on Congress doing something useful, so...lol.
How do you motivate these people? Or manage their performance? Or manage a good outcome for the busieness, the payor and the client?
This wasn't a hospital setting. Much lower acuity. Upon joining they measured exactly this: CPT codes, bills, A/R, etc. 95% of the time those metrics correlate with their job: getting your complex insurance to reimburse for a procedure they administered.
It's a) not clear that's what you should measure, but let's assume it's not the worst thing in the world, b) straightforward how you can get the "evil" white board example you mentioned.
Not saying this is good or bad and American healthcare is arguably broken. But just another example to maybe calibrate your view.
What has changed about healthcare in the last 20yrs to drive up the cost of insurance premiums and pretty much everything?
I hope your wife has made a full recovery!
I recently had a MRI, and in the process of filling out the usual new-patient form at the imaging center, they wanted me to sign a blank LCD touchscreen. No indication whatsoever what I would be signing. Is it even a contract if you never saw the offer and thus no "meeting of the minds"?
After explaining that I wasn't going to sign a "blank check" contract (and would always need to read the entire contract before first), they eventually figured out how print the actual document. After several minutes reading the 8 page (!) contract, I found a clause I haven't seen before. After more or less normal stuff about agreeing to pay for the service, in a section about sending the bill to a collection agency if I didn't pay, they wanted me to agree to 1) pay for the collection agency and any other fees associated with recovering the debt, and 2) pay their attorney fees if they decided to take me to court over the debt.
I wounder a judge would actually enforce that clause. Agreeing to pay someone to sue yourself seems unconscionable. I told them I wouldn't sign their unreasonable contract (that wasn't the only problem) and they sent me off to have the MRI scan anyway.
She gave me a laminated card; three pages. I think she was kinda shocked I read it.
Kinda unrelated ... I was at a Wal-Greens and the checkout person wanted to scan my ID. I was like, "NO! I do not consent."
So I turned my bag upside down, emptied everything out and said goodbye. I no longer buy alcohol at Wal-greens (or anyone who scans my ID), and I find it disturbing I was the first person who asked.
Most people don't care about their privacy or what they're signing. It's fucking insane.
PhilosophyTube recently posted a great video essay (Socratic dialogue?) that explores that exact situation.
The one that really jumped out to me was the Power of Attorney. Yes, the provider wanted me to grant them an indefinite Power of Attorney as part of being a patient. I asked if I had to complete this and was told I could skip it. I was really glad to see that about 1/2 the people in the waiting room had the same question.
Isn't this similar to the same trick those business loan sharks employ? They ask you to sign a "Notice Of Default" or similar document upfront, that they present to the court to get an instant summary judgement if anything goes wrong with repayment?
If I remember correctly, there might have been something about PoA in my contract. I already hand several reasons to not sign it, so I only skimmed the last ~1/3 of the document.
For comparison, I had a minor surgery (ulnar nerve release) in the surgical center across the hallway from the imaging center. I think they are part of the same umbrella healthcare company? The surgery center only wanted me to sign a short, concise contract that was mainly standard stuff (surgery always has some risk). I don't understand why an MRI (very safe, short) needs 3x-4x longer contract than surgery (always has some risk, involves a lot more people). This seems backwards.
Surely this should be reported to someone that could do something about it. I would hope so anyway, as that seems like a dark pattern that could be litigated.
Yes. It's a normal and enforceable clause. It's very common in all kinds of contracts.
The credit card companies apparently didn't care.
If the hospitals simply want to gain insight on your ability to pay your medical bills, wouldn’t your “normal” credit score be able to provide that insight.
What’s different between your “medical” credit score and your normal credit score?
Additionally, there are laws in place in the US that state in emergent situations, no hospital (public or private) can deny care - regardless if you can pay or not. So the article title might be a bit sensationalized.
Really, it's disgusting.
credit unions are one of the few pro-consumer entities in the financial world, it would be a shame to smear them
Ideally in 2008 all the "banks" should have gone bankrupt and the vacuum should have been filled with credit unions, instead lawmakers gave the banks $2T as a reward for ruining the US economy so they could float their own debts instead of declaring bankruptcy and enough so they could buy up their competitors to further consolidate the marketplace.
And given that it’s now a US requirement to have medical insurance, I’m still struggling to understand what this medical credit score is accomplishing.
It became a "requirement" in 2014 with Obamacare, but since the repeal of the individual mandate in 2019, there is no financial punishment (except well, the increased possibility of medical bankruptcy) for not having insurance:
Similarly, if the insurance company for any reason disputes a hospital claim for any reason, up to and including disagreeing with the hospital that the issued treatment was appropriate in lieu of a cheaper treatment, the hospital goes to the patient to foot the bill.
So it is entirely possible to be fully insured and still be forced into unpayable medical debt through factors completely outside of one's control.
It's frustrating to me that this point is very often overlooked in the discussions about health insurance in the US. A lot of people who go bankrupt over medical bills are fully insured and suffer for reasons entirely beyond their control like the hospital an ambulance decides to route them to when they're unconscious.
