5 ms·

CA/usa, broken ankle, two surgeries: $110k in billings. All told, probably 10-12 doctor-hours. Insurance, beyond insuring you, does something perhaps more imp

by x0x0 11y ago

CA/usa, broken ankle, two surgeries: $110k in billings. All told, probably 10-12 doctor-hours. Insurance, beyond insuring you, does something perhaps more important: they negotiate massive discounts with all medical practices/hospitals/etc. My insurer negotiated that to something reasonable (approx $35k, though memory fails me); I could even afford that if I needed to. Crucially (and I understand this is fucking stupid; go 'murica), uninsured people pay way more than insured people even including what the insurance pays. Like integer multiples greater than 3 and up to 20 times more.

carlob 11y ago
> Like integer multiples greater than 3 and up to 20 times more. Or maybe even real multiples. :)
jsudhams 11y ago
wow that is lot of money, India should seriously kick medical tourism. Already happens but this can scale lot more. May be US can sponser MBBS students (There is huge amount of students does not opt for MBBS due to cost of up to $150,000 which includes donation to institutions) and then setup operting theators here in India.
rasz_pl 11y ago
Anecdote/comparison: there is a guy on YT doing Taiwan motorcycle tours, one of the US guests broke an ankle falling off the scooter with no tourist insurance. They went to the hospital and asked to pay in cash. Xray, cast, emergency room, all in all few hours of work came down to below $1K no questions asked.
VLM 11y ago
"uninsured people pay way more" A minor but important correction is they are billed way more, not necessarily pay way more. For example I dated a girl who just out of high school with no insurance had a really badly broken arm (car accident IIRC) and the hospital "charged" her, in total, $100K+ as an imaginary amount, complained at her for awhile, and then they wrote her off after some token payment (more than they would have gotten in bankruptcy, less than it would have cost her in legal fees to file bankruptcy, but a moderately huge amount of money at part time minimum wage income). Now whats important is the difference between the imaginary retail price of $100K and what it actually cost to provide services is incredibly valuable from an accounting standpoint. Also from a marketing standpoint her "$100K" of services was donated by a gracious company to the poor, they sure as heck don't publicize the actual cost of providing that service was only $10K even including minor surgery and recuperation. They did a good job, by the time I met her, I had no idea her arm had been so ruined just a year or two ago until she told me and showed me her arm, by no means did they cheap out on her care or recovery just because she was uninsured. Finally the hope is that if they charged that poor girl a fair $10K then it would be hanging over her head for years until she could pay it off or more likely bankruptcy filing fees costing less than $10K they'd get nothing at all, but if they "charge" $100K then they might jackpot and she could qualify for some govt grant or fundraiser or whatever. If they know she's going to declare bankruptcy no matter what they charge and they're going to get $0 revenue, then game theory shows they should ask for $100M on the off chance by a miracle she wins the lottery, or qualifies from some weird govt grant or school support fund or something. I think something foreigners often don't understand is we charge poor people $100K for a broken arm but we only charge them like $2K to file bankruptcy, so there are no acute medical problems that cost more than $2K, and for chronic problems they make life hell until either the chronic problem goes away and so do the bankruptcy bills, or the victim dies, but its not really expensive. The business model ruins middle class aspirations (how will I have the vacation home and RV if I file bankruptcy?) but we solved that problem by shipping off all the middle clss jobs to China, not having a middle class means not having to worry about a middle class anymore, there's just really rich people and peasants who own nothing.
- hwstar 11y ago
  Except: 1. Bankruptcy can only be filed once every 7 years. What happens if there are medical complications and you are re-hospitalized after you filed for bankruptcy? Answer: You are screwed. 2. It's usually far cheaper and less hassle to purchase an ACA policy to prevent being presented with these large bills in the first place.
- x0x0 11y ago
  Your main point is not true. First: hospitals are required by law to stabilize you regardless of your ability to pay. Stabilize. They are not required to treat you beyond getting you to the point you won't die on your way out of the ER. Second: many of the better medical practices, UCSF Ortho for example, will not treat you if you don't have insurance. Third: bankruptcy is not quite as straightforward as you make it sound, and if you have any assets, you may well lose them. You can have $10 or $20k and still find a $100k surgery very expensive. For example, in CA, you can only protect $3k or $5k, depending, of value in your car during bankruptcy. And there isn't a $3k or $5k car in the US worth a damn.
eru 11y ago
Do you think it would help if prices were openly displayed before the procedures? (That would certainly encourage shopping around.)

