44 ms·

U.S. health care's widespread overbilling problem

186 points by msrpotus 9y ago

Moshe_Silnorin 9y ago
Healthcare will always be overpriced so long as we allow this guild system to limit the supply of doctors for its own member's profit. Everything else is window dressing.
- yequalsx 9y ago
  Guild systems do not inevitably resort to overbilling. They may resort to being overpriced but not to overbilling or lack of transparency in billing. I've not heard of doctor salaries being the reason for the U.S. spending far more per capita than other nations. It definitely contributes to this but my impression is that it is a very small part of this. Do you have evidence to the contrary? Note that the same guild system is in force in just about every other country.
  - bentruyman 9y ago
    This is basic supply/demand. We have an increase in demand with the supply of doctors apparently staying stagnant. I think that's the point of this particular thread – not necessarily the billing issue.
- objclxt 9y ago
  If that's the case then how come in other countries with similar strong unions/guilds healthcare costs are so much lower? Nobody complains the BMA is increasing the price of healthcare in the UK. > Everything else is window dressing I think most reasonable people can figure out a) the difference between the US healthcare system and nearly all other countries, and b) what that difference might mean for costs. Here's a hint, it's not "the guild system limiting the supply of doctors".
- opportune 9y ago
  Yep. The AMA/AAMC is essentially screwing the rest of the US so that they can keep doctors' salaries artificially high. There are tons of medical school applicants who get rejected every year, and not because they can't become doctors, but because medical school sizes have remained constant while the country's population (and demand for healthcare) has increased drastically.
  - pragone 9y ago
    The problem is not medical school spots, it's residency spots. Having medical school graduates is useless if they can't get licensed or board certified.
    - pancreas 9y ago
      How is that a problem? About 130 medical schools graduate on average 100 MDs every year, that is 13,000. Available residency spots are near 29,000. so, the rest of the spots are filled by FMGs, foreign medical graduates.
  - yequalsx 9y ago
    My wife recently completed her residency. She has $370,000 in student loans. In order to pay off the loans she needs a high salary. The high salary doesn't go away once the school loans are paid off. It'd make a whole lot more sense for the country to just pay for higher education upfront. We'd be fine with her making half her salary and have the loans forgiven. It'd be much cheaper for society to do this.
    - virmundi 9y ago
      Indiana, and other states, have programs that will pay for your medical degree provided you go to an in-state institution and work with the under served. Now the definition of under served, just means people with not enough doctors per capita. In the case of Indiana, this includes large portions of the inner-circle of Indianapolis. So you could work with a 30-45 minute commute inside the circle (465) and go home to lovely Carmel Indiana. You'd have access to a diverse cultural center and no loans. While it doesn't help your wife, this information can help readers that either want to go into medicine themselves, or have family members seeking such employment.
- pancreas 9y ago
  You think that doctors profit from the current system? How exactly? Applications to med schools have been down for the last few years, and the trend is worrisome. Your doctor-bashing stance is common but uninformed.
- rscho 9y ago
  Coming from a country where the number of MDs per capita is 100x that of the US, I am sorry to tell you that this would not have the impact you think it would have. As of now, no first world country seems to have found a real solution to healthcare prices. My personal opinion is that doctor salaries have a minor impact on prices. Healthcare system structure and culture (as in how much do insurance companies control, and how readily you perform expensive tests) is much more important, I think.
  - pancreas 9y ago
    YES. Salaries are not that high, either, for people in medical academia and now in HMOs as well. One can justify paying a neurosurgeon 430 per year - after 8 years of post-graduate training, and if you count college and medschool, that is 16 years. During all that time a future neurosurgeon mostly acquired debt, while working 120 hours per week.
  - camiller 9y ago
    According to the WHO the country with the most MD's per capita is Cuba with 7.5 per 1000, while the US has 2.5 per 1000. So at best you come from a country with 3x that of the US, not 100x. Edit: http://gamapserver.who.int/gho/interactive_charts/health_workforce/PhysiciansDensity_Total/atlas.html http://gamapserver.who.int/gho/interactive_charts/health_wor...
    - rscho 9y ago
      Indeed, I was misinformed. The ratio is much lower than I thought. I think my point still holds, though.
  - Moshe_Silnorin 9y ago
    You are asking me to believe that 2 in 10 people in your country are doctors? And accepting this, prices haven't come down?
    - rscho 9y ago
      I was told that the US had far less MDs than what is actually reported by the WHO. My bad for not checking my sources. However, we apparently have 40 MDs per 10'000. My main point was that doctors salaries have a minor impact on the cost of the whole system, and i think that still holds, though. If you calculate the ratio of the in-pocket sum that goes to the MD compared to the whole bill for a hospital stay, I do not think it is that high. So even if you are right about the guild problem, I don't think that makes it a solution. I admit I did not look at official numbers about that, though.
maxxxxx 9y ago
To me hospitals are basically scam operations. My girlfriend has had several surgeries in the last two years. In addition to already outrageous standard prices ($40000 surgical center cost for a surgery where we spent in total five hours at the center) pretty much every bill had mistakes. Then after a few months a collection agency will try to collect for something that never got billed and never has happened. I can accept a mistake from time to time but this seems to be pervasive.
- paulpauper 9y ago
  but you have to also take into account that a lot of people don't pay (charity care)
  - maxxxxx 9y ago
    This doesn't justify billing mistakes.
  - mfoy_ 9y ago
    No you don't.
  - feld 9y ago
    in reality that's covered by the price gouging and the hospital getting to write it off
  - EvanAnderson 9y ago
    Fraud perpetrated against some Customers is not a remedy for non-payment by others.
  - maxerickson 9y ago
    Some non payment is also considered bad debt (they expect the patient to pay, the patient doesn't pay). With charity care, the bill is explicitly forgiven. The hospital industry claims non payments total around 6% of hospital expenses. http://www.modernhealthcare.com/article/20120106/BLOGS01/301069983 http://www.modernhealthcare.com/article/20120106/BLOGS01/301... I do wonder if they calculate that 6% on what they bill though, rather than on what things actually cost. The margin on an unpaid bill isn't really a cost.
projectramo 9y ago
I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-pocket price would be without insurance. She told me a range! It was $96-$115. This was close to the range that google says was about average for the procedure. So this was not a case of over-charging, or unfair pricing. I really did not know if the test was $10,000 or $100 till this call. If they just made the pricing transparent, I think a lot of the problems would evaporate. (Although I think the profit centers would suddenly become the emergency medicine section of the hospital.) I know this article focuses on fraud, but the non-fraud part of the healthcare is just as broken, and probably costs more.
- maxxxxx 9y ago
