This madness has to end and I don't give a shit that we are trying Single Payer. Everyone talks about Cost but what about Administrative issues ? Fighting incorrect claims, billing errors and what not. As far as I am concerned, this is one area where I am totally against Profit making motive. Let me correct myself. I am totally ok with Doctors and Hospitals directly making some profit but not insurance companies. Private insurance companies can go suck it. I am sick and tired of paying for their profits. Status quo has to change, that's it.

EDIT: I am not against Insurance of some sort but they should only exist for Catastrophic illnesses. I need to go see my doctor for preventive care ? No need to involve Insurance company and wasting time on filing a claim that by definition requires more money to pay for the people involved unnecessarily.

My SO has a condition that requires a pill to help out with. My SO has some trouble working regular hours due to this condition and takes one pill per day. Depending on the insurance, we have paid between $1 and $5 per pill in the past. This particular chemical is a part of horse feed. Like, how we just put Vitamin D in Milk, or Iodine in Salt; they put this chemical in horse feed. It does not change the cost of the horse feed appreciably, just like with human additives.

I was once offered a job. When we dug into the insurance that the job had, it would have cost us ~$100 per pill, or ~$3k/mo. It was an otherwise dream job, perfect for me. But a ~$36k/year increase in our yearly cost of living. We had to turn the job down, of course.

For a substance that they put in horse feed for basically free.

The last time that I posted this issue on HN, a VERY kind person pointed me to a way to buy this chemical online and in bulk. It comes to your door in volumes of about ~$100 per CUBIC METER. They ship by volume, not weight.

US Healthcare is totally, completely, utterly, broken.

https://www.youtube.com/watch?v=7Z2XRg3dy9k

~ the 7 minute mark

It’s reasonably common to have private healthcare insurance for unexpected events even in places with national health services. I’ve had it variously through work, unions and now as a private individual. Typically you want it to make up the difference between the level of provided state support and what you’d lose by not working.

Personally I’d rather than private insurance and healthcare industry wasn’t necessary but the American debate seems polarised into either/or rather than realising that it’s very common for private healthcare to coexist and be part of nationalised healthcare systems.

Of course it's probably better to start at utopia and get semi-utopia than start at the public option and only get the public option.

I can see maybe something bigger to cover things like maybe subsidies for fertility which my wife's really concerned about - because there's a LOT of emotional depression related to that, and maybe even adoption which sort of ties into fertility.

Though, I'd definitely be happy w/ lesser I mean what we have now is murderous.

And that happens all over the country. Not everyone has my time to call, write and complain. Those are the moments I am ready to change the system. It is not really working for me. It is merely acceptable to a few.

That is nuts. The fact that a consultant with expertise in this “skill” exists and is required is also a sign of a supremely broken system.

I give you though that at least it is one set of admin rules than N.. which might be better.

But the fact that the people with money and good insurance are suffering from the system as well as the poor seems to be lost on Democrats, and the Republicans are just paralyzed by the whole idea of fixing health care. It's a massive political failure for both parties.

Thank you for saying that. I am amazed at how so many people don't see and understand this. It is not just about Cost which is insane alright. It is about the BS we have to go through after a visit to a doctor or hospital. I am scared about the type of bills and claim fights I have to do if I visit a doc. Not because I cannot afford it necessarily. But because I have to spend may be like 5 hours calling doctor's offices, insurance admins, billing departments and what not.

Regular rank and file workers use to have HMOs but those plans have given way to HSAs and PPOs. PPOs were advertised as doctor choice but that's really misleading, all they really do is increase your out of pocket. For a condition that can't be handled in network within a reasonable distance of your house then the HMO insurer has to allow out of network access. HSAs are a great deal if you don't get sick, are rich or can put money in them... but if you need health care they aren't so good since the out of pocket is high.

If we don't get a public option or Medicare for all then I think HSAs will be the future, basically pushing insurance as catastrophic care with some legally mandated primary care covered by default (with a copay).

