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Hospitals Block ‘Surprise Billing’ Measure

154 points by howard941 7y ago

mc32 7y ago
This is ridiculous, along with that judge blocking the order to bring cost transparency to advertised drugs. But here we are in California a self described progressive state, but the pols pull this? Note, I’m not a progressive as I agree and disagree with many things and am politically all over the map but I think these are things that are good for all of us.
- wrong_variable 7y ago
  When it comes to your wallet - it doesn't matter if you are a progressive or conservative. You are going to protect your financial interests. It's a principal as old as Life itself.
  - kyshoc 7y ago
    This is a massive oversimplification -- if everyone voted purely to protect their financial interests, "voter-approved tax increases" wouldn't exist.
    - ndiscussion 7y ago
      Not the op, but I believe your statement is also a massive oversimplification. Increasing taxes raises the cost to the individual, but it also raises costs for all their neighbors, and results in community improvement (ideally). Is investing an attack on your financial interests?
    - blackflame7000 7y ago
      Many people see it as "Oh I was paying $500 a month on healthcare but now the government will pay for it by increasing taxes. However, I'm not a 1% so it won't affect me as much as it affects them so I'm getting a dollar's worth of government for 80 cents today." Those same people aren't paying attention to their tax withholdings all they know is that if they don't get a refund then they are upset.
      - perl4ever 7y ago
        I think you are misguided in your assumptions about motivations. Insurance is worthwhile whether you get $0.80 or $1.25 back on the dollar. It's not necessary for people to have a positive expected value from it.
        blackflame7000 7y ago
        There will always be a large number of Americans that don't want to pay for other's poor habits. With car insurance people with fewer accidents or tickets get discounts but you can't do that in healthcare because of pre-existing conditions. I propose a 2 part system. One system is government funded and pays for ambulances, ER visits, annual checkups/physicals, and maybe a few other basic services like dental cleaning. When you dial 911, the police and fire department both come for free, so why does the ambulance bill you a grand? Any sort of life or death situation would be covered by this. Abuse of the system can be monitored and the government has plenty of recourse. The 2nd part of the system would cover short and long-term illnesses and conditions as well as prescriptions. Things like orthodontics could also be a part of it. Basically, it pays for any doctor that doesn't work in an ER. This way people who don't use these services a lot aren't burdened by those that do while at the same time eliminating the fear (and litigation) that comes with being bankrupted by a catastrophic accident
        perl4ever 7y ago
        The analogy to car insurance comes up over and over, but I think it's flawed. Pre-existing conditions are not defined by the average paid out in claims to a person. It's normal to have a deductible that's over $5K and is not met in a typical year, and one or more pre-existing conditions. So it bewilders me how people keep debating as though the contrary were typical. The question is not whether a person should have their predictable costs paid for through "insurance", but whether a person should be able to get insurance for catastrophic costs, if they are considered to have a non-quantifiable risk. There is a fundamental inefficiency in a market that discriminates against sick people, not just a lack of "social justice" or whatever. If insurance companies are allowed to discriminate against pre-existing conditions, then they have to charge not just enough to cover the true risk of the high risk customers, but enough to cover the risk of being wrong about the risk - insurance against "unknown unknowns", adverse selection. "Fairness" often costs more money.
    - tathougies 7y ago
      > This is a massive oversimplification -- if everyone voted purely to protect their financial interests, "voter-approved tax increases" wouldn't exist. Yes, it would! People always vote to raise taxes on the minority (the 'rich') to give money to the majority (the 'poor'). This is rule by tyranny, a common issue with democratic governments. It is one of the main reasons democracy is not the ultimate value of the United States governmental system.
- davidw 7y ago
  California talks the progressive game, but in housing for instance, they've failed and failed. Oregon passed significant housing reform this year - California failed (OR HB 2001 vs CA SB 50). Lots of articles on this: https://www.sfchronicle.com/opinion/article/San-Francisco-Bay-Area-is-not-progressive-on-13319525.php https://www.sfchronicle.com/opinion/article/San-Francisco-Ba... https://marketurbanismreport.com/blog/the-disconnect-between-liberal-aspirations-and-liberal-housing-policy-is-killing-coastal-u-s-cities https://marketurbanismreport.com/blog/the-disconnect-between... And one on Oregon's bill: https://www.sightline.org/2019/06/30/oregon-just-voted-to-legalize-duplexes-on-almost-every-city-lot/ https://www.sightline.org/2019/06/30/oregon-just-voted-to-le...
  - blackflame7000 7y ago
    There are a lot of NIMBYs in California. It's really easy to signal virtue but to actually follow through takes real work.
- lotsofpulp 7y ago
  CA is progressive, compared to most of the other states. Just shows how un-progressive the US is. We only have 6 or 7 with paid family leave!
- luckydata 7y ago
  In california the democratic party has occupied the space left by the disappearance of the GOP by having a lot of very conservative members. California politics are not particularly progressive, and they look that way only if you compare us to Alabama, otherwise we're a solidly center-right state. We just don't do extreme right (GOP).
godzillabrennus 7y ago
I read recently that the Cleveland Clinic has lost 91% of its net income: https://www.beckershospitalreview.com/finance/cleveland-clinic-s-annual-net-income-drops-91-on-heavy-investment-losses.html https://www.beckershospitalreview.com/finance/cleveland-clin... This just a few years after a 71% loss of operating income: https://www.beckershospitalreview.com/finance/cleveland-clinic-s-operating-income-plummets-71.html https://www.beckershospitalreview.com/finance/cleveland-clin... Maybe healthcare systems are in a pinch?
- mwerd 7y ago
  Their net income swing is almost entirely attributable to a ~1 billion change in investment returns. Their operating income only fell 20%, because they had 8% increase in operating expenses without a commensurate increase in revenue. It's actually all laid out in your link.
  - dredmorbius 7y ago
    Curiously, the 1980's liability insurance crisis also arose out of dramatic swings in investment returns, not massive changes to the liability risk side (instances or awards). Which itself precipitated from the Volker Fed's exceedingly ill-considered moves to reign-in inflation (ironically because the financial / FIRE sector dislikes high inflation). Insurers (and the Cleveland Clinic) achieve income through both premiums charged and investment return on those premiums. Because premiums are a competitive market, more subscribers can be acquired by lowering premiums, possible by pursuing higher investment income. Which works until it doesn't. Premiums and payouts are locked-in contractually, whilst currency valuation and investments float on the market. Stay on the right side of that and you're Life's Golden Child. Get on the wrong side and nothing can go right. Curiously, the insurance (that is: risk-management industry) seems blind to the investment-side risk and keeps getting bit by that bug every decade or two. Wikipedia's (very brief, incomplete) treatment: https://en.wikipedia.org/wiki/Liability_insurance_crisis https://en.wikipedia.org/wiki/Liability_insurance_crisis
- jeanperrot 7y ago
  From these links -- revenues of $7.2b in 2015, $8.9b in 2018; money inflow sure isn't pinched.
droithomme 7y ago
I've been through the surprise billing stuff multiple times. At this point unless I am unconscious and can not consent, I'm not going to the hospital. I'll bleed out and die on the street if necessary, or spread ebola or whatever. No way am I going there. You go in, they do nothing, then you have $30,000 in bills that arrive in hundreds of stages over the next 24 months. You're better off borrowing money from the mafia than you are visiting most any emergency room in the US. The mafia has much more straightforward billing transparency, fewer surprises, and is generally more honest.