  Totally agree. If people in the US want to have markets for health care there should be price transparency. When I had a high deductible plan I always tried to compare prices but you almost never get a straight answer. If the Republicans want to reform health care that's where they should be starting.
  - tanderson92 9y ago
    > If the Republicans want to reform health care that's where they should be starting. They don't.
  - deleted 9y ago
    [deleted]
  - anigbrowl 9y ago
    If people in the US want to have markets for health care I think only certain 'legal persons' and their executive officers and major shareholders want that. Patients, not so much.
- Osiris 9y ago
mfoy_ 9y ago
It's also telling when the hospital gives you different bills depending on if you're insured or not. If you're insured they charge waaay more. They give you a more "realistic" bill if you are uninsured. It's a ridiculous system.
- wvenable 9y ago
  It's back-handed socialized medicine. Hospitals cannot turn anyone away so the money has to come from somewhere and this is how they do it. Oddly enough this is what keeps the whole system from collapsing.
  - EvanAnderson 9y ago
    This "shadow" socialized system fills me with anger simply because we can't seem to deal with it in a mature and constructive way. As long as Americans can't stomach the idea of turning away people who cannot pay for emergency care to die we have socialized medicine. I don't understand why we can't, as a society, have a "grown up" conversation about this fact.
    - mfoy_ 9y ago
      Why not just have proper socialized medicine, such as in Canada? Instead of this perverse system of "shadow" socialized medicine, fraud, and over-billing, why not just make it come out of everyone's taxes? That way everyone pays a very modest amount in tax and no one has to be financially ruined by flukes of nature. Also kills a huge amount of overhead in the billing departments, collection agencies, insurance companies, etc.
      - pancreas 9y ago
        It will be nice to have socialized medicine, but please, not as in Canada. Their system is not good. I would prefer Medicare expansion to all, or a VA-like system while medicare and medicaids are phased out. This will happen eventually, but alas not soon.
sixdimensional 9y ago
For more information about the rough guidelines by which pricing works in the US (or doesn't work), check out the often referred to term "usual and customary" (UCR) charges. Read about it and then form your own opinion - I'd rather not bias too much by offering mine. https://en.m.wikipedia.org/wiki/Usual,_customary_and_reasonable https://en.m.wikipedia.org/wiki/Usual,_customary_and_reasona...
- tcj_phx 9y ago
  There was a reform, maybe sometime around 1985, that replaced "usual, customary and reasonable" with 'what should this procedure actually cost'. Your wikipedia links to this page: Resource-based relative value scale - https://en.wikipedia.org/wiki/Resource-based_relative_value_scale#History https://en.wikipedia.org/wiki/Resource-based_relative_value_... It took the government 20 years to figure out that they couldn't give the medical system a blank check. /methinks a helpful medical reform would be to get insurance-paid doctors on fixed salaries. Under the present status quo, some doctors bill insurance companies for as much as they can get away with.
  - sixdimensional 9y ago
    Actually, I used to work in health insurance, so I have a bit more insight into this than most, although I've been out of it for a while (10 years or so). If you look into how the RBRVS are calculated, there is effectively a privately run panel that determines input variables and factors that are used in the RBRVS calculations. At some point, someone has to determine the portion of the calculation that represents "physician value added". While it is true that RBRVS is an alternative system to pure UCR rates, I can assure you that UCR rates still play a major role in many health insurance lines of business and calculations. By the way, RBRVS aren't the only system that organizations have tried to use to figure out how to bill/cost services - there are also DRG groups (diagnostic related groups), ASC groups (ambulatory surgical center) groups and others. RBRVS were mainly made to try to control physician office costs in Medicare and are used by HMOs that offer Medicare plans. While other HMOs and private insurers use RBRVS, there are a lot of them that still use UCR (calculated internally) as well. There was a huge problem around 2009/10 with a big company, Ingenix, that was offering a commercial UCR database which was probably of poor data quality - based on surveys of regional prices from doctor's offices. There were lawsuits, etc. over that and many insurers moved away from commercial sources of UCR and instead brought that in-house. Here's a link that talks a little bit about that: https://www.managedcaremag.com/archives/2009/5/ingenix-aftermath https://www.managedcaremag.com/archives/2009/5/ingenix-after... Price transparency could help (if it could be achieved), but there are a lot of for-profit organizations who actively try to keep their strategies internal. Transparency might not be enough without pricing controls, but exercising control would be extremely difficult for legal/political/profit motive reasons as well. For that matter, coming up with singular pricing systems that govern controls at scale is incredibly difficult.
alphanumeric0 9y ago
I would like to ditch insurance and find a doctor who would allow me to pay a monthly subscription fee, much like a gym membership, for preventative care. Isn't the primary purpose of insurance for exceptional and accidental situations? If that's true, then why am I using it for predictable monthly expenses?
- jayd16 9y ago
  Preventative care means less risk of catastrophic care. Its cheaper for insurance to encourage you towards preventative care than pay for the catastrophic care.
- pancreas 9y ago
  This is available for rich folks. This is "boutique medicine". Possibly the way of the future - to coexist with social medicine, of course.
  - mac01021 9y ago
    How rich do you have to be? Why is it not available for the rest of us?
    - gnicholas 9y ago
      It's not unavailable to the non-rich, just unaffordable.
      - Dove 9y ago
        Your information is outdated. It was unafforadable fifteen years ago . . . in the last five to ten, it has become very, very affordable and has exploded in popularity to the point that it's available all over the country. Here's one example: https://atlas.md/wichita/our-fees/ https://atlas.md/wichita/our-fees/ Children 0-19 years old, $10/month with at least one parent membership Adults 20-44 years old, $50/month Adults 45-64 years old, $75/month Adults 65+ years old, $100/month Employer groups with 5+ employees, $50/mo/adult That particular practice offers wholesale-priced labs and meds as part of the price (which is common), which can save you more than the entire cost of the membership if you're dealing with something chronic. https://atlas.md/wichita/benefits/ https://atlas.md/wichita/benefits/
mfoy_ 9y ago
Just to be clear... the "grown up" conversation you wish Americans could stomach is the one that involves socializing medicine and not the one that involves letting random people die needlessly, right?
- EvanAnderson 9y ago
  I am an American. When I'm particularly exasperated with the healthcare system (usually in the weeks/months following some kind of medical engagement) my answer would be "I don't give a damn which we choose. Let's just make a decision to either socialize medicine completely or let people die." (My mood is unreasonably caustic after dealing with anything medical. The stress of dealing with healthcare billing, health insurance, and the patriarchal attitudes of medical practitioners raises my blood pressure and gives me near panic attacks.) When I'm in a more calm and normal mental state my answer would lean toward socializing as much of the healthcare system as possible. Literally nothing is a bigger fear-factor in my life than medical expenses. The fact that the entirety monetary value of my life's work could be destroyed in a moment by a medical issue freaks me out. The fact that I cannot, in any financially viable manner, insure against this kind of event amplifies that fear. I feel comfortable in saying that, at least in an abstract way, I am less afraid of death than of leaving my family destitute as a result of unforeseen medical expense.
