Ugh. A similar experience here in some ways; we lost twins at childbirth and had to work through a billing nightmare after spending almost a week at a university hospital that was 2h drive south of our home, hearing optimistic expectations from various doctors and surgeons.
> Medical billing experts who reviewed the case described it as a dispute between a large hospital and a large insurer, with the patient stuck in the middle.
This seems really, REALLY common...an individual ends up soaking up the most bitter aftershocks of a care incident and the accompanying battle between two possibly-responsible parties.
I asked about one of these cases online for a friend at one point, and an insurance industry middle-man chimed in. Not to help out, but simply to become defensive, letting me know that he worked with these cases all the time, and you generally get what you pay for.
So next time pay more for insurance, was his point.
Meanwhile this person's Reddit profile was full of photos of his new Tesla. It made me sick to my stomach to have to tell my friend that yes, somebody replied, and no, it wasn't that helpful, and...let's change the subject for now.
I do feel that insurers get the short-end of the stick. The doctors and hospital are the ones charging $257,000. And they're also driving Teslas. I've lost all respect for the hospital system after receiving a $47,000 surprise bill from an ER visit to get a single stitch.
Uh, ouch. I got charged like $80 for two nurses to give me a venesection (half hour blood letting) and supervision, which was fully covered by our public health care system and billed the government directly. Didn’t even have to get a receipt. Australia.
Not as extreme, but I burned my hands on bacon grease a few years back and needed a trip to the ER and some bandages on both hands. When they were signing me out, I asked what care I was supposed to do for the bandages and they said to come back tomorrow and someone could show me.
A few weeks after, it was quite a surprise to receive a not one, but two pricey ER bills!
While the hospital ended up waiving the second visit, I imagine many people either pay it or go into debt especially since it required a couple of hours during business hours to sort out.
How the fuck does a single stitch cost that much money? It's not like the Australian government is paying $47k to hospitals under Medicare. Things just don't cost that much.
This argument makes no sense. Medical bills are the number 1 cause of bankruptcy. Hospitals knowingly employ out-of-network doctors so they can bill patients huge sums directly.
Agreed. This is a case where an unfree market has arrived at the most absurd and circuitous route to everyone getting a slice of the pie. It's crazy that a lot of Americans fight any reform of the insurance industry on the grounds that doing so would constitute socialism or an attack on the free market. What we have right now is the furthest thing from a free market. It's a set of local monopolies fixing prices, and another group (doctors) trying to get paid in a broken system.
Just terrible. There are thousands of similar, less sensational stories generated by the U.S. health system every month. All parties in the system are to blame, as all parties have twisted incentives—profit—when it comes to providing and paying for healthcare. This isn’t news, obviously, and without some kind of legislative sledgehammer that alters the potential earnings of millions of people who are now cogs in this system, the problem will remain intractable.
> legislative sledgehammer that alters the potential earnings of millions of people who are now cogs in this system
Doing this all at once might not be palatable to a lot of people. In reality, boiling the frog slowly may be the better way to go here. Reduce their earnings a fraction each year, over say a 20 year timespan. Decreasing the eligibility age for Medicare each year by a year or so might partly accomplish this.
One shining light in the healthcare world is the Surgery Center of Oklahoma. It's a multi-specialty operation with all prices posted on their website. Pricing is clear and known up-front. The surgeons involved make a profit, and the patients are happy to pay their prices. Physicians own and operate the facility, pricing is transparent and set by the surgeons themselves. People come from all over the world, and the center continues to serve the public year after year.
No, it's not an emergency room or a labor & delivery suite, so it's a it different than the article on this page.
That's incredible. Many people say we need free or heavily subsidized healthcare. I disagree, we need to remove legislation from healthcare entirely and let the free market figure things out.
A true free market is where someone can hold a gun to your head and make you pay them whatever they want, and you gladly do so because you got rid of all the police who could stop them. In a true free market, the guy with the biggest gun and the most money can buy everyone else out, so that he now has a complete monopoly.
You don’t really want a true free market. You want a market with full price transparency. You want a market with lots of competition, and where no one in the market can get an unfair advantage over anyone else. And that only happens if it is a well-regulated market, which is a lot like a well-regulated militia.
