The Future of US Healthcare

[LynnieS]

Originally Posted by ClockWorkAngel

Wait so the doctors will charge you $100 000 for a $900 000 surgery if you don't have insurance. Where did that $800 000 go? I don't think that doctors suddenly decide to starve for a few months when their patients don't have insurance.

In the U.S., medical facilities that participate in Medicare, by law, have to provide emergency care to patients. That includes diagnosis, treatment to stabilize the patient, and transfer to a facility better suited for follow-up care.

Spoiler for Keep things collapsed:

As for the US$800,000 difference in the example, based on my own experience when I was younger and my HMO had denied payment, I was then billed directly by the hospital, and had to pay the difference between the hospital bill and the HMO payment myself. If I didn't, the usual practice by the hospital is to submit the claim to a company that will then pursue me for the money.

In such a case, I have really 2 choices:

1. Work out some way of paying the hospital, which usually involves regular payments (with interest charged).
2. Refuse to pay.

In the 2nd case, the hospital doesn't have much of a choice but eat the cost themselves (unless they really want to push things, which can be bad PR and risk, say, my declaring bankruptcy - and they would then get nothing, I believe).

Hospitals, in the past, had been willing to work with individuals to come up with payment options that fit their budget. From personal experience, they had also discounted some fees, and I would assume that they either (1) ate the costs themselves out of their own budget then or (2) used the profit (if it exists) from the treatment as a cushion. It's pretty much a last resort, though; you usually would have to try and fail everything else first - "everything else" usually means proving that your family can't help, the government (state or federal) help can't be offered 100%, charities and so on. I mean, without a profit, how can they deal with the operating costs of running a hospital? Medicare and such don't pay much these days; even before I had left the U.S., doctors were not taking new patients with just those.

I believe that there were, a few years ago, several articles in the news about U.S. hospitals having gone into substantial debt because of non-payment of emergency care.

The U.S. healthcare system isn't that great, IMHO. It's very much dependent on the insurance industry to "lower" the cost for individuals by pooling their (individually somewhat small) premiums and driving down prices of tests and treatment by (essentially) mass production. A drug that cures 1 person only can be very expensive, but one that can be and is used by 100,000 people becomes cheaper.

Japan's socialized medical plan (assuming that you are enrolled) is better, but OTOH, I haven't gotten into anything more serious than the flu. China's, based on personal observations and IMHO, is quite bad, and demands payment upfront; not sure if China has a "patient-dumping" law like the U.S., though, but nothing I had read seems to show it.

[ClockWorkAngel]

Originally Posted by iLney

@ClockWorkAngel: If I were in the position of the cashier, I wouldn't charge someone that much if I knew he couldn't pay. On the other hand, if I knew you and your insurance company would pay that 900,00$ (and assumed that the conpany would pay most of it), why would I charge you 100,000$? Maybe I was greedy, maybe I hated big, fat insurance companies or maybe I just thought that the extra 800,000$ can be used to help more people without insurance or much poorer? The good (or bad) news is there are more people who has insurance than those who don't, and those who don't would not use the service that often. Plus, there are those who enjoy the Medi status.

It may start out just as 20,000$ instead of 3,000$. Despite that price, someone paid. Then many followed suit. Suddenly the real price became 20,000$. And so on... I don't think a successful insurance company would be as stupid as willing to pay 20,000$ in the beginning.

You're sidestepping the facts. Hospitals don't charge you a lump sum and tell you to pay. Its the total for all of the services and equipment uses. It's not that they charge you $20 000, its the fact that it now COSTS $20 000. They aren't going to alter the price for you or for anyone, stop thinking that hospitals want to screw insurance companies over, they don't care where their money comes from. Hell, if your insurance company doesn't pay out you still gotta pay the remainder or sometimes all of it. I don't think hospitals will say "Well I'm sorry, I guess it now costs $100 000.".

Doctors don't charge using a patient by patient situational charge, its flat. They don't go spiking the price because they don't like you or your insurance company, do you know why? Because its bad PR, it's also fraud, which guess what is punishable by law.

Prices don't inflate when one doctor charges $20,000 for a $3000 service, people go to other doctors then when they know they're getting ripped off. The only time they would increase price was because it costed more, because of new technology, more people on the job etc. Medical regulations in the US maybe are abit laissez-faire but they're not completely worthless.

