5 ms·

I live in Europe and I never understood the in-network and out-of-network concept (I know what it is, I just see it is ripe for abuse). So I wonder, why hasn't

• zajd 6y ago
  > why hasn't Congress enacted legislation to put a ceiling on out-of-network charges Because they are bought and paid by the same people profiting off the system.
• shadowmore 6y ago
  Because "muh free market". Even in 2020, both conservatives and liberals (the non-radicals on both sides) still cling to the idea of lack of regulation being a good thing, despite decades of evidence to the contrary. The liberals are softening on this because they don't counter-signal the radicals on their side, while the conservatives actively demonize the radicals on theirs. As a result, only one radical fraction of one half of the political duopoly actually has both the desire and energy to enact this kind of legislation, and that isn't enough.
  • refurb 6y ago
    Healthcare in the US is incredibly regulated already. And one reason for the wacky pricing is bad regulation. Well, regulation with good intentions and bad outcomes. For example, there is a law that all hospitals need to maintain a chargemaster list and that no customer can be charged more than the price listed. Sounds great! Well, because hospitals are allowed to negotiate discounts, the most rationale thing to do is make your chargemaster price so high that it will never impact your business. Have a procedure you charge $1,000 for typically? Make the chargemaster price $10,000. That way it will give you some room to up your price to customers (say double it to $2,000). Problem solved for the hospital! So the regulation solved nothing and actually incentivized negative behavior.
    • mancerayder 6y ago
      Couldn't you argue that's not over, but under-regulation? The problem is, as you said, "make your chargemaster price so high." Such things are not allowed in many countries with national insurance options. Why not? Simple: because governments are paying, and governments can negotiate the prices or simply enact laws or regulatory bodies that determine the fair price of procedures, and especially, drugs.
      • refurb 6y ago
        You could argue it's the wrong kind of regulation, but at least in terms of level of regulation, I'm not sure I'll describe it as less.
• 34679 6y ago
  Copying another comment that was downvoted out, because it is 100% accurate: > why hasn't Congress enacted legislation to put a ceiling on out-of-network charges Because they are bought and paid by the same people profiting off the system.
  • icedistilled 6y ago
    >Because they are bought and paid by the same people profiting off the system. I know broad sweeping characterizations feel good and are easy, but I can't help but feel they help those taking the most money from lobbyists hide from view. And I can't help but feel they encourage giving up entirely on government and voting in outsiders regardless of their actual qualifications, who double down on the problems instead of fixing them. It takes a lot more effort to name some specifics either rules or people, but broad sweeping statements don't usually help.
    • 34679 6y ago
      Sometimes broad problems demand broad statements. We could get into the specifics of the two-party duopoly and the legacy of kowtowing to healthcare and health insurance industries, but the examples are far too numerous and stretch back far too long. I will provide two examples, one from each party, so as to be less divisive: Affordable Care Act: Democrats controlled the house, senate, and presidency. They could've passed any bill they wanted. Instead of medicare for all or similar, they passed a bill that required everyone to purchase a 3rd party product called insurance. The overhead and profits of the insurance industry add to the cost of actual healthcare. National Health Planning and Resources Development Act: Nixon signed this in 1974. It mandates that anyone trying to build a healthcare facility apply for and receive a Certificate of Need. This creates local monopolies for existing healthcare facilities by eliminating new competition. It's a blatant form of protectionism.
      • bobthepanda 6y ago
        To pass ACA the Democrats needed 60 out of 100 seats in the Senate and they had 58. To pass it they caucused with two independents, and one of them, Joe Lieberman, specifically would not vote for it if it had a public option.
• dustingetz 6y ago
  Observations about US policy and behavior is fundamentally a stencil of the balance of power. It's a democracy after all, balancing all those powerful interests and alliances is guaranteed to result in a mess known as “politics”. That's the tradeoff.
• itronitron 6y ago
  As much as I hate the in-network vs. out-of-network concept because of the risk to the patient, this story is a good example of why some providers are in-network. The in-network providers are (or should be) less likely to overbill because they have negotiated contracts with the insurance companies. Providers that don't have a contractual agreement with insurers are therefore out-of-network.
  • brianwawok 6y ago
    The best part is when you go to an in network hospital, and one random doctor that worked on you is out of network. Oops 10k surprise bill
• mattmcknight 6y ago
  Even better would be to limit what providers can charge to 105% of what they charge Medicare and Medicaid. You can put it in the Medicare contract with the provider that if you want to get paid by Medicare, you can't charge anyone more than Medicare. With about 50% of hospital and doctor spending coming from Medicare and Medicaid, they already have monopsony pricing power.
  • brianwawok 6y ago
    What happens to an effective treatment Medicare pays under cost? Those exist and right now are subsidized by the higher paying private policies. Do these treatments just go away?
    • mattmcknight 6y ago
      The rates get renegotiated so they aren't being subsidized by the uninsured and those with poorly negotiated prices.
• microcolonel 6y ago
  > I just see it is ripe for abuse Insurers not having control of which hospitals they associate with is ripe for even more abuse.
• cmurf 6y ago
  Congress is the political wing of American capitalism. The #1 way they get there is by appeasing moneyed interests. Only by pissing off just enough voters, do they lose elections in favor of some other person who has already appeased enough moneyed interest. Appeasement is necessary because elections are expensive and aren't publicly funded.
• mercer 6y ago
  Any Dutchie correct me if I'm wrong, but some degree of this concept has already arrived here as well. We have two types of health insurance, and the cheaper kind gives you less freedom to choose your care unless you're willing to pay extra. I have no idea how much extra that is, or how particular the insurance companies are about where you go, though. Last time I looked into my health insurance the slightly lower cost didn't really seem worth the hassle.