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To the hospital systems and insurance companies, the confusion is a feature, not a bug. They assume most patients and their families will just knuckle under and

To the hospital systems and insurance companies, the confusion is a feature, not a bug. They assume most patients and their families will just knuckle under and pay what they're told they owe. Since the health care sector is one of the largest political donors, elected officials have little incentive to fix anything, so they nibble at the edges and call it reform.

junofan 3y ago
It’s not donations. It’s the fact that the largest employer in nearly every congressional district is a healthcare system. Heard this from a guy who worked on the ACA.
- Workaccount2 3y ago
  I never really thought about it, but you could effectively use sick people to import money into your desolate community. In the same way that tourists bring tourists dollars, sick people bring government dollars.
  - b112 3y ago
    There are some poorer countries, which do specialize in excellent health care for economic reasons.
    - selimthegrim 3y ago
      Cuba?
      - visarga 3y ago
        .., Turkey, India
  - junofan 3y ago
    They’re price makers in a local area. They don’t need to import sick people.
- mdorazio 3y ago
  Even beyond employment, healthcare represents a ridiculous 18% of the US GDP these days.
  - AnthonyMouse 3y ago
    That number is ridiculous but it's also the broken window fallacy. If people spent less on healthcare inefficiency they'd have more money and spend it on something else. So it's not like you actually have to preserve the wasteful bureaucracy as though you're gaining something from it -- the jobs would just move to whatever industry supplies the things people would buy if they weren't forced to waste their money on this. The real problem is the employment, because then you have not just the industry but its unions lobbying to preserve the inefficiency.
  - peteradio 3y ago
    I struggle how we can include that into GDP. It should be a number we are attempting to reduce not grow because its a massive tax on the citizens.
    - junofan 3y ago
      It’s a shadow tax that goes to decent-yet-useless $60–90k jobs to buy political influence. There’s no countervailing influence.
      - sydbarrett74 3y ago
        I'm reminded of the Terry Gilliam film Brazil.
  - sydbarrett74 3y ago
    Yep, the United States spends an outsized portion on it, but has some of the worst outcomes of any developed country.
- sydbarrett74 3y ago
  Good point. Although I still think donations play a decent part.
grecy 3y ago
> largest political donors You pay politicians, and you get the outcomes you want. Every other country in the world calls it bribery.
- hulitu 3y ago
  > Every other country in the world calls it bribery. This is, unfortunately, not true for the majority of "democratic" countries. They call it "lobby". They avoid to call it "conflict of interest".
  - TRiG_Ireland 3y ago
    In principle, there's nothing wrong with lobbying. Legislators cannot be specialists on everything that needs to be done. Bat conservation charities lobby the government on issues related to bat conservation. Deaf associations lobby the government on issues related to education of Deaf students and Deaf accessibility. Lobbying from commercial interests is infinitely more suspect, of course, but still sometimes reasonable. The trick is to have very strong laws about openness: lobbyists should be registered, and minutes of meetings should be published. Ireland's Regulation of Lobbying Act (2015) [1] is something of a gold standard, which some other countries are considering using as a model [2]. [1]: https://www.lobbying.ie/help-resources/information-for-lobbyists/quick-guide-to-the-act/ https://www.lobbying.ie/help-resources/information-for-lobby... [2]: https://www.politico.eu/article/ireland-lobbying-clampdown-model-for-europe/ https://www.politico.eu/article/ireland-lobbying-clampdown-m...
    - pmyteh 3y ago
      There's also a need to stop lobbying being used as a cover for bribery: either openly or as a quiet quid-pro-quo. Your firm's argument for the importance of a regulatory change may be useful, but the associated $10k "donation" is just corruption. I've been reading vol. 3 of Robert Caro's biography of LBJ and the amount of illegal money routed from various Texas oil tycoons via Johnson in support of various causes is astonishing.
adamredwoods 3y ago
Another technique is to pass the burden of proof onto the consumer. The hospital creates a new charge, and it is up to the patient to prove it should have been covered by insurance. For example, showing something like meeting your yearly out-of-pocket is a difficult task. Sometimes it's up to the consumer to connect the two departments, insurance and the hospital billing, on the phone at the same time. Seems simple but the wait time between the two parties is high, and either one of them will drop off mysteriously. If the bill is in dispute for too long, you will be sent to collections, and have your credit score degrade.
- adhesive_wombat 3y ago
  C.f. Executive Function Theft https://hedgehoglibrarian.com/2023/08/14/executive-function-theft/ https://hedgehoglibrarian.com/2023/08/14/executive-function-...
moribvndvs 3y ago
Absolutely. I work in HIT for small to medium size practices. We all know how badly insurance is treating us as patients, but what’s not as well known is how much they squeeze medical providers (example [1]). Hospitals and networks have the weight to navigate insurance, but small independent offices don’t and are also getting absolutely fucked over. In addition to staffing issues, rising operational costs, excessive demand, slow turn around in receipts, rising complexity in software and regulatory compliance, a lot of local doctors are selling to networks and hospitals or just straight up closing doors. Large entities absorb all the same problems primarily by economies of scale which can result in poor individual care, increased out of pocket costs, amongst other things. [1] https://www.npr.org/sections/health-shots/2023/08/15/1193754380/why-doctors-pay-millions-in-fees-that-could-be-spent-on-care https://www.npr.org/sections/health-shots/2023/08/15/1193754...
- TedDoesntTalk 3y ago
  > local doctors are selling to networks and hospitals My primary care physician did this a couple of years ago. He still works at the practice and I still see him. When I asked him why he sold, he said he wants to do what he loves - practice medicine - not spend most of his time working with insurance companies. The worst part is all my records from years of visiting him did not transfer to the new system. It’s as if I’ve been seeing him for 2 years instead of 10 because no one can access my old test results and records. So much for continuity of care. Now I download all documents in their portal and save locally.
- TheNewsIsHere 3y ago
  You’re not joking. There’s a major dental insurance carrier that finds it perfectly acceptable to “pay” dental offices with prepaid debit/credit cards. Think Greendot, Mastercard, or Visa prepaid cards. I’m fairly certain my dentistry firm is fighting back in ways I’m not comfortable sharing because I don’t know any facts and would just be speculating, but I do hope they’re sticking it to them.

