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The entire medical bill and insurance system is insane. I say this after going through 2 pregnancies (with my wife) and now with 2 young kids. The process is t

The entire medical bill and insurance system is insane. I say this after going through 2 pregnancies (with my wife) and now with 2 young kids. The process is that you go to the doctor, they will NOT tell you how much it costs out of pocket because that amount is probably insane anyway but you need insurance to "bill" that insane amount to the insurance company. The doctor will send say $1000 bill to insurance company for a simple checkup (yes, it can be that bad). THe insurance company then will say "no no sir, we only allow $200 for this specific item". Then insurance company will figure out how much you the patient ius supposed to pay out of that $200 (copay, co-insurance etc) and THEN they will pay the remainder to the doctor. See the issue here ? The price of a simple checkup is inflated from $200 (we can argue on this too) to $1000. This $1000 is just to scare you but really does not mean shit. Imagine that the doctor could bill you that $200 directly anyway or whatever amount they eventually get from insurance company. It will save their time, your time, their staff hours and probably save more for them in terms of resource usage. What we need is a system where not everything goes through insurance. This scare of having mandatory insurance is the root cause. Doctors/hospitals need to have transparent pricing just like other businesses and insurance should only bee needed for really catastrophic events like cancer, major accident etc. I would much rather pay $200 to a couple of visits instead of paying insrance $1000/month just to "insure" myself.

acveilleux 11y ago
Or you get a single payer and this charade goes away because the single payer's price list is fixed. This is how the rest of the world does it.
- yummyfajitas 11y ago
  Western Europe != rest of the world. The Indian system is a 1 billion payer system. The single price is also fixed and usually written on the wall, or maybe in a big book of prices. You ask for a price quote, receive it, pay that much and get it done. If the price is too high you go elsewhere. It works nearly perfectly. For any medical conditions I have that permit flight, I'm voting for it with a plane ticket.
- prostoalex 11y ago
  As a counter-point, a lot of Eastern European systems are single-payer (inherited from the Soviet days of free medical care), and because the fixed price amounts to pretty much nothing, there's lack of supply of doctors and implied cash gifts for each and every transaction you undertake at the hospital.
- tzs 11y ago
  You can have a fixed price list without single payer. Examples include Germany, Japan, and Switzerland.
pcurve 11y ago
"What we need is a system where not everything goes through insurance. This scare of having mandatory insurance is the root cause." I think providers should not be allowed to bill patients any more than what they would bill insurance companies. Period. Also, they should streamline 'accumulators / indemnities", which are dirty insurance tools designed to not pay. Copay was simple enough. But now we have co-insurance, deductible, out of pocket cost, out of pocket maximum, health savings accounts, family vs individual deductible and/or maximum out of pocket, etc. Nobody really understands this. We should have two things: percentage-based co-insurance payment where insured people pay percentage of the service, with adjustments for people who have pre-existing conditions.
michaelochurch 11y ago
Insurance is a problematic industry in general, because the insurer's incentive is to fail you when you need them: to take your premiums while things go well, then fuck you over when a disaster happens, often on a technicality (e.g. "you had hurricane insurance but no flood insurance" in Katrina). It's just a terrible model for health issues, which are generally more complex than event-based insurance policies. We should have gone single-payer in the 1940s; we didn't get it then, because a bunch of Southern racists didn't want to desegregate the hospitals. Doctors themselves often don't know what their services cost. The hospital does the billing, not them. And hospital bills are obscene, bizarre, and intentionally obfuscated. An aspiring costs $70 and a box of tissues becomes $150 "mucus collection therapy". It's absurd, but it also performs a social function similar to the persecution of witches, heretics, and old eccentrics. (Yes, this sounds like it's coming out of left field. Please continue.) Namely, witch hunts were mostly economic in nature; you had middle- and upper-middle class (but not rich or important) older people, often women but some men, who'd amassed sizable savings that, being weakened by age and declining health and social isolation, they couldn't really defend. Witch hunts were a great way for corrupt clerics (Catholic, Protestant, both "sides" were in on it) and enterprising inquisitors to yank the savings of old and modestly wealthy people, in a way that had enough official muscle (religion) behind it that a large portion of their heirs wouldn't deign to go into the fight (for fear of being labelled heretics or witches themselves). Witch hunting was about many things, but raising money was a primary and overlooked motive. Older people tend to have savings without the ability to defend it. When you have undefended money, there's a risk that someone will try to steal it. In the 16th century, witch hunting was the means. In the 21st-century U.S., it's medical bills: cooking up a way to suck savings off of people who are close to death and won't need them anymore. (The 25-year-old who gets denied cancer treatment is seen as just a casualty, but she's not the main target.) Medical bills are basically an inheritance tax built to fuck the middle class, yet the conservatives (who get up in arms if you apply an estate tax to double-digit millionaires) have absolutely nothing to say about it.
- SamReidHughes 11y ago
  The healthcare system is not a way for corrupt clerics to suck savings off of dying old people. Also, "conservatives" aren't getting rid of medicare any time soon, and you'll find that most would have a lot to say about how our healthcare system works and why it's expensive.
joezydeco 11y ago
If you've delivered a baby under anesthetic/epidural then you've probably also encountered the "independent" anesthesiologist who works as subcontractor to the hospital and not the OB delivering the baby. So now you have everything in-network, except the coin-flip of a guy that shows up 30 minutes before you hit the end of early labor. One time I got hit with an out-of-network refusal on the epidural and I flat out refused to pay it. It eventually (mysteriously) changed to an in-network charge.