I never said I wanted full laissez faire capitalism. I just want the healthcare market to have the same ability to operate in our current "free market" as other private businesses do.
Usually when people say something regarding the "free market" they aren't calling for abolition of the government in it's entirety unless they explicitly mention such, but loosened legislative measures taken on a specific segment of the existing market.
I think Europe does it well. You have two models there: one is subsidized by taxes and the other one is commercial, with either direct access (pay for visit/procedure) or commercial insurance. So basically people have a good choice of options. They can rely only on state healthcare (which is great in some countries and less so in others - but they don't have to pay), or, if they wish to do so, they can also use commercial facilities where any visit/procedure will usually happen quicker.
This system works relatively well and is particularly good in case something goes wrong and you need to spend some substantial time in hospital. And if the worst happens, you get the comfort of knowing that even though your family will lose a part of the income coming from your work, at least they won't end up in huge debts from medical bills.
Only in America, you have no idea what healthcare would cost before entering a hospital. When you go for a car maintenance/repair, they give you an upfront estimate. Nothing when they work on your body. I blame employer coverage that distorts the market.
Universal Health care doesn't ensure you know the price before hand. If anything, it further obscures it because you don't pay, so you NEVER know the cost... but you DO pay, because nothing is free.
Exactly. I would prefer having universal health care for emergencies while letting the market make non-emergency care (especially routine care) cheap and quick.
I will never understand why so many US people want their health system as it is. Maybe it is because of neoliberalism or communism fear propaganda of big money interests idk. I can simply not understand otherwise.
I have long reached the maximum of having to pay near 800€ for public health care in Germany month by month with my salary - it covers me, my wife and two children. I'm well aware that most of the time the money is used for people who pay far less or nothing like retired, students, people with less income or refugees (solidarity it is called). Most of the time until I'm in need treatment myself...
I love to live in a country where nobody goes bancrupt because of a health bill. Where nobody has to live in fear of death if he cannot afford treatment. Where nobody has to choose between money and a dead child or mother.
Don't you see how many social and crime problems come from a missing health system? If I would live in constant fear of death or bancruptcy I might as well easier decide to rob a bank, do cyber crime or kill someone in anger with my gun (only source of fake power in my life) or do some insider trade or whatever. A death threat hanging over you and your family, if you lack financial success, is making you do wrong things (crime) and feel bad things (fear, anger, desperation) leading to undesired behaviour (even more crime, unhealthy life with stress and obesity and much more).
An affordable and solidarity public health system is the foundation for a healthy society and mentally healthier citizens. It has exacly zero to do with communism or socialism, it's an investment in having a better country for everyone.
I think few people want the system as is. It's a combination of a) thinking this doesn't affect you because you have good insurance (until it does, becase something like this happens), b) not realizing just how fucked you are because you don't have insurance but haven't gotten seriously sick yet, and c) simply not realizing things could be different/better.
Particularly for the last point, socialized medicine is often weirdly spun as bureaucrats taking away your freedom of choice and preventing you from getting health care ("death panels" and all that). So people visualize the current fucked-up system, imagine what it would be like if they had even more obstructive bureaucracy dictating whether you're allowed to get surgery and how long you need to wait in line, and often course they think that sounds even worse -- although the reality is that would be better for most people than the status quo of only being able to get surgery if you can afford it, and still risking getting bankrupted in the process.
I hope the US somehow gets over this phase, it would easily be affordable I think. Just a few companies and people would no longer fill their pockets just as much as they do now.
I am not going to try to change your mind, in fact, I largely agree with what you're saying. It's a very complicated and contentious issue in the US.
First, we have a strange relationship with taxes. The highest amounts are paid to the Federal Government (at the nation-level) and as you travel down the chain to state and then local (city/county), less tax money is owed to these places typically. Regardless of where someone sits on the political spectrum, it is widely accepted that the federal government does not efficiently spend the money, with citizens receiving no tangible value. For example, during the pandemic, many people got $1200 stimulus checks and a "good luck" even though taxpayers fork over thousands over the course of their lives. Stuff that actually affects our lives directly is often done at the local level, with roads, for example, funded by a tax on gas in California (and some federal dollars, too).
