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In the US, patients generally don't have adequate transparency to make decisions that impact how much medical debt they acrue. They see a medical professional,

In the US, patients generally don't have adequate transparency to make decisions that impact how much medical debt they acrue. They see a medical professional, the professional makes some recommendation, and then the patient accepts or rejects the recommendation. Neither the medical professional nor the patient know the costs the patient will eventually encounter. The patient only finds out their costs some months later when they receive one or more bills negotiated between administrative groups and their health insurance provider. Any goods and services have already been rendered, and the patient is now on the hook for whatever the bills happen to see. Maybe the more "fair" answer is to make medical costs transparent instead of treating medical debt different than other kinds, but the system is broken and needs critical attention either way. This is essentially a path of least resistence.

simfree 2y ago
TL;DR: Our medical billing practices in the USA are fraud. Medical practices bill an insanely high amount with zero upfront disclosure while demanding every bit of personal information (employers past and present, educational history, SSN, all possible insurers, etc) and are often caught billing people they failed to serve (left after waiting hours) or refused to serve. The medical insurers aren't any better is the real kicker!
blackeyeblitzar 2y ago
I don’t disagree with any of that but that’s a different problem which should be directly addressed. If someone has debts they legally must pay off then it seems like regardless of how that debt came about, it would affect the risk associated with them, since they already owe someone else lots of money. For example if I were to offer them a loan and wasn’t aware that they’re saddled with medical debt, wouldn’t that leave me in a bad position as a lender?
- JumpCrisscross 2y ago
  > debts they legally must pay off then it seems like regardless of how that debt came about Many medical debts aren't paid off. I've disputed my fair share of them until the hospital agreed in writing to waive the charges. (Never went to collections, granted.) The first step in each of those cases was refusing to pay. > if I were to offer them a loan and wasn’t aware that they’re saddled with medical debt, wouldn’t that leave me in a bad position as a lender? Yes, probably. This rule likely needs a sibling regulation reducing the capacity of collectors to collect on medical debt in ways that financially impair the consumer.
  - tacticalturtle 2y ago
    > Yes, probably. This rule likely needs a sibling regulation reducing the capacity of collectors to collect on medical debt in ways that financially impair the consumer. But if we did that, then medical debt would become even less valuable to collectors, and hospitals will struggle to sell off unpaid accounts. They’d have to make up the difference elsewhere, and raise prices further. This regulation seems well meaning but it’s just beating around the bush that our healthcare system is way too expensive and there’s no politically feasible solution.
    - blackeyeblitzar 2y ago
      What’s the politically infeasible but effective solution in your opinion? I’m having trouble coming up with something that doesn’t create an additional cost elsewhere.
      - JumpCrisscross 2y ago
        > What’s the politically infeasible but effective solution Proper published pricing, for starters. If the price isn’t properly published and price wasn’t agreed upon ex ante, the bill should be dismissible. (It’s technically the law, but compliance is miserable.)
    - JumpCrisscross 2y ago
      > then medical debt would become even less valuable to collectors, and hospitals will struggle to sell off unpaid accounts Medical debt is already heavily discounted given its abysmal collection rates. Papering over that by pretending something that trades at pennies is worth face value strikes me as a useless fiction to continue propagating. > have to make up the difference elsewhere, and raise prices further Medical debt trades at a nickel to a dime on the dollar [1]. This isn’t a meaningful difference. [1] https://www.solosuit.com/posts/how-much-collection-agencies-pay-medical-debt https://www.solosuit.com/posts/how-much-collection-agencies-...
- saghm 2y ago