- avionicsguy 7y ago
  I've been both insured and uninsured. I agree with you. I'd rather die than go to a hospital and leave with enough debt to cover Harvard, Standford, or [name your institution]. Also, know that the primary care givers (nurses mostly but also doctors) don't get paid as much as you think they might. The insurance companies are all for profit so the system is gamed this way. [Edit] If you need non-emergent surgery and have an idea of what you need you can check out: https://surgerycenterok.com/pricing/ https://surgerycenterok.com/pricing/ Disclaimer: I have no affiliation with this organization but I applaud them!
  - droithomme 7y ago
    Thanks for that link! For non-urgent routine care I have a local doctor. I was going to recommend to you a2zimaging, which was a service I used for discount MRIs using unused capacity nationwide, but I see just now they've gone defunct in the last year or so. They used to have MRI scans for $250-$500 depending on state. This was less than the over $10,000 I was quoted without. I seems there's other services claiming to do something similar now but I have no experience with them. I've also paid cash at old specialists who don't accept Medicare, and traveled to Mexico for care. I've also gotten superb care while overseas. Single payer is probably the answer. If I need serious surgery some day I will likely do it in India. Your site there seems a reasonable alternative I would look into. But this still leaves open the situations with a serious accident requiring immediate care which would surely bankrupt anyone. Insurance never covers whatever care is nearest to a random accident site, and this scheme is by design, along with the curious situation where each hospital and their staff are carefully partitioned out to different networks.
Someone1234 7y ago
This is why the very concept of insurance discounts are problematic. It might sound counter-intuitive to argue against "discounts" as a solution to bringing costs down, but it actually would. Medical facilities are forced to artificially inflate bills. Insurance then artificially gets a discount back to a sane price. This helps insurance look like they're "doing something" even when they aren't e.g. High Deductible when you pay 100% up to the deductible ("at least I got the insurance rate!"). Out of network also suffers from this. The networks themselves are discount networks and prices for uncovered patients are artificially high. If you banned insurance discounts and insurance had to pay the same dollar to dollar cash price (without kickbacks/incentives), it would help the uninsured, it would help re-align patient/insurer motivations (i.e. both demanding low cash prices), it would make price transparency actually meaningful, and it would eliminate insurance networks. But ideas like this, and removing employer provided healthcare (e.g. everyone on an open health insurance exchange) are politically impossible in the US because no politician can get elected for "taking people's employer insurance and taking their discounts." Even if they're the right thing to do to simplify, reduce costs, align goals, and force insurers to compete again.
- JumpCrisscross 7y ago
  > it would eliminate insurance networks It wouldn't. Insurers would still need to approve providers' prices, and those negotiations would have other levers that could be pulled. But broadly speaking, yes--requiring insurers pay the same price that is advertised and available to the uninsured public is basic price-transparency policy.
  - Someone1234 7y ago
    Or they would just cap prices for specific procedures. Then the patient could use price transparency to see if they'd wind up with an overage bill, and consider if they'd be willing to pay the remainder (e.g. if the doctor was preferred). Right now insurance either do cover something or they don't. That in itself is problematic. If insurance would cover a procedure up to e.g. $500 at one medical clinic why do they cover up to $0 at another? Shouldn't it be $500 here or $500 there? Networks inherently pit you against both the insurer and healthcare provider. Instead you and your insurer should be on the same "side" against healthcare providers.
godelski 7y ago
I'll start this by saying that I'm highly in favor of universal health care. Seems like the best insurance company would be the one with the most patients, which can thus negotiate the best deals. So with that out of the way... Doesn't this bill completely undermine the insurance business? If a hospital can't charge more than the median value that in network patients are charged, why would you buy insurance? I must have misunderstood or misread something. I would think this would make it substantially more difficult for insurance providers to make negotiations and cut deals with hospitals. I would imagine they would just pass off the cost to the consumers, as they typically do. It always seems to me that these half way positions between universal health care and commercial end up being worse than either. From a very high level it sounds like a fantastic thing, preventing patients from getting screwed, but isn't the cost that those with insurance pay more? I would assume that there's far more people paying insurance than the number of people that get these surprise bills. Though I'll admit the whole system feels rigged at this point and is likely intentionally convoluted to make consumers uninformed (by level of difficulty).
- bhelkey 7y ago
  > If a hospital can't charge more than the median value that in network patients are charged, why would you buy insurance? You would buy health insurance for the same reason anyone buys any kind of insurance (above legal minimums). Suppose a thousand people have a 1% chance of owing $10,000. Their EV is -$100. If a company offers insurance for $120, the company benefits by making $20 * 1000 and the individuals benefit by removing variance from their life.
  - michaelmrose 7y ago
    A massive portion of medical expenses presently paid for by insurance are predictable costs that the insured knew going into the year. You can find affordable car insurance because your actual payout from your insurer is very likely zero this year. If your actual payout this year is certainly 10-100k this year depending on what actually goes wrong this year how on earth do you affordably insure that individual. Remember also that sickness stunts family income. Insurance only makes sense for large hard to predict expenses.
fortran77 7y ago
No they didn't. Lawmakers did.
- tacofan 7y ago
  Too many CA Republicans I guess.
cameldrv 7y ago
I'm not sure that on its face that this makes much sense. It reminds me of the kids song "I don't know why she swallowed the fly." Fundamentally the problem is that prices are set by a market, but the market has some inherently unusual characteristics, and has become controlled by a series of government sanctioned cartels. With private insurance, your insurance contracts with some hospitals. If you go to a hospital that's not contracted, your insurance will pay what it deems "reasonable", and you have to pay the balance of whatever the hospital decides to charge you. With a law like this, the hospital would have to just take whatever the insurance company deemed to be the correct price. This would seem to incentivize insurance companies to have very low "reasonable" prices for out of network visits.
Havoc 7y ago
My European insurance policy specifies >Global except north america i.e. You go to war torn Sudan we've got your back but if you dare going anywhere near that bastion of freedom known as the US...you're on your own. The fact that medical insurance companies are down with Sudan, North Korea and China...but not the US...that would suggest the need for some introspection frankly. (Bit puzzled by the Canada inclusion though - any ideas?)
- swebs 7y ago
  Can you link the policy? I highly doubt they cover Sudan.
  - Havoc 7y ago
