"Invisible asterisks" captures the reality perfectly. The asterisks are invisible and infinite. I think even Kafka would be horrified.
We've turned medical billing into an impenetrable Byzantine hellscape, and I fear that the only way to fix it would be to nuke it from orbit and start over.
People complain that all the people in private insurance will be put out of their jobs - I view that as a feature, not a bug.
They sent me a bill for $350 then I called up to complain and suddenly the bill goes away because it’s billed to my other insurance that I didn’t even think I had anymore.
If I sent a client a random bill for $$$ things would not go nearly as nicely, but they have so captured the regulators and politicians that this is the world we live in now.
I want nothing to do with many of the policies of the left, but this would make things so much easier for small businesses and people Changing jobs in the labor market.
A primary breadwinner should carry at least 10x his family's annual living expenses in term life insurance coverage.
Once the size of his retirement accounts exceeds this, he can start thinking about reducing the insurance.
Both will pay directly to beneficiaries in the event of his death.
The only real benefit of having "insurance" in the US is having reasonable access to basic preventative care. Don't get me wrong, it is a massive advantage to have default access to basic preventative care (without it being a cost-benefit tradeoff each time), but that is in no way/shape/form "insurance" in the typical meaning of the term.
It's terrible that these things happen at all, and we CERTAINLY need to improve the US healthcare system, but exaggerations like "the only benefit of insurance in the US is access to preventative care" doesn't help. If people were regularly getting fucked like that the system wouldn't have the entrenched support it does from the "but I want to keep my insurance" camp, and so speaking in generalities like that just makes you appear uninformed to the millions who regularly see doctors, get treatment, have surgery, etc, without these problems.
It also cheapens the inequality problem: the gap isn't just "has access to preventive care" vs "doesn't have that access." The gap is "has hundreds of thousands of dollars, or even millions, of bills turn into nothing" vs "bankrupt if they seek treatment for any serious problem."
I'm sorry, but I just can't see how this is true. Do you only go to the doctor for a yearly checkup, or something?
I've had "good" coverage (paid for by big employers with cushy all inclusive packages), and I've also had the cheapest option on CA’s exchange, and the only difference was whether I had to pay the receptionist $25 or $150.
The "we won't cover this" and the "surprise, this costs 50x what you were told!" billing nightmare comes six months later. This has happened with every insurer I've ever had.
In my experience it does help to have an HMO. My mom uses Kaiser. So there's none of this in- vs out-of-network. One billing system, one insurance, etc. She has nothing but positive things to say about them. My dad had a similar experience towards the end of his life. He loved 'em. And nobody was left destitute as the result of his medical care.
Lets look at it this way: If that was the true price, what percentage of the US population do you think has the funds to actually pay $420k/year in for medication?
> what percentage of the US population do you think has the funds to actually pay $420k/year in for medication?
Zero, plus or minus. That's why the manufacturers basically give it away to people who can't afford it. Because they can, and it helps them somewhat mitigate the bad PR.
I don’t see how that follows.
The “I’ve got mine” camp doesn’t care that it happens to those other people, and also doesn’t understand that it could happen to them in their old age (or simply after bad luck) because they’ve only made short visits into the system.
Of my different health insurance policies, the longest duration in an ICU that was covered by any of those insurance policies was 60 days. My father was "lucky" in that he was on a subsidized Obamacare policy that "only" charged $350 per month (which was cheaper than my employer's policy) but was FAR superior to any of my employers' health insurance in every aspect.
I'm not sure what point you're trying to make, but it sounds like you're making the claim that people in the US don't regularly end up with massive surprise medical bills? This entire conversation is about action the government is taking because it happens so often.
> "has hundreds of thousands of dollars, or even millions, of bills turn into nothing"
That's not really how that works. It's not like your insurance company is actually paying "millions of dollars", they're paying some level of reasonable negotiated rate. If they actually had to pay "millions of dollars", that's when they claim something is not covered and you get stuck with a bill anyways.
Edit: First quote was just wrong from a bad copy/paste
Wouldn't it be better if you went to the hospital, gave them your insurance information, and that's the last you ever were involved with anything regarding payment? Isn't that one of the reasons we have insurance?