  > I don’t disagree with any of that but that’s a different problem which should be directly addressed I think most people here will probably agree with that (myself included!), but I suspect the disagreement is about whether that's a convincing argument against this policy given the political reality that reforming healthcare as a whole is not feasible at the moment and won't likely be any time soon. Trying to reform healthcare right now would require passing in the Senate (meaning either a supermajority voting for it or the majority party eliminating the filibuster), the House (which currently is not controlled by the same party as the Senate and the White House and unlikely to agree with them on any healthcare laws), signed by the president, upheld by the Supreme Court when it inevitably gets challenged, and then not repealed subsequently by a later presidential administration and Congress. The part that people disagree with you on isn't whether this proposal is the best possible way to handle the issue of people unfairly having medical debt; it's whether doing nothing until the entire healthcare system gets overhauled would be letting the perfect be the enemy of the good.
- RoyalHenOil 2y ago
  It should be addressed, but it is not addressed. Even though this is a serious issue that intimately, negatively affects nearly every American citizen at some point in their life, there is still not enough pressure on the government to enact a real change. Insurance companies simply have more political power than voters do. This change will mean creditor companies have skin in the game, too, and so hopefully they will now lobby the government to fix the medical problem. It's not fair — it's not their fault that the insurance lobby is out of control — but fairness isn't working. The way I see it, corporations are manmade tools, not human beings with innate desires and rights. Corporations cannot exist unless a society chooses to legally define incorporation, and societies only do this because corporations are very useful for advanced economies. Thus corporations ultimately exist in service to the society that creates them and grants them the means to participate in said society. If some corporation get out of control, society should have the right to rope its other corporations into reigning the rogue corporation back in if necessary — because all corporations are ultimately tools that society creates, uses, and dissolves.
_heimdall 2y ago
The whole point of a credit report is to indicate the likelihood that an individual will pay back new debt that they're applying for. Isn't it helpful and important to know that a) how much debt the person is liable for and b) that they're willing to sign a contract allowing someone to charge them any amount to be decided at a later date? The later seems important both to know that the person may continue to agree to writing blank checks in the future and that their willingness to do so says something about their financial awareness.
- yazzku 2y ago
  (b) does not apply here. Like the parent said, you don't know how much exactly a medical procedure is going to cost you until the price is negotiated with the insurance company, which can often take months. The medical office will, at best, give you an upper bound. When you're in pain, you don't really have choice.
  - _heimdall 2y ago
    B) applies here because medical intake forms include agreeing to the way prices are decided and agreeing to allow any treatments they deem necessary. It is basically a blank check. B) shouldn't be legal at all though, and that's the real problem. It is a fact that patients agree to owe whatever the hospital says they owe, and in my opinion that should be part of a credit history. Its also a fact, though, that hospitals charging this way is fraud and the system needs to be fundamentally fixed rather than band-aided by trying to just hide how much debt they are creating.
    - yazzku 2y ago
      By "does not apply" I meant that you can't use the same logic in a health situation. You're mostly just paraphrasing.
      - _heimdall 2y ago
        Say more if you don't mind. What logic did I use that isn't right, and why can't it specifically for a health situation? I'm guessing the argument here is that you can't expect someone to have the chance to make a nuanced decision or to turn down care because of the terms a hospital requires you to agree to. That's simply not true. Beyond the obvious, but unreasonable, fact that one doesn't actually have to get treated there if they don't like the terms, it's a contract and contracts have to be agreed to by both parties. A patient doesn't have to sign intake papers as-is. It's a contract, scratch out what you don't agree to and add your own terms if necessary. Include "Under duress" with your signature and make sure the person at the desk is aware. You aren't trying to be difficult or fight with them, you simply don't agree to some of the contract and are making that legally clear while signing in.

