5 ms·

> health care isn't what most of the poor care most about Every time I've been in that category, it's been my #1 concern. Medical bills are also the #1 reason

> health care isn't what most of the poor care most about Every time I've been in that category, it's been my #1 concern. Medical bills are also the #1 reason for bankruptcies in the United States. > hospitals will drop 80-90% of your bill if you're over that, etc. etc. My experience is... different. Not only are adjustments more modest, not only are they harder to get than you're implying in the first place, I've found that hospitals will hound you for a $100 copay they think they didn't receive because when you paid it they accidentally credited it to the wrong account (glad I could dig up the receipt). There's things to value about America's enterprising spirit and some of its policies, but health care is pretty far from it. Overall it's a drag on the rest of the economy, and the incentives are wrong for there to be private solutions.

lettergram 5y ago
You bring up an interesting point about those “situations” and “bankruptcy”. So, real experience for me in priorities have always been: 1. Food 2. Shelter 3. Clothes 4. Transportation 5. Employment / Income 6. Healthcare You’re correct bankruptcy is an option and I know of multiple people who’ve done it for medical reasons. Honestly; it didn’t seem to impact them, as much as I suspected, but I didn’t see their internal finances. I do know they restructured and paid some and got on a plan to pay the rest. The first five on my list aren’t impacted by bankruptcy (typically) due to healthcare issues. That’s why I think a lot of people are okay taking the hit. But I think you bring up the key question which is “drag on the system”. There’s a reason our system is so expensive and it’s regulation and litigation from that regulation. Why do they limit the number of doctors graduating medical schools? Or zone hospitals such that all are profitable? Or have Medicare pay a fraction of what the private health insurance pays (increasing premiums for those with insurance?)? There’s a ton of systemic issues and it’s almost entirely from well meaning laws turning into a hellscape of rules. Bankruptcies are accounted for in the lending rates of banks, so that’s also impacted. Finally, I recommend asking the hospital for charge codes and looking up what Medicare will pay, pay that. It’s basically 20-50% of what your bill will be.
- wwweston 5y ago
  > 1. Food 2. Shelter 3. Clothes 4. Transportation 5. Employment / Income 6. Healthcare If you're facing risk or serious insecurity to any one of these, consider that health issues (especially those insurance matters for) often (a) produce costs that are higher to nigh-unbounded (b) may well present as issues that are upstream of all of these things ("Tell me, Mr. Anderson, what good is a phone call/job/meal when you are unable to speak/work/keep food down?"). #1-5 may be more foundational in some kind of pyramid of needs than mild health concerns, but serious health care concerns are equal-to-more foundational. Also, #1-5 are also more easily provided by friends and family or community charity on an episodic basis. > Honestly; it didn’t seem to impact them, as much as I suspected, but I didn’t see their internal finances. A merely low credit score has substantial financial impacts and will cut you off from some possibilities outright. A bankruptcy will close more doors. It's less an "option" than a salvage operation. > There’s a reason our system is so expensive and it’s regulation and litigation from that regulation Specific regulations sometimes do introduce compliance costs, and like code, can often be reviewed for optimization. But criticizing "regulation" in abstract is like criticizing code in abstract. And litigation is how legal accountability happens. Additionally, more heavily "regulated" systems than ours control expenses better, so it seems unlikely that's necessarily the source, and there's other explanations available in incentive analysis. > Why do they limit the number of doctors graduating medical schools? Ask the AMA. I expect part of it is incentives, though... how many more doctors do you think could be reasonably graduated? > I recommend asking the hospital for charge codes I've actually asked hospitals for charge masters before, even ahead of time. Answers ranged from "I'm not sure what that is" to "we don't do that." That was pre-ACA, so perhaps things have changed, but if so, it's thanks to regulation.

lettergram 5y ago

You bring up an interesting point about those “situations” and “bankruptcy”. So, real experience for me in priorities have always been: 1. Food 2. Shelter 3. Clothes 4. Transportation 5. Employment / Income 6. Healthcare You’re correct bankruptcy is an option and I know of multiple people who’ve done it for medical reasons. Honestly; it didn’t seem to impact them, as much as I suspected, but I didn’t see their internal finances. I do know they restructured and paid some and got on a plan to pay the rest. The first five on my list aren’t impacted by bankruptcy (typically) due to healthcare issues. That’s why I think a lot of people are okay taking the hit. But I think you bring up the key question which is “drag on the system”. There’s a reason our system is so expensive and it’s regulation and litigation from that regulation. Why do they limit the number of doctors graduating medical schools? Or zone hospitals such that all are profitable? Or have Medicare pay a fraction of what the private health insurance pays (increasing premiums for those with insurance?)? There’s a ton of systemic issues and it’s almost entirely from well meaning laws turning into a hellscape of rules. Bankruptcies are accounted for in the lending rates of banks, so that’s also impacted. Finally, I recommend asking the hospital for charge codes and looking up what Medicare will pay, pay that. It’s basically 20-50% of what your bill will be.

wwweston 5y ago
> 1. Food 2. Shelter 3. Clothes 4. Transportation 5. Employment / Income 6. Healthcare If you're facing risk or serious insecurity to any one of these, consider that health issues (especially those insurance matters for) often (a) produce costs that are higher to nigh-unbounded (b) may well present as issues that are upstream of all of these things ("Tell me, Mr. Anderson, what good is a phone call/job/meal when you are unable to speak/work/keep food down?"). #1-5 may be more foundational in some kind of pyramid of needs than mild health concerns, but serious health care concerns are equal-to-more foundational. Also, #1-5 are also more easily provided by friends and family or community charity on an episodic basis. > Honestly; it didn’t seem to impact them, as much as I suspected, but I didn’t see their internal finances. A merely low credit score has substantial financial impacts and will cut you off from some possibilities outright. A bankruptcy will close more doors. It's less an "option" than a salvage operation. > There’s a reason our system is so expensive and it’s regulation and litigation from that regulation Specific regulations sometimes do introduce compliance costs, and like code, can often be reviewed for optimization. But criticizing "regulation" in abstract is like criticizing code in abstract. And litigation is how legal accountability happens. Additionally, more heavily "regulated" systems than ours control expenses better, so it seems unlikely that's necessarily the source, and there's other explanations available in incentive analysis. > Why do they limit the number of doctors graduating medical schools? Ask the AMA. I expect part of it is incentives, though... how many more doctors do you think could be reasonably graduated? > I recommend asking the hospital for charge codes I've actually asked hospitals for charge masters before, even ahead of time. Answers ranged from "I'm not sure what that is" to "we don't do that." That was pre-ACA, so perhaps things have changed, but if so, it's thanks to regulation.