What insurance do you have where the cost of the annual premium is less than what the out of pocket costs would be for annual checkups for the covered individuals?
I have the cheapest insurance I can get. Yes, it pays for basic preventative care (basically a checkup per person per year), and it also costs more than my mortgage.
There are plenty of medical practices and institutions that function well and deliver good value to the patient. But there are many that do not.
As someone who doesn't have friends inside the health care industry, it can be extremely difficult to figure out what to do in an emergency. Quite often your options are limited especially if you are caring for a loved one rather than yourself.
The best advice I can give is to find good doctors before you need them, and when conversations come up about someone else's medical care, be willing to ask, who is your doctor and how good are they? Or, which hospital did you go to, and do you feel you had a good experience?
Often there is little out-of-pocket difference between the cost of excellent medical care and lower quality care, if you have good insurance.
If you don't have good insurance and you are looking at a potentially significant medical procedure, ask to speak to someone about financial assistance. Good practices and good hospital systems are not looking to bankrupt their patients.
most US doctors are part of a bigger group in order to provide more comprehensive coverage (and due to systematic buyouts), which in turn have preferred insurance providers and additional out-of-network providers, and emergency services are generally for wherever an ambulance takes you. your physician may be great, but they are just a tiny cog in a broken machine
one of the only outs, afaict, is something like working & living near a big & strong HMO like kaiser. but that comes at the cost of pretty firm boundaries on what services they allow: capped care
(my SO is also a physician at one of the nation's best hospitals, and despite that, patients struggle w the broader system outside of her practical daily control)
People also want cutting edge care from some of the smartest and most highly educated people in the world (which is in short supply) for cheap.
Actually, people just want someone to help them with their health issues and not treat them like shit.
Sure, I guess you could find people with the above attitude, but it's mostly a straw man you are using to deflect responsibility from the health industry.
Perhaps what we need is something like the WTO's most-favored-nation rule for domestic insurers, but imposed statutorily. If you're treating an out-of-network patient extemporaneously, you can only charge that person's insurer at the lowest rate you'd charge an in-network provider.
This would remove the incentive for out-of-network providers to eagerly provide many services. That has its own downsides, of course, but it might help to resolve many of these billing nightmares.
But, heck, maybe something like that already exists. Obamacare (aka ACA) comprehensively thought through many of these dilemmas. But enforcement has been gutted by the GOP.
As far as whether facilities could be "nicer", I mean... maybe? I actually kind of prefer healthcare to be like schools in this way— if I don't think it's nice enough for me, then I need to lobby the province to collect more taxes and make it nicer for everyone rather than just taking my dollars elsewhere.
And that doesn't even address the whole billing-surprise angle. I would happily wait forever if the alternative was not knowing if I was going to randomly be stuck with a $10M bill.
To be fair, Americans have a very low standard for “functioning healthcare system” due to the American healthcare system.
I also do not buy that doctors do not know which code will be used. I don’t care if the doctor themself does not know, surely someone that works with them knows and can provide it.
It should be dead simple to go to a doctor’s website and find the codes for routine procedure that they will bill. If something in the visit happens outside of that, the doctor can feel free to say that is outside of the scope of the visit, just like a mechanic can tell me he will not fix the transmission if I am in for a brake job.
And no one can really afford that, but instead of spreading the costs around to all taxpayers, we were spreading it around by inflating everything else. ACA helps with this, but today’s announcement about out of network care will help more too.
That can't be true, everyone knows that people are only greedy and stupid, and it's really the citizens' fault for the prices of the current healthcare setup. The industry itself is all made up of kind-hearted super heroes who would never think of manipulating prices to syphon more money from patients.
I would also point to the unnecessarily arduous and lengthy process of becoming a doctor in the US as one of the US system’s problems.
If I’m going to be asked to sacrifice all of my 20s and maybe early 30s and worked on 24 hour shifts during the prime of my life, I am also going to be making sure I get paid a ton for it. Otherwise, I would choose a different career.