[Vexx]

I'll just keep noting that iLney is in no position to critique anything because he doesn't understand the current system and shows it in post after post. His tactic of misrepresenting other ideas makes it pretty much worthless to squander a lot of energy speaking to him. So far his only proposal that I can detect is a non-starter both politically and ethically because of the chaos and suffering it would cause. That is a bit of surmise because it is from him pointing to a link; he really hasn't proposed anything explicitly, only attacked others.

[iLney]

Originally Posted by ClockWorkAngel

You're sidestepping the facts. Hospitals don't charge you a lump sum and tell you to pay. Its the total for all of the services and equipment uses. It's not that they charge you $20 000, its the fact that it now COSTS $20 000. They aren't going to alter the price for you or for anyone, stop thinking that hospitals want to screw insurance companies over, they don't care where their money comes from. Hell, if your insurance company doesn't pay out you still gotta pay the remainder or sometimes all of it. I don't think hospitals will say "Well I'm sorry, I guess it now costs $100 000.".

They did this to me, luckily, I have a lawyer . The monetary cost is driven by supply and demand. Hospitals know you will pay and your insurance company will likely to pay. How dare they make such assumption, you ask? Because someone else paid the same for the same service, and whoever it was would gladly use the same service again. The hospitals would probably say "well, tough luck, Will the Medi paid the same" or "Well, see that homeless guy over there?...."

Doctors don't charge using a patient by patient situational charge, its flat. They don't go spiking the price because they don't like you or your insurance company, do you know why? Because its bad PR, it's also fraud, which guess what is punishable by law.

No they don't, but they can discount, can't they? The problem here is, even if you can't pay, others can and is willing to.

Prices don't inflate when one doctor charges $20,000 for a $3000 service, people go to other doctors then when they know they're getting ripped off.

I have no objection. Price inflates because a lot of people are willing to pay. Why they are? Simple: it's not their money.

@Vexx: hey, I didn't attack you. I attacked your ideas. What did I misinterpret? And this is the second time you told people to ignore me.

So far his only proposal that I can detect is a non-starter both politically and ethically because of the chaos and suffering it would cause.

At least, you are honest now. If this is the main grudge, as I expected, against me, why don't you state it in the beginning? I never claim that my proposal able to sooth the situation; I even admitted that it would be disastrous for many, and that is what it takes to solve the problem. It is a valid stance, is it not?

As far as that link goes, I don't know why you detest it that much. It's pretty innocent. I guess the reason it is not favorable here is because it is political incorrect, right? I mean, who dares to mention those two programs and SS.

PS:@ClockWorkAngel: from my personal experience, the way it works is something like this: initially, the hospital charged a very high price which they expected the other party to refuse. Then both parties continue negotiating. However, there emerged some parties who were willing to pay at any price as along as it's not too unreasonable (say 1,000,000 for a band aid). That practice drove up the price significantly. Initially, those hospitals had great margin of profits. However, their suppliers saw this and also wanted a piece of the cake. Thus, everything started to inflate. Of course, the hospital always have profits. But to keep that margin, they have to continuous raise the price. If they don't and others do, they will become significantly less competitive. Now this sounds weird, right? But the fact is that the consumer who started this in the beginning had an enormous demand that no single supplier could satisfy. Other suppliers must constantly upgrade their facilities using the money paid by this consumer.

The problem here is that the demand of this consumers can outgrow the supply. Given that, this big fat consumer somehow has unlimited capacity to pay for the bill, it's obvious that other consumers would suffer.

[ClockWorkAngel]

Originally Posted by iLney

They did this to me, luckily, I have a lawyer . The monetary cost is driven by supply and demand. Hospitals know you will pay and your insurance company will likely to pay. How dare they make such assumption, you ask? Because someone else paid the same for the same service, and whoever it was would gladly use the same service again. The hospitals would probably say "well, tough luck, Will the Medi paid the same" or "Well, see that homeless guy over there?...."

Isn't the fact that you needed a lawyer any sign to you that maybe, just maybe something is possibly wrong? And I might have worded it improperly I should added "it now costs $100 000" it can be interpretted other ways.

No they don't, but they can discount, can't they? The problem here is, even if you can't pay, others can and is willing to.

I'm not in the US so I wouldn't know first hand if discounts are uncommon or not, I'm supposing they're not seeing as people are more than likely have their companies negotiate discounts etc. But others willing to pay isn't my problem, it might be adding to problems later on but it certainly also not helping my problem either. Where are you going with this if you are going with this.