junofan 3y ago

It’s not donations. It’s the fact that the largest employer in nearly every congressional district is a healthcare system. Heard this from a guy who worked on the ACA.

Workaccount2 3y ago
I never really thought about it, but you could effectively use sick people to import money into your desolate community. In the same way that tourists bring tourists dollars, sick people bring government dollars.
- b112 3y ago
  There are some poorer countries, which do specialize in excellent health care for economic reasons.
  - selimthegrim 3y ago
    Cuba?
    - visarga 3y ago
      .., Turkey, India
- junofan 3y ago
  They’re price makers in a local area. They don’t need to import sick people.
mdorazio 3y ago
Even beyond employment, healthcare represents a ridiculous 18% of the US GDP these days.
- AnthonyMouse 3y ago
  That number is ridiculous but it's also the broken window fallacy. If people spent less on healthcare inefficiency they'd have more money and spend it on something else. So it's not like you actually have to preserve the wasteful bureaucracy as though you're gaining something from it -- the jobs would just move to whatever industry supplies the things people would buy if they weren't forced to waste their money on this. The real problem is the employment, because then you have not just the industry but its unions lobbying to preserve the inefficiency.
- peteradio 3y ago
  I struggle how we can include that into GDP. It should be a number we are attempting to reduce not grow because its a massive tax on the citizens.
  - junofan 3y ago
    It’s a shadow tax that goes to decent-yet-useless $60–90k jobs to buy political influence. There’s no countervailing influence.
    - sydbarrett74 3y ago
      I'm reminded of the Terry Gilliam film Brazil.
- sydbarrett74 3y ago
  Yep, the United States spends an outsized portion on it, but has some of the worst outcomes of any developed country.
sydbarrett74 3y ago
Good point. Although I still think donations play a decent part.