I know a lot of doctors that advise their kids to not pursue medicine even if they want to do it, simply because the cost benefit is not worth it anymore (if you have other options).
I recently had a family member get surgery for a life threatening condition where a cutting edge treatment greatly reduces complications. The equipment only exists in a small number of hospitals on the planet and their normal hospital, which wasn’t even a particularly fancy US hospital, had one. It's probably not an issue for small and rich countries though. Probably more-so for medium income countries.
https://en.wikipedia.org/wiki/Filial_responsibility_laws?wpr...
It sounds like a good startup. Do background checks on homeless people, see if they have any living relatives, and if so you can house them in a nursing home and charge the relatives.
Are they fair? I mean ... sometimes? These laws (supposedly) solved a problem where parents would bequeath their estate to their children prior the parents' death and, then, the children would leave their parents destitute. It's not clear how much of a problem this really was (think "19th century); it was probably just a popular image that politicians used as a talking point?
My suspicion is you'd need to use jury nullification to make the law "go away".
That is literally inheriting debt. That should be illegal, yet almost half the country allows this.
This reminds me of tobacco tax to pay for children’s healthcare initiative. As if the responsibility sits directly with cigarette smokers. It sits on all of us, not one person. Impoverished elderly people that need medical care should receive aid from the state indiscriminately where we all foot the bill.
https://www.medicaidplanningassistance.org/medicaid-look-bac...
Transferring assets isn't crazy but you do need to be careful if you want to do it in a non-taxable manner (you can't just give your kid $500k cash without them counting it as income).
I think it's worth noting that while this may be true if you're dead, it's not the case when you're still alive.[1]
Filial responsibility laws mean that adult children can be legally required to pay their impoverished parents' medical bills. The above cites a case where a man was required by the courts to pay $93,000 for his mother's rehabilitation.[2] From what I've read, Pennsylvania may be particularly onerous compared to other states, but it's not a slam dunk kids won't be on the hook.
[1]: https://en.wikipedia.org/wiki/Filial_responsibility_laws
[2]: https://abcnews.go.com/Business/pennsylvania-son-stuck-moms-...
More info is here:
https://www.nolo.com/legal-encyclopedia/your-obligation-pay-...
Because Wikipedia only talks about their existence, not a discussion of them.
I have to imagine that it's pretty rare, and I don't think it's appropriate to generalize from what appears to be a pretty sensationalist case. I expect the laws are usually structured to ensure that children don't fleece their parents out of money and turn them effectively into wards of the state, etc. It doesn't seem unreasonable to me that states would encourage families to take care of each other, though PA seems a bit of an outlier in this regard.
Typically when it's used it's to recover money in cases of fraud. For example, where the parent or child conspires to hide money from the state to avoid paying for care. To the best of my knowledge, PA is one of the only states that allows private entities to sue. Some states are like Ohio where it's a criminal statute, so only the state has standing to bring charges. All said, don't get legal advice on the internet, this is an armchair discussion by laypeople.
As an aside, I don't see why the children should have any specific burden to take care of their parents medical expenses now that we have Medicare and Social Security. We've decided it's better to have all of society to take care of our elderly rather than tie it to their children's ability to pay.
Pennsylvania has filial support laws which mean that children can be held directly responsible for the medical expenses of their parents. This requires that Pennsylvania have jurisdiction over the children, of course.
France: https://fr.wikipedia.org/wiki/Obligation_alimentaire_en_Fran...
Germany: https://de.wikipedia.org/wiki/Elternunterhalt
Asia has a ton, I'm sure.
The parent does not need to live in PA at all, but a suit needs to be brought against the defendant to make them pay, and therefore the court needs to have jurisdiction over that person in order for the lawsuit to succeed.
And if they do that well enough to have you make a payment, most legal systems will consider that acceptance of full financial responsibility on your part.
Hospital billing practice are pretty horrible. If a more compliant person had received this bill, they might have paid it, even though there is no way it was legit.
A parent’s debts cannot be put on to their children. Once your father died, anything not covered by his estate had to be written off by everyone.