At least with a $25k deductible you generally won't go bankrupt and you just have to imagine paying off that imaginary new car for 5 years.

In practice, it was less expensive out of pocket for the intensive surgery (a bit over $1000) than it was two months ago for the low-intensity local anesthesia surgery ($1300), even though the initial bill was over twice as high.

At any rate, because of my chronic condition, I'm very sensitive to costs. I'll take the good insurance, thank you!

For my condition that requires regular surgeries (like 3x/year), there are two levels of surgery - one local anesthetic, one general anesthetic. The first time I got the general one done, the bill to my insurance was $35k. This time, with the new insurance, the bill was $19k. So I think the PPO relationship is making a huge difference in how the internal billing works.

At a higher level, the full hospital general anesthetic surgery in January on new insurance cost me less out of pocket than the much less complex local anesthetic surgery cost me in December, on previous insurance.

I was very careful. The doctor was in network, the hospital was in network, and my copay was, I believe, $30 for each visit, covered under my insurance. One day I showed up for my appointment, they led me to a room where I waited 10 minutes. Then the doctor came in, and it wasn't the guy I had been seeing for the last three months. He told me my doctor had taken ill and he was covering the appointments. He asked me how I was doing, and had the nurse redo the dressing on the wound vac. Then we were done.

A month later I received a bill from this doctor for $1900 because he was out-of-network, and while my insurance covered out of network at 80%, they covered it at 80% of the in-network rate. The doctor billed out of network patients at about twice the negotiated in-network rate (a fairly common occurrence), so the 80% coverage was actually 40% coverage, and I owed the other 60% which came to about $1900 for 5 minutes of work (the nurse who changed the dressing worked for the hospital so her work and materials were covered in network.) And the kicker was that I didn't know a different doctor was going to be attending me until he walked in the door.

If you think that maybe your "max out of pocket" will save you, it won't. If the insurance lists a "out of network max out of pocket" it only covers expenses at a negotiated in network rate. Any amount your out-of-network doctor bills that is over the insurance company's in network rate is effectively unlimited. Despite having a $2500 in network max, ad a $5000 out of network max, and a very good health plan. I left that accident with about $35k in medical debt.

(An interesting side note, when it came time to remove the hardware, I went back to the same hospital/trauma center and doctor who had installed it--though a different hospital from above. A day before the surgery I went to the hospital for the pre-op stuff. At the end of the process, the hospital admin met with me to take my payment. I was expecting a $30 copay or similar, but I found out that while the hospital was in network six months before, they had dropped their contract with my insurance company a month prior and the pre-op was going to cost me $800. So of course I cancelled the surgery, but I was still on the hook for the pre-op work. Today every time I visit a medical professional of any kind, no matter how many times I've visited them before, I ask about in network coverage.)

can you think of any other role where a professional interfacing directly with customers wouldn't be expected to at least estimate how much the service will cost them?

However, a car body shop can estimate how much it will cost to fix up my vehicle after a collision with a deer. Those professionals can provide an estimate based on the amount of effort and materials they believe are required. But they don't sit there and try and tell me how much my insurance will pay and how much I will have to pay out of pocket or if my insurance will cover any of the bill.

Obviously in the situation above, time isn't of the essence as much as it might potentially be for a medical issue.

Knowing the "hourly" rates and what treatments may be needed can allow a doctor to estimate the total cost range from a low end to the high end (might be $200 for simple diagnostic and we find nothing more to treat to $2,000,000 if as we progress done the rabbit trail we find evidence that leads up to more tests and it turns out to be cancer). Medical issues are like software development. You don't know what you don't know so God only knows how much effort (cost) will be involved. We can give estimates but the doctor and the software developer shouldn't be trying to figure out if the work involved is covered by external requirements (what and how much will medical insurance cover or does this development qualify for some tax credit or is considered sufficient to fall under some contractual constraint/requirement higher up). Should we expect software developers to know and understand tax laws? Should we expect doctors to know everyone's insurance plans and coverages?