  - mfoy_ 9y ago
    I am so sorry you have to live with that shadow hanging over your head. :( I know people must get sick of the "holier than thou" attitudes of the nations with universal health care, but it's stories like yours that make it all the more sad... living life only one medical emergency away from financial ruin and destitution... It's truly a tragedy. It would already be awful enough that you'd be in ER facing a life-threatening situation, but add on looking forward to the bill... holy. fucking. shit.
  - arethuza 9y ago
    "fear-factor" Worth noting that the book describing the principles of the UK NHS by its founder was called "In Place of Fear": https://en.wikipedia.org/wiki/Aneurin_Bevan https://en.wikipedia.org/wiki/Aneurin_Bevan Medical emergencies are stressful enough when there is no money involved - I have no idea how people cope when there is a stressful financial situation added on top as well.
trey-jones 9y ago
At the risk of spiking my blood pressure I will write a few words on this topic. I will start by saying this: The whole system is fucked. I am referring to the system that facilitates American residents getting healthy and staying that way. What is the basis of my claims? I admit that I am a healthy 33 year old white male and I probably have only seen that tip of the iceberg. I am also a father of 3. My oldest daughter was born with a chronic health problem, diagnosed at 19 weeks gestation. Since her birth, a little over 7 years ago, we have received a bill from the hospital that provided her care at least once per week. This continues today, despite not having had any services provided in almost a year. If I paid all of these bills, bankruptcy would be my only recourse. I try to communicate with my insurance provider (employer provided), to determine what's legitimate, and what should be covered. In the end, I'm mostly left to my own devices to pay for the services that I think I received. Every year we pay the deductible, and every year we get billed for significantly more. As another example, not along ago, my third daughter was born. Due to the complications of my wife's first pregnancy we received care from two different OBGYN facilities, one local to us, and one at the delivering hospital. Though the local facility was only responsible for less than 10 checkups, they claimed that we still owed our entire deductible to them, prior to delivery. We paid half. A week prior (this much is hilarious in itself) to delivery by a doctor from the other facility, we received a bill for the full deductible amount, due to them also. When the delivery actually happened, it took less than 2 hours, and we stayed one night. We also had 3 checkups at this other facility. Our bill of course is the same as everybody else's, regardless of whether they had a C-Section and stayed for 5 nights, or had 30 hours of labor. I could actually be OK with this (I'm onboard for socialized healthcare), if they could get the billing part right. Again: * I am constantly billed directly by healthcare providers over and above what my insurance policy says I should pay. * I pay almost 25% of my yearly earnings in insurance premiums. * I end up deciding what I will pay and what I will not pay. I admit that this is probably not the best situation for anyone. The whole system is fucked.
- jrs235 9y ago
  A family friend had twins. One born before midnight, the other after (different birth days). When they got their bill(s) from the hospital they noticed they were charging room fees for both infants starting the day of the first born. The second child wasn't even "alive" (born) for the first day they were trying to charge for! What's also absurd is that the first child wasn't in the receiving room until after midnight anyways (since all three, two infants, and mother were in a delivery room until the wee AM hours)!
mfoy_ 9y ago
"The United States remains one of the only advanced industrialized democracies in the world without universal coverage. While this in and of itself is not a problem, the United States also spends more on health care as a percentage of GDP than any other advanced country in the world and has worse health outcomes – with lower life expectancy, higher infant mortality and higher obesity rates than comparable countries like Australia, Canada, the United Kingdom, Germany, France and Japan." - http://theconversation.com/three-reasons-the-us-doesnt-have-universal-health-coverage-67292 http://theconversation.com/three-reasons-the-us-doesnt-have-...
- camiller 9y ago
  I think this is because we choose to live less healthy lifestyles rather than the quality of medical care. Super size that...
  - nucleardog 9y ago
    I don't think the lifestyles are all that different between Canada and the US, and the healthcare expenditures in Canada are significantly lower.
    - virmundi 9y ago
      I grant this is anecdotal, but you might want to learn about the Canadian system from the point of view of sick people in Canada. https://www.youtube.com/watch?v=q2jijuj1ysw https://www.youtube.com/watch?v=q2jijuj1ysw
      - nucleardog 9y ago
        Thanks. I live in Canada and have first hand experience with the healthcare system.
  - romuloab42 9y ago
    Not just that, but remember not everybody can afford health care in US, so it's not unfathomable to think some of those bad statistics is due to people not being able to afford proper care, not just that they don't live a healthy life (which can certainly contribute to that).
arielweisberg 9y ago
They don't even mention the harm caused by fraud that involves inventing conditions and treatments out of thin air. Those doctor's notes follow you around forever when you go to do things like purchase disability insurance or seek treatment. Suddenly you are no longer a healthy individual you are an individual with a history of condition X and Y which you have never even heard of. And because a doctor wrote it down it's now a reality and the patient is a liar!
rdudek 9y ago
There are so many variables that affect healthcare cost here in the US. Looking from outside, things are different than looking from inside. There is something really wrong with current US healthcare system, and it's really difficult to put a blame on one or two things. Side note, I work IT in healthcare, so I sometimes view "interesting" things to say the least. A while back I stumbled upon a document that was accidentally shared. It showed accounts receivable in collections agencies for one hospital in our system. Between 2009 and 2012, there was $154m dollars in collection agencies from delinquent accounts. Remember, this is just one hospital that is actually in a more upscale location. We have some hospitals who are always in red due to their locations. Then you deal with inflated prices for services and drugs. I really don't even know if they can ever fix this part.
chiph 9y ago
I would love to go to a doctor that had a price board hung in their waiting room so I'd know up front what the cost would be. Well-baby checkup: $120 School sports physical: $150 Blood tests: $80 Minor broken bone: $400 Major broken bone: $1200
- jrs235 9y ago
  "But we don't know [major vs minor] until we look at it!..." So add what all car shops say: Hourly rate: $100 / hour. And begin with a 30 minute to 60 minute diagnostic estimate (providing findings at 30 minute increments).
  - mac01021 9y ago
    But then they wouldn't be able to bill $1350 for a 15 minute visit.
- pancreas 9y ago
  This is the way it should be. Hopefully we are going in that direction.
mnm1 9y ago