Given the perception of how grossly incompetent, understaffed, or ill-prepared government offices are to deal with anything, people are not exactly lining up to have such an inefficient system provide them with insurance.
We also have an accessibility problem in that every process that one must initiate to receive most government benefits, is rife with bureaucratic, over-reaching, and easy to mess-up paperwork designed by people who's goal it is to dish out as few benefits as possible.
Having spent a bit of time in Germany myself, it's clear the attitude is different. Germans (and EU citizens) actually receive benefits from the taxes they pay that are both accessible and tangible. Having medical expenses paid by the state via taxation is ultimately what creates a more healthy society.
Second is the fact that we allow large lobbies and organizations (like insurance companies) to influence what legislation gets passed. This is also so far removed from people's every day life that this sort of non-corruption, special-interest sway happens all the time. Insurance companies have a great thing going on for them, imagine being able to charge whatever you want and be wildly inept and unwilling to actually provide services (pay out) when your customer requires it as per the policy you sold them. They fund (behind the scenes) mass-marketing campaigns (yes, instead of paying actual claims) that spread propaganda about how bad healthcare is if left up to the government.
There are other problems, but maybe this helps see why it's such a big social issue here. This is just my take on what I find to be two major ones.
I see your point. It's easy to forget that a single state in the US is as large as an European country. And the federal government is more like our EU Government. Some far more distant institution to my daily life, where I also have some trust issues from time to time and less insight (still I feel like an EU citizen and don't want Germany to disband like some do, don't get me wrong).
Anyways I hope the US society will find a solution that fixes this sad situation. It's sad to hear and see such stories and think about the victims of such political failiure (not that such failure would not happen here too, especially the lobby influence an corruption is a thing in Germany - sometimes it feels like our Country is run mostly by special interest). The US once was such an inspiring country, I really hope you find a way to overcome all this.
As a Canadian, but who's somewhat interested in living in Germany, could you elaborate on how you end up paying anything for public health care? We don't pay anything out of pocket for most things, but we do pay for drugs and dental if we don't have insurance. How does it work?
In Germany there is a term called social insurance mandatory employment. This covers basically every non self employed situation. Where you can live from your capital alone you also do not apply.
At soon as you have an employment you will have to pay a bit up to about 800€ for higher salary levels for public health insurance - half of which you never see in any calculation, payed silently by the employer and the other half reduced from your pay check.
Additionally you pay mandatory retirement insurance, loss of work insurance and old age care taking insurance plus tax. (not sure about translations)
So from 7500€ a month you will end up with about 4900€ after all this, if you are married otherwise you pay a bit more tax. If you cannot find work and cannot pay you have all the same benefits, except the retirement will be minimal.
To sum up have social security with this. Every treatment is payed (sometimes you have to pay a little in top, let's say you want plastic instead of metal teeth fixes, basically for everything not mandatory in the eyes of the doctor you have do pay the difference).
But mandatory stuff is completely covered, up to brain tumor removal with the particle accelerator in Heidelberg or so.
Some fine print:
If you and your wife work both pay for family insurance (so up to 1600 together if both earn very well). If one works alone and pays there is only one payment.
Actually you can opt out op the public health insurance as soon as you reach the maximum. Then you can opt for a private insurance.
To sum up again: with all this Germany is certainly not the place to become filthy rich by saving money from your income as employee. But for about third of your salary you get a a) good infrastructure (tax), b) mediocre but ok, bancruptcy protected retirement, 3) no need to fear health issues from financial side, d) job loss insurance for a year (pays on about 60% after that social security... much less like a flat for the family and 500€) and e) care of a certain degree when of old age.
Quite a good deal for me. Still it's better to save also several 100k for retirement. To become rich here you need to start a business, be very creative or become a top manager or politican like everywhere else.
P.S. 5AM here sorry for bad grammar, typos and information gaps =)
I remember when I lived in Germany that you were able to choose from different health insurers. I chose Big-Gesundheit . I never really understood the difference between them, but I did use the health system quite a bit : I had several tests done (including endoscopies, colonoscopies, MRI , allergy tests among others) in addition to a stay in the ER (syncope, hit my head and lots of blood everywhere), including an ambulance.