I'll rephrase my statement. medical insurance/billing is too complicated to reasonably expect a doctor or patient to fully understand. this being the case, there should be someone working at the hospital/practice whose job it is to actually understand this shit and give me an estimate at each step of the process. doesn't really fix the underlying problem, but at least then I could make an educated choice between receiving care and being able to afford retirement.

I'd argue though that those best adept at handling the complexity are actually winning in this model. If you are reasonably healthy already and can navigate HDHP/HSA rules, you can have a much higher take-home income + savings than in other countries with government run healthcare systems.

Ironically, the whole point of HDHPs was to put downward pricing pressure on the medical system by encouraging people to price-shop. Alas, due to a variety of market/regulatory factors, that hasn't happened.

We have a pretty pricey insurance plan: family of 4, 36k/year. When my wife had a gall bladder attack and had to get it removed, the insurance company quickly paid the surgeon's bill, and followup doctor visits.

But the insurance company denied the anesthesiologist bill, the hospital surgery room rental bill, and the hospital recovery room bill all as "medically unnecessary", also known as: they won't be covering it.

We tried talking to the original doctor and surgeon but of course they got paid and their offices said the rest of this wasn't their concern. We weren't really sure who we should be talking to to help us show the insurance company that anesthesia is fucking necessary when someone cuts you open.

After about 8 months of stress it was all eventually resolved for a fraction of the original price. In those 8 months though everyone who wasn't getting paid were sending us notices about how we didn't pay yet and how we could set up a payment plan. We talked to hospital billing and they said they usually just drop bills insurance doesn't cover. Usually. And that we shouldn't worry since this happens all the time and that it usually isn't resolved until lawyers get involved.

the usual "gotcha" that people mention is going in for a planned procedure and accidentally receiving care from an out-of-network physician. this makes your out of pocket max irrelevant. I've never had this happen to me and I have no idea how often it actually occurs (outliers are always the loudest on the internet), but it still worries me.

They’ll put a note in your file.

If someone else gets swapped in when your in the table, call back and bitch to them. I’ve had that eliminate the out of network charge.

Is it still a massive pain in the ass we shouldn’t have to deal with? Yes.

I've never been to a doctor without a ridiculous "outlier" scenario following the visit for months.

I broke my nose, was seen within 5 minutes and it was straightened (after anaesthetic).

I got hit by a car on my bike, was seen in 5 minutes, no worries.

Needed and x-ray for my lugs to get residency. Took 10 minutes. Free.

My brother broke his leg horribly. Multiple surgeries, a month in hospital, etc. etc.

There are no bills, just taxes - though it's very manageable.

Don't forget over a months waiting time for a simple antibiotic shot, which my friend died while waiting.

Don't forget, can't see a doctor for two freaking weeks for a simple stomatitis.

Don't forget 3+ months and waiting for a freaking endoscope procedure.

For everyone not in critical situation, your country's health care is shit. Don't even deny that it's fucked up.

Thanks god I moved out of that country after my friend died due to sepsis because of the fucked up system that made him wait months to get his antibiotic shot.

I heard the absolute horror stories, and the opposites, too.

What province/territory/city were you in?

I've only heard stories about how it is in the East, I've never met anyone first hand that has experienced it, or really hates it.

Doctors try hard to not make problem a problem because the system is fucked in a way that doctors benefit from less patients. They don't try to cure. They wrap up the symptom and makes patients think it's a small problem.

Oh yeah, there is a way to be cured without waiting in Canada. When you're on the verge of death.

I despise hypocrites praising health-not-care in Canada. It just makes me sick.

I can't help thinking you over exaggerating the issue to avoid single-payer heathcare in the US at all costs.

Also, I lived in Australia for 23 years. It works great there.

I agree that for those fringe cases, healthcare in the U.S. might be better (Uruguay is also bad with tough to diagnose diseases).

But for 99.99% of the remaining cases, Canadian or Uruguayan health system is way better.

