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I've told this story here before. My girlfriend at the time, now wife and I both had pneumonia. Identical symptoms. We saw the same doctor the same day, back t

• SV_BubbleTime 3y ago
  I like that only 13 years later after a decade of ranting about it - people are finally understanding on their own why the “Affordable Care Act” was such a bullshit scam entirely supported by insurance providers. It was even sold in a ridiculous way. “We all know health care is broken, so if we just force everyone to sign up, and give them more guaranteed income streams then it will fix itself!!”. I don’t want to hear about how Obama actually wanted single payer or X. He knew exactly what it was the whole time. “Medical billing” is an industry probably larger than medical care. I fully support Costco here, insurance is a scam.
  • somewhat_drunk 3y ago
    Please describe how the Affordable Care Act led to the situation you're responding to.
  • kromem 3y ago
    It would have been better had the provider constraints not been struck down by the supreme court. The entire idea was using the threat of losing access to Medicare $$$ to force acceptance of all ACA plans by providers in order to drive down cost negotiations for individual payers. Large companies get to leverage large group sizes, and the idea of the ACA was to effectively turn all government aligned plans including Medicare into a single giant "all or nothing" group. But when the courts struck that down, instead it became the exact opposite, allowing for even more division and sub-grouping across ACA plans, which drives up the end payee costs because there's little to no consequences for providers telling ACA plans to get bent. The ACA as designed was effectively a compromise, and then the courts reversing the key compromise meant the overall result was a hot pile of crap outside of finally ditching preexisting condition lock-in (which was still a win overall, but a much more minor one).
    • david2ndaccount 3y ago
      Perhaps the president/congress shouldn’t try to make unconstitutional compromises.
      • afavour 3y ago
        It’s all interpretation though, isn’t it? Unsurprisingly, the Constitution has very little say on the topic of health insurance. How the content of the document gets applied to modern contexts is a matter of enormous debate, in a lot of contexts “unconstitutional” is a moving target.
        • smsm42 3y ago
          It used to be the case that anything that the Constitution didn't allow the government to do was considered not allowed. Too bad now it's the opposite - anything the Constitution doesn't explicitly prohibit it to do, it feels free to. And anything it does prohibit - like regulating speech - it does anyway, in a roundabout way. But at least we got all the problems they promised us to solve this way, actually solved, right?
      • Fezzik 3y ago
        whether or not something is found constitutional just depends on the prudence of the bench. Segregated schools were found constitutional under the same constitution that later found them not to be. The Supreme Court overrules itself all the time; the march of progress is slow: https://www.grunge.com/895625/the-supreme-court-has-overruled-itself-more-than-you-think/ https://www.grunge.com/895625/the-supreme-court-has-overrule...
    • valleyer 3y ago
      Could you clarify which part of the ACA you are saying was struck down by the Supreme Court? The only such parts I know of are the mandatory Medicaid expansion and some stuff related to covering contraception. (And the individual mandate penalty was reduced to zero by Congress in 2017.) I was not aware of any part of the ACA that required insurers to carry certain plans, apart from the general regulations it introduced on health insurance plans in general.
• Solvency 3y ago
  So why didn't you just say you didn't have insurance.
  • runako 3y ago
    You didn’t know until much later how much it would cost you after using insurance, and normally you have no way even after the fact to compare to the uninsured price. (The medical provider also likely won’t be able to provide accurate all-in pricing at the time of service.)
    • nayuki 3y ago
      Yeah, this is a stupid system. The free market doesn't work properly when people can't know the price before deciding to buy or refuse the service. Transparency is not an optional perk.
      • 8f2ab37a-ed6c 3y ago
        It drives me insane that, when ordering medication from my HMO, it is no longer able to tell me the price of the pills ahead of time. It's worse than "lobster of the day, market rate", at least you can ask the server what the rate is. I think we're only a few steps away from patients having to place limit orders on medication like they're on ETrade. Edit: I double-checked and now at least it gives you an "estimated price". But.. what is there to estimate? Why is there a real-time market rate for perfectly generic prescription pills? https://imgur.com/a/grNPBUB https://imgur.com/a/grNPBUB You end up having to place the order and the charge shows up a little while later. It's never 2x or anything of the sort, but it's also bewildering that they can't tell you what it will cost.
      • wokkel 3y ago
        As I see it, there is no free market when it comes to healthcare: there is no real choice, only choices that we introduce. What i mean is: when I get hit by a bus, i want to be in the nearest hospital asap and don't have the time nor the consciousness to play the healthcare market game.
• cavisne 3y ago
  There is a book on this “never pay the first bill” It’s all a big scam.