    >I highly doubt they cover Sudan. The wording is literally global except for. There might be some gotcha in terms of "doesn't cover active warzones" that I'm not aware of, but my point stands. Insurers are fundamentally OK with the concept of global...but won't touch America. Makes sense - US medical system pulls numbers out of a hat so how do you insure against that as an outside non-US medical aid? The claims I've filed in other African countries cleared without question. In fact I try to do my annual checkups there. Edit...no can't link..its a custom policy...but i believe it to be reasonably close to market terms
  - fesoliveira 7y ago
    That is not really his point. He means that he can go almost to any other country and be covered, but if he goes to the US, which is one of the richest and most medically advanced countries in the world, he won't.
    - Havoc 7y ago
      >That is not really his point. Correct. Thanks for elaborating.
    - perl4ever 7y ago
      Or Canada.
jimbob45 7y ago
Seems like this problem could be solved by forcing an insurance provider to cover every emergency room in a state (note, not Urgent Care). And in all honesty, it seems that 60% of the problem with modern insurance lies with these totally arbitrary delineations of what is in-network and what is not. The insurance company gains implicit power over where you get treated by making up these "networks". Why should an insurance company be the one certifying hospitals? Shouldn't that be done by, yknow, a government agency and not a profit-seeking insurance firm?
- tathougies 7y ago
  > Why should an insurance company be the one certifying hospitals? Shouldn't that be done by, yknow, a government agency and not a profit-seeking insurance firm? I mean, governments do certify hospitals. If you don't have gov't certification, you can't provide medical services.
wayne_skylar 7y ago
I'm currently uninsured and trying to deal with the healthcare system in the US is so annoying it makes me want to give up and move to Canada. I went to an urgent care center and had a doctor perform a routine examination for a sinus infection. No special tools or materials were used. Before I went in I signed a form stating that I acknowledged that I was on the hook for whatever extra it cost if the situation required it. I was thinking along the lines of bloodwork, x-rays, etc. The doctor was very helpful in avoiding unnecessary expense as well. A month after I paid and left I got a bill in the mail stating the that doctor had performed an 'extensive examination' and that cost an extra hundred dollars. They had all the information necessary to bill me this as I left the urgent care. Yet they chose to wait and send me a bill because it's a complete fraud. I really wish I could find out the answer to how this works, but my guess is that there is some automated process that tacks on extra billing where possible as a way of boosting income. Ordinarily it's a 'victimless' crime in that it is paid for by an insurance company. But ultimately we're fucked in this country with regards to healthcare. It is a disaster that keeps people sick, yet we need it because it's such a large part of our economy. Little by little this sector has inserted themselves into the literal lifeblood of the nation's finance and health and is holding everyone hostage.
- cabaalis 7y ago
  I've never had to do this before from a patient standpoint, but perhaps you could try to find out what codes were billed for the visit. [1] Compare this to what was actually performed. It is possible they upcoded your visit, either inadvertently or on purpose (illegally.) Aside from that, (EDIT: More likely) it could also be that lots of billing actually takes place when a coder reviews the doctor's note of the encounter. This can be several days after the visit. This is a legitimate and very common practice. They might not have known the correct amount to charge until everything was properly coded. [1] https://coder.aapc.com/cpt-codes-range/2869 https://coder.aapc.com/cpt-codes-range/2869 [2] https://www.verywellhealth.com/what-is-upcoding-2615214 https://www.verywellhealth.com/what-is-upcoding-2615214
- refurb 7y ago
  Your exam notes are sent to billing, who, using the notes tries to determine which billing codes are correct. Obviously they have every incentive to “up code” and get the most amount of money.
erentz 7y ago
In my case I would’ve received treatment for a serious neurological issue sooner but for the fact that the hospital did not extend to me an honest price for the treatment. I think this kind of thing effectively amounts to denying some patients treatment and should be treated as such. We went in the ER and I was admitted. The five day course of treatment on admission we were told would run in the vicinity of $20,000. Something I could afford given the extreme circumstances if insurance were to deny it (longer story there). But the next day we were told that insurance would deny and the total would now end up around $100,000 for the full treatment. Not something we could afford. And I was not in the state of mind or ability to handle this smartly or know I could get a lawyer or try to start some negotiation with them as people might suggest. So we had to be discharged without completing the treatment. A month later I had been relocated across country to change insurance to a provider that covered it and was able to start treatment. Now we could see that an insurance company was only paying $16,000 for the full course. This effectively denied me treatment (amongst other things) and caused pretty significant harm. (This is not ignoring that I am lucky to be in a position to afford a $16,000 treatment bill and many aren’t, but this is to say that when the hospital jacks up the price 7 fold in a situation like this they’re effectively saying “go away we won’t treat you”. They could’ve just as easily given me the real pricing and then I would’ve been able to be treated.)
- sizzle 7y ago
  Was it an experimental procedure? Why would insurance not cover it once your max out of pocket amount is passed? Sorry if I'm mistaken, health insurance is mind boggling for me, just trying to learn from others if I find myself in the same situation moving forward.
  - erentz 7y ago
    So in the USA if you work for a medium-large company they will almost certainly have you on a "self funded health plan". These are plans where the Cigna, Anthem, etc. card you get makes it look like that's your insurer, but in actual fact your employer is your ensurer. The Cigna/Anthem/etc. you are interfacing with is just a contracted administrator that handles the billing, claims, etc. processes, then passes the full costs back to the employer. (The employer will also have various re-insurance set ups to limit their total liability in case of very expensive situations.) This administrator (Cigna et al.) will have a bunch of policies for certain treatments and drug uses that define when they can be used. These operate like a firewall rule, being parsed, and if you don't match perfectly, you get denied. Sometimes they'll be more flexible, but some are known to be terrible (cough Cigna cough). If you don't match this policy perfectly then your treatment gets classified as "experimental". At that point they point you to something called the "XYZ Company Handbook" which is something your employer maintained. This is a document that almost never exists in reality, but the gist is that "XYZ Company Handbook" will say experimental treatments are not covered. (There was nothing really experimental about my treatment, it’s just high dose IVIG, with lots of patients on it and a half dozen of my doctors all supporting it. Experimental seems to be their euphemism for “expensive, so we don’t want to cover it”.) So administrator points to employer, then you go to your employer, they point to the administrator. Then you go to a lawyer or your state insurance commission for help, and they say because it's a self funded health plan it is not technically an insurance product, and is regulated under federal law as an ERISA plan. This means years in court, and the maximum you can ever recoup is only the costs of the treatment. So you have to pay for treatment up front, then fight to get those costs reimbursed. And because there can be no punitive penalties there is no real incentive to act in good faith. Your lawyer (or state insurance comission) will also point out that because the plan is self funded your employer is actually the ultimate authority and can approve or deny or make exceptions for any claim. The appeals process can include something called an independent review, where an outside organization can review your case and recommend treatment or not. This is a time consuming process though. Also it doesn't always work out. And they tell you that they are not bound by the results of the IRO anyway. In our case we were able to change from our employer's self funded plan to a legacy brokered plan, an old school type one where your premiums actually go to the insurance company and the insurance company pays for all treatments. These are regulated by state insurance commissions. This plan was actually provided by a not for profit Blue Cross/Blue Shield and they covered the treatment immediately because my case was pretty darn obvious that I needed it.