And I think there has to be a way to reconciliate the very good U.S. top of the line healthcare with the way better general healthcare most of the rest of the world has.

My sister lives in San Francisco and there are several benefits I regularly use which you basically can't access in the U.S. except if you're a millionaire - like doctor visiting your house when you're sick, and I mean things like a fever or a flu, and ambulance coverage included in basic healthcare.

Kind of, yes. The vast majority of healthcare spending is, unsurprisingly, on very sick people.

Insurance is for the outlier cost. The difference from other insurances is that almost everyone faces that outlier cost eventually in their lives, assuming they don't get hit by a bus in their 20s.

Interesting. So is it also the case that you can "negotiate" medicine prices? Is the actual price then different from what is on the tag?

This is why California recently made is illegal to provide copay assistance to drugs where generics are available. I have a drug which cost $800/month to the insurance. My copay was $80/month. The manufacturer was so helpful to give me a $75/month copay card to cover this. Around some point the patent expired but the manufacturer continued to give that card out. Eventually the drug became generic and my pharmacy offered the generic version at $10/month. So my copay is higher but insurance cost is much lower. In fact the original manufacturer bugged me to petition the state legislature to change back that law.

I got the CT scan somewhere else.

My dog has a pulmonary condition that requires him to take Sildenafil daily (yes, generic Viagra). We got the prescription filled at a local pharmacy for a 90 count, they charged us something around $280 for. We were not expecting that high of a prescription, for a dog, for a generic medicine. Of course, since this is for a dog, we can't get our human health insurance rate for it, but the pharmacy is operating primarily for humans rather than animals. The person at the counter said that if we look at coupon sites like GoodRx, we might be able to save some money.

A coupon we pulled up on our phone while standing there brought the price down to something below $30 for the same 90 day supply. Roughly 1/10 of the price.

Clearly, the pharmacy must still be making some money even at $30. In what universe is it acceptable to charge a 900% markup above profitability on medicine? Yes, some people use this drug "recreationally", but it's also a lifesaving medicine for other humans and animals. I can't imagine what people must go through that need more expensive medicines for themselves or their families without insurance. And even with insurance, it's not much better.

And that's just one of many anecdotes. I have others, like a relative being charged hundreds of dollars per Tylenol they received while in the hospital, only for insurance to "adjust" that down to something more "reasonable" like a couple of dollars per pill.

This system is broken and needs monumental, uncomfortable, complete and total rebuilding, not repair.

[0] https://en.wikipedia.org/wiki/Pharmacy_benefit_management

[1] https://armandalegshow.com/episode/why-are-drug-prices-so-ra...

The manufacture price is insignificant but the bulk of the price is pinned on other things like R&D and other costs the pharmaceuticals claim. There are costs but there's also a huuuuuuuge profit to be made.

Yeah, so between my employer and I, it is $20k for my HDP for family of 4. Then I sock away the HSA max of $7k every year to pay for the actual costs (including dental, which I don’t have).

If making a better health care system was a problem that everyone else sucked at also then I'd be more inclined to worry that trying to improve ours could make it worse, but with so many good examples--using a variety of different approaches--of how to do it better I'm not worried that trying to fix ours would make it suck even more.

Even if, somehow, we actually do manage to make it suck more we can just try again. Eventually we'll have run out of new ways to suck and will have to stumble onto one of those good approaches that the other first world countries use.

So yes, much of your costs are for possible emergencies and especially as you get older, your costs increase.

Plus they actually did a good job reimbursing me for costs when I had to get care in a non-kaiser state no hassle or haggling.

I think the overall costs are lower for Kaiser, I think I have one of the gold plans and it's only like $20-40 copay for fairly specialist visits and most medicine is really affordable. I pay labs costs and I think looking at bill I remember them being more than the actual Doctor and they seem fairly expensive.

In past years I've found I barely have any costs or recently with a 'high health' year a few of the more rate big costs helped me the out of pocket pretty quick.

Just googling found this: http://info.kaiserpermanente.org/healthplans/colorado/indivi...