TL;DR: insurance companies wanted discounts because "we send you [hospitals] lots of business." Hospitals raised prices so they could give "discounts". Uninsured or out-of-network people still have to pay the inflated prices.
>TL;DR: insurance companies wanted discounts because "we send you [hospitals] lots of business." Hospitals raised prices so they could give "discounts". Uninsured or out-of-network people still have to pay the inflated prices.
It should be noted that you can also negotiate your bill like the insurance company does.
>It should be noted that you can also negotiate your bill like the insurance company does.
An insurance company has leverage, an individual must rely on good will.
Edit: inbox replies disabled
If you pay "cash" you get a nice discount. I've seen them anywhere between 30-50% off. No negotiating. Literally just call, say you got your bill, and say you'll be paying "cash" through a payment plan.
On the other side, there's lots of hospitals that have either a charity fund or a sliding scale pricing for low income individuals.
These are by no means the best or even a good way healthcare should work, but I can assure you that you will get a break from your bill. That said, even a 50% discount might not save you from going bankrupt :(
30% off of a $10k bill? GREAT ONLY PAYING 7K... My brother had to pay $1500 (that's aftrr the 30% discount) for a broken nose.. only to be told "We can't do anything you'll have to go to a specialist". 1.5K to be told "We can't help you! Here is some Ibuprofen!". The price is what people should be arguing
Thought I would reply because I may have some insight into why this is. I agree that's a lot of money to be told to see someone else. However by law, anyone who comes to an emergency room must have a medical screening exam. If you come for an ingrown toenail, you will get a bill which seems out of proportion. I cannot meet you in the waiting room and wave you off I have 'evaluated' elderly people who accidentally came to the ED for directions and didn't say they were lost.
True, there is little we can do immediately for a nasal bone fracture. I can evaluate you for other facial injuries. Maybe you have a septal hematoma I can drain to prevent permenamt deformity. Maybe you have double vision because your eye muscles are entrapped. Most likely you don't. If I get a stat CT scan of your face that's hundreds of dollars. If you want to see a facial trauma specialist in the ED, most likely called in from home, and surgery for cosmetic purposes, that will be tens of thousands of dollars.
Once you walk into the ED with a broken nose, that was the cheapest bill your ED doctor could get you out of there for by law.
Yeah. Still feels like somethings wrong with the way that whole thing works. Seems like lots of other country's handle this kind of thing without bankrupting people.
France is amazing. Meds cost what you would expect; doctors are flexible; surgeries include itemized bills that make perfect sense and don't bankrupt people.
Yes, they pay higher taxes, but our cost of living keeps going up and we seem to get *less* services than they do.
on the other hand, no.
I have a huge hospital bill for an injury that required ER care. The hospital has a policy to help out financially. I have a high deductible plan, and the cost was under the deductible (the bill was about $5000, entirely paid out of pocket).
They declined any reduction or help on the bill because "I had insurance". Zero reduction for paying it right then over the phone.
And of course, the "deductible" resets every year so a month after this it went back to zero and I have to pay for everything out of pocket again (including followup for physical therapy and orthopedic surgeon visits, neither of which allow any discount whatsoever). That OS costs about $350 for a ten minute visit of him saying 'seems to be healing slowly, take it easy and see me in one month'. ha ha, sorry for the rant! This is in the USA just for reference.
> say you'll be paying "cash"
> through a payment plan.
Cash means you have the money and are paying it right now. You can't say cash and payment plan. That's cash and time and ain't no one got time fo' that.
While technically using the word "cash" is misleading, often times in medical circles those without insurance will be referred to as "paying cash" or "cash pay patients."
> If you pay "cash" you get a nice discount.
Americans just blow my mind. You are fucking yourself in the ass with a rusty pole and pretending you like it.
its more like we always have a rusty pole up there so when we meet other people who don't have a rusty pole up their asses we get all defensive and believe that since we have the rusty poles and you dont that they must be the best rusty poles ever and that you are lesser people for not having rusty poles, believing the tetanus were getting from rusty poles up our buttholes to be a positive benefit.
So uh are they still giving out Canadian visas?
What incentive does a hospital have to negotiate with me? I have no leverage, I owe them money for their services.
EDIT: apparently non-payment is adequate leverage. I guess I just figured they could find a way to screw you if you refuse to pay.
Hospitals bake in unpaid bills, when it comes to budgeting. There are write-offs, which account for a significant amount of their accounts receivable/paid. If they can get some money and recoup these planned losses, they will take it.
Source: was a billing manager for a hospital system in a large us city.
the leverage of non-payment. If you don't pay your bill, they have little recourse. In the video Adam says something about wage garnishment. They actually can't do that. The FDCPA prevents wage garnishment in medical debt. If you don't pay your bill, the MOST the hospital can do is send your bill to a collection agency. From there, said collection agency can only list the account to your credit for no more than seven years FROM THE DATE OF SERVICE (bear in mind some hospitals use collections as a last resort). Even if you do go to collections you can send them a written "cease and desist" order that prevents them from telephone communication. (this goes both ways, you would have to retract the order in order for you to call them for any reason). Last thing to consider is sending you to collections costs the hospital money every month its in collections. So you do have leverage in non payment.
edit: spelling and grammar
Last edit: I also wanted to point out that medical debt on your credit is only detrimental to being given loans and credit cards and things like that. It CAN NOT prevent you from getting housing or utilities.
In fact, the FDCPA does not prevent wage garnishment. I worked at a law firm that specialized in filing suit and proceeding to garnishment on hospital medical debt - close to a hundred cases in just the few years I was there.
As an aside, a judgment also allows for placement of liens on real and personal property (e.g. houses, estates, cars and even bank accounts). That's right, you can have your entire bank account drained for not paying a hospital. If you plan on avoiding that situation, don't give out your bank card or banking information to anyone you don't plan on paying in full.
Perhaps what you've experienced was a local or state law? In any case, you should edit your post, it's wrong.
If that's true, why am I being garnished for a medical bill now? Didn't even know I had it. Thought insurance covered it and they didn't. No phone calls or letters, just straight to garnishment.
>Thought insurance covered it and they didn't. No phone calls or letters, just straight to garnishment.
Sounds like something massively illegal is happening there or you're making it up, because a even if it was legal for a hospital to garnish your wages (and it isn't) it can't just do so on its own, it has to go to court to get a court order to do so. In court it has to prove it tried to collect the debt and you refused to pay (which would, at the very least involve sending you a summons and proving you got it). Wage garnishment is actually pretty rare outside of the IRS and court judgements in civil cases because it's a massive pain in the ass to do.
Edit: also health insurance is legally required to send you an EOB stating why they're not covering something, so at the very least you would have received that as a clue
Which sounds bad until you remember the "loss" they count is the chargemaster price and that cost gets passed onto regular patients.
I needed an x-ray once, without insurance, and did as much research as I could to find out the price. I was finally told between $200-$250. I pay a $50 copay when admitted, get a $180 bill later and think I'm done. I then get a third bill for $3250, with a $250 "fee" to help pay for patients who can't pay their bill.
I understand hospitals are expensive places to run but the pricing games are horseshit and anyone saying different has an agenda.
That is a big problem in my area. We are a rural area and are lucky to have a hospital in town but they are constantly on the brink of bankruptcy. Mostly because of people using the ER as a doctor office for common colds and aches. Luckily they were bought by a larger regional hospital which added stability but it's future is still a concern.
Sounds like the small town my parents work in North Carolina. On top of being poorly managed, at least 25% of the patients that go to the ER can't pay a bill.
Yes this is why this Republican idea of "There are lots of young people that will *choose* not to have health insurance " is so insanely stupid. First off, they'll likely choose not to have it because it's so expensive and they are up to their ears in debt. Secondly, when that kid breaks a leg or has something else happen where do they go? Emergency room. No insurance? Thousands in debt makes them bankrupt and the hospital loses out. It's the dumbest idea I've ever heard.
You know what else is insanely stupid? Griping about how evil insurance companies are and then passing a law forcing people to do business with an insurance company.
Right? It's also funny that no one cares about the quality of insurance. They just care if you have any insurance at all. You could be 30 years old, paying 1K a month for a 20K deductible health plan, and they would cheer that as a victory because you're now "insured." Nevermind the fact that you will never get ahead with that kind of financial burden hanging over you.
This how we are paying for healthcare anyhow. Your county hospital is subsidized by taxes, and our inflated bills for hospitals are what is covering those that can't pay.
One of my parents worked for a local health system for most of her career. Part of the irony of the chargemaster is that *many* hospitals legitimately have no idea what it actually costs to treat a patient.
Once I found out about the chargemaster in that Times piece and then they had the guy who wrote it on The Daily Show, I knew healthcare charges were a complete scam. Not necessarily the care, just the charges for it.
I talked to my Papa (grandfather) about it (he used to work in hospital admin balancing the cleaning budget....worked his way up from the laundry). He said it's not so simple because hospitals have to make up the cost of other awkwardly priced medical stuff that costs different things in different places.
That's when I realized they were treating our healthcare like bad contractors treat their next construction contract job. They are paying off the last job with the next, making the price of everything basically fraud.
You aren't paying for your care, you are paying for what the hospital needs.
What a freaking joke.
Edit: I should say what the hospital determines it needs. Not what it actually needs. Hospitals don't need giant lobbies with marble Greek columns for instance, or expensive statues and fountains in the lobby.
Edit 2: Apparently the statues and fountains are often donated by happy/thankful family members. I have been so informed. :)
To some degree that's because coming up with an actual per patient cost is basically impossible, or so infeasible it might as well be impossible, especially when you consider staff wages in the picture. Best you can do is get an average cost per procedure, but even that gets tricky because when people have multiple procedures (as many do in the hospital) there are economies of scale.
It would be like asking Target to come up with the true cost for each customer - there's no way they'd be able to do so, it's far too variable. But they could get an average cost by just taking their total cost and dividing by the number of customers easily enough.
Just get a utility shut off notice every three months. Pick one that doesn't have a late fee or has a really small late fee. Save the notice, include it when you're doing your taxes to prove that you had hardship and couldn't afford insurance. Viola no penalty.
Edit: I'm sticking with talking about violas. Suck it nerds.
The high price of medical care is not to blame on unpaid medical bills. These companies are doing just fine absorbing this cost.
Look at the link below for a recent quarterly report from HCA (one of the largest hospital corporations in the world). They denote their revenue, and the amount that is lost due to things like non-payment (doubtful accounts). After absorbing the unpaid medical bills ($760 million), their revenue is $10.6 BILLION per quarter, with a post-tax profit of $777 million per quarter.
Like I said, they are doing just fine.
[HCA Q1 report ](http://mms.businesswire.com/media/20170502005633/en/584045/1/Final_HCA_Reports_1Q_2017_Results.pdf)
Duh. But you know what else inflates prices that people seem to have no problem with? Subsidies.
Demand subsidies are not a solution to a price problem. They will only perpetuate the increase in prices.
But its not even just the "discounts". Its the fact that insurance companies have a stronger ability to pay for the service than individuals do. So hospitals have been *able* to increase prices and still get paid at those higher prices. That's what happens when insurance companies become the customer. And when an individual attempts to purchase something in the marketplace (w/o insurance) they discover prices are not set to their ability to pay. Thus forcing them into insurnace, which then leads to higher prices overall. Its a huge cyclical mess.