doggydogs94 7y ago
Politicians talk big on health care reform and do nothing. And California’s assembly is over 2/3 Democrat; no Republicans to be the fall guy.
blackflame7000 7y ago
Balance billing is a total scam. One time I broke my hand while in another city. I went to a clinic and they told me they could perform the surgery on site in about an hour and that they would talk to my insurance company. I got a voicemail from the clinic 2 days before my surgery saying they talked with my insurance company and everything was all set. My surgery went fine and took an hour as expected. My insurance company calculated that the average cost of the surgery should be about 10k and that's what they were willing to pay. 6 months later I got a bill for $150,000 even for the surgery. First, what are the chances that a bill that large is perfectly even? It's an obvious scam that these places will literally try to charge as much as they think they can get away with. They ask for huge numbers hoping to settle above market rate. At no point during this process was I told anything other than you're covered and with a broken hand, it's not exactly easy to do research.
- asark 7y ago
  I've seen enough over- or mis-charging "errors" from healthcare billing departments that I'm 100% sure a good portion of them are intentionally committing fraud, knowing that if you call them on it they can just go "oops sorry didn't mean to send that here let me fix it" and not get in any trouble at all. Even if they do it over, and over, and over.
  - blackflame7000 7y ago
    You're exactly right. I called them out on it and the bill mysteriously vanished. Funny how that works.
  - LorenPechtel 7y ago
    I have long felt that errant bills should be inverted, not simply gotten rid of. You legitimately owe $100, they bill you for $300. Now they owe you $200. There are far too many such mistakes for it to be pure chance. Some of it certainly is carelessness but they don't care if they make such mistakes. (For example, once my wife got back to the exam room before it was realized that the appointment shouldn't have ever existed--she was sent home without anything being done. Many months later they bill for the co-pay for that visit. Obviously some auditing procedure noted the "visit" and the lack of a corresponding bill and "fixed" it.)
oceanghost 7y ago
A certain number of these surprise bills are fraudulent as well. I had to go to the ER during the middle of the night. Saw the doctor for 10 mins total. A few months later, I got a bill from the physician on duty saying they were out of network; it was for a shade under $1000. I called the insurance company, and they said, the hospital had a history of sending fraudulent bills, that they had already paid the physician AND previously had sued the hospital for sending these fraudulent bills and obtained a legal settlement enjoining them from doing it. In another incident, my wife's OBGYN kept sending us small bills, $29, $74, etc. even though we have paid our co-pays. I called them up and asked what the bills were for, and they honestly couldn't tell me-- saying they would call us back. Which they never did. Which I assume meant, "you caught us lying."
- vkou 7y ago
  The only question I have is: How are these doctors and bill coders not sharing a jail cell with Bernie Madoff, and that guy who keeps stealing six-packs from my grocery?
ericol 7y ago
I don't understand health care in the US. I live in Argentina, that's like being the most-dysfunctional and mentally challenged cousing in an already dysfunctional extended family (South & Central America). We have lots of issues with health care here, _specially_ for those that work on our own (I don't exactly work on my own, but working for a foreign company is more or less the same). There are lot of stories going around (some of them I know first hand because some relative's kid has a rather strange syndrome, and getting their health care org to cover that was an impossible task) but still, the "You broke your leg here's a 50K bill" kind of story I often get from the us is a total and utter madness. I kind of enjoy in a bewildered amusement these public displays of lobbying, thought.
Pinckney 7y ago
It died without a vote, and thus it's not even clear from the article who I ought to be calling and yelling at. Chiu? Presumably he pulled it because of pressure from others. Is there some way for me, as a voter, to determine which individual legislators are to blame?
Yizahi 7y ago
Don't worry, the free market (tm) will sort itself. It's all for the best for consumers.
gregkerzhner 7y ago
The American system is pretty messed up compared to the rest of the world, but I think the elephant in the room is that if you are insured and have money to spend, I think the American system is better just because you have more options and can see specialists quicker. I broke my ankle in a really bad way rock climbing two years ago. When I first broke it, my health insurance was Kaiser, an HMO, which is a decent example of how a government healthcare system might look like in other parts of the world (you cannot just go see a specialist and everything is controlled by referrals). I had major trauma in my ankle that required surgery, but Kaiser won't even let me see an orthopedic surgeon. Their policy was that since it was foot injury, I would only be able to see a Podiatrist, and I had no choice in that matter since I had no control over which kind of specialist I could or coudn't see. When I talked to my orthopedic surgeon friend about this referral to a Podiatrist, they thought it was crazy. I went to see that Podiatrist and they basically told me that my ankle was screwed, there was not much they could do for me, and that I will spend the rest of my life in pain. I think in another country like Canada or Britain, that would probably be the end of the story. I am pretty young, so I didn't want to give up just yet. I went and got a second, third, fourth, etc... opinion from other doctors, just paying in cash outside of my insurance. Eventually, I switched insurances to a PPO plan (just a regular Obamacare plan) and found my way to The Steadman Clinic in Vail, which is where a lot of pro sports players get orthopedic surgery. There, a surgeon recommended a procedure where they use stem cells during the surgery to rebuild dead tissue. I was able to have that procedure. Two years later, my ankle is still pretty messed up, so I went to that doctor again, and he recommended a third surgery to clean up a bunch of dead tissue. From the time when I decided to see the doctor again to the time I had the surgery was 1.5 weeks! All this is a great example of why the US system is bad overall, but actually good for the patient if you have money. I have seen like 10 orthopedic surgeons for this injury and have had 3 surgeries, all because I was motivated to try to get better and to try all options. I don't think I would have gotten nearly that much or that good of care under a government plan. The amazing thing about the US system is that if you have money, and you want to try stuff, you just can! There is noone telling you otherwise.
- yks 7y ago
  There are private clinics in Europe (and I suspect Canada too) to splurge on, it's not a unique American feature
blendo 7y ago
It's important to point out that in California, if you are treated "out of network" AND your health insurer is an HMO (such as Kaiser), you WILL NOT receive a surprise bill (see https://caselaw.findlaw.com/ca-supreme-court/1001051.html https://caselaw.findlaw.com/ca-supreme-court/1001051.html). Anecdotally, our family have been Kaiser members for nearly 25 years, and we've NEVER been party to a billing dispute. Perhaps Kaiser fights with SF General or other ER providers, but they thankfully keep their members out of it. Finally, my yearly cost to remain with Kaiser tends to be about 10% less than our company's other PPO options.
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154 points by howard941 7y ago