I think at most I had to pay like 200 EUR myself for something after the fact. But overall, the German health system was amazing.
I had similar stories in the NHS which I think is even better. Too bad the UK government is dismantling it.
I also don't understand the difference. Some cost a few 0,1% less, some more. When you try to compare they differ in many tiny things like paying for professional tooth cleaning once a year or paying for a a certain periodic checkup or not etc. Hard to do objective comparison without much work and exacly knowing what you need. I'm still in the one my father decided for the family when I was a kid xD
The problem is that there are many ok solutions and most differ in details that could be worked on incrementally after implementation.
But the problem in the US I think is that the society is so divided that it got stuck and certain powers want it exacly divided like that. With a totally polarized 50/50 population nothing important will ever change, everything is a big circus. I hope the best for the US citizens though. If the US continue their democratic downward spiral this all will end up in an even bigger crisis with even more individuals left behind.
The problem is that the big insurers are some of the most profitable companies ever. Just look at the lists of highest paid CEOs. As long as they can afford the most and best lobbyists nothing will ever change.
True, that's why I am a big fan of "liquid Democracy", there they would have to bribe the people directly, which es ok I think. Look at Island, it's a far superior democracy style opposed to 4 year period representative democracy.
Is this not a capitalist country? There should be multiple competing solutions for everyone to freely choose from. Nothing like this racketeering situation.
There should be, but this is an example of poorly-targeted regulation where (by design) it makes it easier for large incumbents to hire a team of consultants to manage red tape and smaller, leaner, and perhaps smarter players from appearing in the market due to only the made-up problem of compliance.
Large organizations can look out for themselves, Governments, in an ideal world, should entirely exist to serve the people and should also be comprised of them. The problem with elections is that it, by and large, dissuades competent people who would otherwise be good members of government and attracts among the worst kind of person who is hungry for power which lobbies play on to get their way.
but the public option is socialism GASP!! & those death panels. Meanwhile, southern tea-party states have for-profit hospitals actually rationing care because of politically motivated dumb-ass-idness.
I do get your point in seeing regulations and other healthcare BS as racketeering stifling competition.
There isn't much choice right now. Make the wrong choice, e.g. which emergency room, you might have to wrestle with unimaginably huge mystery bills. Again perhaps that's the racketeering you bring up.
But to me, it seems like markets - if we have to concede that language - as huge as nationwide healthcare create way too big of $ barriers for upstarts to try and come in and compete even if we had very low bureaucracy. I personally think a nationalized system is the best solution and I think we can come up with some hybrid Americanizations that introduce more competition within the system.
If the proposed reconciliation passes it gets us closer. just keep expanding medicare/aide until everyone is covered. And they are trying to allow drug price negotiation e.g. competition - which is insane that's not legal right now. Baby steps. But IMHO adding to the albatross costs way more than doing the hard thing of a near complete new system.
Government prevents actual markets in the USA. The closest you get is elective surgeries. Hell, many states won't let you open a new hospital without getting the permission of existing hospitals. Not very capitalist.
The nature of medical emergencies prevents actual markets. If you have a chest pain, that's not the time to be comparison shopping and reading reviews of different hospitals. It's the time to get to the nearest ER while you can. Markets rely on well-informed buyers, which are just not possible in the circumstances.
And what about people who haven't had a compelling reason to maintain a running comparative opinion of their local ERs, simply because they don't have a chronic condition that keeps sending them back to ERs?
OP's point is valid: it's reasonable to expect someone to look up information before deciding on, say, where to eat that evening. It's farcical to expect someone experiencing acute angina or stroke symptoms to inform themselves about their free-market healthcare options by looking up online reviews or whatever for local ERs.
My experience is people know the “good hospitals” and “bad hospitals”, much like they know “good schools” and “bad schools” or even the “good DMVs” and “bad DMVs”.
The problem is most people have no choice.
For ER care individual doctor ratings are unimportant, because you have no idea who the doctor will be.
What matters is the institution. And they absolutely do have reputations.
For example, Kaiser Permenante has a reputation so foul it’s known nationwide, despite only operating a few states.
Also, I’ve never had any difficulty getting an ambulance to take me to the ER of my choice (that is, my insurers choice), and I’ve done this many, many times.
