The state can be corrupt. Actors on behalf of the state can be.

Whoever decided $2000 dollars for a feeding tube is fair market rate is part of the corruption.

The corruption is in both people being forced into unreasonable costs for healthcare and the state failing to provide a good recourse for persons in debt this deep.

Policies you happen to disagree with are not “corruption.”

What do you call this then? Fraud?

> The $164,000 billed to Waldron for intestinal surgery was more than twice what a commercial insurer would have paid for her care [..]. Charges on her bill included $2,000 for a $20 feeding tube.

Fraud is where you lie about a material fact to induce someone to give you some benefit. Where is the fraud here?

The lie is the fictitious "list price" on the bill, which is nowhere near the amount generally paid nor agreed upon beforehand.

Let's say I'm going out and offer to bring you back a sandwich. I can't give you the sandwich and then claim you owe me $20 because that was my price. I either need to form that contract up front, or I can only expect reimbursement for the amount I actually paid.

I call it price gouging, which is not corruption. How is it corruption?

The corruption is how the courts actually enforce these funny money debts rather than doing the right thing and dismissing them. Barring a proper contract (which the sheer majority of these outrageous bills inherently lack), the basis for owing the debt is unjust enrichment. But that means a patient should at most be paying the lower of the medicare/medicaid/insurance negotiated prices - it shouldn't be a license for the hospital to simply make up any number and play poker.

I don't think we definitively need single payer, but we do need uniform (per provider) pricing and price transparency. (Although allowing everyone to buy into medicare/medicaid would be a no-brainer)

Barring systematic reform, I'd really like to see a trend of "healthcare extortion trusts" to keep everyone's life savings safe from these vampires.

> Barring a proper contract, the basis for owing the debt is unjust enrichment.

And I want to add to this: patients can't even be held at fault for this: have no ability to even find out! I've asked and asked for this up front (after being hit myself with a huge bill for what was a tiny visit! No surgery, just an examination!), and been told by providers that it is "impossible" to provide even an estimate of a price, even when the provider has all of my insurance information. Which is bullshit.

To make a patient choose between an unknown bill and their health is extortion.

> The corruption is how the courts actually enforce these funny money debts rather than doing the right thing and dismissing them.

How is that corruption? Who is being corrupted, and by whom? The state cannot corrupt itself.

> The state cannot corrupt itself

Obviously if you define the term "corruption" so that it is inapplicable, then there is no "corruption". FWIW I'm totally on board with viewing "the state" as a singular malevolent actor, I just don't think that paradigm is particularly useful here.

For there to be corruption in this case there would need to be one state organization paying off (directly or indirectly) people in another state organization so the first organization can get what it wants. Is that what you are suggesting is happening here?

My definition of corruption does not require someone being paid off, rather just the decision making process of an authority being well, corrupted, by common interests / worldview / cross pollination. In this case, the courts are treating claims by large institutions as prima facie valid rather than giving each party equal standing and making the claimant substantiate the basis for the debt.

If that price was arrived at by an official process and properly documented, then that's the system working as intended.

The questions is, intended by whom?

So with careful planning and proper documentation you can rob a bank ?

Intent is a serious factor in crime.

Essentially, yes. Please familiarise yourself with sub-prime mortgages and 2007 - 2009.

With the right kind of paperwork you can not only rob a bank you can also make yourself a beneficiary of multiple bailouts and benefits. With even better paperwork you then claim the losses as part of lowering your tax obligation.

Is it theft if you steal QE ?

I mean... is it really there ?

By itself not, no.. However if you figure in how said policies came to be, looking at for instance the amount of money the "healthcare industry" spends on lobbying, then the term "corruption" seems not unreasonable.

This is completely a state issue. How is industry lobbying relevant? What are they lobbying for? More profits for the State of Virginia?

The reasons people end up with medical debt(being underinsured, etc) are absolutely not a state issue and directly related to industry lobbying.

I thought we were talking about the extortionate bills from this state-run hospital. What does lobbying have to do with that?

Also, at the risk of not getting that question answered, what does lobbying have to do with people being underinsured?

The general walled garden existence of health care providers - the incredible disparity between list prices for procedures (the "chargemaster") and the cost to deliver those procedures including labour and parts - these are some entrenched business that lobby the government to establish a broken healthcare system, but it isn't everything!

You also need to look at PBMs that eek out a living as a middleman between pharma companies and insurers and survive by bulk offering pharmaceutical consumption in exchange for rebates while advocating for higher pre-insured prices to maximize the price difference between direct purchasing and their rebate reduced price.