mc32 7y ago

This is ridiculous, along with that judge blocking the order to bring cost transparency to advertised drugs. But here we are in California a self described progressive state, but the pols pull this? Note, I’m not a progressive as I agree and disagree with many things and am politically all over the map but I think these are things that are good for all of us.

wrong_variable 7y ago
When it comes to your wallet - it doesn't matter if you are a progressive or conservative. You are going to protect your financial interests. It's a principal as old as Life itself.
- kyshoc 7y ago
  This is a massive oversimplification -- if everyone voted purely to protect their financial interests, "voter-approved tax increases" wouldn't exist.
  - ndiscussion 7y ago
    Not the op, but I believe your statement is also a massive oversimplification. Increasing taxes raises the cost to the individual, but it also raises costs for all their neighbors, and results in community improvement (ideally). Is investing an attack on your financial interests?
  - blackflame7000 7y ago
    Many people see it as "Oh I was paying $500 a month on healthcare but now the government will pay for it by increasing taxes. However, I'm not a 1% so it won't affect me as much as it affects them so I'm getting a dollar's worth of government for 80 cents today." Those same people aren't paying attention to their tax withholdings all they know is that if they don't get a refund then they are upset.
    - perl4ever 7y ago
      I think you are misguided in your assumptions about motivations. Insurance is worthwhile whether you get $0.80 or $1.25 back on the dollar. It's not necessary for people to have a positive expected value from it.
      - blackflame7000 7y ago
        There will always be a large number of Americans that don't want to pay for other's poor habits. With car insurance people with fewer accidents or tickets get discounts but you can't do that in healthcare because of pre-existing conditions. I propose a 2 part system. One system is government funded and pays for ambulances, ER visits, annual checkups/physicals, and maybe a few other basic services like dental cleaning. When you dial 911, the police and fire department both come for free, so why does the ambulance bill you a grand? Any sort of life or death situation would be covered by this. Abuse of the system can be monitored and the government has plenty of recourse. The 2nd part of the system would cover short and long-term illnesses and conditions as well as prescriptions. Things like orthodontics could also be a part of it. Basically, it pays for any doctor that doesn't work in an ER. This way people who don't use these services a lot aren't burdened by those that do while at the same time eliminating the fear (and litigation) that comes with being bankrupted by a catastrophic accident
        perl4ever 7y ago
        The analogy to car insurance comes up over and over, but I think it's flawed. Pre-existing conditions are not defined by the average paid out in claims to a person. It's normal to have a deductible that's over $5K and is not met in a typical year, and one or more pre-existing conditions. So it bewilders me how people keep debating as though the contrary were typical. The question is not whether a person should have their predictable costs paid for through "insurance", but whether a person should be able to get insurance for catastrophic costs, if they are considered to have a non-quantifiable risk. There is a fundamental inefficiency in a market that discriminates against sick people, not just a lack of "social justice" or whatever. If insurance companies are allowed to discriminate against pre-existing conditions, then they have to charge not just enough to cover the true risk of the high risk customers, but enough to cover the risk of being wrong about the risk - insurance against "unknown unknowns", adverse selection. "Fairness" often costs more money.
  - tathougies 7y ago
    > This is a massive oversimplification -- if everyone voted purely to protect their financial interests, "voter-approved tax increases" wouldn't exist. Yes, it would! People always vote to raise taxes on the minority (the 'rich') to give money to the majority (the 'poor'). This is rule by tyranny, a common issue with democratic governments. It is one of the main reasons democracy is not the ultimate value of the United States governmental system.
davidw 7y ago
California talks the progressive game, but in housing for instance, they've failed and failed. Oregon passed significant housing reform this year - California failed (OR HB 2001 vs CA SB 50). Lots of articles on this: https://www.sfchronicle.com/opinion/article/San-Francisco-Bay-Area-is-not-progressive-on-13319525.php https://www.sfchronicle.com/opinion/article/San-Francisco-Ba... https://marketurbanismreport.com/blog/the-disconnect-between-liberal-aspirations-and-liberal-housing-policy-is-killing-coastal-u-s-cities https://marketurbanismreport.com/blog/the-disconnect-between... And one on Oregon's bill: https://www.sightline.org/2019/06/30/oregon-just-voted-to-legalize-duplexes-on-almost-every-city-lot/ https://www.sightline.org/2019/06/30/oregon-just-voted-to-le...
- blackflame7000 7y ago
  There are a lot of NIMBYs in California. It's really easy to signal virtue but to actually follow through takes real work.
lotsofpulp 7y ago
CA is progressive, compared to most of the other states. Just shows how un-progressive the US is. We only have 6 or 7 with paid family leave!
luckydata 7y ago
In california the democratic party has occupied the space left by the disappearance of the GOP by having a lot of very conservative members. California politics are not particularly progressive, and they look that way only if you compare us to Alabama, otherwise we're a solidly center-right state. We just don't do extreme right (GOP).

godzillabrennus 7y ago

I read recently that the Cleveland Clinic has lost 91% of its net income: https://www.beckershospitalreview.com/finance/cleveland-clinic-s-annual-net-income-drops-91-on-heavy-investment-losses.html https://www.beckershospitalreview.com/finance/cleveland-clin... This just a few years after a 71% loss of operating income: https://www.beckershospitalreview.com/finance/cleveland-clinic-s-operating-income-plummets-71.html https://www.beckershospitalreview.com/finance/cleveland-clin... Maybe healthcare systems are in a pinch?

mwerd 7y ago
Their net income swing is almost entirely attributable to a ~1 billion change in investment returns. Their operating income only fell 20%, because they had 8% increase in operating expenses without a commensurate increase in revenue. It's actually all laid out in your link.
- dredmorbius 7y ago
  Curiously, the 1980's liability insurance crisis also arose out of dramatic swings in investment returns, not massive changes to the liability risk side (instances or awards). Which itself precipitated from the Volker Fed's exceedingly ill-considered moves to reign-in inflation (ironically because the financial / FIRE sector dislikes high inflation). Insurers (and the Cleveland Clinic) achieve income through both premiums charged and investment return on those premiums. Because premiums are a competitive market, more subscribers can be acquired by lowering premiums, possible by pursuing higher investment income. Which works until it doesn't. Premiums and payouts are locked-in contractually, whilst currency valuation and investments float on the market. Stay on the right side of that and you're Life's Golden Child. Get on the wrong side and nothing can go right. Curiously, the insurance (that is: risk-management industry) seems blind to the investment-side risk and keeps getting bit by that bug every decade or two. Wikipedia's (very brief, incomplete) treatment: https://en.wikipedia.org/wiki/Liability_insurance_crisis https://en.wikipedia.org/wiki/Liability_insurance_crisis
jeanperrot 7y ago
From these links -- revenues of $7.2b in 2015, $8.9b in 2018; money inflow sure isn't pinched.