I think this is a great argument for a single payer system. Let the government and hospitals duke it out. When it's the government's money that is being lost, the government might actually care and start negotiating with these providers. Even if it doesn't, at the very least, patients lives won't be ruined by bills for services that they had no control over or knew the cost of beforehand. Not only that, but the government can afford it. When they're losing trillions of dollars on the defense side, I'm certain they can pay for every medical procedure in the country and still have plenty left over. This whole idea that the government doesn't have money to pay for healthcare and other necessary social services is such fucking bullshit when they have the ability to lose trillions in defense and just shrug it off. That's not even mentioning the money that isn't lost on the defense side. Unfortunately, I don't think people have the capability to push their government to spend that money correctly. But that's a different problem altogether.
- arrty88 9y ago
  Since when has government cared about losing money?
  - mnm1 9y ago
    That's my point. They don't care that much. And if they decide to care at some point, they have the resources to fight it out. Let these abstract entities (gov't, healthcare providers) fight it out on their own so that people don't have to die.
- int_19h 9y ago
  Single payer is overly restrictive (although it would still be a lot better than what we have now). A non-profit public option, with an explicit legislative grant to negotiate prices with its full strong-arming ability, would deal with this stuff just as well, while still enabling people to shop for insurance if and when they want to.
code_duck 9y ago
My friend's wife resigned from a nursing position over this issue. A superior asked her to falsify billing records to say they were providing a higher level of care than they actually were, and she refused.
- AngeloAnolin 9y ago
  Instead of resigning, wouldn't it have been better if she exposed the malpractice? Or would the consequences on her part damage her so much that their lives would be destroyed? Ethics would dictate she would fight otherwise.
  - code_duck 9y ago
    Due to the corruption and other factors, she didn't wish to work for them any longer. I don't recall all the specifics, but I believe she did file a complaint with the state. Hopefully the company was investigated.
virmundi 9y ago
Another issue not mentioned, but associated with the same pool, is that hospitals get dramatically more money for the same procedure than a private practice doctor. Not even upcoding. Fortunately, Medicare is looking at this problem now. http://www.compassphs.com/blog/health-navigation/medicare-to-stop-paying-more-to-doctor-office-if-owned-by-hospital-system/ http://www.compassphs.com/blog/health-navigation/medicare-to...
makecheck 9y ago
Generally it is really hard to negotiate fair pricing if one side knows the other side has tons of money. "Oh gee, government contract? That'll be $15,000 more for no good reason." Perhaps anonymizing all billing would help so that negotiations simply cannot know what the other side can afford.
- skummetmaelk 9y ago
  Whereas it's really hard to negotiate pricing with people who are going to die or be physically impaired for the rest of their lives if they don't pay whatever you ask?
craigvn 9y ago
This is what happens when you make the health care system capitalist. Despite rumours to the contrary, capitalism doesn't reduce prices, that would make no sense for a company trying to make a profit.
- coredog64 9y ago
  French outpatient care runs in a capitalist manner. You pay full price at the office, and your insurance reimburses you at 80% of "reasonable and customary". You are free to choose any Doctor, and it is up to you to decide how much any conveniences or perceived quality is worth.
  - craigvn 9y ago
    Can't say I am an expert on the French system, but a quick Google says that the insurance is pretty tightly regulated by government.
pancreas 9y ago
While I do feel compassion for you and your pain, I need to point out to you that you are unreasonable, bordering on psychopathological irrational fear. The scenario in which "the entirety monetary value of my life's work could be destroyed in a moment by a medical issue" - is very uncommon, the stuff of scary stories, not reality. in reality, you are protected even if you don't have a good insurance. Think about "medical issues" that could happen to you or anybody to leave your "family destitute". 1. You can break a leg skiing. Suppose it is a nasty break requiring surgery then rehabilitation. Your ED bill would be 3-5 K, the surgical bill 4-10 K, hospital room x 3 days about 15 K, rehab charges maybe 3K. So you owe roughly 33 K. At most. You can negotiate it down by 1/2 easily, with customer service, the hospital would rather get some money than none. They can design a payment plan an 0% over 10 years. You can also walk away - you won't be taken to court, the hospital will eat the bill and sell it to collectors - but you will turn your phone off. Medical contributions to bad credit are not as toxic as your unpaid Target bill, and you can still get loans by pointing out that you are in negotiation over the unfairly large hospital bill. So... Unpleasant, but no tragedy. 2. Suppose a tragedy happens. You have a horrible illness that will require millions in maintenance. There is a social worker and a case worker assigned to you, and you will get Medicaid retrospectively, or Medicare - both have loopholes that allow certain disabled patients to be included before they even apply for disability. So... You are in tough shape, but not financially. Your wealth is protected.
- dang 9y ago
  > you that you are unreasonable, bordering on psychopathological We ban accounts that go in to personal attack like this, so please don't. Also, please don't use HN primarily for political or ideological argument; occasionally that's fine, but we ban accounts that exist only to comment that way, especially when they're use flamewar phrases like "Your doctor-bashing stance" and whatnot. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newswelcome.html https://news.ycombinator.com/newswelcome.html
  - pancreas 9y ago
    Psychopathological - this is not a personal attack, but a doctor's observation that a person has gone far over the deep end into anxiety about a subject that is rationally not panning out, only for his lack of knowledge of what happens if he does get sick unexpectedly and without a solid insurance. I tried to reassure him. Second, "doctor-bashing" may be an inflammatory phrase, but please look and see how many comments derogatory and unfair to physicians you tolerated without a word. So, one is to conclude that your moderating style allows certain disparaging and humiliating words, towards doctors, for example - but does not allow to call a person using such abusive language a doctor-basher? That is indeed interesting. Finally, my comments/replies have no more "political" in them than the rest of posts in this thread. The post is about the cost of medicine.
ridgeguy 9y ago
I guess it won't hurt to offer my own anecdata point about idiot medical billing. Stanford hospital billed us for an IVF procedure. However, we were in Paris at the time they claimed my wife was undergoing the procedure. It took going down to the billing office with our ticket stubs and pitching a fit to get it zeroed out. I agree there's lots of room for improvement in medical billing.
microcolonel 9y ago
Because there's too much coverage, and effectively no choice (due to excessive standardization), the insurance companies are forced not to operate as insurance companies at all. No choice, no competition, no money left when they're done with you.
rev_null 9y ago
I think that people always want to look for the worst in every situation. America's healthcare system may not be up to first world standards for treatment. And it bankrupts hundreds of thousands of people a year. But, it's the most profitable healthcare system in the world, and that's the metric that investors really care about.
jjt-yn_t 9y ago
I know from browsing reddit com subreddit medicine, for example, that this issue concerns [1] your medical professionals as much as it does the receiver of care or their families. [ at least the majority, if I read correctly, of those posting about the issue. ]