You _also_ need to look at health insurers that operate in pretty much the same manner as PBMs but with everything that isn't a drug, highers list prices at hospitals coupled with lower negotiated rates for their patients is why a person with good insurance may pay 130$ for a 13k list price procedure, and the people with bad insurance are hit with the full cost.

Lastly the siloing of patients to specific care networks gives healthcare providers better control over how much that after insurance take-home is for themselves, if there are three hospitals within a few hours of you but two are out of network and the last one won't give you upfront information about their pricing then you have no freedom to choose efficiently.

Oh also, the pharma companies, they've gotten a bad rap recently for opiods. But it's a generally policy that drug reps that monetarily reward doctors for prescribing certain volumes of medication without any relation to patient needs, thus driving up the unnecessary usage of medication (and the cost to insurers, and the cut of PBMs) while also potentially causing further health issues from side effects of a drug the person didn't need in the first place.

Everything in this system is broken and it's basically just a carousel of terrible where each pillar is supporting the other ones because everyone is making so much damn money - and politicians are happy to force any state offerings to play by the same rules for a share of that cash for themselves.

In a sane system without the lobbying and corruption this cartel of players would be unsustainable because public interest would force politicians to cut down on their crap, but that ain't happening. And, while I think some intents of the law were decent, the actual effect of the ACA has been to cement the improper running of this market into law while forcing absolutely everyone into insurance - the ACA was a huge gift to insurers and it, and the private insurance and healthcare market that spawned it, need to be nationalized.

I agree with all these problems. I'm not disputing any of it.

What does this have to do with an extortionate bill from a state-run hospital?

The existence of that state-run hospital and the illogical size of their bill is a result of a lot of the lobbying done to keep the private industry from being uncompetitive with publicly offered healthcare.

If better priced options are available people are going to stop playing in that private healthcare sandbox - it's part of the same reason why the house has been unable to legalize purchasing drugs abroad... that too would weaken the price fixing abilities of pharmaceutical manufacturers and PBMs - also maybe pharmacies, they tend to get squeezed pretty hard by PBMs though so only in the case where a pharmacy is being squeezed by its own PBM (as is the case of CVS) is the pharmacy really embroiled heavily in this mess as a loss leader.

> The existence of that state-run hospital and the illogical size of their bill is a result of a lot of the lobbying done to keep the private industry from being uncompetitive with publicly offered healthcare.

Do you have evidence of the Virginia legislature meddling with the hospital's charge master? I could certainly believe that, but in the absence of evidence I'm more inclined to think it's just the hospital administrators trying to extract every dollar they can out of patients. For some reason even non-profit and government entities often seem to have a disturbing emphasis on revenue enhancement.

I don't have any such evidence and I agree with you that it's quite possible that this particular hospital isn't being directly influenced - the fact that the market seems to be dictating that these prices are acceptable could in fact be the sole influence over the charge master - but it's my view that this pricing level would be impossible is surrounding private healthcare facilities had more reasonable prices.

This, and the number of bad actors involved with healthcare, is sort of the issue - whenever the PBMs are under attack they claim innocence and say it's the pharma manufacturers - similarly here the hospital did indeed act in a rational way in their pricing, but that way is only made rational by the broken national system - and if, while an aspirin at a hospital normally costs 100$, at this publicly funded hospital that aspirin cost you 3c[1] then there would probably be outcry by the private hospital that the public healthcare offering is unfairly undercutting prices in a manner that private organization couldn't compete with - you can see this happening right now with the wonderful debate on municipal internet.

1. Insert reasonable cost here, 3c seems much less stupid expensive to me, it's probably still like a 100% markup if buying in bulk but Amazon is willing to give me 100 pills of aspirin for $3.08

A large part of the cost of care is driven by the cost of the providers (mallpraction and other) insurance. Who do you think sets the prices of that?

So, is anybody going to actually answer the questions?

You commented about collections being one step removed in a universal healthcare system, but you can't spot the corruption one step removed in our current system?

The corruption happens around pricing. There should be fee guidelines in place with caps.

There are fee guidelines. The govt sets caps for the folks who get medicare / public aid.

Insurance companies negotiate rates for everyone else. So much so that when my wife was going to get an Iron infusion the doctor couldnt let us pay for it out of pocket ( we were in a hurry to go somewhere and couldnt wait for insurance) we were told we couldnt pay out of pocket unless the insurance company allowed it

Let that sink in... you cant pay for healthcare out of pocket unless your insurance allows it.

Unregulated pricing is not corruption. Words have meaning.

Adding unreasonably priced hidden items to a bill after the procedure is done without any contract in place beforehand is definitely corruption. The only reason they get away with it is because they have state backing, otherwise this system would have gotten outlawed a long time ago, similarly to how car mechanics can't bill you $100k for simple fixes without warning you about the huge cost before they start working.