simfree 2y ago

TL;DR: Our medical billing practices in the USA are fraud. Medical practices bill an insanely high amount with zero upfront disclosure while demanding every bit of personal information (employers past and present, educational history, SSN, all possible insurers, etc) and are often caught billing people they failed to serve (left after waiting hours) or refused to serve. The medical insurers aren't any better is the real kicker!

blackeyeblitzar 2y ago

I don’t disagree with any of that but that’s a different problem which should be directly addressed. If someone has debts they legally must pay off then it seems like regardless of how that debt came about, it would affect the risk associated with them, since they already owe someone else lots of money. For example if I were to offer them a loan and wasn’t aware that they’re saddled with medical debt, wouldn’t that leave me in a bad position as a lender?

JumpCrisscross 2y ago
> debts they legally must pay off then it seems like regardless of how that debt came about Many medical debts aren't paid off. I've disputed my fair share of them until the hospital agreed in writing to waive the charges. (Never went to collections, granted.) The first step in each of those cases was refusing to pay. > if I were to offer them a loan and wasn’t aware that they’re saddled with medical debt, wouldn’t that leave me in a bad position as a lender? Yes, probably. This rule likely needs a sibling regulation reducing the capacity of collectors to collect on medical debt in ways that financially impair the consumer.
- tacticalturtle 2y ago
  > Yes, probably. This rule likely needs a sibling regulation reducing the capacity of collectors to collect on medical debt in ways that financially impair the consumer. But if we did that, then medical debt would become even less valuable to collectors, and hospitals will struggle to sell off unpaid accounts. They’d have to make up the difference elsewhere, and raise prices further. This regulation seems well meaning but it’s just beating around the bush that our healthcare system is way too expensive and there’s no politically feasible solution.
  - blackeyeblitzar 2y ago
    What’s the politically infeasible but effective solution in your opinion? I’m having trouble coming up with something that doesn’t create an additional cost elsewhere.
    - JumpCrisscross 2y ago
      > What’s the politically infeasible but effective solution Proper published pricing, for starters. If the price isn’t properly published and price wasn’t agreed upon ex ante, the bill should be dismissible. (It’s technically the law, but compliance is miserable.)
  - JumpCrisscross 2y ago
    > then medical debt would become even less valuable to collectors, and hospitals will struggle to sell off unpaid accounts Medical debt is already heavily discounted given its abysmal collection rates. Papering over that by pretending something that trades at pennies is worth face value strikes me as a useless fiction to continue propagating. > have to make up the difference elsewhere, and raise prices further Medical debt trades at a nickel to a dime on the dollar [1]. This isn’t a meaningful difference. [1] https://www.solosuit.com/posts/how-much-collection-agencies-pay-medical-debt https://www.solosuit.com/posts/how-much-collection-agencies-...
saghm 2y ago
> I don’t disagree with any of that but that’s a different problem which should be directly addressed I think most people here will probably agree with that (myself included!), but I suspect the disagreement is about whether that's a convincing argument against this policy given the political reality that reforming healthcare as a whole is not feasible at the moment and won't likely be any time soon. Trying to reform healthcare right now would require passing in the Senate (meaning either a supermajority voting for it or the majority party eliminating the filibuster), the House (which currently is not controlled by the same party as the Senate and the White House and unlikely to agree with them on any healthcare laws), signed by the president, upheld by the Supreme Court when it inevitably gets challenged, and then not repealed subsequently by a later presidential administration and Congress. The part that people disagree with you on isn't whether this proposal is the best possible way to handle the issue of people unfairly having medical debt; it's whether doing nothing until the entire healthcare system gets overhauled would be letting the perfect be the enemy of the good.
RoyalHenOil 2y ago
It should be addressed, but it is not addressed. Even though this is a serious issue that intimately, negatively affects nearly every American citizen at some point in their life, there is still not enough pressure on the government to enact a real change. Insurance companies simply have more political power than voters do. This change will mean creditor companies have skin in the game, too, and so hopefully they will now lobby the government to fix the medical problem. It's not fair — it's not their fault that the insurance lobby is out of control — but fairness isn't working. The way I see it, corporations are manmade tools, not human beings with innate desires and rights. Corporations cannot exist unless a society chooses to legally define incorporation, and societies only do this because corporations are very useful for advanced economies. Thus corporations ultimately exist in service to the society that creates them and grants them the means to participate in said society. If some corporation get out of control, society should have the right to rope its other corporations into reigning the rogue corporation back in if necessary — because all corporations are ultimately tools that society creates, uses, and dissolves.

_heimdall 2y ago

The whole point of a credit report is to indicate the likelihood that an individual will pay back new debt that they're applying for. Isn't it helpful and important to know that a) how much debt the person is liable for and b) that they're willing to sign a contract allowing someone to charge them any amount to be decided at a later date? The later seems important both to know that the person may continue to agree to writing blank checks in the future and that their willingness to do so says something about their financial awareness.

yazzku 2y ago
(b) does not apply here. Like the parent said, you don't know how much exactly a medical procedure is going to cost you until the price is negotiated with the insurance company, which can often take months. The medical office will, at best, give you an upper bound. When you're in pain, you don't really have choice.
- _heimdall 2y ago
  B) applies here because medical intake forms include agreeing to the way prices are decided and agreeing to allow any treatments they deem necessary. It is basically a blank check. B) shouldn't be legal at all though, and that's the real problem. It is a fact that patients agree to owe whatever the hospital says they owe, and in my opinion that should be part of a credit history. Its also a fact, though, that hospitals charging this way is fraud and the system needs to be fundamentally fixed rather than band-aided by trying to just hide how much debt they are creating.
  - yazzku 2y ago
    By "does not apply" I meant that you can't use the same logic in a health situation. You're mostly just paraphrasing.
    - _heimdall 2y ago
      Say more if you don't mind. What logic did I use that isn't right, and why can't it specifically for a health situation? I'm guessing the argument here is that you can't expect someone to have the chance to make a nuanced decision or to turn down care because of the terms a hospital requires you to agree to. That's simply not true. Beyond the obvious, but unreasonable, fact that one doesn't actually have to get treated there if they don't like the terms, it's a contract and contracts have to be agreed to by both parties. A patient doesn't have to sign intake papers as-is. It's a contract, scratch out what you don't agree to and add your own terms if necessary. Include "Under duress" with your signature and make sure the person at the desk is aware. You aren't trying to be difficult or fight with them, you simply don't agree to some of the contract and are making that legally clear while signing in.