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It’s hard to understand how the basically fraudulent billing practices in US healthcare are viewed as acceptable and nothing gets done to correct things. I know

It’s hard to understand how the basically fraudulent billing practices in US healthcare are viewed as acceptable and nothing gets done to correct things. I know many people who have stories of people being overbilled by not a little but by a multiple of the normal price. Or the hospital bills for things that never happened. That while the patient never got an estimate upfront. There is basically no way to do it “right”. And even when you discover a problem you are expected to spend countless hours on the phone negotiating between provider and insurance. I can’t imagine any other industry getting away with such a persistent track record of bad behavior.

ukd1 6y ago
This is why I love Kaiser (kp.org) as they are the insurer and the provider. They haven't over-billed themselves with care for me or friends.
- mnm1 6y ago
  Until they deny you your necessary cancer screening for a few months and your cancer comes back with a vengeance requiring an operation and some major chemo just to give you a chance at staying alive, this system is great. Then again, if you never get sick, any system is fine and they all work the same.
- Osiris 6y ago
  I had a great experience with Kaiser (had to drop them when rates spiked after the last election). They made it easy to get answers without going in to the doctor. The primary care physician would just call/email specialist for you rather than sending you to another appointment (until it was necessary). It was obvious they wanted to keep their costs low but that also made a lot of things much more convenient for patients also.
- athms 6y ago
  Except they don't provide adequate mental health care even with the parity law. It takes about a month for your consultation and they funnel everybody into group therapy and/or drugs. Only those with severe mental disorders are given access to a shrink and only every 3-4 months. If you want weekly or biweekly visits to a psychoanalyst, you will be paying out of pocket. Also, as much as Kaiser likes to call themselves a non-profit, the doctor group is for-profit. Kaiser is actually composed of three separate legal entities: insurer, hospitals, and doctors. Any profit left over at the end of the fiscal year is split evenly by the hospital and doctor groups, with the doctors engaging in profit sharing. There is an incentive to provide less care to those paying out of pocket for the insurance because the doctors will reap a bigger bonus. This is not the case for Medicare and Medicaid recipients because reimbursement is based off both treatment and outcome metrics.
  - shajznnckfke 6y ago
    A “shrink” means a psychiatrist, and a psychiatrist is how you get drugs. So I feel there is some conflict in your answer where you say they funnel people to drugs and also it’s hard to see a psychiatrist. In my case I went to Kaiser and it took a few weeks to get to see the shrink, who gave me drugs. If you’re looking to have your health insurance cover therapy, I agree that Kaiser is the wrong choice. I also saw a therapist for a while, who was covered by my employer’s EAP (a separate benefit from health insurance). I didn’t think most insurers would cover regular visits with a psychoanalyst. I thought they were a pretty rare resource, so if people with insurance had free access, wouldn’t they all be fully booked?
- pengaru 6y ago
  This is a very undesirable conflict of interests when you find yourself victim seeking damages. Your insurer should represent your best interests, not the healthcare provider's. I personally never choose KP when starting a new job if there's an alternative. You'll find yourself severely disadvantaged when the shit hits the fan under their care, speaking from experience.
noobermin 6y ago
People have been trying to fix things politically for years now, they just face the same system that tries to stop things from happening legislatively.
burlesona 6y ago
I've never heard anyone defend the current status quo as acceptable, but the problem I see is that it's a profoundly byzantine system wherein every participant has many other people to point at and blame, while outsiders have extreme difficulty even figuring out where to start to untangle the mess. Case in point, one of my cousins works in Pharma. He has no end of stories of hospital administrators doing wasteful things, and insurance companies screwing doctors and suppliers, of doctors running rackets, and of course (his opinion) that huge numbers of Americans get medical treatment and then disappear, never paying their bills, and so the whole system is designed to extract 2-3x from the people who _do_ pay in order to cover the ones who don't. Meanwhile, this same person (at a different time) will tell you with a little twinkle in his eye what a good business it is selling pulse oximeters. Again in his words (so I don't know if he is exaggerating or if this is accurate)... His company has exclusive deals with a bunch of hospitals where they are the only supplier. They make the little plastic devices in bulk for pennies apiece, then they charge several dollars for each one. But then, most "cleverly" the company worked the product through FDA such that it is only authorized for "single use." So while in real life the device could easily be sanitized and reused many many times, instead every hospital needs a constant supply of these which they use once and dispose, resulting in a constant trickle of small purchases that add up to a huge business. He says this from the living room of his huge, very nice house, and gestures around as if to say "and that's what pays for all this." In short, I think the industry is dominated by people who are there to make money and _are_ making a lot of money, and they don't want that to change. Ie. pretty much normal humans just as deplorable as the rest of us. Thus I don't see the harms they are inflicting on society being fixed until the remainder of society organizes and says no, shutting down the racket. But unlike most industries, screwing up the medical system has life and death consequences, so to date when the rest of us get angry and propose a dramatic change that should help, we are easily cowed by the doctors/nurses/pharmacists/etc. who scream "it can't work, people will die!" Thus I am very, very pessimistic that a democratic society is capable of fixing this kind of deep corruption. If it is ever fixed, I suspect it will only be when the system collapses under its own weight.
- spaetzleesser 6y ago
  That's the thing. People like to always find the one cause that's causing these problems. They don't realize that at this point pretty much all participants in this system are corrupt and milking patients for as much as possible. No need to point fingers at hospitals, doctors, pharmaceutical companies or other parties. They all are complicit in this fraudulent system. "He has no end of stories of hospital administrators doing wasteful things, and insurance companies screwing doctors and suppliers, of doctors running rackets, and of course (his opinion) that huge numbers of Americans get medical treatment and then disappear, never paying their bills, and so the whole system is designed to extract 2-3x from the people who _do_ pay in order to cover the ones who don't." when you look at what the US spends as percentage of GDP compared to other countries then it's pretty clear that they are covering way more than the losses non-paying patients cause.
vmception 6y ago
> It’s hard to understand how the basically fraudulent billing practices in US healthcare are viewed as acceptable because it is tied to the national identity, or more accurately that the alternatives are seen as an affront to that national identity