by x0x0 11y ago

carlob 11y ago

> Like integer multiples greater than 3 and up to 20 times more. Or maybe even real multiples. :)

jsudhams 11y ago

wow that is lot of money, India should seriously kick medical tourism. Already happens but this can scale lot more. May be US can sponser MBBS students (There is huge amount of students does not opt for MBBS due to cost of up to $150,000 which includes donation to institutions) and then setup operting theators here in India.

rasz_pl 11y ago

Anecdote/comparison: there is a guy on YT doing Taiwan motorcycle tours, one of the US guests broke an ankle falling off the scooter with no tourist insurance. They went to the hospital and asked to pay in cash. Xray, cast, emergency room, all in all few hours of work came down to below $1K no questions asked.

VLM 11y ago

"uninsured people pay way more" A minor but important correction is they are billed way more, not necessarily pay way more. For example I dated a girl who just out of high school with no insurance had a really badly broken arm (car accident IIRC) and the hospital "charged" her, in total, $100K+ as an imaginary amount, complained at her for awhile, and then they wrote her off after some token payment (more than they would have gotten in bankruptcy, less than it would have cost her in legal fees to file bankruptcy, but a moderately huge amount of money at part time minimum wage income). Now whats important is the difference between the imaginary retail price of $100K and what it actually cost to provide services is incredibly valuable from an accounting standpoint. Also from a marketing standpoint her "$100K" of services was donated by a gracious company to the poor, they sure as heck don't publicize the actual cost of providing that service was only $10K even including minor surgery and recuperation. They did a good job, by the time I met her, I had no idea her arm had been so ruined just a year or two ago until she told me and showed me her arm, by no means did they cheap out on her care or recovery just because she was uninsured. Finally the hope is that if they charged that poor girl a fair $10K then it would be hanging over her head for years until she could pay it off or more likely bankruptcy filing fees costing less than $10K they'd get nothing at all, but if they "charge" $100K then they might jackpot and she could qualify for some govt grant or fundraiser or whatever. If they know she's going to declare bankruptcy no matter what they charge and they're going to get $0 revenue, then game theory shows they should ask for $100M on the off chance by a miracle she wins the lottery, or qualifies from some weird govt grant or school support fund or something. I think something foreigners often don't understand is we charge poor people $100K for a broken arm but we only charge them like $2K to file bankruptcy, so there are no acute medical problems that cost more than $2K, and for chronic problems they make life hell until either the chronic problem goes away and so do the bankruptcy bills, or the victim dies, but its not really expensive. The business model ruins middle class aspirations (how will I have the vacation home and RV if I file bankruptcy?) but we solved that problem by shipping off all the middle clss jobs to China, not having a middle class means not having to worry about a middle class anymore, there's just really rich people and peasants who own nothing.

hwstar 11y ago
Except: 1. Bankruptcy can only be filed once every 7 years. What happens if there are medical complications and you are re-hospitalized after you filed for bankruptcy? Answer: You are screwed. 2. It's usually far cheaper and less hassle to purchase an ACA policy to prevent being presented with these large bills in the first place.
x0x0 11y ago
Your main point is not true. First: hospitals are required by law to stabilize you regardless of your ability to pay. Stabilize. They are not required to treat you beyond getting you to the point you won't die on your way out of the ER. Second: many of the better medical practices, UCSF Ortho for example, will not treat you if you don't have insurance. Third: bankruptcy is not quite as straightforward as you make it sound, and if you have any assets, you may well lose them. You can have $10 or $20k and still find a $100k surgery very expensive. For example, in CA, you can only protect $3k or $5k, depending, of value in your car during bankruptcy. And there isn't a $3k or $5k car in the US worth a damn.

eru 11y ago

Do you think it would help if prices were openly displayed before the procedures? (That would certainly encourage shopping around.)