droithomme 7y ago

I've been through the surprise billing stuff multiple times. At this point unless I am unconscious and can not consent, I'm not going to the hospital. I'll bleed out and die on the street if necessary, or spread ebola or whatever. No way am I going there. You go in, they do nothing, then you have $30,000 in bills that arrive in hundreds of stages over the next 24 months. You're better off borrowing money from the mafia than you are visiting most any emergency room in the US. The mafia has much more straightforward billing transparency, fewer surprises, and is generally more honest.

avionicsguy 7y ago
I've been both insured and uninsured. I agree with you. I'd rather die than go to a hospital and leave with enough debt to cover Harvard, Standford, or [name your institution]. Also, know that the primary care givers (nurses mostly but also doctors) don't get paid as much as you think they might. The insurance companies are all for profit so the system is gamed this way. [Edit] If you need non-emergent surgery and have an idea of what you need you can check out: https://surgerycenterok.com/pricing/ https://surgerycenterok.com/pricing/ Disclaimer: I have no affiliation with this organization but I applaud them!
- droithomme 7y ago
  Thanks for that link! For non-urgent routine care I have a local doctor. I was going to recommend to you a2zimaging, which was a service I used for discount MRIs using unused capacity nationwide, but I see just now they've gone defunct in the last year or so. They used to have MRI scans for $250-$500 depending on state. This was less than the over $10,000 I was quoted without. I seems there's other services claiming to do something similar now but I have no experience with them. I've also paid cash at old specialists who don't accept Medicare, and traveled to Mexico for care. I've also gotten superb care while overseas. Single payer is probably the answer. If I need serious surgery some day I will likely do it in India. Your site there seems a reasonable alternative I would look into. But this still leaves open the situations with a serious accident requiring immediate care which would surely bankrupt anyone. Insurance never covers whatever care is nearest to a random accident site, and this scheme is by design, along with the curious situation where each hospital and their staff are carefully partitioned out to different networks.

Someone1234 7y ago

This is why the very concept of insurance discounts are problematic. It might sound counter-intuitive to argue against "discounts" as a solution to bringing costs down, but it actually would. Medical facilities are forced to artificially inflate bills. Insurance then artificially gets a discount back to a sane price. This helps insurance look like they're "doing something" even when they aren't e.g. High Deductible when you pay 100% up to the deductible ("at least I got the insurance rate!"). Out of network also suffers from this. The networks themselves are discount networks and prices for uncovered patients are artificially high. If you banned insurance discounts and insurance had to pay the same dollar to dollar cash price (without kickbacks/incentives), it would help the uninsured, it would help re-align patient/insurer motivations (i.e. both demanding low cash prices), it would make price transparency actually meaningful, and it would eliminate insurance networks. But ideas like this, and removing employer provided healthcare (e.g. everyone on an open health insurance exchange) are politically impossible in the US because no politician can get elected for "taking people's employer insurance and taking their discounts." Even if they're the right thing to do to simplify, reduce costs, align goals, and force insurers to compete again.

JumpCrisscross 7y ago
> it would eliminate insurance networks It wouldn't. Insurers would still need to approve providers' prices, and those negotiations would have other levers that could be pulled. But broadly speaking, yes--requiring insurers pay the same price that is advertised and available to the uninsured public is basic price-transparency policy.
- Someone1234 7y ago
  Or they would just cap prices for specific procedures. Then the patient could use price transparency to see if they'd wind up with an overage bill, and consider if they'd be willing to pay the remainder (e.g. if the doctor was preferred). Right now insurance either do cover something or they don't. That in itself is problematic. If insurance would cover a procedure up to e.g. $500 at one medical clinic why do they cover up to $0 at another? Shouldn't it be $500 here or $500 there? Networks inherently pit you against both the insurer and healthcare provider. Instead you and your insurer should be on the same "side" against healthcare providers.

godelski 7y ago

I'll start this by saying that I'm highly in favor of universal health care. Seems like the best insurance company would be the one with the most patients, which can thus negotiate the best deals. So with that out of the way... Doesn't this bill completely undermine the insurance business? If a hospital can't charge more than the median value that in network patients are charged, why would you buy insurance? I must have misunderstood or misread something. I would think this would make it substantially more difficult for insurance providers to make negotiations and cut deals with hospitals. I would imagine they would just pass off the cost to the consumers, as they typically do. It always seems to me that these half way positions between universal health care and commercial end up being worse than either. From a very high level it sounds like a fantastic thing, preventing patients from getting screwed, but isn't the cost that those with insurance pay more? I would assume that there's far more people paying insurance than the number of people that get these surprise bills. Though I'll admit the whole system feels rigged at this point and is likely intentionally convoluted to make consumers uninformed (by level of difficulty).

bhelkey 7y ago
> If a hospital can't charge more than the median value that in network patients are charged, why would you buy insurance? You would buy health insurance for the same reason anyone buys any kind of insurance (above legal minimums). Suppose a thousand people have a 1% chance of owing $10,000. Their EV is -$100. If a company offers insurance for $120, the company benefits by making $20 * 1000 and the individuals benefit by removing variance from their life.
- michaelmrose 7y ago
  A massive portion of medical expenses presently paid for by insurance are predictable costs that the insured knew going into the year. You can find affordable car insurance because your actual payout from your insurer is very likely zero this year. If your actual payout this year is certainly 10-100k this year depending on what actually goes wrong this year how on earth do you affordably insure that individual. Remember also that sickness stunts family income. Insurance only makes sense for large hard to predict expenses.

fortran77 7y ago

No they didn't. Lawmakers did.

tacofan 7y ago
Too many CA Republicans I guess.

cameldrv 7y ago

I'm not sure that on its face that this makes much sense. It reminds me of the kids song "I don't know why she swallowed the fly." Fundamentally the problem is that prices are set by a market, but the market has some inherently unusual characteristics, and has become controlled by a series of government sanctioned cartels. With private insurance, your insurance contracts with some hospitals. If you go to a hospital that's not contracted, your insurance will pay what it deems "reasonable", and you have to pay the balance of whatever the hospital decides to charge you. With a law like this, the hospital would have to just take whatever the insurance company deemed to be the correct price. This would seem to incentivize insurance companies to have very low "reasonable" prices for out of network visits.