Honestly, I appreciate reading about your experiences, and bottom line, I'm happy that you're able to access medical care.
Your experience hints at some of the flaws in US healthcare:
> For ER care individual doctor ratings are unimportant, because you have no idea who the doctor will be.
Right, and if the ER doctor you happen to draw is out of network for you, RIP your savings and/or credit score. Isn't this a decently common problem, where even an "in-network" institution employs practitioners who are "out of network" for you, so you thought you were covered by your insurance company's rules, only to be surprised days after treatment?
EDIT: this "out-of-network provider at an in-network institution" problem was so common and frustrating that Congress has had to ban the practice, as linked in the article: https://archive.is/50VQv
> take me to the ER of my choice (that is, my insurers choice)
Leaving the choice of ER to one's insurer doesn't sound like my idea of "free market" healthcare. What if they choose your area's "bad" ER? I suppose you can indirectly pre-choose your ER by choosing an insurer which covers the ER of your choice -- that is, unless you get insurance through your employer, in which case I guess you'd have to purchase private coverage for your ER of choice.
Different institutions have different reputations in single-payer publicly funded health systems too, so I'm not so sure if that's the crux of the matter. What upsets me is that those people who are in the most desperate need of healthcare are almost by definition in the worst possible position to make an informed choice. Picture an unconscious victim of an accident, violence, stroke, heart attack, etc. Oh, and it seems generally impossible for even an awake and alert person to "shop around" by comparing price quotes for the healthcare they need, preventing competitive choice.
Then there's the issue that ERs must stabilize and treat anyone who enters, regardless of ability to pay. Someone has to cover the cost of this.
What kind of "market" keeps prices secret from incapacitated consumers? I think MereInterest summed it up perfectly: The nature of medical emergencies prevents actual markets.
And it doesn’t require a free market to refrain from using “bad places.” I avoid the “bad DMV” like the plague - and that’s a branch of the state government.
Regarding free market health care. It can be done - a good example is Canada.
In Canada, health care is free to patients. The state pays doctors directly. The prices are set by the state, so doctors compete on quality/patient preference.
In America, almost all hospitals are nominally nonprofit (religious, university, etc). In Canada they are often for-profit (there are quite a few public ones too.)
Patients can see whoever they want. Good hospitals get patients, bad ones don’t.
Good hospitals make profits, while bad ones don’t.
That seems like a good system to me.
My Canadian relatives love it. The comparison I made is really just me paraphrasing them.
Hrm. You know? I can remember times in .de where public healthcare was really free for everything! Meanwhile we have Zuzahlung/co-pay for more involved dental work and glasses.
Not that I needed it so far, but I get that they can be massive, especially for anything dental. This tends to be funny every few years on routine checkups at the dentist when they try to sell this and that which isn't covered by anything, and I'm like: 'No, just the basics, dammit!'
Yes plastic and gold teeth cost extra if you insist on it for example. There are certainly also problems with special fee medicaments that doctors subscribe because they get a nice business trip to Hawaii in exchange. Not perfect. But still you get basic needs covered in everything, even if it needs brain tumor treatment by Heidelbergs particle accelerator or similar expensive stuff if your doctor sees it as required. And you might pay extra 20€ for extra breakfast or so.
At least it's not going to bankrupt you unexpetedly
If you take quick stock, you'll notice that everything called a "system" is corrupt and absurdly dysfunctional. Then think about other areas of life that don't fall under a "system" and notice how they're not nearly as insane, and we often take them for granted, since they just work.
I lived under this system for 2 years and it was awesome. The lack of paperwork alone was...eye opening. The speed of service was astonishing. All you need is your insurance card (we used Die Teckniker) and you can see most doctors. And the doctors will just do the tests on you themselves, during the visit.
The American system generates a tremendous amount of administrative work, and reduces the quality of care. If you've ever been in a doctors office, or a hospital in the US, they are constantly looking at the paperwork, not at you. Totally different in Germany. (Which was weird because in virtually every other respect Germans seem to love paperwork!)
Like a fish that doesn't know what water feels like, it dawned on me how stressful all that paperwork is, and how much worse it makes you feel, when you are already feeling bad. And of course in the US any contact at all with the healthcare system is not just painful now, it could be painful for years.