A Bronze family plan will typically have a $13k deductible. You pay that entire amount out of pocket before insurance kicks in, and it resets annually... so if you're in the hospital December 31 through Jan 1, you might be on the hook for $26k.
There's also nightmare scenarios where the hospital is in-network, but the doctor isn't. https://www.reuters.com/article/us-health-insurance-surprise...
Many states have surprise billing laws to limit what bills you can receive from out of network providers.
There are a lot of subsidized folks on the Bronze plans with zero ability to pay an unexpected $400 bill, let alone a $13k deductible. They're insured, but only technically.
> Also almost all bronze plans cover the first 3 doctor visits with a normal copay, and any preventive care has no copay.
Sure, but I'm referring to the sorts of bills that bankrupt people, not an annual physical.
"There is good evidence to support the idea that acne and associated scarring negatively affect a person's psychological state, worsen mood, lower self-esteem, and are associated with a higher risk of anxiety disorders, depression, and suicidal thoughts."
While Acne probably won't kill you, it certainly won't make you happier and could contribute to suicide if left untreated. We are lucky that acne meds are cheap, but there is nothing stopping those companies from shooting up their prices tomorrow.
Also by the way, the requirement to provide care to any walk-in patient only applies to ER's, and only until they have stabilized the patient.
> “Emergent” properly means “emerging” and normally refers to events that are just beginning—barely noticeable rather than catastrophic. “Emergency” is an adjective as well as a noun, so rather than writing “emergent care,” use the homely “emergency care.”
Medical debt can still be added to your credit report.
Moves like this erode my opposition to nationalizing the entire US health-care sector. If they're going to cartelize or confederate, patients--which is to say everyone in the country that lives and breathes--will also want a seat at the table.
From a more generous perspective, this may be a tool for price discrimination. Hospitals will charge based on what they think the patient can pay, rather than the actual costs of providing the care. When you receive care, you will be billed for a number that is calculated to make you sigh, flinch, or wince, but not call a bankruptcy lawyer.
This is a symptom of illness in the system, and leaving it untreated seems like a bad idea.
This is true, but many life-saving treatments (such as chemo or radiation treatment for cancer) are not "emergency" treatments, despite being necessary and somewhat urgent.
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.
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.
> 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.
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.
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.
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!
Maybe rich Canadians think differently, but universal healthcare will always be better for the general population.
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.
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.
>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 . 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.
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.
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.
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.
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.
Is that really "all the same"?
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.
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.
> 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 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.
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.
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.  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. 
 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?  We do. Guess who, once the dust settled, turned out to have overcharged us, and eventually cut us a cheque? The surgery center.
 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?
 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.
The US is certainly not immune from this reality.
In other words, you didn't actually need surgery. The system worked as intended.
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.
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.
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?
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.
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.
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.
Every time you visit the doctor, the hospital tells experian (by querying the experian system) and then experian resells this information for profit.
This article talks about how Experian have SOC-2 issues, which is a cause for concern, but smaller hospitals with tighter budgets could be inclined to look past it.
In general, it's important to understand that HIPPA doesn't prevent data from being shared, it gives it a legal framework to be shared within. When things go bad, the HIPPA-associated paperwork provides a roadmap for assigning liability.
Liability does get assigned, and companies (providers, insurers, network providers) are held responsible, despite the popular imagination: https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf
HIPAA pertains to PHI and PII (protected health information and personally identifiable information, respectively). The fact of your office visit is not either of those if it's not linked to health information (labs, medical records, notes, itemized bills).
Further, it may be allowed under permitted uses and disclosures as-is, without authorization under the language for payments. I couldn't tell from the article, but the health systems could simply decline to treat you without your authorization for the credit check.
Separately, people love to make healthcare into the bad guy, but it's not a monolith and there are hospitals closing down because they are losing money. There is a systemic problem in the US here, and I bet this is those 2nd/3rd tier markets in smaller systems that can't absorb defaults like nationals can.
False. Directly from HHS, emphasis mine:
“Individually identifiable health information” is information, including demographic data, that relates to:
* the individual’s past, present or future physical or mental health or condition,
* the provision of health care to the individual, or
* the past, present, or future payment for the provision of health care to the individual,
"As needed" is a definition that most patients would disagree with
Your prescriptions, hospital admissions, radiology orders, etc are in the hands of any of a dozen third parties before your claim is processed. It is trivial to un-anonymize the data.
My father is also a pharmacist (and now owns a pharmacy) and he constantly tells me horror stories about the cat and mouse game that insurers play with patients, where they have doctors prescribe and offer discounts on specific drugs, depending on what is most profitable. He pointed to an interesting bit of software  that uses machine learning to find the best margins.
I could seriously go on and on about all the insanity that is our healthcare system. These problems runs deep, from top to bottom.
 - https://amplicare.com/
If you look really bad, they'll refuse to check you in.
First, bureaus get very little detailed information about the episode of care that led to the medical bill: essentially, they'll just get info on when the bill was due and what amount on it is still overdue, plus enough info on the patient to match it to the right person (name, address, phone, SSN if available). HIPAA and similar legislation allows the sharing of billing data like this, and no other PII (or any PHI) gets shared in the process.