• meitham 3y ago
  The pricing of Medicare in the uk is a bit more transparent. If you visit private health care provider they will give upfront the price for self-paying vs insurance. The insurance price is often more than double, e.g. MRI scan via insurance is around £950 vs £450 for self paying. It’s often cheaper to cover your medical bills personally than to pay a for-profit corporation and beg them to authorise every treatment when you need.
  • poirot2 3y ago
    Sorry what? The NHS is free. There is no Medicare. Private health insurance is a luxury, it’s basically a queue jump to see the same doctors often in the same hospital as the NHS offers. Pricing is transparent because they just send you to the NHS for non profitable stuff. And if the test were necessary + urgent you’d get it free in the NHS anyway. In fact the awful incentives it creates mainly just lead to lots of unnecessary tests. That’s why insurance often won’t pay.
    • meitham 3y ago
      The NHS is indeed free, but I was not referring to treatment by the NHS. If you are adult with slipped disc, torn muscle or hernia or other no serious issues then good luck trying to be treated on the NHS. The waiting list is usually two or three years. I was referring to the numerous private hospitals existing in London, where you can see a health specialist within days (it sounds like a luxury in britian, but really is the norm in most countries even heavy sanctioned ones like Cuba and Iran)
• sambazi 3y ago
  seems to me that the moral of the story is that you subsidized the much more expensive treatments of other customers of your insurer whereas your so only paid what she was using. hedge big losses with small investments, that's the idea behind insurances, isn't it?
  • peteradio 3y ago
    You're already paying insurance premiums (and your employer) (out the ass probably) for that purpose.
• username332211 3y ago
  This is the consequence of the maximum profit margin provisions of the Affordable Care Act[1]. Because of it, insurance companies are now happy to pay more for the same procedures, because it actually increases their profits. In your case, they managed to negotiate such high prices that your co-pay is higher than the normal cost of the medical procedure. If you are on a Gold plan with a 20% co-pay, you can be sure that the money you paid is what went to the insurance company, while 4 times as much money went to funding healthcare! You should be really happy about this, because this is a rule created to make sure your insurance funds hospitals, not Wall Street greed! [1] https://www.washingtonpost.com/news/wonk/wp/2013/07/18/the-obamacare-provision-that-terrifies-insurers/ https://www.washingtonpost.com/news/wonk/wp/2013/07/18/the-o...
• lelanthran 3y ago
  > I've told this story here before. My girlfriend at the time, now wife and I both had pneumonia. Identical symptoms. > We saw the same doctor the same day, back to back. Got prescribed the same antibiotics. > I had "good" health insurance, she had none. My bill AFTER insurance was higher than her bill without insurance. > I'm really not sure the moral but it was frustrating as heck. The moral is that any system which introduces price opacity will gradually increase the price of the product until the price is above what the market will bear. Look at it this way - at the point of purchase, you are buying a product with absolutely no price information, because "the insurance will take care of it". With no price information to the consumer, there is no price discovery, and without price discovery the supplier will increase prices beyond what the consumer is willing to pay. If all medical insurances were banned, the cost of medical will not exceed what the market will bear: it can't. But that's extreme - how about a practical and workable solution: no private dealings between medical insurance suppliers and medical service suppliers. You have medical insurance? Lovely - you will be forced to submit the claim yourself. When you visit the medical services supplier (doc, hospital, pharmacy, etc) for non-emergency services[1], you will be liable for the bill, and so you will have to lookup what that/those particular code/codes cost/s. In this way the cost of medical services will actually come down, to what the market will bear. We've seen the same thing with US tertiary education - free money introduced into the system by the government caused tuition fees to skyrocket, with all the profit captured by the providers. IOW, the price rose to what the market will bear, and since the government was the market in this case, the price rose to what the government was able to pay, which is perhaps 3x to 10x what an unemployed 18 yo is able to pay. [1] For emergency care, obviously the claim will be submitted to you by the hospital, and you can then forward that claim to the insurance. Even better would be if all emergency procedures have state-backed insurance.
  • troupo 3y ago
    > You have medical insurance? Lovely - you will be forced to submit the claim yourself. When you visit the medical services supplier (doc, hospital, pharmacy, etc) for non-emergency services[1], you will be liable for the bill, and so you will have to lookup what that/those particular code/codes cost/s. Ah yes. Because I, the lay person, know exactly what all those codes mean and their actual costs. > IOW, the price rose to what the market will bear, and since the government was the market in this case, the price rose to what the government was able to pay, which is perhaps 3x to 10x what an unemployed 18 yo is able to pay. Strange how this didn't play out in (most of) Europe.