acveilleux 11y ago

Or you get a single payer and this charade goes away because the single payer's price list is fixed. This is how the rest of the world does it.

yummyfajitas 11y ago
Western Europe != rest of the world. The Indian system is a 1 billion payer system. The single price is also fixed and usually written on the wall, or maybe in a big book of prices. You ask for a price quote, receive it, pay that much and get it done. If the price is too high you go elsewhere. It works nearly perfectly. For any medical conditions I have that permit flight, I'm voting for it with a plane ticket.
prostoalex 11y ago
As a counter-point, a lot of Eastern European systems are single-payer (inherited from the Soviet days of free medical care), and because the fixed price amounts to pretty much nothing, there's lack of supply of doctors and implied cash gifts for each and every transaction you undertake at the hospital.
tzs 11y ago
You can have a fixed price list without single payer. Examples include Germany, Japan, and Switzerland.

pcurve 11y ago

"What we need is a system where not everything goes through insurance. This scare of having mandatory insurance is the root cause." I think providers should not be allowed to bill patients any more than what they would bill insurance companies. Period. Also, they should streamline 'accumulators / indemnities", which are dirty insurance tools designed to not pay. Copay was simple enough. But now we have co-insurance, deductible, out of pocket cost, out of pocket maximum, health savings accounts, family vs individual deductible and/or maximum out of pocket, etc. Nobody really understands this. We should have two things: percentage-based co-insurance payment where insured people pay percentage of the service, with adjustments for people who have pre-existing conditions.

michaelochurch 11y ago

Insurance is a problematic industry in general, because the insurer's incentive is to fail you when you need them: to take your premiums while things go well, then fuck you over when a disaster happens, often on a technicality (e.g. "you had hurricane insurance but no flood insurance" in Katrina). It's just a terrible model for health issues, which are generally more complex than event-based insurance policies. We should have gone single-payer in the 1940s; we didn't get it then, because a bunch of Southern racists didn't want to desegregate the hospitals. Doctors themselves often don't know what their services cost. The hospital does the billing, not them. And hospital bills are obscene, bizarre, and intentionally obfuscated. An aspiring costs $70 and a box of tissues becomes $150 "mucus collection therapy". It's absurd, but it also performs a social function similar to the persecution of witches, heretics, and old eccentrics. (Yes, this sounds like it's coming out of left field. Please continue.) Namely, witch hunts were mostly economic in nature; you had middle- and upper-middle class (but not rich or important) older people, often women but some men, who'd amassed sizable savings that, being weakened by age and declining health and social isolation, they couldn't really defend. Witch hunts were a great way for corrupt clerics (Catholic, Protestant, both "sides" were in on it) and enterprising inquisitors to yank the savings of old and modestly wealthy people, in a way that had enough official muscle (religion) behind it that a large portion of their heirs wouldn't deign to go into the fight (for fear of being labelled heretics or witches themselves). Witch hunting was about many things, but raising money was a primary and overlooked motive. Older people tend to have savings without the ability to defend it. When you have undefended money, there's a risk that someone will try to steal it. In the 16th century, witch hunting was the means. In the 21st-century U.S., it's medical bills: cooking up a way to suck savings off of people who are close to death and won't need them anymore. (The 25-year-old who gets denied cancer treatment is seen as just a casualty, but she's not the main target.) Medical bills are basically an inheritance tax built to fuck the middle class, yet the conservatives (who get up in arms if you apply an estate tax to double-digit millionaires) have absolutely nothing to say about it.

SamReidHughes 11y ago
The healthcare system is not a way for corrupt clerics to suck savings off of dying old people. Also, "conservatives" aren't getting rid of medicare any time soon, and you'll find that most would have a lot to say about how our healthcare system works and why it's expensive.

joezydeco 11y ago

If you've delivered a baby under anesthetic/epidural then you've probably also encountered the "independent" anesthesiologist who works as subcontractor to the hospital and not the OB delivering the baby. So now you have everything in-network, except the coin-flip of a guy that shows up 30 minutes before you hit the end of early labor. One time I got hit with an out-of-network refusal on the epidural and I flat out refused to pay it. It eventually (mysteriously) changed to an in-network charge.