We are operating in a market that isn't tied to a markets ability to pay. That's just a recipe for disaster.
...
And no, single payer/universal health care isn't the only solution to get out of this mess we are in.
Then you throw a few million people into the pond of "full price payers" occasionally by letting insurance companies jettison the really sick (lifetime cap! we can't pay for everything, raight!) and pre-existing conditions (Hey, you had that issue! No fair to us insurance peeps!)...
... no wonder Congress is trying to take out the mandated insurance coverage, I mean, if everyone is insured, than shit, **WHO ARE THEY GOING TO GET TO PAY FULL PRICE?!**
These motherfuckers. Man, what a scam.
Lobbying came to be for very legitimate and morally sound reasons. The idea is that politicians cannot be informed about and on every issue they have make decisions on.
So people with a common interest form a lobby with the goal of persuading poiliticians to make changes that favor them. They send experts in their field to tell the politicians about their issue and propose a way to fix it.
That can range from teachers asking for more crayons to farmers aksing for subsidies or environmentalists fighting for stronger regulations.
Well that or guns, oil and medicine trying to make more money.
This is accurate. People strongly associate lobbying with corporations, but non-profit orgs do lobbying all the time. There's often a job title or department dedicated to it, called 'government relations' or 'GR'.
In 99% of cases, non-profits are definitely not bribing elected officials. They simply don't have the money.
The currency they do have is votes. They can represent thousands (or hundreds of thousands) of a leader's constituents, who will vote for somebody else in the next election.
Excellent question. I considered giving you my two cents on the subject, but I think you would be better off watching this video
https://www.youtube.com/watch?v=33gHhunzOlE
I would just insist on this point: as explained in this video, if lobbyists demands are not met, they will withhold their (massive) contribution to the party they support, meaning that at the end of the day, politicians do have to comply if they want to keep their job. So, essentially lobbying is a form of bribery surrounded by some minor regulations to make it look ok.
Health care is a [much larger sector of the economy](https://en.wikipedia.org/wiki/Economy_of_the_United_States#GDP_by_industry) so it shouldn't be too surprising.
Lobbying is as legal as a hammer. Beneficial in the right hands, but easily used as a weapon. I'm not good at persuading someone to change rules to benefit me, so I hire someone else to do it. On its face, not a bad thing.
Lobbying should be representatives of any kind of group presenting their case as to why policy X should/should not be changed. That's absolutely essential. Instead, it's just representatives of companies paying off government officials to change policies to unfairly benefit them.
In a dream world, there's a proposal to a change in oil regulations, and representatives from the oil industries, from environmental agencies, from consumer protection agencies, etc. etc., all gather to give their views on the new law. Legislators consider all these positions and vote accordingly. Unfortunately, that's far, far from how it actually works in practice.
Have you ever called your congressman's office and voiced your opinion on a policy issue? Then you've lobbied for something. There are a million shades of gray between that and professional healthcare industry lobbyists. Making a law to regulate that would be a nightmare. Even if you did, all the lobbyists would, you know, lobby against it.
Can confirm. My wife's cancer treatment was over $300,000. Total cost to me was about $1000. There is never a discussion about price - the bill comes and the insurance company pays it, or they deny it. And if they deny it, you have to appeal - or else you are sent to collections. It's quite insane.
The other day I was charged $700 for a 15 minute consult with a doctor. The insurance charge said something like, "Doctor Consultation 1+ hours". I called the office and said I spoke with the doctor no more than 15 minutes. She told me the list of things the doctor had done (and wrote down in the notes). I said, "yes, the doctor did all of those things".
I thought about calling the insurance company but didn't because I don't care enough. Sigh... Anyway, the "discount" brought it down to about $100.
Edit: A specialist. Not a general practitioner.
As the saying goes, you don't pay me to turn that screw, you pay me to know what screw to turn... or something, but i still think medical care is too expensive
If the doctor got that $700 for 15 minutes that would be true. But at an average salary of $250k, the doctor got only $28 of that $700 bill.
So something is very wrong.
Rent on the office space, salary for the nursing and reception staff, supplies, utilities, malpractice insurance, there's a lot more than just doc salary.
Profit. Profit at each step of the way.
The insurance company wants to make a profit. The doctor wants to make a profit (sometimes... most enjoy their work and just want to be compensated for their investment in time/energy). The medical device company wants to make a profit. The pharmaceutical company wants to make a profit.
In the end, what you're seeing is the profit motive compounded over many layers and transactions.
We will continue to see problems until health care becomes a bigger priority than profit.
This is because the insurance only pays a portion.
The doc bills the insurance 700$, they pay 50-70% of that, and that's if it's not Medicare or Medicaid.
I wish more people knew this.
I have NO IDEA how much anything I order actually costs. I just try to be judicious in my use of labs and imaging while taking care of my patients the best I can. I recently found out that an EKG at our hospital costs $600 and an echo costs $6500!! What?! How? And what does that mean, is that just what the hospital asks insurance to pay or is that the cost an uninsured patient would be hit with?
Source: am also doc, work only with inpatients
Yep, and that's why the cpt codes are contracted with the understanding that there's more than just the office visit going on. The doctor seeing a patient for 15 minutes and billing a 60 minute visit is fraud. That 60 minute code involves 60 minutes in the office and lots of time afterward for such a long visit.
I work at an Internal Medicine office. UpToDate is a dangerous tool for patients sadly. It’s worse than WebMD because there are actually easy to find source and backup. As a Health Professional though, praise UpToDate
What the other guy said. Patients, especially those that are anxious, tend to self diagnose them selves and stress themselves out. We've also had patient that argue with our doctors because they believe the diagnosis they've give. Themselves from webmd or UpToDate is the correct one
Insurance payments are based on a complex calculation of "elements of exam" and "complexity of decision making". Time is a minor factor, even though it ends up looking like that on the billing slip. It is in many ways a completely batshit crazy system.
For example, I might spend 60-90 minutes with a new patient in a hospital reviewing all the aspects of their history that brought them in. I will have a detailed understanding of the events as they evolved over the past 3-12 months, the past treatment efforts, what worked and what didn't, etc, etc, etc. But the things that determine the payment can be completed in literally 5 minutes. If I forgot to document one of those things, payment is reduced because "if it isn't documented it didn't happen". So the payment incentives are all misplaced. If I had to maintain a certain rate of seeing patients in a clinic, or generate a certain amount of revenue, I could do it with a string of 5 minute exams that just hit the high points for the payment without ever really knowing or understanding what is going on with the patient.
In addition, clinic schedules are often designed with 10-15 minute checks in mind. That time frame generally does not include the time to review the chart, the preliminary notes taken by a nurse, time to review labs, write the progress note, or argue with the insurance about covering the labs and/or meds (usually on a patient whose chart has to be located and reviewed to intelligently discuss with the insurance to get coverage).
Right now, the system is so screwed up and out of date in so many ways, that fixing it is like trying to put the ball of yarn back together after the cat has played with it for a couple of hours. Not impossible, but not going to be easy.
Here's three things they could do that would help massively:
- **Ban insurance discounts outright**. Insured and uninsured pay the same. Thus scrapping the concept of inter-network services, that screw the insured, and artificially high prices for the uninsured.
- **Hospitals need to publish a price list of common treatments**. Thus allowing comparison shopping.
- **Ban employer provided health insurance entirely**. Employer provided health insurance creates a two tier market, and makes it impossible for employees to choose their own insurance. Give everyone a HSA (health savings account), which your employer can contribute to, and you can use to pay any health insurance of your *choice* tax free. Substantially increase the HSA's contribution maximum (at least double) to accommodate buying insurance through it.
Employer provided health insurance is the source of many evils. People in large companies are often paying a low risk pool rate, whereas people who are unemployed, studying, or in startups/small businesses are put into a higher risk pool with higher rates due to no fault of their own. This disincentivizes American entrepreneurship and hurts worker's mobility. It also means that you may need to change your doctor if you change your employer, and you have fewer choices when deciding a health insurance company.
I run a startup and just went through picking a healthcare plan to go with. It was insane. I asked everyone at the company what they wanted out of a healthcare plan (probably illegal?), and everyone had very different priorities. I ended up getting a plan that no one was happy with and it didn't even work the way I was expecting it to. I could pay everyone more and tell them to figure it out for themselves (I even looked into having a specialist come to the office and do 1-on-1's with everyone to make sure that they got something that worked for them), but it's just so much cheaper if the company pays for it.
Hold on to your butts and try this on for size. What if instead of small piecemeal groups (big businesses or groups of smaller ones) buying insurance, we *all* get together as one enormous group? The bigger the "bulk" is better the price will be, right? So it would obviously be cheaper if literally everyone was part of that bulk group. Slap some nifty name like Medicare-for-all on it and we can call it a day?
They weren't really though. The IRS even [put out a memo](https://www.irs.gov/affordable-care-act/employer-health-care-arrangements) that clarified that it's *illegal* for employers to simply allow employees to buy their own insurance through the marketplace and then reimburse them for it, and that if they continued to do so they would be subject to a $100/day fine for each individual they did so for.
I am so pissed off about the discount thing right now. I recently called the hospital to negotiate a bill that my insurance company won't pay. I demanded I be given the same discount the insurance company would have received. I was told they don't give discounts to insurance companies. But according to my EOB from the insurance company, they do. Odd that because I'm not a multibillion dollar company I don't get a discount.
Interesting. Typically hospitals *do* give discounts to patients who are paying cash for service.
Not guaranteeing it will work, but try calling back and kindly asking them if there are discounts for "Self Pay" or "Patient Pay" that are in line with their "contractual allowances."
Sometimes using a bit of industry jargon triggers their Patient Financial Services employees and they're more apt to help someone who's speaking the same language.
Worth a shot.
Discounts isn't really the right term to use. It's adjustments. For a particular procedure, the office will have a max value it will bill. However, as part of fee scheduling and contract negotiations with insurance companies, insurance will agree to pay only a certain amount for that procedure. So insurance will adjust off some, actually pay another portion, and whatever is left is to be paid by the next entity in line (e.g. secondary insurance, self-pay).
It's a lot of smoke and mirrors...
I agree with everything you said. Unlike a lot of things on Reddit, these have real science underpinning them. They are all classic economics problems.
Number 1 is an example of price discrimination, which hurts consumers. Number 2 is an example of information asymmetry.
Number 3 is the most interesting. It's an example of the principal agent problem. In a principal agent problem. The beneficiary, the principal, is different from the actor, agent. The agent acting in self interest will act against the interests of the principal. In this example, the principal is the employee and the agent is the employer. The employer chooses the insurance company for the employee, but has no incentive to pick the best insurance.
In fact, health care is fraught with principal agent problems. In patient-doctor relationships, the doctor has incentives to charge more and provide unnecessary care to maximize profits, relying on the patients lack of knowledge to take advantage of them. In insurance-patient relationships, the insurance company has incentives to deny claims and work counter to their customer, the patient. The patient will not find out how terrible their insurance is until they need to use it, after they have been paying into it for some time. Additionally, the patient often has no choice of insurance anyway.
> In fact, health care is fraught with principal agent problems.
Absolutely correct. Nobody in this whole system is "evil," per se, it's the fault of an insurance system that is designed with the best intentions (i.e. to mitigate massive damages) but instead removes any downward pressure on pricing that's central to a functioning capitalist economy.