Second, medical debts have been a part of bureau data for a while now. What's new here is that Experian is trying to build a machine learning model on it to try to sell the model as a new product. I've never worked for any of the bureaus before but know many people who do, and in general, these specialized scores seldom sell well, but since the marginal cost to Experian is low (let a few data scientists at it for a few weeks), they still put out new ones anyway. Even things like new FICO/Vantage scores like the new FICO that's been in the news lately tend to take a while (on the order of years) to make it out into the wild since lenders like to have consistency in their processes as long as possible.
Third, it's actually beneficial to most consumers to have medical debts split out of the bureau data explicitly. Most big lenders use raw bureau data much more than the aggregated credit scores, and since the US medical system has so many distortions that correspond more to broken processes rather than a person's creditworthiness, many exclude medical debts from consideration explicitly, and others implicitly as models they build don't often find those attributes as useful as others.
All in all, it's good to be thoughtful about how information like this is disseminated and used, but the dire warnings of the article are really not warranted in this case.
I have no idea if they can require it or not, but I always assumed it was optional because they wouldn't turn away foreigners without SSNs.
> Experian doesn't match information to a person's credit history using only the Social Security number. Experian matches information using all of the identification information provided by the lender, so the account will be accurately shown in your report, even if no Social Security number is provided.
Usually the only time they'll fail to ID you is when you show up to the front desk with no identification and lie about your personal details, which I don't particularly recommend doing.
Bear in mind this fact when working on systems that make use of SSNs.
Brokers reselling my health info is far more critical to me than my buying habits.
Is there a "do not sell my health info" checkbox?
Yeah, except, sadly, it'll most likely be "You're welcome to try the hospital across town if you'd like...".
I think the medical field here in Mexico is much more affordable because it's cash based, with real competition between doctors
Hospitals want this leverage again so they built their own credit system.
This is from the product's lit:
"Predict propensity to pay using our proprietary Healthcare Financial Risk Score, which factors in historical healthcare payment outcomes and the patient’s credit history"
She mentions that the product also lets them pull "FPL", which in this case I imagine means "Federal Poverty Level", in addition to household size. Cincinnati Childrens has some info that might put that info into context: https://www.cincinnatichildrens.org/patients/resources/finan...
Further, unstated, perhaps speculative context: most people who go to the hospital pay through insurance and out of pocket. But if you go to the hospital without insurance, or can't cover your out of pocket component, most (every?) hospital will negotiate a lower rate; almost nobody pays rack rate out of pocket. So what they're calling "charity" might just as likely be the name they give the program where they come up with their real rate on the fly (I've been through this process with a large hospital chain in Chicagoland).
Either way: it doesn't support the post's claim that Experian's health score --- which I'm disinclined to trust, just like everyone else --- is being used to "deny care". That's an argument the article does not appear to marshal evidence to support.
For context, hospitals are only likely to lose money on very complex patient cases, i.e. the kinds of program described in the video. In those situations, it makes sense that hospitals will want to make sure that either (1) the patient will be able to pay or (2) charities or government programs will cover them, once they apply.
Experian's system claims to helps them make that assessment. Will that lead to patients being turned away? Maybe, but it's not a straightforward conclusion, like you imply. The comparison to Uber ratings holds no water.
The reality is that American healthcare is a complicated market with many sources of revenue that aren't patients' bank accounts (charities, govt subsidies, insurance), and it doesn't lend itself well to this kind of oversimplifying analysis.
Even though they're determining eligibility for "their own" charity, they're likely determining eligibility for "other charities", if you follow the money.
Then you go home and receive separate bills that trickle over several months. One from milk consultant, one from the doorman, one from the cleaner and other folks you never even met. The total bill could buy you a truck of milk in other countries but you’re glad you have supermarket insurance and you only pay the price of 10 gallons of milk out of pocket.
How is this not a complete violation of HIPAA?
Are they working around it by having very general HIPAA release forms?
> The Privacy Rule permits covered entities to continue to use the services of debt collection agencies. Debt collection is recognized as a payment activity within the “payment” definition. See the definition of “payment” at 45 CFR 164.501. Through a business associate arrangement, the covered entity may engage a debt collection agency to perform this function on its behalf. Disclosures to collection agencies are governed by other provisions of the Privacy Rule, such as the business associate and minimum necessary requirements.
That's how Canada's healthcare system works, too.
> Government health insurance plans give you access to basic medical services. You may also need private insurance to pay for things that government plans don’t fully cover.
The above aspect of "wealthy people get to buy nice things" really doesn't contribute anything interesting to the conversation.
Their Standard for basic care is much higher though. You can’t compare that.
In Canada, you get Medicare-like primary care, benefit from price controls on drugs, and can buy secondary coverage to get more. In the US, you get to subsidize drug development for the world and enrich a variety of different cartels.
Could we classify 'not being able to afford, either time wise, emotional labor wise, or money wise, to deal with the messed up medical billing system' as a pre-existing condition?
OT: I left google and use bing now. Interesting, google's search results for my query were absolutely horrible. obvious spam and various detritus. and all the results had the little ad icon ^W^W favicon! I thought they backtracked from that? oh well.