ukd1 6y ago

This is why I love Kaiser (kp.org) as they are the insurer and the provider. They haven't over-billed themselves with care for me or friends.

mnm1 6y ago
Until they deny you your necessary cancer screening for a few months and your cancer comes back with a vengeance requiring an operation and some major chemo just to give you a chance at staying alive, this system is great. Then again, if you never get sick, any system is fine and they all work the same.
Osiris 6y ago
I had a great experience with Kaiser (had to drop them when rates spiked after the last election). They made it easy to get answers without going in to the doctor. The primary care physician would just call/email specialist for you rather than sending you to another appointment (until it was necessary). It was obvious they wanted to keep their costs low but that also made a lot of things much more convenient for patients also.
athms 6y ago
Except they don't provide adequate mental health care even with the parity law. It takes about a month for your consultation and they funnel everybody into group therapy and/or drugs. Only those with severe mental disorders are given access to a shrink and only every 3-4 months. If you want weekly or biweekly visits to a psychoanalyst, you will be paying out of pocket. Also, as much as Kaiser likes to call themselves a non-profit, the doctor group is for-profit. Kaiser is actually composed of three separate legal entities: insurer, hospitals, and doctors. Any profit left over at the end of the fiscal year is split evenly by the hospital and doctor groups, with the doctors engaging in profit sharing. There is an incentive to provide less care to those paying out of pocket for the insurance because the doctors will reap a bigger bonus. This is not the case for Medicare and Medicaid recipients because reimbursement is based off both treatment and outcome metrics.
- shajznnckfke 6y ago
  A “shrink” means a psychiatrist, and a psychiatrist is how you get drugs. So I feel there is some conflict in your answer where you say they funnel people to drugs and also it’s hard to see a psychiatrist. In my case I went to Kaiser and it took a few weeks to get to see the shrink, who gave me drugs. If you’re looking to have your health insurance cover therapy, I agree that Kaiser is the wrong choice. I also saw a therapist for a while, who was covered by my employer’s EAP (a separate benefit from health insurance). I didn’t think most insurers would cover regular visits with a psychoanalyst. I thought they were a pretty rare resource, so if people with insurance had free access, wouldn’t they all be fully booked?
pengaru 6y ago
This is a very undesirable conflict of interests when you find yourself victim seeking damages. Your insurer should represent your best interests, not the healthcare provider's. I personally never choose KP when starting a new job if there's an alternative. You'll find yourself severely disadvantaged when the shit hits the fan under their care, speaking from experience.