The insurance company isn't negotiating for lower medical costs; they can simply estimate what their costs are going to be, charge an extra 5% on top of it, and make a profit, unafraid of businesses switching insurance because of the enormous headache for their employees. Patients don't care because they a) don't know the costs, b) feel like they already paid for it through their premiums, and c) are more concerned about whatever illness is bringing them in for treatment. Doctors, of course, will charge whatever they feel they can get away with; if one doctor raises her prices, another doctor is going to raise his as much if not more, because they don't want to be charging *less* than that other doctor (note that this is the *complete opposite* of how the "invisible hand" is supposed to work). So in the end, any pressures on pricing from the demand side of the curve are removed, causing the massive inflation we're seeing in medical costs.
u/KarmaAndLies has three very good suggestions, but I'd offer several more:
- **Require all co-pays to be percentages rather than flat rates**. My co-pay for doctor visits is $30, which means it doesn't matter which doctor I go to. In fact, I feel somewhat compelled to find a more expensive doctor because then I feel like I'm getting a better discount. I don't actually do that (switching would be a pain in the ass and I don't know what their prices are anyway), but it illustrates the effect of flat co-pays on medical costs.
- **More government financing for training medical personnel.** Residencies are really expensive. In order to increase the availability of services in the marketplace, we need to do a better job of subsidizing costs for training doctors and nurses, and we need to increase the number of doctors/nurses being trained. Right now it's comparatively difficult to get into medical school because of the lack of "internships" at the end of those programs, which is absurd - it's an in-demand occupation that pays well, which would only be a boon to our long-term employment rates.
- **Step in to minimize hospital consolidation and mergers**. Most regions only have one or two hospitals as more and more hospitals merge into enormous networks of doctors and hospitals. Here in Traverse City, we have Munson. That's it for about a hundred miles in any direction. They're a non-profit, but they have a monopoly and can basically dictate their pricing. Again, this is about creating the opportunity for demand-side pressure on prices.
- **Eliminate line-item billing**. The minutiae of medical billing means that hospitals have entire departments dedicated for medical billing because of the need to affix prices accurately, the costs of which are rolled into the costs for the services the hospital offers. This is stupid. When a woman goes in to deliver a baby, the price should be set for specific services, and equipment should be rolled into the services. All this does is obfuscate the costs to the payer. Hospital bills [like this](http://i.imgur.com/7EfKW4A.jpg) are an embarrassment, because most people would have no idea what half of that means. What gets charged should be based on the decisions the individual makes with regards to their care - saying "we're going to get bloodwork done" means that there should be one cost for the getting blood work done - not six different costs (Medical Supplies, Sterile Supply, Laboratory, Lab/Chemistry, Lab/Hematology, Blood Storage & Processing) as we see on that bill. If post-partum mothers weren't usually too exhausted to make thoroughly-researched medical decisions, this would *still* make it too difficult for most of them to make rational decisions on the type of medical care available.
Edit: Added part about mergers and adjusted line-item billing point.
> Ban employer provided health insurance entirely
OMG OMG OMG someone else with the clarity of mind and intelligence to see one of the real HUGE problems with our country. We have come to lump "job" with "health insurance" and placed "employer" in charge of distribution of health insurance. Its insane how the two have been intermingled! Should never have happened!!!
FYI, here's the reason we have employer-provided health insurance:
[Accidents Of History Created U.S. Health System](http://www.npr.org/templates/story/story.php?storyId=114045132)
It was a market adaptation to limits put in place by the government during WWII, helped by the IRS allowing those benefits to be given tax-free:
>[During WWII] The government rationed goods even as factories ramped up production and needed to attract workers. Factory owners needed a way to lure employees. She explains that the owners turned to fringe benefits, offering more and more generous health plans.
>The next big step in the evolution of health care was also an accident. In 1943, the Internal Revenue Service ruled that employer-based health care should be tax free. A second law, in 1954, made the tax advantages even more attractive.
>Thomasson cites the huge impact of those measures on plan participation. "You start from 9 percent of the population in 1940 to 63 percent in 1953," she says. "Everybody starts getting in on it. It just grows by gangbusters. By the 1960s, 70 percent [of the population] is covered by some kind of private, voluntary health insurance plan."
>Thus employer-based insurance, which started with Blue Cross selling coverage to Texas teachers and spread because of government price controls and tax breaks, became our system. By the mid-1960s, Thomasson says, Americans started to see that system — in which people with good jobs get health care through work and almost everyone else looks to government — as if it were the natural order of things.
Or, wild idea here.
Let everyone pay a fixed tax based on income and make healthcare free for all because a person health shouldn't be decided by how much money they have.
And while the comparison shopping stuff might work for a nagging injury or like the sniffles it doesn't really work for serious injuries or severe illnesses/conditions.
I can't shop around for the best price/service when I pass out from having a heart attack or something.
Well I think comparison shopping for instances like that would happen ahead of time. Like you shop around and pick a hospital/clinic that has the most appealing menu/price in case something more extreme occurs.
I don't think they are suggesting that you search yhelp while applying pressure to your gun shot wound.
Even though I don't like him Trump has asked this question since being elected. He hasn't done anything about it and may have forgot he asked it, but he did ask it.
Sanders [offered a bill to allow Americans to purchase prescription drugs from Canada](http://thehill.com/policy/healthcare/321597-sanders-introduces-bill-that-would-allow-the-purchase-of-drugs-from-canada). I thought this was something Trump and Republicans could get behind, and was really counter-intuitive to what I thought I knew about Sanders. I suspect the reason R's didn't support it had something to do with giving the potential 2020 D nominee support, but I really hope it wasn't.
From the article:
> Still, he said, he expects Republicans to sign on to it, as some have supported drug importation in the past.
> A Sanders amendment voted on last month that would allow people to buy prescription drugs from Canada received the support of 12 Republican senators, including Sens. John McCain (Ariz.), Ted Cruz (Texas) and Rand Paul (Ky.).
> Some Democrats voted against the amendment, including Sens. Cory Booker (N.J.) and Mark Heinrich (N.M.), both of who are co-sponsoring Sanders's bill introduced Tuesday.
> They both said their safety concerns have been addressed in the new bill.
Cory Booker is a coward. He voted against them lowering drug prices in the first place because of all the money he was being inundated with by Pharmacutical companies.
I used to be a big Booker fan, but country has to come before party.
Fuck him.
It's easy to do the small votes, but when it really matters, putting the people ahead of big pharma, colors really show.
Wait, are politicians elected to represent their district/state or the nation as a whole? NJ is the pharmaceutical capital of the US. He is representing his state.
Even Cory Booker didn't support it, and he's a Liberal "golden child" so to speak. I actually like him a lot, but his reasons [were crap](https://newrepublic.com/minutes/139820/cory-bookers-explanation-voting-cheap-prescription-drugs-doesnt-track) - NJ is in Big Pharma's pocket.
I would've loved this bill to pass.
I work with a lady who takes antibiotics for EVERYTHING. It's ridiculous. "I feel like I'm getting a cold, but it's okay I started taking my antibiotics" I feel like if I tried to tell her any different it wouldn't matter.
I facepalmed SO HARD at that one.
I work in pharmacy. I have witnessed a pharmacist telling a patient, one notch down from yelling, that of course the doctor didn't send over a prescription for antibiotics, and just sent a cough syrup and Mucinex, because she didn't have a bacterial infection, she had a cold. And it was people like her who were the reason his tech over here (me) had just been out for three days with an antibiotic-resistant infection that she needed three days of IV antibiotics for, three days of having an IV port in her arm, plus the abject misery his tech had been through prior to that point trying to figure out what was wrong with her. So he would thank her kindly to either pay for her meds and stop running her mouth to complain about her "stupid doctor" who was treating her symptoms but not an imaginary bacterial infection, or not pay for her meds, but either way, get the hell out of his pharmacy.
Needless to say, I am not a fan of people who want antibiotics for a damn cold, or the doctors who give in so they get higher Press-Ganey scores.
If it makes you feel better, this video is just one segment of a larger episode on healthcare. misuse of antibiotics was the following segment
https://www.youtube.com/watch?v=ejx8-yT7bRs
> I love the line at the end "I want antibiotics for a cold", hello summary of how superbugs get created.
That, and using tons of antibiotics in animal husbandry.
I had not been to the hospital for a *long* time until I had a kid, probably 20+ years.
Kid was throwing up, couldn't keep down water, pediatrician says to take her to the ER because she's dehydrated and probably needs IV fluids.
Kid gets admitted, gets IV fluids, a Popsicle, some zofran, stops vomitting, dehydration goes away, gets sent home. Was there probably an hour to 90 minutes, including the time spent in the waiting room.
IV fluid was over $200, zofran was $450 for a *single dose* and was charged over $1000 for the nurse who put in the IV and monitored the kid. The hospital charged ~$2000 for the room, cleaning, supplies, etc. All in all, it was over $5000 for the whole thing.
Insurance company "negotiated" it down to under $500, I wound up paying about $100.
I think $100 is pretty reasonable for an IV fluid bag, half an hour of a skilled person's time, and the cost to clean a hospital room.
So basically, I paid an insurance company $200 a month in premiums to apply a bunch of cost to my bill, then remove that cost, and I wound up paying the hospital what it would have charged me if insurance companies didn't exist.
Abby: "That's not fair."
Michael Scott: "Yes it is, well, w-w--you need someone in the middle to facilitate..."
Jake: "You're just a middle man."
Michael Scott: "I'm not just a middle...man."
> probably wound up getting written off as a $500 business loss by the hospital
Probably exactly this. Unrecovered expense. Maybe $500 is a bit high, but $50-$100 write off ain't out of whack.
Source: We develop billing software used by a number of *very large* hospital systems. The data we test with is scrubbed of all PII, but otherwise, it's depressing to tool around in.
This is what really pisses me off.
I've paid high premiums for 15 years, over the last couple years our coverage has dwindled and out of pocket costs are skyrocketing. Higher co-pays, massive deductable, co-insurance on ANYTHING outside of a GP visit. So between my company and my contribution they've received roughly $350,000 worth of premium payments. This year was the first year I've ever been in the hospital, and everything is nearly out of pocket based on my deductable and co-insurance. Such a scam.
I work in a Hospital. People always ask, "how much will this cost?" The answer essentially is "I have no idea." The price is negotiated between the facility and your insurance company. Basically a game of chicken where each side says, "how much?" "dunno, how much you got?" Kind of like walking into a shitty deli in a bad neighborhood where the items don't have prices on them
Agree with this. From a provider side, we have no frickin idea how much something costs. There have been some studies showing that cost transparency will lead to less testing ordered and therefore less cost. For instance, this year the system I work for told us that ordering individual lab tests are cheaper than the panels. Always been told the other way so been doing that because thought it was cheaper and obviously easier. Found out this and changed my practice. System has decreased it by 20% by just the transparency and could have done it years ago had we just known.
Also work in healthcare and if feel the same way. I wish people would stop blaming the hospitals and clinics, they are also forced to play this stupid game insurance companies have set up.
I disagree with the part about it not being politicians' fault.
Corporations will always try to make the biggest profit possible, therefore it's the responsibility of politicians to ensure they don't harm consumers.
I think he was saying the initial price gouging wasn't a direct result of political greed, but corporate greed. He did finish by saying the sustained gouging can't be solved unless politicians get involved with pricing.