Parents, talk to an attorney while you're healthy. Some of the states have rules that will surprise you.
So I immediately imagine an absurd nonsense like "liquid gold transfusion", then I realized it's 800g gold per day in the current gold price.
My pathetic mind can't even imagine the how absurd that is.
EDIT: Some argue here that it'll average out, however at what cost to others? [1]Here's article about African Americans getting limbs amputated as their treatment for diabetes.
[1]https://features.propublica.org/diabetes-amputations/black-a...
Insurance is more effective at dispersing that cost when the pool is larger, so the most effective scenario would be for everyone to pay in via taxes and simply… be covered.
Edit: I don't understand the point you're trying to make with your edit.
How much of that are salaries for underperforming, bloated structures in charge of "management" and billing?
[1]https://www.theglobeandmail.com/life/health-and-fitness/heal...
So during your life - broken bones etc - roughly equal.
But if you are stuck in ICU for a year when 75+ - that's uniquely American and incredibly expensive.
"Numerous articles on EOL costs show that a large proportion of Medicare expenditures occur during the last 6 months of life.1-9 This phenomenon has continued for many years as the number of Medicare decedents has increased with the aging American population. Medicare expenditures for EOL have increased dramatically from 1983 to 2016, primarily because of the increase in the number of decedents. Other articles compare EOL expenditures in the United States to other countries10,11 or focus on Medicare expenditures for specific diseases.12-14 A recent development in the literature challenges the idea that EOL costs are responsible for a high percentage of health-care costs.15
This study suggests that your interpretation is not correct: https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0174 Mean end of life spending is only marginally higher in the U.S. than in other countries.
I've also heard that something like 5% of folks generate 50% of costs.
So the argument has been that because in the US total expenditure can go so high (ie, we will easily spend $10M on one person where other countries won't) that you end up with a serious spike as a result of last year of life and extraordinary effort costs.
Other countries have less variance (including income inequality)
Extrapolated cost for Canada: 6,758.2
[1]https://www.longwoods.com/content/20878/healthcare-quarterly...
In any case, it's not the correct number. Quebec data from the study I cited showed 60k per capita on hospital alone, with incomplete data to characterize the remainder of the costs.
Assuming nothing else changes, it'll about double the cost of what people pay now for private insurance (in terms of taxes).
However, there's no reason to assume nothing else changes. The US spends an atrocious amount on the overhead of bookkeeping our "free-market" semi-adversarial healthcare system. Estimates over the past 22 years range from 13 to 25% of the cost is raw administration. Assume most of that cost goes away (let's say 90%, which seems fair) and you're left with Americans paying about $250-400 a month more on average in taxes for healthcare than what is paid now.
Since it's taxes, the progressive tax rate would kick in and this would translate overall to most Americans paying almost nothing more, the middle class getting squeezed (this could be ameliorated with laws, but if nothing else changes the middle class gets squeezed), and the wealthy and super-wealthy shouldering the bulk of the cost.
Problems are often not addressed in a reasonable time frame because many people don't have access to reasonable health care. Even they they do, they may be hesitate to use it. Anecdotally, last time I went for a preventative check, I was given an FAQ sheet when I signed in reminding me that if I ask about anything specific, or diagnostic, that is not preventative (as if I'm supposed to understand the difference), then it would have to be billed separately and may-or-may-not be covered by my insurance. That was almost enough for me to not ask my doctor questions while I was at the office.
I would imagine that more widely addressing issues early on before they become expensive would remove another large portion of overall US healthcare costs.
My father passed away before making it home, but when all was said and done, insurance was billed $10 million in total, of which the various doctors and hospitals billed the estate $2 million. My dad didn’t have an estate because he had no assets. But imagine your life + childrens’ lives being ruined for having insurance yet filled with invisible asterisks.
At the time, NJ laws were onerous in this regard and favored insurance companies so we had no recourse. The state had a process for dealing with issues like this, but it was more of a cursory “jobs done here boss” type process and didn’t provide consumers with relief. Because of that, I moved my family out of NJ. When all contingency plans are filled with asterisks, do you really have insurance/protection?