noobermin 6y ago

People have been trying to fix things politically for years now, they just face the same system that tries to stop things from happening legislatively.

burlesona 6y ago

I've never heard anyone defend the current status quo as acceptable, but the problem I see is that it's a profoundly byzantine system wherein every participant has many other people to point at and blame, while outsiders have extreme difficulty even figuring out where to start to untangle the mess. Case in point, one of my cousins works in Pharma. He has no end of stories of hospital administrators doing wasteful things, and insurance companies screwing doctors and suppliers, of doctors running rackets, and of course (his opinion) that huge numbers of Americans get medical treatment and then disappear, never paying their bills, and so the whole system is designed to extract 2-3x from the people who _do_ pay in order to cover the ones who don't. Meanwhile, this same person (at a different time) will tell you with a little twinkle in his eye what a good business it is selling pulse oximeters. Again in his words (so I don't know if he is exaggerating or if this is accurate)... His company has exclusive deals with a bunch of hospitals where they are the only supplier. They make the little plastic devices in bulk for pennies apiece, then they charge several dollars for each one. But then, most "cleverly" the company worked the product through FDA such that it is only authorized for "single use." So while in real life the device could easily be sanitized and reused many many times, instead every hospital needs a constant supply of these which they use once and dispose, resulting in a constant trickle of small purchases that add up to a huge business. He says this from the living room of his huge, very nice house, and gestures around as if to say "and that's what pays for all this." In short, I think the industry is dominated by people who are there to make money and _are_ making a lot of money, and they don't want that to change. Ie. pretty much normal humans just as deplorable as the rest of us. Thus I don't see the harms they are inflicting on society being fixed until the remainder of society organizes and says no, shutting down the racket. But unlike most industries, screwing up the medical system has life and death consequences, so to date when the rest of us get angry and propose a dramatic change that should help, we are easily cowed by the doctors/nurses/pharmacists/etc. who scream "it can't work, people will die!" Thus I am very, very pessimistic that a democratic society is capable of fixing this kind of deep corruption. If it is ever fixed, I suspect it will only be when the system collapses under its own weight.

spaetzleesser 6y ago
That's the thing. People like to always find the one cause that's causing these problems. They don't realize that at this point pretty much all participants in this system are corrupt and milking patients for as much as possible. No need to point fingers at hospitals, doctors, pharmaceutical companies or other parties. They all are complicit in this fraudulent system. "He has no end of stories of hospital administrators doing wasteful things, and insurance companies screwing doctors and suppliers, of doctors running rackets, and of course (his opinion) that huge numbers of Americans get medical treatment and then disappear, never paying their bills, and so the whole system is designed to extract 2-3x from the people who _do_ pay in order to cover the ones who don't." when you look at what the US spends as percentage of GDP compared to other countries then it's pretty clear that they are covering way more than the losses non-paying patients cause.

vmception 6y ago

> It’s hard to understand how the basically fraudulent billing practices in US healthcare are viewed as acceptable because it is tied to the national identity, or more accurately that the alternatives are seen as an affront to that national identity