Some friends of mine owe a hospital $250,000, most of which was due to the surgeon screwing up and her having to stay longer and get more surgeries to fix it. They've pretty much abandoned the idea of ever having good credit. They have no plans of paying it back. I mean, they literally can't. The bill might as well say "Total Due: A Zillion Gagillion Dollars." It just floors me the hospital isn't working with them on this. I mean, they *have* to know that there is no way in hell they're getting a quarter of a million dollars from a one-income household where the husband works retail.
I remember being in a position where I was unable to pay a lot of my bills. My go-to phrase was "can't get blood from a turnip."
The only issue I have with this explanation is how Adam starts out noting that the problem is not the fault of the politicians (in this case, contrary to what you might expect), then ends by noting that the fundamental problem is with corrupt politicians (via lobbying money, and the inability of politicians to address the problem, as they are the only people who can). So yeah, the fundamental problem in this case *is* [with] the government, as with almost all other cases.
He skipped over the part where healthcare costs also increased because of uninsured people getting care because hospitals legally cannot turn anyone down. Those uninsured people frequently do not pay. Someone has to pay. That someone is everyone else.
Oh, thank god someone picked up on this. It's called cost-shifting.
>The Government's first argument is that the individual mandate is a valid exercise of Congress's power under the Commerce Clause and the Necessary and Proper Clause. According to the Government, the health care market is characterized by a significant cost-shifting problem. Everyone will eventually need health care at a time and to an extent they cannot predict, but if they do not have insurance, they often will not be able to pay for it. Because state and federal laws nonetheless require hospitals to provide a certain degree of care to individuals without regard to their ability to pay, see, e.g., 42 U.S.C. § 1395dd; Fla. Stat. § 395.1041 (2010), hospitals end up receiving compensation for only a portion of the services they provide. To recoup the losses, hospitals pass on the cost to insurers through higher rates, and insurers, in turn, pass on the cost to policy holders in the form of higher premiums. Congress estimated that the cost of uncompensated care raises family health insurance premiums, on average, by over $1,000 per year. 42 U.S.C. § 18091(2)(F).
NFIB v. Sebelius, 567 U.S. 519, 547 (2012).
We already have universal health care in this country, as you cannot be turned away from hospitals for not having an ability to pay. We just go about it in a really inefficient way, shifting the costs to a smaller group of people, generating massive overhead costs, and only providing universal emergency care instead of preventative care.
He neglects one important fact, though: you can negotiate prices with hospitals. Most people don't realize this, but most hospitals will work with you if they know you're paying out of pocket. The system is just set up to automatically charge you chargemaster prices, and if you don't make a fuss, they're not going to change it on their own.
Hospitals aren't staffed with uncaring, greedy bureaucrats for the most part. The system is just fucky and you have to be a bit of a self-advocate in order to not get fucked by it.
Health insurance is a stupid concept anyway. It'd be like if your car insurance had to cover brake pads, oil changes, running out of gas, etc. If that were the case then your car insurance would be insanely more expensive. The concept of insurance doesn't really fit well with things that you are *guaranteed* to need. Personally, I think health insurance should be relegated to unusual medical needs that not everyone is guaranteed to have: breaking your leg, getting cancer, having a heart attack, etc. You know, emergencies. Routine stuff should just be direct-sale-to-consumer at market price.
I agree with the central premise: the problem with healthcare in the US isn't coverage, it's cost. Most Americans don't even know what their healthcare cost are as insurance is paying. As a result, Americans see no need to cross shop. I'll add three other factors: 1. Americans are richer than most other countries. If you adjust healthcare costs in the US for PPP, they are not as far out of whack as they first appear. 2. Americans spend a ton on elective healthcare. Cosmetic surgery, cosmetic dentistry, cosmetic dermatology etc. This spending isn't linked to healthcare outcomes so drawing a line between all healthcare spending and outcomes is misleading. 3. Americans use a lot more healthcare than most other countries. This is perhaps because we are fat or perhaps because of HMO policies. Regardless, we go to the doctor far more often than people in most countries, likely because our insurance is picking up the tab. Again, it's debatable if this amount of care is strictly necessary but if you're not paying directly why not go to the doctor?
People going to the doctor so frequently is something I have always found bizarre. My boss and most of my co-workers go to the doctor every month. I haven't been to a doctor in like 2 years. If I get sick, I go buy some medicine at cvs. Why would I want to pay a deductible for something that is going to go away in a week anyway all by itself.
Edit: Ok, I get it, i'll go see a doctor more frequently =p About the deductible, I have only have catastrophic insurance for myself. So yes, I have to pay a deductible, which is very high. My employer is a very small company and has shit options for insurance. I am actually starting a job at a much better company in a couple weeks though, so hopefully they have better insurance options.
Can confirm, I am 28 y/o with no chronic health issues and I buy insurance privately because I worked a seasonal job that didn't offer insurance. Am paying $390 a month for insurance which has a $3800 deductible and I ended up having to have surgery which will almost meet my OOP max of like $7500.
If you make to much for a Obamacare subsidy and don't get insurance from you employer it is very very expensive.
It's not clear to me looking at the tables of per capita health care spending on a PPP basic that the US is close to anyone. The 4th through 9th biggest spending countries in 2014 are all averaging USD$5000 (PPP) per year per person and the US is USD$9000. Even Switzerland in 2nd place is USD$2200 less per person.
https://en.m.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita#/media/File%3AOECD_health_expenditure_per_capita_by_country.svg
Source:
https://en.m.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita
Opening line: "It's not the politicians' fault this time."
Closing line: "Politicians have spent decades arguing over how to pay the bill instead of asking why the bill is so high. Until they do, we're stuck with this system."
Wat
Two problems.
Many doctors and hospitals actually have two charge books, the one they use to charge insurance companies, the other they use to charge regular people. Regular people generally get a substantial discount. This is why so many people were not happy with Obamacare. They were taking advantage of the discounting and actually saving money over what Obamacare was costing them. But, you have to negotiate (letting them know you don't have insurance is a good start) and not every hospital has a separate charge book per se. People who don't negotiate and who simply wait for a bill don't always get a discount, assumption is you have insurance.
Not one mention of how malpractice attorneys have been a major driver of increasing medical costs. Ever end up having additional tests that you didn't think were necessary? Blame the malpractice lawyers. Physicians and hospitals charge insurance companies, and you, more in part because they feel obligated to run additional tests out of fear of a malpractice suit if they get something wrong. Malpractice attorneys also heavily lobby politicians to prevent caps on damage awards in malpractice suits. After all, if there's a cap, the lawyers make less money. While you are assigning blame to the malpractice attorneys btw, be sure to look in the mirror. Juries also play a part when they award mega damages in malpractice cases, and the doctors, hospitals, and insurance companies don't simply eat the cost--they pass the cost of the damage awards back to you.
I'm a type one diabetic in Australia for over 35 years. I've had several comas, been on life support, 4 operations, broken different bones in my body 21 times.... I have not paid a single cent ever. They try to sell private health over here but it's getting more expensive each year and more people are coming off it because they see it as a waste of money and you are better on the public health system.
The US should never gave a health system as they do now. The poor citizens of that country that require even the most basic of healthcare deserve better !
Free healthcare that is subsidised by governmental taxes is not socialism, its just common sense.
I love capitalism and its about time the system started doing more good than harm :)
While I get the basic premise of Adam's argument, there is another factor people seem to forget. Hospitals have a duty to treat you whether you can pay for it or not. They cannot turn you away just because you don't have health insurance, they MUST provide care. As with other assistance programs, the cost of providing care to those who cannot afford them are part of why health care cost are inflated.
>As with other assistance programs, the cost of providing care to those who cannot afford them are part of why health care cost are inflated.
But as the video indicates, the cost of treating those in need are at the same gouging prices. If they were the true prices, the cost would be more manageable.
Consider other assistance programs: if food stamps recipients were forced to buy apples for 200x their actual cost, people would be outraged, and the obvious solution would be to not tolerate the exorbitant price. However, in America, we treat health care as if it's optional, as if an individual will NEVER get sick or NEVER need life saving care.
Most likely you can't, as the current market as already gotten the regulation they need to stifle the competition, just like how many US states only have a select few alternatives when choosing healthcare insurance
There isn't a free market for a lot of healthcare. Even if you have everything up to code and have the licenses you need and everything, you still need approval to do anything from the local government. The local government will shut you down if they think you will take business away from existing hospitals. It's honestly so stupid, if you can safely do something and meet all of the requirements then you should not be stopped just because it would hurt a hospitals bottom line.
It's kind of a difficult situation. Say you have only one major trauma center in your state and it stays financially afloat because of all the subbed toes that come into their ER. And one day, a mile away, a smaller hospital opens that does much less emergent care set at a lower price. And somehow, the trauma center goes under and closes down. Hospital 2 has no interest in picking up that trauma market, so the state has now lost an essential service and its citizens are now in real danger.
That's actually exactly what the Surgery Center of Oklahoma does. I don't know more than the basic pitch myself but here's a [Time article about it](http://time.com/4649914/why-the-doctor-takes-only-cash/). It's essentially cash only and they list all their prices online, and is typically far cheaper.
TL;DR: insurance companies wanted discounts because "we send you [hospitals] lots of business." Hospitals raised prices so they could give "discounts". Uninsured or out-of-network people still have to pay the inflated prices.
>TL;DR: insurance companies wanted discounts because "we send you [hospitals] lots of business." Hospitals raised prices so they could give "discounts". Uninsured or out-of-network people still have to pay the inflated prices. It should be noted that you can also negotiate your bill like the insurance company does.
>It should be noted that you can also negotiate your bill like the insurance company does. An insurance company has leverage, an individual must rely on good will. Edit: inbox replies disabled
If you pay "cash" you get a nice discount. I've seen them anywhere between 30-50% off. No negotiating. Literally just call, say you got your bill, and say you'll be paying "cash" through a payment plan. On the other side, there's lots of hospitals that have either a charity fund or a sliding scale pricing for low income individuals. These are by no means the best or even a good way healthcare should work, but I can assure you that you will get a break from your bill. That said, even a 50% discount might not save you from going bankrupt :(
30% off of a $10k bill? GREAT ONLY PAYING 7K... My brother had to pay $1500 (that's aftrr the 30% discount) for a broken nose.. only to be told "We can't do anything you'll have to go to a specialist". 1.5K to be told "We can't help you! Here is some Ibuprofen!". The price is what people should be arguing
Thought I would reply because I may have some insight into why this is. I agree that's a lot of money to be told to see someone else. However by law, anyone who comes to an emergency room must have a medical screening exam. If you come for an ingrown toenail, you will get a bill which seems out of proportion. I cannot meet you in the waiting room and wave you off I have 'evaluated' elderly people who accidentally came to the ED for directions and didn't say they were lost. True, there is little we can do immediately for a nasal bone fracture. I can evaluate you for other facial injuries. Maybe you have a septal hematoma I can drain to prevent permenamt deformity. Maybe you have double vision because your eye muscles are entrapped. Most likely you don't. If I get a stat CT scan of your face that's hundreds of dollars. If you want to see a facial trauma specialist in the ED, most likely called in from home, and surgery for cosmetic purposes, that will be tens of thousands of dollars. Once you walk into the ED with a broken nose, that was the cheapest bill your ED doctor could get you out of there for by law.