PS:@ClockWorkAngel: from my personal experience, the way it works is something like this: initially, the hospital charged a very high price which they expected the other party to refuse. Then both parties continue negotiating. However, there emerged some parties who were willing to pay at any price as along as it's not too unreasonable (say 1,000,000 for a band aid). That practice drove up the price significantly. Initially, those hospitals had great margin of profits. However, their suppliers saw this and also wanted a piece of the cake. Thus, everything started to inflate. Of course, the hospital always have profits. But to keep that margin, they have to continuous raise the price. If they don't and others do, they will become significantly less competitive. Now this sounds weird, right? But the fact is that the consumer who started this in the beginning had an enormous demand that no single supplier could satisfy. Other suppliers must constantly upgrade their facilities using the money paid by this consumer.

The problem here is that the demand of this consumers can outgrow the supply. Given that, this big fat consumer somehow has unlimited capacity to pay for the bill, it's obvious that other consumers would suffer.

It's quite obvious that the hospitals are going to try to get some money out of their services, they are in the private sector after all. The problem with it is that there's no real initative in the US health system to readily shift the private service of medicine into the public sector, making it cheaper as it'd be government regulated.

A single consumer shouldn't have the ability to force the hand of the rest of the entire population. And I think you're misjudging how much the hospitals are inflating the costs. And actually if they don't raise the prices, they don't become less competitive, they become more so. Because people have the mindset to go to the cheaper hospitals! Suppliers will always raise prices and so will institutions this is mainly because of their additional costs; eg more people cause of expansion, money inflation etc.

[iLney]

Jeez, the mod requested me to stop posting here in order to "allow broader conversation." A valid request, I respect that. Anyway, farewell


Last words @ClockWorkAngel: replace "the customer" by "the government" or "Medicare and Medicaid," you'll see it more clearly. And if you still don't think that such amount of spending has little effects on prices as well as the supply and demand sides of the market, I have nothing more to say. We just think differently

BTW, the first question I was asked by the hospital when I was admitted was "Do you have an insurance?" and the first question my insurance agent asked me (As the hospital was not in their network) was "Did you tell them that you had an insurance?"

[User91411]

I don't live in the US (well duh), but from what I hear, you Yanks are screwed when it comes to healthcare.

[LynnieS]

Well, it's not quite as bad as "screwed"... As long as you have either the cash and/or medical insurance, you can get some of the best care available in the world. I see the problem being:

1. It isn't great for the working poor. Medicare and Medicaid are not bad, but above a certain income threshold (among other limits that can exist), Medicaid is not available. Medicare is also limited to the elderly. It's also not "KISS".

2. It isn't good for someone outside of the "common denominator". Costs are usually driven by the number of patients possible, and is primarily driven by capitalism. If you are sick with something that is rare (but is still curable), the cost can be high; there is just not enough people around whom the cost can be spread.

If you fall outside of the middle areas, you are in trouble if something major happens.

There is that proposal to reform healthcare being hammered out, but the cost will be high. The use of "exchanges" in which people can purchase insurance sounds hard to work with as well. Something like the socialized healthcare would be great, but the costs, money and political, will stop people from doing it for everyone, IMHO.

[WanderingKnight]

As long as you have either the cash and/or medical insurance, you can get some of the best care available in the world.

Yah, and that is the case everywhere 'round the world, my friend. Even in the tiniest poorest countries.

Yet people insist things aren't like that, that there are true, substantial differences of essence between different countries. Every country has poor people, every country has rich people. And in every country, most poor people are screwed. That's a reality of the system, and it's unavoidable.

What we can at least do, if we want to keep on clinging to this unfair system, is try to mitigate at least a little bit these differences. At least to make it so that people get their debt up their asses due to a medical condition they have no responsibility for.

[Anh_Minh]

Originally Posted by WanderingKnight

Yah, and that is the case everywhere 'round the world, my friend. Even in the tiniest poorest countries.

Yet people insist things aren't like that, that there are true, substantial differences of essence between different countries. Every country has poor people, every country has rich people. And in every country, most poor people are screwed. That's a reality of the system, and it's unavoidable.

What we can at least do, if we want to keep on clinging to this unfair system, is try to mitigate at least a little bit these differences. At least to make it so that people get their debt up their asses due to a medical condition they have no responsibility for.