186 points by msrpotus 9y ago

Healthcare will always be overpriced so long as we allow this guild system to limit the supply of doctors for its own member's profit. Everything else is window dressing.

yequalsx 9y ago
Guild systems do not inevitably resort to overbilling. They may resort to being overpriced but not to overbilling or lack of transparency in billing. I've not heard of doctor salaries being the reason for the U.S. spending far more per capita than other nations. It definitely contributes to this but my impression is that it is a very small part of this. Do you have evidence to the contrary? Note that the same guild system is in force in just about every other country.
- bentruyman 9y ago
  This is basic supply/demand. We have an increase in demand with the supply of doctors apparently staying stagnant. I think that's the point of this particular thread – not necessarily the billing issue.
objclxt 9y ago
If that's the case then how come in other countries with similar strong unions/guilds healthcare costs are so much lower? Nobody complains the BMA is increasing the price of healthcare in the UK. > Everything else is window dressing I think most reasonable people can figure out a) the difference between the US healthcare system and nearly all other countries, and b) what that difference might mean for costs. Here's a hint, it's not "the guild system limiting the supply of doctors".
opportune 9y ago
Yep. The AMA/AAMC is essentially screwing the rest of the US so that they can keep doctors' salaries artificially high. There are tons of medical school applicants who get rejected every year, and not because they can't become doctors, but because medical school sizes have remained constant while the country's population (and demand for healthcare) has increased drastically.
- pragone 9y ago
  The problem is not medical school spots, it's residency spots. Having medical school graduates is useless if they can't get licensed or board certified.
  - pancreas 9y ago
    How is that a problem? About 130 medical schools graduate on average 100 MDs every year, that is 13,000. Available residency spots are near 29,000. so, the rest of the spots are filled by FMGs, foreign medical graduates.
- yequalsx 9y ago
  My wife recently completed her residency. She has $370,000 in student loans. In order to pay off the loans she needs a high salary. The high salary doesn't go away once the school loans are paid off. It'd make a whole lot more sense for the country to just pay for higher education upfront. We'd be fine with her making half her salary and have the loans forgiven. It'd be much cheaper for society to do this.
  - virmundi 9y ago
    Indiana, and other states, have programs that will pay for your medical degree provided you go to an in-state institution and work with the under served. Now the definition of under served, just means people with not enough doctors per capita. In the case of Indiana, this includes large portions of the inner-circle of Indianapolis. So you could work with a 30-45 minute commute inside the circle (465) and go home to lovely Carmel Indiana. You'd have access to a diverse cultural center and no loans. While it doesn't help your wife, this information can help readers that either want to go into medicine themselves, or have family members seeking such employment.
pancreas 9y ago
You think that doctors profit from the current system? How exactly? Applications to med schools have been down for the last few years, and the trend is worrisome. Your doctor-bashing stance is common but uninformed.
rscho 9y ago
Coming from a country where the number of MDs per capita is 100x that of the US, I am sorry to tell you that this would not have the impact you think it would have. As of now, no first world country seems to have found a real solution to healthcare prices. My personal opinion is that doctor salaries have a minor impact on prices. Healthcare system structure and culture (as in how much do insurance companies control, and how readily you perform expensive tests) is much more important, I think.
- pancreas 9y ago
  YES. Salaries are not that high, either, for people in medical academia and now in HMOs as well. One can justify paying a neurosurgeon 430 per year - after 8 years of post-graduate training, and if you count college and medschool, that is 16 years. During all that time a future neurosurgeon mostly acquired debt, while working 120 hours per week.
- camiller 9y ago
  According to the WHO the country with the most MD's per capita is Cuba with 7.5 per 1000, while the US has 2.5 per 1000. So at best you come from a country with 3x that of the US, not 100x. Edit: http://gamapserver.who.int/gho/interactive_charts/health_workforce/PhysiciansDensity_Total/atlas.html http://gamapserver.who.int/gho/interactive_charts/health_wor...
  - rscho 9y ago
    Indeed, I was misinformed. The ratio is much lower than I thought. I think my point still holds, though.
- Moshe_Silnorin 9y ago
  You are asking me to believe that 2 in 10 people in your country are doctors? And accepting this, prices haven't come down?
  - rscho 9y ago
    I was told that the US had far less MDs than what is actually reported by the WHO. My bad for not checking my sources. However, we apparently have 40 MDs per 10'000. My main point was that doctors salaries have a minor impact on the cost of the whole system, and i think that still holds, though. If you calculate the ratio of the in-pocket sum that goes to the MD compared to the whole bill for a hospital stay, I do not think it is that high. So even if you are right about the guild problem, I don't think that makes it a solution. I admit I did not look at official numbers about that, though.

maxxxxx 9y ago

To me hospitals are basically scam operations. My girlfriend has had several surgeries in the last two years. In addition to already outrageous standard prices ($40000 surgical center cost for a surgery where we spent in total five hours at the center) pretty much every bill had mistakes. Then after a few months a collection agency will try to collect for something that never got billed and never has happened. I can accept a mistake from time to time but this seems to be pervasive.

paulpauper 9y ago
but you have to also take into account that a lot of people don't pay (charity care)
- maxxxxx 9y ago
  This doesn't justify billing mistakes.
- mfoy_ 9y ago
  No you don't.
- feld 9y ago
  in reality that's covered by the price gouging and the hospital getting to write it off
- EvanAnderson 9y ago
  Fraud perpetrated against some Customers is not a remedy for non-payment by others.
- maxerickson 9y ago
  Some non payment is also considered bad debt (they expect the patient to pay, the patient doesn't pay). With charity care, the bill is explicitly forgiven. The hospital industry claims non payments total around 6% of hospital expenses. http://www.modernhealthcare.com/article/20120106/BLOGS01/301069983 http://www.modernhealthcare.com/article/20120106/BLOGS01/301... I do wonder if they calculate that 6% on what they bill though, rather than on what things actually cost. The margin on an unpaid bill isn't really a cost.

projectramo 9y ago

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-pocket price would be without insurance. She told me a range! It was $96-$115. This was close to the range that google says was about average for the procedure. So this was not a case of over-charging, or unfair pricing. I really did not know if the test was $10,000 or $100 till this call. If they just made the pricing transparent, I think a lot of the problems would evaporate. (Although I think the profit centers would suddenly become the emergency medicine section of the hospital.) I know this article focuses on fraud, but the non-fraud part of the healthcare is just as broken, and probably costs more.