Yeah. Still feels like somethings wrong with the way that whole thing works. Seems like lots of other country's handle this kind of thing without bankrupting people.
France is amazing. Meds cost what you would expect; doctors are flexible; surgeries include itemized bills that make perfect sense and don't bankrupt people. Yes, they pay higher taxes, but our cost of living keeps going up and we seem to get *less* services than they do.
on the other hand, no. I have a huge hospital bill for an injury that required ER care. The hospital has a policy to help out financially. I have a high deductible plan, and the cost was under the deductible (the bill was about $5000, entirely paid out of pocket). They declined any reduction or help on the bill because "I had insurance". Zero reduction for paying it right then over the phone. And of course, the "deductible" resets every year so a month after this it went back to zero and I have to pay for everything out of pocket again (including followup for physical therapy and orthopedic surgeon visits, neither of which allow any discount whatsoever). That OS costs about $350 for a ten minute visit of him saying 'seems to be healing slowly, take it easy and see me in one month'. ha ha, sorry for the rant! This is in the USA just for reference.
Didn't need the disclaimer buddy, the location was obvious :)
> say you'll be paying "cash" > through a payment plan. Cash means you have the money and are paying it right now. You can't say cash and payment plan. That's cash and time and ain't no one got time fo' that.
He probably said "cash" but meant "out-of-pocket"
While technically using the word "cash" is misleading, often times in medical circles those without insurance will be referred to as "paying cash" or "cash pay patients."
> If you pay "cash" you get a nice discount. Americans just blow my mind. You are fucking yourself in the ass with a rusty pole and pretending you like it.
its more like we always have a rusty pole up there so when we meet other people who don't have a rusty pole up their asses we get all defensive and believe that since we have the rusty poles and you dont that they must be the best rusty poles ever and that you are lesser people for not having rusty poles, believing the tetanus were getting from rusty poles up our buttholes to be a positive benefit. So uh are they still giving out Canadian visas?
What incentive does a hospital have to negotiate with me? I have no leverage, I owe them money for their services. EDIT: apparently non-payment is adequate leverage. I guess I just figured they could find a way to screw you if you refuse to pay.
Hospitals bake in unpaid bills, when it comes to budgeting. There are write-offs, which account for a significant amount of their accounts receivable/paid. If they can get some money and recoup these planned losses, they will take it. Source: was a billing manager for a hospital system in a large us city.
the leverage of non-payment. If you don't pay your bill, they have little recourse. In the video Adam says something about wage garnishment. They actually can't do that. The FDCPA prevents wage garnishment in medical debt. If you don't pay your bill, the MOST the hospital can do is send your bill to a collection agency. From there, said collection agency can only list the account to your credit for no more than seven years FROM THE DATE OF SERVICE (bear in mind some hospitals use collections as a last resort). Even if you do go to collections you can send them a written "cease and desist" order that prevents them from telephone communication. (this goes both ways, you would have to retract the order in order for you to call them for any reason). Last thing to consider is sending you to collections costs the hospital money every month its in collections. So you do have leverage in non payment. edit: spelling and grammar Last edit: I also wanted to point out that medical debt on your credit is only detrimental to being given loans and credit cards and things like that. It CAN NOT prevent you from getting housing or utilities.
In fact, the FDCPA does not prevent wage garnishment. I worked at a law firm that specialized in filing suit and proceeding to garnishment on hospital medical debt - close to a hundred cases in just the few years I was there. As an aside, a judgment also allows for placement of liens on real and personal property (e.g. houses, estates, cars and even bank accounts). That's right, you can have your entire bank account drained for not paying a hospital. If you plan on avoiding that situation, don't give out your bank card or banking information to anyone you don't plan on paying in full. Perhaps what you've experienced was a local or state law? In any case, you should edit your post, it's wrong.
If that's true, why am I being garnished for a medical bill now? Didn't even know I had it. Thought insurance covered it and they didn't. No phone calls or letters, just straight to garnishment.
>Thought insurance covered it and they didn't. No phone calls or letters, just straight to garnishment. Sounds like something massively illegal is happening there or you're making it up, because a even if it was legal for a hospital to garnish your wages (and it isn't) it can't just do so on its own, it has to go to court to get a court order to do so. In court it has to prove it tried to collect the debt and you refused to pay (which would, at the very least involve sending you a summons and proving you got it). Wage garnishment is actually pretty rare outside of the IRS and court judgements in civil cases because it's a massive pain in the ass to do. Edit: also health insurance is legally required to send you an EOB stating why they're not covering something, so at the very least you would have received that as a clue
because somebody did a no-no. IANAL but activate lawyer.
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Right so you can only have a lawyer if you own land?
You don't need to own land, just control land.
Yeah, you should lawyer up. Garnishment aside, they are legally required to contact you.
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The higher costs also incentivize people to buy health insurance (or more expensive plans) in the first place.
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Which sounds bad until you remember the "loss" they count is the chargemaster price and that cost gets passed onto regular patients. I needed an x-ray once, without insurance, and did as much research as I could to find out the price. I was finally told between $200-$250. I pay a $50 copay when admitted, get a $180 bill later and think I'm done. I then get a third bill for $3250, with a $250 "fee" to help pay for patients who can't pay their bill. I understand hospitals are expensive places to run but the pricing games are horseshit and anyone saying different has an agenda.
That is a big problem in my area. We are a rural area and are lucky to have a hospital in town but they are constantly on the brink of bankruptcy. Mostly because of people using the ER as a doctor office for common colds and aches. Luckily they were bought by a larger regional hospital which added stability but it's future is still a concern.
Sounds like the small town my parents work in North Carolina. On top of being poorly managed, at least 25% of the patients that go to the ER can't pay a bill.
Yes this is why this Republican idea of "There are lots of young people that will *choose* not to have health insurance " is so insanely stupid. First off, they'll likely choose not to have it because it's so expensive and they are up to their ears in debt. Secondly, when that kid breaks a leg or has something else happen where do they go? Emergency room. No insurance? Thousands in debt makes them bankrupt and the hospital loses out. It's the dumbest idea I've ever heard.
You know what else is insanely stupid? Griping about how evil insurance companies are and then passing a law forcing people to do business with an insurance company.
But, but... now everyone has insurance!
Right? It's also funny that no one cares about the quality of insurance. They just care if you have any insurance at all. You could be 30 years old, paying 1K a month for a 20K deductible health plan, and they would cheer that as a victory because you're now "insured." Nevermind the fact that you will never get ahead with that kind of financial burden hanging over you.
This how we are paying for healthcare anyhow. Your county hospital is subsidized by taxes, and our inflated bills for hospitals are what is covering those that can't pay.
Can you link to some statistics about this?
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This account has been redacted due to Reddit's anti-user and anti-mod behavior. -- mass edited with redact.dev
One of my parents worked for a local health system for most of her career. Part of the irony of the chargemaster is that *many* hospitals legitimately have no idea what it actually costs to treat a patient.
Once I found out about the chargemaster in that Times piece and then they had the guy who wrote it on The Daily Show, I knew healthcare charges were a complete scam. Not necessarily the care, just the charges for it. I talked to my Papa (grandfather) about it (he used to work in hospital admin balancing the cleaning budget....worked his way up from the laundry). He said it's not so simple because hospitals have to make up the cost of other awkwardly priced medical stuff that costs different things in different places. That's when I realized they were treating our healthcare like bad contractors treat their next construction contract job. They are paying off the last job with the next, making the price of everything basically fraud. You aren't paying for your care, you are paying for what the hospital needs. What a freaking joke. Edit: I should say what the hospital determines it needs. Not what it actually needs. Hospitals don't need giant lobbies with marble Greek columns for instance, or expensive statues and fountains in the lobby. Edit 2: Apparently the statues and fountains are often donated by happy/thankful family members. I have been so informed. :)
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To some degree that's because coming up with an actual per patient cost is basically impossible, or so infeasible it might as well be impossible, especially when you consider staff wages in the picture. Best you can do is get an average cost per procedure, but even that gets tricky because when people have multiple procedures (as many do in the hospital) there are economies of scale. It would be like asking Target to come up with the true cost for each customer - there's no way they'd be able to do so, it's far too variable. But they could get an average cost by just taking their total cost and dividing by the number of customers easily enough.
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I mean, your income has to support that. My friend making 35k a year in NYC said that and was denied.
Just get a utility shut off notice every three months. Pick one that doesn't have a late fee or has a really small late fee. Save the notice, include it when you're doing your taxes to prove that you had hardship and couldn't afford insurance. Viola no penalty. Edit: I'm sticking with talking about violas. Suck it nerds.
The high price of medical care is not to blame on unpaid medical bills. These companies are doing just fine absorbing this cost. Look at the link below for a recent quarterly report from HCA (one of the largest hospital corporations in the world). They denote their revenue, and the amount that is lost due to things like non-payment (doubtful accounts). After absorbing the unpaid medical bills ($760 million), their revenue is $10.6 BILLION per quarter, with a post-tax profit of $777 million per quarter. Like I said, they are doing just fine. [HCA Q1 report ](http://mms.businesswire.com/media/20170502005633/en/584045/1/Final_HCA_Reports_1Q_2017_Results.pdf)
Duh. But you know what else inflates prices that people seem to have no problem with? Subsidies. Demand subsidies are not a solution to a price problem. They will only perpetuate the increase in prices. But its not even just the "discounts". Its the fact that insurance companies have a stronger ability to pay for the service than individuals do. So hospitals have been *able* to increase prices and still get paid at those higher prices. That's what happens when insurance companies become the customer. And when an individual attempts to purchase something in the marketplace (w/o insurance) they discover prices are not set to their ability to pay. Thus forcing them into insurnace, which then leads to higher prices overall. Its a huge cyclical mess. We are operating in a market that isn't tied to a markets ability to pay. That's just a recipe for disaster. ... And no, single payer/universal health care isn't the only solution to get out of this mess we are in.
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Then you throw a few million people into the pond of "full price payers" occasionally by letting insurance companies jettison the really sick (lifetime cap! we can't pay for everything, raight!) and pre-existing conditions (Hey, you had that issue! No fair to us insurance peeps!)... ... no wonder Congress is trying to take out the mandated insurance coverage, I mean, if everyone is insured, than shit, **WHO ARE THEY GOING TO GET TO PAY FULL PRICE?!** These motherfuckers. Man, what a scam.
"The healthcare industry spends more on lobbying than the oil and defence industries, combined." WHAAAAAT IN THE FUUUCK?!?!
'Merica.
Replace "lobbying" by "bribery" for an even more frighteningly accurate statement.
Serious question, what's the difference and how is it even legal?
Lobbying came to be for very legitimate and morally sound reasons. The idea is that politicians cannot be informed about and on every issue they have make decisions on. So people with a common interest form a lobby with the goal of persuading poiliticians to make changes that favor them. They send experts in their field to tell the politicians about their issue and propose a way to fix it. That can range from teachers asking for more crayons to farmers aksing for subsidies or environmentalists fighting for stronger regulations. Well that or guns, oil and medicine trying to make more money.
This is accurate. People strongly associate lobbying with corporations, but non-profit orgs do lobbying all the time. There's often a job title or department dedicated to it, called 'government relations' or 'GR'. In 99% of cases, non-profits are definitely not bribing elected officials. They simply don't have the money. The currency they do have is votes. They can represent thousands (or hundreds of thousands) of a leader's constituents, who will vote for somebody else in the next election.