Or, you know, try to be one of those guys with the cash.

What baffles me is all those "poor" (and in the US, poor can be defined as still pretty well off by most standards... including their own. It's easy to lose it all with medical bills there.) who insist they want to be bankrupted and/or die in a ditch.

[WanderingKnight]

Or, you know, try to be one of those guys with the cash.

What for? To perpetuate this unfair, selfdestructing, contradictory system?

I mean, I have no problem with you being for that. As long as you accept that it's an unfair, selfdestructing, contradictory system. Or else you're being either hypocritical or an outright liar (or it could be that you just don't know).

Everyone does that anyways... I'm not saying I'm not like that. But I accept the reality of the system, and at least wish for it to be different.

What baffles me is all those "poor" (and in the US, poor can be defined as still pretty well off by most standards... including their own. It's easy to lose it all with medical bills there.) who insist they want to be bankrupted and/or die in a ditch.

Feedback loop due to lack of education or cultural conjunctures. Sociology's subject of study isn't merely the free will of the people (in fact, I'd say it's exactly the other way around).

And being marginalized goes beyond not being "well off". As I said, there are no substantial differences of essence between the poorest people of the US and the poorest people of Haiti. All it amounts to is to a quantitative difference. Qualitatively, within the context of both societies, it's exactly the same.

[Kamui4356]

Originally Posted by Anh_Minh

Or, you know, try to be one of those guys with the cash.

What baffles me is all those "poor" (and in the US, poor can be defined as still pretty well off by most standards... including their own. It's easy to lose it all with medical bills there.) who insist they want to be bankrupted and/or die in a ditch.

Personally I think there's a few reasons for it. One, it's a relic of the cold war. Since the Soviet Union was "communist" anything communist or socialist was portrayed as evil, while anything capitalist was portrayed as good. As a result, socialist style programs meet a lot more resistance just on the fact that they're socialist, rather than considering if they're a good idea. This also leads to the "free hand of the market will solve everything" thinking. Sure, the free market might be able to produce a cheap TV, but there are other industries that the free market simply doesn't work for. Health insurance is one of them.

Two, there's an idea that anyone can get ahead if they just have the right oppertunity. As such they don't like programs designed to help th poor at tax payer's expense, because that's accepting that they need it and won't get become rich or see it as blocking their chance to make money.

Three, there's always been a strong libertarian trend in the US. Such people basicly see governments as inheirantly oppressive, thus they must be kept as small as possible. Of course those same people seem to overlook the fact that private corporations can be just as oppresive in their drive to maximize profits.

Four, it's because most people get their news from the talking heads on fox and cnn and simply don't bother to look any further than that. They just accept what the media is spoon feeding them as the complete truth.

There are probably a few more reasons too.

[Zippicus]

Originally Posted by Kamui4356

Three, there's always been a strong libertarian trend in the US. Such people basicly see governments as inheirantly oppressive, thus they must be kept as small as possible. Of course those same people seem to overlook the fact that private corporations can be just as oppresive in their drive to maximize profits.

I just wanted to comment on this part. While it's true that private corporations can be oppressive, people can solve that problem by not using their services until they go away. If it's a service people need someone else will step up to deliver it. That approach doesn't work so well with the government.

As a libertarian myself I don't see the government as oppressive, but rather exceeding their responsibilities and sometimes even their capabilities. The biggest problem I have with the government being involved in health care is that it's something that's already too expensive and they're just going to make it worse in that respect due to waste and corruption that always seems to follow government money trails around.

[Anh_Minh]

Originally Posted by WanderingKnight

What for? To perpetuate this unfair, selfdestructing, contradictory system?

I mean, I have no problem with you being for that. As long as you accept that it's an unfair, selfdestructing, contradictory system. Or else you're being either hypocritical or an outright liar (or it could be that you just don't know).

Everyone does that anyways... I'm not saying I'm not like that. But I accept the reality of the system, and at least wish for it to be different.

I'm just saying. You don't have to do anything. If you've got a system, you can try to change it, or you can try to make it work for you. A priori, both approaches are equally rational.

Personally, I'm not rich, and am not likely to ever be. Societal level solidarity's worked for me in the past, and it may do so again in the future. Hopefully not too near future. So I'm generally in favor of it. But if I was made of money, maybe I'd think differently.

Feedback loop due to lack of education or cultural conjunctures. Sociology's subject of study isn't merely the free will of the people (in fact, I'd say it's exactly the other way around).