maxxxxx 9y ago
Totally agree. If people in the US want to have markets for health care there should be price transparency. When I had a high deductible plan I always tried to compare prices but you almost never get a straight answer. If the Republicans want to reform health care that's where they should be starting.
- tanderson92 9y ago
  > If the Republicans want to reform health care that's where they should be starting. They don't.
- deleted 9y ago
  [deleted]
- anigbrowl 9y ago
  If people in the US want to have markets for health care I think only certain 'legal persons' and their executive officers and major shareholders want that. Patients, not so much.
Osiris 9y ago

mfoy_ 9y ago

It's also telling when the hospital gives you different bills depending on if you're insured or not. If you're insured they charge waaay more. They give you a more "realistic" bill if you are uninsured. It's a ridiculous system.

wvenable 9y ago
It's back-handed socialized medicine. Hospitals cannot turn anyone away so the money has to come from somewhere and this is how they do it. Oddly enough this is what keeps the whole system from collapsing.
- EvanAnderson 9y ago
  This "shadow" socialized system fills me with anger simply because we can't seem to deal with it in a mature and constructive way. As long as Americans can't stomach the idea of turning away people who cannot pay for emergency care to die we have socialized medicine. I don't understand why we can't, as a society, have a "grown up" conversation about this fact.
  - mfoy_ 9y ago
    Why not just have proper socialized medicine, such as in Canada? Instead of this perverse system of "shadow" socialized medicine, fraud, and over-billing, why not just make it come out of everyone's taxes? That way everyone pays a very modest amount in tax and no one has to be financially ruined by flukes of nature. Also kills a huge amount of overhead in the billing departments, collection agencies, insurance companies, etc.
    - pancreas 9y ago
      It will be nice to have socialized medicine, but please, not as in Canada. Their system is not good. I would prefer Medicare expansion to all, or a VA-like system while medicare and medicaids are phased out. This will happen eventually, but alas not soon.

sixdimensional 9y ago

For more information about the rough guidelines by which pricing works in the US (or doesn't work), check out the often referred to term "usual and customary" (UCR) charges. Read about it and then form your own opinion - I'd rather not bias too much by offering mine. https://en.m.wikipedia.org/wiki/Usual,_customary_and_reasonable https://en.m.wikipedia.org/wiki/Usual,_customary_and_reasona...

tcj_phx 9y ago
There was a reform, maybe sometime around 1985, that replaced "usual, customary and reasonable" with 'what should this procedure actually cost'. Your wikipedia links to this page: Resource-based relative value scale - https://en.wikipedia.org/wiki/Resource-based_relative_value_scale#History https://en.wikipedia.org/wiki/Resource-based_relative_value_... It took the government 20 years to figure out that they couldn't give the medical system a blank check. /methinks a helpful medical reform would be to get insurance-paid doctors on fixed salaries. Under the present status quo, some doctors bill insurance companies for as much as they can get away with.
- sixdimensional 9y ago
  Actually, I used to work in health insurance, so I have a bit more insight into this than most, although I've been out of it for a while (10 years or so). If you look into how the RBRVS are calculated, there is effectively a privately run panel that determines input variables and factors that are used in the RBRVS calculations. At some point, someone has to determine the portion of the calculation that represents "physician value added". While it is true that RBRVS is an alternative system to pure UCR rates, I can assure you that UCR rates still play a major role in many health insurance lines of business and calculations. By the way, RBRVS aren't the only system that organizations have tried to use to figure out how to bill/cost services - there are also DRG groups (diagnostic related groups), ASC groups (ambulatory surgical center) groups and others. RBRVS were mainly made to try to control physician office costs in Medicare and are used by HMOs that offer Medicare plans. While other HMOs and private insurers use RBRVS, there are a lot of them that still use UCR (calculated internally) as well. There was a huge problem around 2009/10 with a big company, Ingenix, that was offering a commercial UCR database which was probably of poor data quality - based on surveys of regional prices from doctor's offices. There were lawsuits, etc. over that and many insurers moved away from commercial sources of UCR and instead brought that in-house. Here's a link that talks a little bit about that: https://www.managedcaremag.com/archives/2009/5/ingenix-aftermath https://www.managedcaremag.com/archives/2009/5/ingenix-after... Price transparency could help (if it could be achieved), but there are a lot of for-profit organizations who actively try to keep their strategies internal. Transparency might not be enough without pricing controls, but exercising control would be extremely difficult for legal/political/profit motive reasons as well. For that matter, coming up with singular pricing systems that govern controls at scale is incredibly difficult.

alphanumeric0 9y ago

I would like to ditch insurance and find a doctor who would allow me to pay a monthly subscription fee, much like a gym membership, for preventative care. Isn't the primary purpose of insurance for exceptional and accidental situations? If that's true, then why am I using it for predictable monthly expenses?

jayd16 9y ago
Preventative care means less risk of catastrophic care. Its cheaper for insurance to encourage you towards preventative care than pay for the catastrophic care.
pancreas 9y ago
This is available for rich folks. This is "boutique medicine". Possibly the way of the future - to coexist with social medicine, of course.
- mac01021 9y ago
  How rich do you have to be? Why is it not available for the rest of us?
  - gnicholas 9y ago
    It's not unavailable to the non-rich, just unaffordable.
    - Dove 9y ago
      Your information is outdated. It was unafforadable fifteen years ago . . . in the last five to ten, it has become very, very affordable and has exploded in popularity to the point that it's available all over the country. Here's one example: https://atlas.md/wichita/our-fees/ https://atlas.md/wichita/our-fees/ Children 0-19 years old, $10/month with at least one parent membership Adults 20-44 years old, $50/month Adults 45-64 years old, $75/month Adults 65+ years old, $100/month Employer groups with 5+ employees, $50/mo/adult That particular practice offers wholesale-priced labs and meds as part of the price (which is common), which can save you more than the entire cost of the membership if you're dealing with something chronic. https://atlas.md/wichita/benefits/ https://atlas.md/wichita/benefits/

mfoy_ 9y ago

Just to be clear... the "grown up" conversation you wish Americans could stomach is the one that involves socializing medicine and not the one that involves letting random people die needlessly, right?