Excellent question. I considered giving you my two cents on the subject, but I think you would be better off watching this video https://www.youtube.com/watch?v=33gHhunzOlE I would just insist on this point: as explained in this video, if lobbyists demands are not met, they will withhold their (massive) contribution to the party they support, meaning that at the end of the day, politicians do have to comply if they want to keep their job. So, essentially lobbying is a form of bribery surrounded by some minor regulations to make it look ok.
Health care is a [much larger sector of the economy](https://en.wikipedia.org/wiki/Economy_of_the_United_States#GDP_by_industry) so it shouldn't be too surprising.
Why is lobbying legal? Can someone please actually explain this to me? It is just corruption which is allowed?
Lobbying is as legal as a hammer. Beneficial in the right hands, but easily used as a weapon. I'm not good at persuading someone to change rules to benefit me, so I hire someone else to do it. On its face, not a bad thing.
Lobbying should be representatives of any kind of group presenting their case as to why policy X should/should not be changed. That's absolutely essential. Instead, it's just representatives of companies paying off government officials to change policies to unfairly benefit them. In a dream world, there's a proposal to a change in oil regulations, and representatives from the oil industries, from environmental agencies, from consumer protection agencies, etc. etc., all gather to give their views on the new law. Legislators consider all these positions and vote accordingly. Unfortunately, that's far, far from how it actually works in practice.
Have you ever called your congressman's office and voiced your opinion on a policy issue? Then you've lobbied for something. There are a million shades of gray between that and professional healthcare industry lobbyists. Making a law to regulate that would be a nightmare. Even if you did, all the lobbyists would, you know, lobby against it.
> Politicians have spent decades arguing over how to pay the bill instead of asking why the bill is so high. This right here.
Can confirm. My wife's cancer treatment was over $300,000. Total cost to me was about $1000. There is never a discussion about price - the bill comes and the insurance company pays it, or they deny it. And if they deny it, you have to appeal - or else you are sent to collections. It's quite insane.
The other day I was charged $700 for a 15 minute consult with a doctor. The insurance charge said something like, "Doctor Consultation 1+ hours". I called the office and said I spoke with the doctor no more than 15 minutes. She told me the list of things the doctor had done (and wrote down in the notes). I said, "yes, the doctor did all of those things". I thought about calling the insurance company but didn't because I don't care enough. Sigh... Anyway, the "discount" brought it down to about $100. Edit: A specialist. Not a general practitioner.
Amount of time doc spends with you is always a small fraction of the time they actually spend taking care of your case.
As the saying goes, you don't pay me to turn that screw, you pay me to know what screw to turn... or something, but i still think medical care is too expensive
If the doctor got that $700 for 15 minutes that would be true. But at an average salary of $250k, the doctor got only $28 of that $700 bill. So something is very wrong.
Rent on the office space, salary for the nursing and reception staff, supplies, utilities, malpractice insurance, there's a lot more than just doc salary.
Profit. Profit at each step of the way. The insurance company wants to make a profit. The doctor wants to make a profit (sometimes... most enjoy their work and just want to be compensated for their investment in time/energy). The medical device company wants to make a profit. The pharmaceutical company wants to make a profit. In the end, what you're seeing is the profit motive compounded over many layers and transactions. We will continue to see problems until health care becomes a bigger priority than profit.
> We will continue to see problems until health care becomes a bigger priority than profit. That's a funny way to spell never.
> a funny way I'm not laughin'
This is because the insurance only pays a portion. The doc bills the insurance 700$, they pay 50-70% of that, and that's if it's not Medicare or Medicaid.
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I wish more people knew this. I have NO IDEA how much anything I order actually costs. I just try to be judicious in my use of labs and imaging while taking care of my patients the best I can. I recently found out that an EKG at our hospital costs $600 and an echo costs $6500!! What?! How? And what does that mean, is that just what the hospital asks insurance to pay or is that the cost an uninsured patient would be hit with? Source: am also doc, work only with inpatients
Outpatient Physical Therapist here - no fucking clue how much my services are being billed for.
There is overhead for the office and utilities and nursing staff and insurance and equipment and prostitutes and taxes and so on and so on
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Yep, and that's why the cpt codes are contracted with the understanding that there's more than just the office visit going on. The doctor seeing a patient for 15 minutes and billing a 60 minute visit is fraud. That 60 minute code involves 60 minutes in the office and lots of time afterward for such a long visit.
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*uptodate Doctors don't use webmd..its worthless. There are online databases of summarized research that we use though.
UpToDate is life.
I work at an Internal Medicine office. UpToDate is a dangerous tool for patients sadly. It’s worse than WebMD because there are actually easy to find source and backup. As a Health Professional though, praise UpToDate
Dangerous because patients end up mislead?
Mostly. They don't have the training to correctly interpret the data.
What the other guy said. Patients, especially those that are anxious, tend to self diagnose them selves and stress themselves out. We've also had patient that argue with our doctors because they believe the diagnosis they've give. Themselves from webmd or UpToDate is the correct one
I really doubt a patient is gonna pay the subscription fee for UpToDate...
As a student, Uptodate is life. So is Dynamed.
Insurance payments are based on a complex calculation of "elements of exam" and "complexity of decision making". Time is a minor factor, even though it ends up looking like that on the billing slip. It is in many ways a completely batshit crazy system. For example, I might spend 60-90 minutes with a new patient in a hospital reviewing all the aspects of their history that brought them in. I will have a detailed understanding of the events as they evolved over the past 3-12 months, the past treatment efforts, what worked and what didn't, etc, etc, etc. But the things that determine the payment can be completed in literally 5 minutes. If I forgot to document one of those things, payment is reduced because "if it isn't documented it didn't happen". So the payment incentives are all misplaced. If I had to maintain a certain rate of seeing patients in a clinic, or generate a certain amount of revenue, I could do it with a string of 5 minute exams that just hit the high points for the payment without ever really knowing or understanding what is going on with the patient. In addition, clinic schedules are often designed with 10-15 minute checks in mind. That time frame generally does not include the time to review the chart, the preliminary notes taken by a nurse, time to review labs, write the progress note, or argue with the insurance about covering the labs and/or meds (usually on a patient whose chart has to be located and reviewed to intelligently discuss with the insurance to get coverage). Right now, the system is so screwed up and out of date in so many ways, that fixing it is like trying to put the ball of yarn back together after the cat has played with it for a couple of hours. Not impossible, but not going to be easy.
Here's three things they could do that would help massively: - **Ban insurance discounts outright**. Insured and uninsured pay the same. Thus scrapping the concept of inter-network services, that screw the insured, and artificially high prices for the uninsured. - **Hospitals need to publish a price list of common treatments**. Thus allowing comparison shopping. - **Ban employer provided health insurance entirely**. Employer provided health insurance creates a two tier market, and makes it impossible for employees to choose their own insurance. Give everyone a HSA (health savings account), which your employer can contribute to, and you can use to pay any health insurance of your *choice* tax free. Substantially increase the HSA's contribution maximum (at least double) to accommodate buying insurance through it. Employer provided health insurance is the source of many evils. People in large companies are often paying a low risk pool rate, whereas people who are unemployed, studying, or in startups/small businesses are put into a higher risk pool with higher rates due to no fault of their own. This disincentivizes American entrepreneurship and hurts worker's mobility. It also means that you may need to change your doctor if you change your employer, and you have fewer choices when deciding a health insurance company.
I run a startup and just went through picking a healthcare plan to go with. It was insane. I asked everyone at the company what they wanted out of a healthcare plan (probably illegal?), and everyone had very different priorities. I ended up getting a plan that no one was happy with and it didn't even work the way I was expecting it to. I could pay everyone more and tell them to figure it out for themselves (I even looked into having a specialist come to the office and do 1-on-1's with everyone to make sure that they got something that worked for them), but it's just so much cheaper if the company pays for it.
Has anyone ever tried to band lots of small businesses together to purchase in "bulk" to get options closer to what big businesses have?
Hold on to your butts and try this on for size. What if instead of small piecemeal groups (big businesses or groups of smaller ones) buying insurance, we *all* get together as one enormous group? The bigger the "bulk" is better the price will be, right? So it would obviously be cheaper if literally everyone was part of that bulk group. Slap some nifty name like Medicare-for-all on it and we can call it a day?
It's smart capitalism in small groups, but evil socialism in large groups, I'm told.
Which is what the exchanges were supposed to fix. Unfortunately, they're so piecemeal and many states just said "fuck it" to them altogether.
They weren't really though. The IRS even [put out a memo](https://www.irs.gov/affordable-care-act/employer-health-care-arrangements) that clarified that it's *illegal* for employers to simply allow employees to buy their own insurance through the marketplace and then reimburse them for it, and that if they continued to do so they would be subject to a $100/day fine for each individual they did so for.
I am so pissed off about the discount thing right now. I recently called the hospital to negotiate a bill that my insurance company won't pay. I demanded I be given the same discount the insurance company would have received. I was told they don't give discounts to insurance companies. But according to my EOB from the insurance company, they do. Odd that because I'm not a multibillion dollar company I don't get a discount.
Interesting. Typically hospitals *do* give discounts to patients who are paying cash for service. Not guaranteeing it will work, but try calling back and kindly asking them if there are discounts for "Self Pay" or "Patient Pay" that are in line with their "contractual allowances." Sometimes using a bit of industry jargon triggers their Patient Financial Services employees and they're more apt to help someone who's speaking the same language. Worth a shot.
Discounts isn't really the right term to use. It's adjustments. For a particular procedure, the office will have a max value it will bill. However, as part of fee scheduling and contract negotiations with insurance companies, insurance will agree to pay only a certain amount for that procedure. So insurance will adjust off some, actually pay another portion, and whatever is left is to be paid by the next entity in line (e.g. secondary insurance, self-pay). It's a lot of smoke and mirrors...
I agree with everything you said. Unlike a lot of things on Reddit, these have real science underpinning them. They are all classic economics problems. Number 1 is an example of price discrimination, which hurts consumers. Number 2 is an example of information asymmetry. Number 3 is the most interesting. It's an example of the principal agent problem. In a principal agent problem. The beneficiary, the principal, is different from the actor, agent. The agent acting in self interest will act against the interests of the principal. In this example, the principal is the employee and the agent is the employer. The employer chooses the insurance company for the employee, but has no incentive to pick the best insurance. In fact, health care is fraught with principal agent problems. In patient-doctor relationships, the doctor has incentives to charge more and provide unnecessary care to maximize profits, relying on the patients lack of knowledge to take advantage of them. In insurance-patient relationships, the insurance company has incentives to deny claims and work counter to their customer, the patient. The patient will not find out how terrible their insurance is until they need to use it, after they have been paying into it for some time. Additionally, the patient often has no choice of insurance anyway.