The reason we don't change is because people don't know or believe it could be better. And that, in turn, is because some of that huge money flowing through the healthcare system pays the salaries of professional sophists and lawyers who are very good at playing on the intellectual weaknesses of an American audience. They have lots of tools, but the two most effective seem to be an appeal to "American exceptionalism" - if we didn't invent it then its not good - and the classic strawman attack that anything that isn't the current system is communism. A foolish claim that has no merit, not least of which because none of those same people would assert that Germany is communist.
It's a very sad state of affairs. The US is like a mean old grannie being robbed by a handsome and clever son-in-law who plays on her prejudices and ignorance. Even when other family members try to warn her, NO, she snaps, he tells me you are the monsters, and he is handsome and clever and better than you! There is a villain here, but it's hard to have much sympathy for the victim, either.
Many people in the US are still under the mistaken belief that we have "the best healthcare in the world"[1], and the only reason for that is the for-profit "free market". Essentially a blind faith in capitalism married with ignorance of the facts.
> If you can afford it, I'm sure the US offers the best medical treatment in the world
But it doesn't! At least not across the board. Yes, there are diseases and conditions for which the best treatment is given in American health care facilities, but it's not consistent. And certainly not for routine stuff.
The truly wealthy travel to other countries to get treatment if that's where the best specialists work. Among the countries with better options for a variety of things are Canada, Singapore. Singapore, Japan, Spain, United Kingdom (yes, even with the much-disparaged NHS) Dubai, and Israel. Canada for drug and alcohol addiction treatment (the US is still mostly stuck in the addiction-as-moral-failing mode), Japan and Singapore for cancer treatments.
And there's one other thing: it can actually be cheaper to fly to another country, get treated there, and fly back to the US, than to stay in the US and get stuck with a US healthcare bill. And there's nothing the rich love more than keeping their money.
Because I've experienced the USA doing a social health system in the form of Indian Health Service. If the USA is incapable of doing a great job with a small population then applying it to the population as a whole is suicidal. Watch "Don't get sick after June". Other family members have experienced the tender mercies of the VA.
The whole argument that it will be better with everyone is absurd. You cannot point to other countries examples when we know what the US does. If advocates of changes in the current system cannot fix IHS or the VA then they are incapable of fixing the rest of it.
Yes a copy paste solution might not work. My point was more about that everybody must be taken care of, nobody should be in constant fear of death or bancruptcy or having to choose because one, because of health issues. And that is is feasible, because fair public health insurance is applied in so many countries.
The U.S. has capable people. The best academics in the world. It's making me sad to hear stories about citizens in such situations and the seeing other consequences.
I thought about it a few times in my life. This is the number wrong reason to not move to the US. Despite all the chances you have there, you could die or go bancupt because of some fine print in a health insurance contract. Reason number two is I don't want to get shot by some (for other reasons) angry citizen for taking his parking lot accidently or similar...
The US medical system is absolutely broken. Big Medicine has the weight to steamroller individuals, so it does. It's absolutely disgusting.
Other countries don't put up with this shit. Even very small and poor countries have a single-payer medical system with the government underwriting the bills for people who are disadvantaged, thus preventing the ridiculous '$1000 dollars for a bag of salt water' kind of charge.
How come the 'exceptional, indispensable' country, the one that's 'the world's sole superpower' somehow can't afford it?
It can of course, except that Big Medicine wants to have its cake and eat it too.
> Medical billing experts who reviewed the case described it as a dispute between a large hospital and a large insurer, with the patient stuck in the middle.
This seems really, REALLY common...an individual ends up soaking up the most bitter aftershocks of a care incident and the accompanying battle between two possibly-responsible parties.
I asked about one of these cases online for a friend at one point, and an insurance industry middle-man chimed in. Not to help out, but simply to become defensive, letting me know that he worked with these cases all the time, and you generally get what you pay for.
So next time pay more for insurance, was his point.
Meanwhile this person's Reddit profile was full of photos of his new Tesla. It made me sick to my stomach to have to tell my friend that yes, somebody replied, and no, it wasn't that helpful, and...let's change the subject for now.