EvanAnderson 9y ago
I am an American. When I'm particularly exasperated with the healthcare system (usually in the weeks/months following some kind of medical engagement) my answer would be "I don't give a damn which we choose. Let's just make a decision to either socialize medicine completely or let people die." (My mood is unreasonably caustic after dealing with anything medical. The stress of dealing with healthcare billing, health insurance, and the patriarchal attitudes of medical practitioners raises my blood pressure and gives me near panic attacks.) When I'm in a more calm and normal mental state my answer would lean toward socializing as much of the healthcare system as possible. Literally nothing is a bigger fear-factor in my life than medical expenses. The fact that the entirety monetary value of my life's work could be destroyed in a moment by a medical issue freaks me out. The fact that I cannot, in any financially viable manner, insure against this kind of event amplifies that fear. I feel comfortable in saying that, at least in an abstract way, I am less afraid of death than of leaving my family destitute as a result of unforeseen medical expense.
- mfoy_ 9y ago
  I am so sorry you have to live with that shadow hanging over your head. :( I know people must get sick of the "holier than thou" attitudes of the nations with universal health care, but it's stories like yours that make it all the more sad... living life only one medical emergency away from financial ruin and destitution... It's truly a tragedy. It would already be awful enough that you'd be in ER facing a life-threatening situation, but add on looking forward to the bill... holy. fucking. shit.
- arethuza 9y ago
  "fear-factor" Worth noting that the book describing the principles of the UK NHS by its founder was called "In Place of Fear": https://en.wikipedia.org/wiki/Aneurin_Bevan https://en.wikipedia.org/wiki/Aneurin_Bevan Medical emergencies are stressful enough when there is no money involved - I have no idea how people cope when there is a stressful financial situation added on top as well.

trey-jones 9y ago

At the risk of spiking my blood pressure I will write a few words on this topic. I will start by saying this: The whole system is fucked. I am referring to the system that facilitates American residents getting healthy and staying that way. What is the basis of my claims? I admit that I am a healthy 33 year old white male and I probably have only seen that tip of the iceberg. I am also a father of 3. My oldest daughter was born with a chronic health problem, diagnosed at 19 weeks gestation. Since her birth, a little over 7 years ago, we have received a bill from the hospital that provided her care at least once per week. This continues today, despite not having had any services provided in almost a year. If I paid all of these bills, bankruptcy would be my only recourse. I try to communicate with my insurance provider (employer provided), to determine what's legitimate, and what should be covered. In the end, I'm mostly left to my own devices to pay for the services that I think I received. Every year we pay the deductible, and every year we get billed for significantly more. As another example, not along ago, my third daughter was born. Due to the complications of my wife's first pregnancy we received care from two different OBGYN facilities, one local to us, and one at the delivering hospital. Though the local facility was only responsible for less than 10 checkups, they claimed that we still owed our entire deductible to them, prior to delivery. We paid half. A week prior (this much is hilarious in itself) to delivery by a doctor from the other facility, we received a bill for the full deductible amount, due to them also. When the delivery actually happened, it took less than 2 hours, and we stayed one night. We also had 3 checkups at this other facility. Our bill of course is the same as everybody else's, regardless of whether they had a C-Section and stayed for 5 nights, or had 30 hours of labor. I could actually be OK with this (I'm onboard for socialized healthcare), if they could get the billing part right. Again: * I am constantly billed directly by healthcare providers over and above what my insurance policy says I should pay. * I pay almost 25% of my yearly earnings in insurance premiums. * I end up deciding what I will pay and what I will not pay. I admit that this is probably not the best situation for anyone. The whole system is fucked.

jrs235 9y ago
A family friend had twins. One born before midnight, the other after (different birth days). When they got their bill(s) from the hospital they noticed they were charging room fees for both infants starting the day of the first born. The second child wasn't even "alive" (born) for the first day they were trying to charge for! What's also absurd is that the first child wasn't in the receiving room until after midnight anyways (since all three, two infants, and mother were in a delivery room until the wee AM hours)!

mfoy_ 9y ago

"The United States remains one of the only advanced industrialized democracies in the world without universal coverage. While this in and of itself is not a problem, the United States also spends more on health care as a percentage of GDP than any other advanced country in the world and has worse health outcomes – with lower life expectancy, higher infant mortality and higher obesity rates than comparable countries like Australia, Canada, the United Kingdom, Germany, France and Japan." - http://theconversation.com/three-reasons-the-us-doesnt-have-universal-health-coverage-67292 http://theconversation.com/three-reasons-the-us-doesnt-have-...

camiller 9y ago
I think this is because we choose to live less healthy lifestyles rather than the quality of medical care. Super size that...
- nucleardog 9y ago
  I don't think the lifestyles are all that different between Canada and the US, and the healthcare expenditures in Canada are significantly lower.
  - virmundi 9y ago
    I grant this is anecdotal, but you might want to learn about the Canadian system from the point of view of sick people in Canada. https://www.youtube.com/watch?v=q2jijuj1ysw https://www.youtube.com/watch?v=q2jijuj1ysw
    - nucleardog 9y ago
      Thanks. I live in Canada and have first hand experience with the healthcare system.
- romuloab42 9y ago
  Not just that, but remember not everybody can afford health care in US, so it's not unfathomable to think some of those bad statistics is due to people not being able to afford proper care, not just that they don't live a healthy life (which can certainly contribute to that).

arielweisberg 9y ago

They don't even mention the harm caused by fraud that involves inventing conditions and treatments out of thin air. Those doctor's notes follow you around forever when you go to do things like purchase disability insurance or seek treatment. Suddenly you are no longer a healthy individual you are an individual with a history of condition X and Y which you have never even heard of. And because a doctor wrote it down it's now a reality and the patient is a liar!

rdudek 9y ago

There are so many variables that affect healthcare cost here in the US. Looking from outside, things are different than looking from inside. There is something really wrong with current US healthcare system, and it's really difficult to put a blame on one or two things. Side note, I work IT in healthcare, so I sometimes view "interesting" things to say the least. A while back I stumbled upon a document that was accidentally shared. It showed accounts receivable in collections agencies for one hospital in our system. Between 2009 and 2012, there was $154m dollars in collection agencies from delinquent accounts. Remember, this is just one hospital that is actually in a more upscale location. We have some hospitals who are always in red due to their locations. Then you deal with inflated prices for services and drugs. I really don't even know if they can ever fix this part.

chiph 9y ago

I would love to go to a doctor that had a price board hung in their waiting room so I'd know up front what the cost would be. Well-baby checkup: $120 School sports physical: $150 Blood tests: $80 Minor broken bone: $400 Major broken bone: $1200

jrs235 9y ago
"But we don't know [major vs minor] until we look at it!..." So add what all car shops say: Hourly rate: $100 / hour. And begin with a 30 minute to 60 minute diagnostic estimate (providing findings at 30 minute increments).
- mac01021 9y ago
  But then they wouldn't be able to bill $1350 for a 15 minute visit.
pancreas 9y ago
This is the way it should be. Hopefully we are going in that direction.