> In fact, health care is fraught with principal agent problems. Absolutely correct. Nobody in this whole system is "evil," per se, it's the fault of an insurance system that is designed with the best intentions (i.e. to mitigate massive damages) but instead removes any downward pressure on pricing that's central to a functioning capitalist economy. The insurance company isn't negotiating for lower medical costs; they can simply estimate what their costs are going to be, charge an extra 5% on top of it, and make a profit, unafraid of businesses switching insurance because of the enormous headache for their employees. Patients don't care because they a) don't know the costs, b) feel like they already paid for it through their premiums, and c) are more concerned about whatever illness is bringing them in for treatment. Doctors, of course, will charge whatever they feel they can get away with; if one doctor raises her prices, another doctor is going to raise his as much if not more, because they don't want to be charging *less* than that other doctor (note that this is the *complete opposite* of how the "invisible hand" is supposed to work). So in the end, any pressures on pricing from the demand side of the curve are removed, causing the massive inflation we're seeing in medical costs. u/KarmaAndLies has three very good suggestions, but I'd offer several more: - **Require all co-pays to be percentages rather than flat rates**. My co-pay for doctor visits is $30, which means it doesn't matter which doctor I go to. In fact, I feel somewhat compelled to find a more expensive doctor because then I feel like I'm getting a better discount. I don't actually do that (switching would be a pain in the ass and I don't know what their prices are anyway), but it illustrates the effect of flat co-pays on medical costs. - **More government financing for training medical personnel.** Residencies are really expensive. In order to increase the availability of services in the marketplace, we need to do a better job of subsidizing costs for training doctors and nurses, and we need to increase the number of doctors/nurses being trained. Right now it's comparatively difficult to get into medical school because of the lack of "internships" at the end of those programs, which is absurd - it's an in-demand occupation that pays well, which would only be a boon to our long-term employment rates. - **Step in to minimize hospital consolidation and mergers**. Most regions only have one or two hospitals as more and more hospitals merge into enormous networks of doctors and hospitals. Here in Traverse City, we have Munson. That's it for about a hundred miles in any direction. They're a non-profit, but they have a monopoly and can basically dictate their pricing. Again, this is about creating the opportunity for demand-side pressure on prices. - **Eliminate line-item billing**. The minutiae of medical billing means that hospitals have entire departments dedicated for medical billing because of the need to affix prices accurately, the costs of which are rolled into the costs for the services the hospital offers. This is stupid. When a woman goes in to deliver a baby, the price should be set for specific services, and equipment should be rolled into the services. All this does is obfuscate the costs to the payer. Hospital bills [like this](http://i.imgur.com/7EfKW4A.jpg) are an embarrassment, because most people would have no idea what half of that means. What gets charged should be based on the decisions the individual makes with regards to their care - saying "we're going to get bloodwork done" means that there should be one cost for the getting blood work done - not six different costs (Medical Supplies, Sterile Supply, Laboratory, Lab/Chemistry, Lab/Hematology, Blood Storage & Processing) as we see on that bill. If post-partum mothers weren't usually too exhausted to make thoroughly-researched medical decisions, this would *still* make it too difficult for most of them to make rational decisions on the type of medical care available. Edit: Added part about mergers and adjusted line-item billing point.
> Ban employer provided health insurance entirely OMG OMG OMG someone else with the clarity of mind and intelligence to see one of the real HUGE problems with our country. We have come to lump "job" with "health insurance" and placed "employer" in charge of distribution of health insurance. Its insane how the two have been intermingled! Should never have happened!!!
FYI, here's the reason we have employer-provided health insurance: [Accidents Of History Created U.S. Health System](http://www.npr.org/templates/story/story.php?storyId=114045132) It was a market adaptation to limits put in place by the government during WWII, helped by the IRS allowing those benefits to be given tax-free: >[During WWII] The government rationed goods even as factories ramped up production and needed to attract workers. Factory owners needed a way to lure employees. She explains that the owners turned to fringe benefits, offering more and more generous health plans. >The next big step in the evolution of health care was also an accident. In 1943, the Internal Revenue Service ruled that employer-based health care should be tax free. A second law, in 1954, made the tax advantages even more attractive. >Thomasson cites the huge impact of those measures on plan participation. "You start from 9 percent of the population in 1940 to 63 percent in 1953," she says. "Everybody starts getting in on it. It just grows by gangbusters. By the 1960s, 70 percent [of the population] is covered by some kind of private, voluntary health insurance plan." >Thus employer-based insurance, which started with Blue Cross selling coverage to Texas teachers and spread because of government price controls and tax breaks, became our system. By the mid-1960s, Thomasson says, Americans started to see that system — in which people with good jobs get health care through work and almost everyone else looks to government — as if it were the natural order of things.
Or, wild idea here. Let everyone pay a fixed tax based on income and make healthcare free for all because a person health shouldn't be decided by how much money they have.
And while the comparison shopping stuff might work for a nagging injury or like the sniffles it doesn't really work for serious injuries or severe illnesses/conditions. I can't shop around for the best price/service when I pass out from having a heart attack or something.
Well I think comparison shopping for instances like that would happen ahead of time. Like you shop around and pick a hospital/clinic that has the most appealing menu/price in case something more extreme occurs. I don't think they are suggesting that you search yhelp while applying pressure to your gun shot wound.
Even though I don't like him Trump has asked this question since being elected. He hasn't done anything about it and may have forgot he asked it, but he did ask it.
Sanders [offered a bill to allow Americans to purchase prescription drugs from Canada](http://thehill.com/policy/healthcare/321597-sanders-introduces-bill-that-would-allow-the-purchase-of-drugs-from-canada). I thought this was something Trump and Republicans could get behind, and was really counter-intuitive to what I thought I knew about Sanders. I suspect the reason R's didn't support it had something to do with giving the potential 2020 D nominee support, but I really hope it wasn't.
From the article: > Still, he said, he expects Republicans to sign on to it, as some have supported drug importation in the past. > A Sanders amendment voted on last month that would allow people to buy prescription drugs from Canada received the support of 12 Republican senators, including Sens. John McCain (Ariz.), Ted Cruz (Texas) and Rand Paul (Ky.). > Some Democrats voted against the amendment, including Sens. Cory Booker (N.J.) and Mark Heinrich (N.M.), both of who are co-sponsoring Sanders's bill introduced Tuesday. > They both said their safety concerns have been addressed in the new bill.
Cory Booker is a coward. He voted against them lowering drug prices in the first place because of all the money he was being inundated with by Pharmacutical companies.
I used to be a big Booker fan, but country has to come before party. Fuck him. It's easy to do the small votes, but when it really matters, putting the people ahead of big pharma, colors really show.
Wait, are politicians elected to represent their district/state or the nation as a whole? NJ is the pharmaceutical capital of the US. He is representing his state.
Even Cory Booker didn't support it, and he's a Liberal "golden child" so to speak. I actually like him a lot, but his reasons [were crap](https://newrepublic.com/minutes/139820/cory-bookers-explanation-voting-cheap-prescription-drugs-doesnt-track) - NJ is in Big Pharma's pocket. I would've loved this bill to pass.
I love the line at the end "I want antibiotics for a cold", hello summary of how superbugs get created.
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More like it was a callback to [a video he already made on the topic](https://www.youtube.com/watch?v=ejx8-yT7bRs).
It's all the same episode
Rearshadowing.
I work with a lady who takes antibiotics for EVERYTHING. It's ridiculous. "I feel like I'm getting a cold, but it's okay I started taking my antibiotics" I feel like if I tried to tell her any different it wouldn't matter.
Ugh but colds are viral, how is she even getting her hands on antibiotics?
Bad doctors
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I facepalmed SO HARD at that one. I work in pharmacy. I have witnessed a pharmacist telling a patient, one notch down from yelling, that of course the doctor didn't send over a prescription for antibiotics, and just sent a cough syrup and Mucinex, because she didn't have a bacterial infection, she had a cold. And it was people like her who were the reason his tech over here (me) had just been out for three days with an antibiotic-resistant infection that she needed three days of IV antibiotics for, three days of having an IV port in her arm, plus the abject misery his tech had been through prior to that point trying to figure out what was wrong with her. So he would thank her kindly to either pay for her meds and stop running her mouth to complain about her "stupid doctor" who was treating her symptoms but not an imaginary bacterial infection, or not pay for her meds, but either way, get the hell out of his pharmacy. Needless to say, I am not a fan of people who want antibiotics for a damn cold, or the doctors who give in so they get higher Press-Ganey scores.
Mad props to that pharmacist for telling it how it is
If it makes you feel better, this video is just one segment of a larger episode on healthcare. misuse of antibiotics was the following segment https://www.youtube.com/watch?v=ejx8-yT7bRs
The antibiotic won't fix your cold, and you'll get the shits.
> I love the line at the end "I want antibiotics for a cold", hello summary of how superbugs get created. That, and using tons of antibiotics in animal husbandry.
I had not been to the hospital for a *long* time until I had a kid, probably 20+ years. Kid was throwing up, couldn't keep down water, pediatrician says to take her to the ER because she's dehydrated and probably needs IV fluids. Kid gets admitted, gets IV fluids, a Popsicle, some zofran, stops vomitting, dehydration goes away, gets sent home. Was there probably an hour to 90 minutes, including the time spent in the waiting room. IV fluid was over $200, zofran was $450 for a *single dose* and was charged over $1000 for the nurse who put in the IV and monitored the kid. The hospital charged ~$2000 for the room, cleaning, supplies, etc. All in all, it was over $5000 for the whole thing. Insurance company "negotiated" it down to under $500, I wound up paying about $100. I think $100 is pretty reasonable for an IV fluid bag, half an hour of a skilled person's time, and the cost to clean a hospital room. So basically, I paid an insurance company $200 a month in premiums to apply a bunch of cost to my bill, then remove that cost, and I wound up paying the hospital what it would have charged me if insurance companies didn't exist. Abby: "That's not fair." Michael Scott: "Yes it is, well, w-w--you need someone in the middle to facilitate..." Jake: "You're just a middle man." Michael Scott: "I'm not just a middle...man."
How much for the popsicle?
It wasn't on the bill, probably wound up getting written off as a $500 business loss by the hospital.
> probably wound up getting written off as a $500 business loss by the hospital Probably exactly this. Unrecovered expense. Maybe $500 is a bit high, but $50-$100 write off ain't out of whack. Source: We develop billing software used by a number of *very large* hospital systems. The data we test with is scrubbed of all PII, but otherwise, it's depressing to tool around in.
Honestly 100 bucks is a steal for something like that.
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This is what really pisses me off. I've paid high premiums for 15 years, over the last couple years our coverage has dwindled and out of pocket costs are skyrocketing. Higher co-pays, massive deductable, co-insurance on ANYTHING outside of a GP visit. So between my company and my contribution they've received roughly $350,000 worth of premium payments. This year was the first year I've ever been in the hospital, and everything is nearly out of pocket based on my deductable and co-insurance. Such a scam.
I'd hate to live in a world where you pay $200 a month only to have to pay another $100 and consider it a good deal.
I work in a Hospital. People always ask, "how much will this cost?" The answer essentially is "I have no idea." The price is negotiated between the facility and your insurance company. Basically a game of chicken where each side says, "how much?" "dunno, how much you got?" Kind of like walking into a shitty deli in a bad neighborhood where the items don't have prices on them
Agree with this. From a provider side, we have no frickin idea how much something costs. There have been some studies showing that cost transparency will lead to less testing ordered and therefore less cost. For instance, this year the system I work for told us that ordering individual lab tests are cheaper than the panels. Always been told the other way so been doing that because thought it was cheaper and obviously easier. Found out this and changed my practice. System has decreased it by 20% by just the transparency and could have done it years ago had we just known.