grecy 3y ago

> largest political donors You pay politicians, and you get the outcomes you want. Every other country in the world calls it bribery.

hulitu 3y ago
> Every other country in the world calls it bribery. This is, unfortunately, not true for the majority of "democratic" countries. They call it "lobby". They avoid to call it "conflict of interest".
- TRiG_Ireland 3y ago
  In principle, there's nothing wrong with lobbying. Legislators cannot be specialists on everything that needs to be done. Bat conservation charities lobby the government on issues related to bat conservation. Deaf associations lobby the government on issues related to education of Deaf students and Deaf accessibility. Lobbying from commercial interests is infinitely more suspect, of course, but still sometimes reasonable. The trick is to have very strong laws about openness: lobbyists should be registered, and minutes of meetings should be published. Ireland's Regulation of Lobbying Act (2015) [1] is something of a gold standard, which some other countries are considering using as a model [2]. [1]: https://www.lobbying.ie/help-resources/information-for-lobbyists/quick-guide-to-the-act/ https://www.lobbying.ie/help-resources/information-for-lobby... [2]: https://www.politico.eu/article/ireland-lobbying-clampdown-model-for-europe/ https://www.politico.eu/article/ireland-lobbying-clampdown-m...
  - pmyteh 3y ago
    There's also a need to stop lobbying being used as a cover for bribery: either openly or as a quiet quid-pro-quo. Your firm's argument for the importance of a regulatory change may be useful, but the associated $10k "donation" is just corruption. I've been reading vol. 3 of Robert Caro's biography of LBJ and the amount of illegal money routed from various Texas oil tycoons via Johnson in support of various causes is astonishing.

adamredwoods 3y ago

Another technique is to pass the burden of proof onto the consumer. The hospital creates a new charge, and it is up to the patient to prove it should have been covered by insurance. For example, showing something like meeting your yearly out-of-pocket is a difficult task. Sometimes it's up to the consumer to connect the two departments, insurance and the hospital billing, on the phone at the same time. Seems simple but the wait time between the two parties is high, and either one of them will drop off mysteriously. If the bill is in dispute for too long, you will be sent to collections, and have your credit score degrade.

adhesive_wombat 3y ago
C.f. Executive Function Theft https://hedgehoglibrarian.com/2023/08/14/executive-function-theft/ https://hedgehoglibrarian.com/2023/08/14/executive-function-...

moribvndvs 3y ago

Absolutely. I work in HIT for small to medium size practices. We all know how badly insurance is treating us as patients, but what’s not as well known is how much they squeeze medical providers (example [1]). Hospitals and networks have the weight to navigate insurance, but small independent offices don’t and are also getting absolutely fucked over. In addition to staffing issues, rising operational costs, excessive demand, slow turn around in receipts, rising complexity in software and regulatory compliance, a lot of local doctors are selling to networks and hospitals or just straight up closing doors. Large entities absorb all the same problems primarily by economies of scale which can result in poor individual care, increased out of pocket costs, amongst other things. [1] https://www.npr.org/sections/health-shots/2023/08/15/1193754380/why-doctors-pay-millions-in-fees-that-could-be-spent-on-care https://www.npr.org/sections/health-shots/2023/08/15/1193754...

TedDoesntTalk 3y ago
> local doctors are selling to networks and hospitals My primary care physician did this a couple of years ago. He still works at the practice and I still see him. When I asked him why he sold, he said he wants to do what he loves - practice medicine - not spend most of his time working with insurance companies. The worst part is all my records from years of visiting him did not transfer to the new system. It’s as if I’ve been seeing him for 2 years instead of 10 because no one can access my old test results and records. So much for continuity of care. Now I download all documents in their portal and save locally.
TheNewsIsHere 3y ago
You’re not joking. There’s a major dental insurance carrier that finds it perfectly acceptable to “pay” dental offices with prepaid debit/credit cards. Think Greendot, Mastercard, or Visa prepaid cards. I’m fairly certain my dentistry firm is fighting back in ways I’m not comfortable sharing because I don’t know any facts and would just be speculating, but I do hope they’re sticking it to them.