Havoc 7y ago

My European insurance policy specifies >Global except north america i.e. You go to war torn Sudan we've got your back but if you dare going anywhere near that bastion of freedom known as the US...you're on your own. The fact that medical insurance companies are down with Sudan, North Korea and China...but not the US...that would suggest the need for some introspection frankly. (Bit puzzled by the Canada inclusion though - any ideas?)

swebs 7y ago
Can you link the policy? I highly doubt they cover Sudan.
- Havoc 7y ago
  >I highly doubt they cover Sudan. The wording is literally global except for. There might be some gotcha in terms of "doesn't cover active warzones" that I'm not aware of, but my point stands. Insurers are fundamentally OK with the concept of global...but won't touch America. Makes sense - US medical system pulls numbers out of a hat so how do you insure against that as an outside non-US medical aid? The claims I've filed in other African countries cleared without question. In fact I try to do my annual checkups there. Edit...no can't link..its a custom policy...but i believe it to be reasonably close to market terms
- fesoliveira 7y ago
  That is not really his point. He means that he can go almost to any other country and be covered, but if he goes to the US, which is one of the richest and most medically advanced countries in the world, he won't.
  - Havoc 7y ago
    >That is not really his point. Correct. Thanks for elaborating.
  - perl4ever 7y ago
    Or Canada.

jimbob45 7y ago

Seems like this problem could be solved by forcing an insurance provider to cover every emergency room in a state (note, not Urgent Care). And in all honesty, it seems that 60% of the problem with modern insurance lies with these totally arbitrary delineations of what is in-network and what is not. The insurance company gains implicit power over where you get treated by making up these "networks". Why should an insurance company be the one certifying hospitals? Shouldn't that be done by, yknow, a government agency and not a profit-seeking insurance firm?

tathougies 7y ago
> Why should an insurance company be the one certifying hospitals? Shouldn't that be done by, yknow, a government agency and not a profit-seeking insurance firm? I mean, governments do certify hospitals. If you don't have gov't certification, you can't provide medical services.

wayne_skylar 7y ago

I'm currently uninsured and trying to deal with the healthcare system in the US is so annoying it makes me want to give up and move to Canada. I went to an urgent care center and had a doctor perform a routine examination for a sinus infection. No special tools or materials were used. Before I went in I signed a form stating that I acknowledged that I was on the hook for whatever extra it cost if the situation required it. I was thinking along the lines of bloodwork, x-rays, etc. The doctor was very helpful in avoiding unnecessary expense as well. A month after I paid and left I got a bill in the mail stating the that doctor had performed an 'extensive examination' and that cost an extra hundred dollars. They had all the information necessary to bill me this as I left the urgent care. Yet they chose to wait and send me a bill because it's a complete fraud. I really wish I could find out the answer to how this works, but my guess is that there is some automated process that tacks on extra billing where possible as a way of boosting income. Ordinarily it's a 'victimless' crime in that it is paid for by an insurance company. But ultimately we're fucked in this country with regards to healthcare. It is a disaster that keeps people sick, yet we need it because it's such a large part of our economy. Little by little this sector has inserted themselves into the literal lifeblood of the nation's finance and health and is holding everyone hostage.

cabaalis 7y ago
I've never had to do this before from a patient standpoint, but perhaps you could try to find out what codes were billed for the visit. [1] Compare this to what was actually performed. It is possible they upcoded your visit, either inadvertently or on purpose (illegally.) Aside from that, (EDIT: More likely) it could also be that lots of billing actually takes place when a coder reviews the doctor's note of the encounter. This can be several days after the visit. This is a legitimate and very common practice. They might not have known the correct amount to charge until everything was properly coded. [1] https://coder.aapc.com/cpt-codes-range/2869 https://coder.aapc.com/cpt-codes-range/2869 [2] https://www.verywellhealth.com/what-is-upcoding-2615214 https://www.verywellhealth.com/what-is-upcoding-2615214
refurb 7y ago
Your exam notes are sent to billing, who, using the notes tries to determine which billing codes are correct. Obviously they have every incentive to “up code” and get the most amount of money.

erentz 7y ago

In my case I would’ve received treatment for a serious neurological issue sooner but for the fact that the hospital did not extend to me an honest price for the treatment. I think this kind of thing effectively amounts to denying some patients treatment and should be treated as such. We went in the ER and I was admitted. The five day course of treatment on admission we were told would run in the vicinity of $20,000. Something I could afford given the extreme circumstances if insurance were to deny it (longer story there). But the next day we were told that insurance would deny and the total would now end up around $100,000 for the full treatment. Not something we could afford. And I was not in the state of mind or ability to handle this smartly or know I could get a lawyer or try to start some negotiation with them as people might suggest. So we had to be discharged without completing the treatment. A month later I had been relocated across country to change insurance to a provider that covered it and was able to start treatment. Now we could see that an insurance company was only paying $16,000 for the full course. This effectively denied me treatment (amongst other things) and caused pretty significant harm. (This is not ignoring that I am lucky to be in a position to afford a $16,000 treatment bill and many aren’t, but this is to say that when the hospital jacks up the price 7 fold in a situation like this they’re effectively saying “go away we won’t treat you”. They could’ve just as easily given me the real pricing and then I would’ve been able to be treated.)

sizzle 7y ago
Was it an experimental procedure? Why would insurance not cover it once your max out of pocket amount is passed? Sorry if I'm mistaken, health insurance is mind boggling for me, just trying to learn from others if I find myself in the same situation moving forward.
- erentz 7y ago
  So in the USA if you work for a medium-large company they will almost certainly have you on a "self funded health plan". These are plans where the Cigna, Anthem, etc. card you get makes it look like that's your insurer, but in actual fact your employer is your ensurer. The Cigna/Anthem/etc. you are interfacing with is just a contracted administrator that handles the billing, claims, etc. processes, then passes the full costs back to the employer. (The employer will also have various re-insurance set ups to limit their total liability in case of very expensive situations.) This administrator (Cigna et al.) will have a bunch of policies for certain treatments and drug uses that define when they can be used. These operate like a firewall rule, being parsed, and if you don't match perfectly, you get denied. Sometimes they'll be more flexible, but some are known to be terrible (cough Cigna cough). If you don't match this policy perfectly then your treatment gets classified as "experimental". At that point they point you to something called the "XYZ Company Handbook" which is something your employer maintained. This is a document that almost never exists in reality, but the gist is that "XYZ Company Handbook" will say experimental treatments are not covered. (There was nothing really experimental about my treatment, it’s just high dose IVIG, with lots of patients on it and a half dozen of my doctors all supporting it. Experimental seems to be their euphemism for “expensive, so we don’t want to cover it”.) So administrator points to employer, then you go to your employer, they point to the administrator. Then you go to a lawyer or your state insurance commission for help, and they say because it's a self funded health plan it is not technically an insurance product, and is regulated under federal law as an ERISA plan. This means years in court, and the maximum you can ever recoup is only the costs of the treatment. So you have to pay for treatment up front, then fight to get those costs reimbursed. And because there can be no punitive penalties there is no real incentive to act in good faith. Your lawyer (or state insurance comission) will also point out that because the plan is self funded your employer is actually the ultimate authority and can approve or deny or make exceptions for any claim. The appeals process can include something called an independent review, where an outside organization can review your case and recommend treatment or not. This is a time consuming process though. Also it doesn't always work out. And they tell you that they are not bound by the results of the IRO anyway. In our case we were able to change from our employer's self funded plan to a legacy brokered plan, an old school type one where your premiums actually go to the insurance company and the insurance company pays for all treatments. These are regulated by state insurance commissions. This plan was actually provided by a not for profit Blue Cross/Blue Shield and they covered the treatment immediately because my case was pretty darn obvious that I needed it.