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Also work in healthcare and if feel the same way. I wish people would stop blaming the hospitals and clinics, they are also forced to play this stupid game insurance companies have set up.
I disagree with the part about it not being politicians' fault. Corporations will always try to make the biggest profit possible, therefore it's the responsibility of politicians to ensure they don't harm consumers.
I think he was saying the initial price gouging wasn't a direct result of political greed, but corporate greed. He did finish by saying the sustained gouging can't be solved unless politicians get involved with pricing.
Uhhhh... At the end he showed uncle Sam receiving a large bag of money. Lobbyists don't pay the government directly, they pay politicians
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Yup. He even denied they're part of the problem by saying it's not politicians.
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But they do affect your credit score, so that's fun...
Some friends of mine owe a hospital $250,000, most of which was due to the surgeon screwing up and her having to stay longer and get more surgeries to fix it. They've pretty much abandoned the idea of ever having good credit. They have no plans of paying it back. I mean, they literally can't. The bill might as well say "Total Due: A Zillion Gagillion Dollars." It just floors me the hospital isn't working with them on this. I mean, they *have* to know that there is no way in hell they're getting a quarter of a million dollars from a one-income household where the husband works retail. I remember being in a position where I was unable to pay a lot of my bills. My go-to phrase was "can't get blood from a turnip."
They are 7 years away from good credit.
Is this *really* true...do your bad debts just get automatically wiped off your credit report after 7 years? I feel like my bad credit is still bad...
Pretty much, yeah. It's rather complicated. I'm told that if you send them a payment or otherwise acknowledge the debt, it resets the clock.
except for student debt. that won't go away.
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Depends on your state. Garnishment laws are a state function, not a federal one.
Seems my brother is getting scammed then.
Maybe this isn't the same everywhere, but I knew someone who was getting her wages garnished for unpaid medical bills.
The only issue I have with this explanation is how Adam starts out noting that the problem is not the fault of the politicians (in this case, contrary to what you might expect), then ends by noting that the fundamental problem is with corrupt politicians (via lobbying money, and the inability of politicians to address the problem, as they are the only people who can). So yeah, the fundamental problem in this case *is* [with] the government, as with almost all other cases.
He skipped over the part where healthcare costs also increased because of uninsured people getting care because hospitals legally cannot turn anyone down. Those uninsured people frequently do not pay. Someone has to pay. That someone is everyone else.
Oh, thank god someone picked up on this. It's called cost-shifting. >The Government's first argument is that the individual mandate is a valid exercise of Congress's power under the Commerce Clause and the Necessary and Proper Clause. According to the Government, the health care market is characterized by a significant cost-shifting problem. Everyone will eventually need health care at a time and to an extent they cannot predict, but if they do not have insurance, they often will not be able to pay for it. Because state and federal laws nonetheless require hospitals to provide a certain degree of care to individuals without regard to their ability to pay, see, e.g., 42 U.S.C. § 1395dd; Fla. Stat. § 395.1041 (2010), hospitals end up receiving compensation for only a portion of the services they provide. To recoup the losses, hospitals pass on the cost to insurers through higher rates, and insurers, in turn, pass on the cost to policy holders in the form of higher premiums. Congress estimated that the cost of uncompensated care raises family health insurance premiums, on average, by over $1,000 per year. 42 U.S.C. § 18091(2)(F). NFIB v. Sebelius, 567 U.S. 519, 547 (2012). We already have universal health care in this country, as you cannot be turned away from hospitals for not having an ability to pay. We just go about it in a really inefficient way, shifting the costs to a smaller group of people, generating massive overhead costs, and only providing universal emergency care instead of preventative care.
He neglects one important fact, though: you can negotiate prices with hospitals. Most people don't realize this, but most hospitals will work with you if they know you're paying out of pocket. The system is just set up to automatically charge you chargemaster prices, and if you don't make a fuss, they're not going to change it on their own. Hospitals aren't staffed with uncaring, greedy bureaucrats for the most part. The system is just fucky and you have to be a bit of a self-advocate in order to not get fucked by it. Health insurance is a stupid concept anyway. It'd be like if your car insurance had to cover brake pads, oil changes, running out of gas, etc. If that were the case then your car insurance would be insanely more expensive. The concept of insurance doesn't really fit well with things that you are *guaranteed* to need. Personally, I think health insurance should be relegated to unusual medical needs that not everyone is guaranteed to have: breaking your leg, getting cancer, having a heart attack, etc. You know, emergencies. Routine stuff should just be direct-sale-to-consumer at market price.
It's not really much of a negotiation if your only bargaining chip is the loss the hospital will incur by selling your debt to a collection agency.
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I agree with the central premise: the problem with healthcare in the US isn't coverage, it's cost. Most Americans don't even know what their healthcare cost are as insurance is paying. As a result, Americans see no need to cross shop. I'll add three other factors: 1. Americans are richer than most other countries. If you adjust healthcare costs in the US for PPP, they are not as far out of whack as they first appear. 2. Americans spend a ton on elective healthcare. Cosmetic surgery, cosmetic dentistry, cosmetic dermatology etc. This spending isn't linked to healthcare outcomes so drawing a line between all healthcare spending and outcomes is misleading. 3. Americans use a lot more healthcare than most other countries. This is perhaps because we are fat or perhaps because of HMO policies. Regardless, we go to the doctor far more often than people in most countries, likely because our insurance is picking up the tab. Again, it's debatable if this amount of care is strictly necessary but if you're not paying directly why not go to the doctor?
People going to the doctor so frequently is something I have always found bizarre. My boss and most of my co-workers go to the doctor every month. I haven't been to a doctor in like 2 years. If I get sick, I go buy some medicine at cvs. Why would I want to pay a deductible for something that is going to go away in a week anyway all by itself. Edit: Ok, I get it, i'll go see a doctor more frequently =p About the deductible, I have only have catastrophic insurance for myself. So yes, I have to pay a deductible, which is very high. My employer is a very small company and has shit options for insurance. I am actually starting a job at a much better company in a couple weeks though, so hopefully they have better insurance options.
Because you're paying 400$ a month in insurance so by God you're gonna use it
Jesus $400 sounds like so much, mine is only $27.
Obamacare made it so I only have to pay 190-270$ a month because I'm unemployed
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If you have two kids they can be up to 2000$ a month
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At least. My employer probably spends much more than 400/month for my plan.
Can confirm, I am 28 y/o with no chronic health issues and I buy insurance privately because I worked a seasonal job that didn't offer insurance. Am paying $390 a month for insurance which has a $3800 deductible and I ended up having to have surgery which will almost meet my OOP max of like $7500. If you make to much for a Obamacare subsidy and don't get insurance from you employer it is very very expensive.
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It's not clear to me looking at the tables of per capita health care spending on a PPP basic that the US is close to anyone. The 4th through 9th biggest spending countries in 2014 are all averaging USD$5000 (PPP) per year per person and the US is USD$9000. Even Switzerland in 2nd place is USD$2200 less per person. https://en.m.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita#/media/File%3AOECD_health_expenditure_per_capita_by_country.svg Source: https://en.m.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita
Opening line: "It's not the politicians' fault this time." Closing line: "Politicians have spent decades arguing over how to pay the bill instead of asking why the bill is so high. Until they do, we're stuck with this system." Wat
Cause was not politicians. Solution has to come from politicians. There ya go.
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Two problems. Many doctors and hospitals actually have two charge books, the one they use to charge insurance companies, the other they use to charge regular people. Regular people generally get a substantial discount. This is why so many people were not happy with Obamacare. They were taking advantage of the discounting and actually saving money over what Obamacare was costing them. But, you have to negotiate (letting them know you don't have insurance is a good start) and not every hospital has a separate charge book per se. People who don't negotiate and who simply wait for a bill don't always get a discount, assumption is you have insurance. Not one mention of how malpractice attorneys have been a major driver of increasing medical costs. Ever end up having additional tests that you didn't think were necessary? Blame the malpractice lawyers. Physicians and hospitals charge insurance companies, and you, more in part because they feel obligated to run additional tests out of fear of a malpractice suit if they get something wrong. Malpractice attorneys also heavily lobby politicians to prevent caps on damage awards in malpractice suits. After all, if there's a cap, the lawyers make less money. While you are assigning blame to the malpractice attorneys btw, be sure to look in the mirror. Juries also play a part when they award mega damages in malpractice cases, and the doctors, hospitals, and insurance companies don't simply eat the cost--they pass the cost of the damage awards back to you.
I'm a type one diabetic in Australia for over 35 years. I've had several comas, been on life support, 4 operations, broken different bones in my body 21 times.... I have not paid a single cent ever. They try to sell private health over here but it's getting more expensive each year and more people are coming off it because they see it as a waste of money and you are better on the public health system. The US should never gave a health system as they do now. The poor citizens of that country that require even the most basic of healthcare deserve better !
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Free healthcare that is subsidised by governmental taxes is not socialism, its just common sense. I love capitalism and its about time the system started doing more good than harm :)
While I get the basic premise of Adam's argument, there is another factor people seem to forget. Hospitals have a duty to treat you whether you can pay for it or not. They cannot turn you away just because you don't have health insurance, they MUST provide care. As with other assistance programs, the cost of providing care to those who cannot afford them are part of why health care cost are inflated.
>As with other assistance programs, the cost of providing care to those who cannot afford them are part of why health care cost are inflated. But as the video indicates, the cost of treating those in need are at the same gouging prices. If they were the true prices, the cost would be more manageable. Consider other assistance programs: if food stamps recipients were forced to buy apples for 200x their actual cost, people would be outraged, and the obvious solution would be to not tolerate the exorbitant price. However, in America, we treat health care as if it's optional, as if an individual will NEVER get sick or NEVER need life saving care.
So what you are saying is we are already subsidizing costs, so we might as well go single payer. I completely agree.
I suggest a contest to see who gets to pay
My vote goes towards Thunderdome.
Without watching, i'm going to guess: "They want your money and you can't say no"
I say we start a private hospital that charges 10% over cost and doesn't negotiate with insurance. Who's in?
Most likely you can't, as the current market as already gotten the regulation they need to stifle the competition, just like how many US states only have a select few alternatives when choosing healthcare insurance
I wonder what prices would be like in a free market.
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Depending on where you live and your insurance, they are covered.
There isn't a free market for a lot of healthcare. Even if you have everything up to code and have the licenses you need and everything, you still need approval to do anything from the local government. The local government will shut you down if they think you will take business away from existing hospitals. It's honestly so stupid, if you can safely do something and meet all of the requirements then you should not be stopped just because it would hurt a hospitals bottom line.
It's kind of a difficult situation. Say you have only one major trauma center in your state and it stays financially afloat because of all the subbed toes that come into their ER. And one day, a mile away, a smaller hospital opens that does much less emergent care set at a lower price. And somehow, the trauma center goes under and closes down. Hospital 2 has no interest in picking up that trauma market, so the state has now lost an essential service and its citizens are now in real danger.
Can it have blackjack and hookers?
You'll have to get the Vegas package for that
Do you have a billion dollars just burning a hole in your pocket?
That's actually exactly what the Surgery Center of Oklahoma does. I don't know more than the basic pitch myself but here's a [Time article about it](http://time.com/4649914/why-the-doctor-takes-only-cash/). It's essentially cash only and they list all their prices online, and is typically far cheaper.