mnm1 9y ago

I think this is a great argument for a single payer system. Let the government and hospitals duke it out. When it's the government's money that is being lost, the government might actually care and start negotiating with these providers. Even if it doesn't, at the very least, patients lives won't be ruined by bills for services that they had no control over or knew the cost of beforehand. Not only that, but the government can afford it. When they're losing trillions of dollars on the defense side, I'm certain they can pay for every medical procedure in the country and still have plenty left over. This whole idea that the government doesn't have money to pay for healthcare and other necessary social services is such fucking bullshit when they have the ability to lose trillions in defense and just shrug it off. That's not even mentioning the money that isn't lost on the defense side. Unfortunately, I don't think people have the capability to push their government to spend that money correctly. But that's a different problem altogether.

arrty88 9y ago
Since when has government cared about losing money?
- mnm1 9y ago
  That's my point. They don't care that much. And if they decide to care at some point, they have the resources to fight it out. Let these abstract entities (gov't, healthcare providers) fight it out on their own so that people don't have to die.
int_19h 9y ago
Single payer is overly restrictive (although it would still be a lot better than what we have now). A non-profit public option, with an explicit legislative grant to negotiate prices with its full strong-arming ability, would deal with this stuff just as well, while still enabling people to shop for insurance if and when they want to.

code_duck 9y ago

My friend's wife resigned from a nursing position over this issue. A superior asked her to falsify billing records to say they were providing a higher level of care than they actually were, and she refused.

AngeloAnolin 9y ago
Instead of resigning, wouldn't it have been better if she exposed the malpractice? Or would the consequences on her part damage her so much that their lives would be destroyed? Ethics would dictate she would fight otherwise.
- code_duck 9y ago
  Due to the corruption and other factors, she didn't wish to work for them any longer. I don't recall all the specifics, but I believe she did file a complaint with the state. Hopefully the company was investigated.

virmundi 9y ago

Another issue not mentioned, but associated with the same pool, is that hospitals get dramatically more money for the same procedure than a private practice doctor. Not even upcoding. Fortunately, Medicare is looking at this problem now. http://www.compassphs.com/blog/health-navigation/medicare-to-stop-paying-more-to-doctor-office-if-owned-by-hospital-system/ http://www.compassphs.com/blog/health-navigation/medicare-to...

makecheck 9y ago

Generally it is really hard to negotiate fair pricing if one side knows the other side has tons of money. "Oh gee, government contract? That'll be $15,000 more for no good reason." Perhaps anonymizing all billing would help so that negotiations simply cannot know what the other side can afford.

skummetmaelk 9y ago
Whereas it's really hard to negotiate pricing with people who are going to die or be physically impaired for the rest of their lives if they don't pay whatever you ask?

craigvn 9y ago

This is what happens when you make the health care system capitalist. Despite rumours to the contrary, capitalism doesn't reduce prices, that would make no sense for a company trying to make a profit.

coredog64 9y ago
French outpatient care runs in a capitalist manner. You pay full price at the office, and your insurance reimburses you at 80% of "reasonable and customary". You are free to choose any Doctor, and it is up to you to decide how much any conveniences or perceived quality is worth.
- craigvn 9y ago
  Can't say I am an expert on the French system, but a quick Google says that the insurance is pretty tightly regulated by government.

pancreas 9y ago

While I do feel compassion for you and your pain, I need to point out to you that you are unreasonable, bordering on psychopathological irrational fear. The scenario in which "the entirety monetary value of my life's work could be destroyed in a moment by a medical issue" - is very uncommon, the stuff of scary stories, not reality. in reality, you are protected even if you don't have a good insurance. Think about "medical issues" that could happen to you or anybody to leave your "family destitute". 1. You can break a leg skiing. Suppose it is a nasty break requiring surgery then rehabilitation. Your ED bill would be 3-5 K, the surgical bill 4-10 K, hospital room x 3 days about 15 K, rehab charges maybe 3K. So you owe roughly 33 K. At most. You can negotiate it down by 1/2 easily, with customer service, the hospital would rather get some money than none. They can design a payment plan an 0% over 10 years. You can also walk away - you won't be taken to court, the hospital will eat the bill and sell it to collectors - but you will turn your phone off. Medical contributions to bad credit are not as toxic as your unpaid Target bill, and you can still get loans by pointing out that you are in negotiation over the unfairly large hospital bill. So... Unpleasant, but no tragedy. 2. Suppose a tragedy happens. You have a horrible illness that will require millions in maintenance. There is a social worker and a case worker assigned to you, and you will get Medicaid retrospectively, or Medicare - both have loopholes that allow certain disabled patients to be included before they even apply for disability. So... You are in tough shape, but not financially. Your wealth is protected.

dang 9y ago
> you that you are unreasonable, bordering on psychopathological We ban accounts that go in to personal attack like this, so please don't. Also, please don't use HN primarily for political or ideological argument; occasionally that's fine, but we ban accounts that exist only to comment that way, especially when they're use flamewar phrases like "Your doctor-bashing stance" and whatnot. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newswelcome.html https://news.ycombinator.com/newswelcome.html
- pancreas 9y ago
  Psychopathological - this is not a personal attack, but a doctor's observation that a person has gone far over the deep end into anxiety about a subject that is rationally not panning out, only for his lack of knowledge of what happens if he does get sick unexpectedly and without a solid insurance. I tried to reassure him. Second, "doctor-bashing" may be an inflammatory phrase, but please look and see how many comments derogatory and unfair to physicians you tolerated without a word. So, one is to conclude that your moderating style allows certain disparaging and humiliating words, towards doctors, for example - but does not allow to call a person using such abusive language a doctor-basher? That is indeed interesting. Finally, my comments/replies have no more "political" in them than the rest of posts in this thread. The post is about the cost of medicine.

ridgeguy 9y ago

I guess it won't hurt to offer my own anecdata point about idiot medical billing. Stanford hospital billed us for an IVF procedure. However, we were in Paris at the time they claimed my wife was undergoing the procedure. It took going down to the billing office with our ticket stubs and pitching a fit to get it zeroed out. I agree there's lots of room for improvement in medical billing.

microcolonel 9y ago

Because there's too much coverage, and effectively no choice (due to excessive standardization), the insurance companies are forced not to operate as insurance companies at all. No choice, no competition, no money left when they're done with you.

rev_null 9y ago

I think that people always want to look for the worst in every situation. America's healthcare system may not be up to first world standards for treatment. And it bankrupts hundreds of thousands of people a year. But, it's the most profitable healthcare system in the world, and that's the metric that investors really care about.

jjt-yn_t 9y ago

I know from browsing reddit com subreddit medicine, for example, that this issue concerns [1] your medical professionals as much as it does the receiver of care or their families. [ at least the majority, if I read correctly, of those posting about the issue. ]