doggydogs94 7y ago

Politicians talk big on health care reform and do nothing. And California’s assembly is over 2/3 Democrat; no Republicans to be the fall guy.

blackflame7000 7y ago

Balance billing is a total scam. One time I broke my hand while in another city. I went to a clinic and they told me they could perform the surgery on site in about an hour and that they would talk to my insurance company. I got a voicemail from the clinic 2 days before my surgery saying they talked with my insurance company and everything was all set. My surgery went fine and took an hour as expected. My insurance company calculated that the average cost of the surgery should be about 10k and that's what they were willing to pay. 6 months later I got a bill for $150,000 even for the surgery. First, what are the chances that a bill that large is perfectly even? It's an obvious scam that these places will literally try to charge as much as they think they can get away with. They ask for huge numbers hoping to settle above market rate. At no point during this process was I told anything other than you're covered and with a broken hand, it's not exactly easy to do research.

asark 7y ago
I've seen enough over- or mis-charging "errors" from healthcare billing departments that I'm 100% sure a good portion of them are intentionally committing fraud, knowing that if you call them on it they can just go "oops sorry didn't mean to send that here let me fix it" and not get in any trouble at all. Even if they do it over, and over, and over.
- blackflame7000 7y ago
  You're exactly right. I called them out on it and the bill mysteriously vanished. Funny how that works.
- LorenPechtel 7y ago
  I have long felt that errant bills should be inverted, not simply gotten rid of. You legitimately owe $100, they bill you for $300. Now they owe you $200. There are far too many such mistakes for it to be pure chance. Some of it certainly is carelessness but they don't care if they make such mistakes. (For example, once my wife got back to the exam room before it was realized that the appointment shouldn't have ever existed--she was sent home without anything being done. Many months later they bill for the co-pay for that visit. Obviously some auditing procedure noted the "visit" and the lack of a corresponding bill and "fixed" it.)

oceanghost 7y ago

A certain number of these surprise bills are fraudulent as well. I had to go to the ER during the middle of the night. Saw the doctor for 10 mins total. A few months later, I got a bill from the physician on duty saying they were out of network; it was for a shade under $1000. I called the insurance company, and they said, the hospital had a history of sending fraudulent bills, that they had already paid the physician AND previously had sued the hospital for sending these fraudulent bills and obtained a legal settlement enjoining them from doing it. In another incident, my wife's OBGYN kept sending us small bills, $29, $74, etc. even though we have paid our co-pays. I called them up and asked what the bills were for, and they honestly couldn't tell me-- saying they would call us back. Which they never did. Which I assume meant, "you caught us lying."

vkou 7y ago
The only question I have is: How are these doctors and bill coders not sharing a jail cell with Bernie Madoff, and that guy who keeps stealing six-packs from my grocery?

ericol 7y ago

I don't understand health care in the US. I live in Argentina, that's like being the most-dysfunctional and mentally challenged cousing in an already dysfunctional extended family (South & Central America). We have lots of issues with health care here, _specially_ for those that work on our own (I don't exactly work on my own, but working for a foreign company is more or less the same). There are lot of stories going around (some of them I know first hand because some relative's kid has a rather strange syndrome, and getting their health care org to cover that was an impossible task) but still, the "You broke your leg here's a 50K bill" kind of story I often get from the us is a total and utter madness. I kind of enjoy in a bewildered amusement these public displays of lobbying, thought.

Pinckney 7y ago

It died without a vote, and thus it's not even clear from the article who I ought to be calling and yelling at. Chiu? Presumably he pulled it because of pressure from others. Is there some way for me, as a voter, to determine which individual legislators are to blame?

Yizahi 7y ago

Don't worry, the free market (tm) will sort itself. It's all for the best for consumers.

gregkerzhner 7y ago

The American system is pretty messed up compared to the rest of the world, but I think the elephant in the room is that if you are insured and have money to spend, I think the American system is better just because you have more options and can see specialists quicker. I broke my ankle in a really bad way rock climbing two years ago. When I first broke it, my health insurance was Kaiser, an HMO, which is a decent example of how a government healthcare system might look like in other parts of the world (you cannot just go see a specialist and everything is controlled by referrals). I had major trauma in my ankle that required surgery, but Kaiser won't even let me see an orthopedic surgeon. Their policy was that since it was foot injury, I would only be able to see a Podiatrist, and I had no choice in that matter since I had no control over which kind of specialist I could or coudn't see. When I talked to my orthopedic surgeon friend about this referral to a Podiatrist, they thought it was crazy. I went to see that Podiatrist and they basically told me that my ankle was screwed, there was not much they could do for me, and that I will spend the rest of my life in pain. I think in another country like Canada or Britain, that would probably be the end of the story. I am pretty young, so I didn't want to give up just yet. I went and got a second, third, fourth, etc... opinion from other doctors, just paying in cash outside of my insurance. Eventually, I switched insurances to a PPO plan (just a regular Obamacare plan) and found my way to The Steadman Clinic in Vail, which is where a lot of pro sports players get orthopedic surgery. There, a surgeon recommended a procedure where they use stem cells during the surgery to rebuild dead tissue. I was able to have that procedure. Two years later, my ankle is still pretty messed up, so I went to that doctor again, and he recommended a third surgery to clean up a bunch of dead tissue. From the time when I decided to see the doctor again to the time I had the surgery was 1.5 weeks! All this is a great example of why the US system is bad overall, but actually good for the patient if you have money. I have seen like 10 orthopedic surgeons for this injury and have had 3 surgeries, all because I was motivated to try to get better and to try all options. I don't think I would have gotten nearly that much or that good of care under a government plan. The amazing thing about the US system is that if you have money, and you want to try stuff, you just can! There is noone telling you otherwise.

yks 7y ago
There are private clinics in Europe (and I suspect Canada too) to splurge on, it's not a unique American feature

blendo 7y ago

It's important to point out that in California, if you are treated "out of network" AND your health insurer is an HMO (such as Kaiser), you WILL NOT receive a surprise bill (see https://caselaw.findlaw.com/ca-supreme-court/1001051.html https://caselaw.findlaw.com/ca-supreme-court/1001051.html). Anecdotally, our family have been Kaiser members for nearly 25 years, and we've NEVER been party to a billing dispute. Perhaps Kaiser fights with SF General or other ER providers, but they thankfully keep their members out of it. Finally, my yearly cost to remain with Kaiser tends to be about 10% less than our company's other PPO options.

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