And being marginalized goes beyond not being "well off". As I said, there are no substantial differences of essence between the poorest people of the US and the poorest people of Haiti. All it amounts to is to a quantitative difference. Qualitatively, within the context of both societies, it's exactly the same.

I'm not sure you see what I was getting at. Or maybe I don't understand you.

In my previous post, I used "poor" as "bankruptable by some ailment that'd be recoverable both medically and financially in a country with working healthcare". In the US, even a short hospital stay isn't trivial, or so I heard. So people who by all right should be considered middle class or more end up paupers because of a single disease or accident.

And yet, you hear those same people, and those even poorer, talk of socialized health care as if it would ruin them all. It's one thing to be a selfish bastard. But to be a selfish bastard while working against your own self-interest? What's up with that?

[Kamui4356]

Originally Posted by Zippicus

I just wanted to comment on this part. While it's true that private corporations can be oppressive, people can solve that problem by not using their services until they go away. If it's a service people need someone else will step up to deliver it. That approach doesn't work so well with the government.

That works fine as long as the scale of business is small. Say there's a small privately owned store that's the only game in town for that product and is over charging the customers. Unless there's some corruption going on, it's not that hard to start your own store offering a competing product. The first store will either have to match your prices, offer a convincing reason why people should pay more for thee stuff sold there, or go out of business. Everyone wins, except the guy that was ripping people off, but if he's smart and adapts, he'll still make out ok too.

The problem is that doesn't work as well as businesses get larger. Larger industries have a much higher cost of entry. If you think health insurance companies are ripping people off and want to start your own, good luck with that. You'll need massive funding just to get on the playing field, and even then you'll likely be absorbed by one of the existing companies. Plus there's the nature of how health insurance is bought. Most times the people don't have a choice on their insurance plans. They get what their company offers. They could try to buy an individual plan, but individual plans are vastly more expensive than the group plans they get through their jobs and may have less coverage on top of that.

As for not using the service, a lot of times there isn't a choice. If it's a service people need and there's a huge cost of entry into the market for new companies, you're pretty much stuck with the existing ones.

As a libertarian myself I don't see the government as oppressive, but rather exceeding their responsibilities and sometimes even their capabilities. The biggest problem I have with the government being involved in health care is that it's something that's already too expensive and they're just going to make it worse in that respect due to waste and corruption that always seems to follow government money trails around.

Yet every other nation with such a system pays less for healthcare. Further the US is by no means at the top of the list for coverage. Right now, under the current private system, we're paying more money for less coverage. Why would the US be more incompetent than other governments here?

[WanderingKnight]

I'm not sure you see what I was getting at. Or maybe I don't understand you.

Forgive me, I was posting half an hour into overtime tired the hell out of my senses, plus the past week's been a bitch at work. I completely misunderstood your post.

As for your other point, well, you have to do something, and whatever you do has a very deep influence from the system that nurtures you, be it interpreted as positive or negative.

[yezhanquan]

From what I can gather, it seems that there are 2 things to do, if you don't want to be screwed by health problems, even sudden ones.

1) Preventive care: Exercise. Don't be overweight (or obese). Cut down on alcohol and tobacco use. Have a healthy diet. It's your body. You, and only you, can enjoy the benefits of a healthy body.

2) Know what your insurance covers. Sit down with someone who understands legal jargon, and look through your current policies, with a microscope if the fine print is that darn small. Know the gaps (if any), and be prepared.

[ClockWorkAngel]

The problem is that often enough you could be healthy enough you cna still attain life threatening diseases, that are often costly and might not be covered. Be it hereditery or for simply having it. There are certain factors you can't control.

My scheme for a system involves every person whom is a citizen and meeting some other credentials (To prevent abuse) to have in their possession an account. Every insurance company and such would be nationalized and combined into a super-organization which is publicly owned. The accounts work like a bank account except money cannot be taken out except to be transferred to other accounts or redeemed with hospitals etc. (Which can be nationalized but may be simply be regulated). Your account starts off with a set amount, and every fiscal year, more money is placed in this account. The money accumulates over time.

This provides a large amount of money for the elderly and people whom are in their later years without as great of a threat of the economy failing because of lack of workers (Because the money isn't forced to suddenly appear, it was already there). Emergency aid is appliable, but all measures would be taken to siphon money from other places, be it from family members, friends and other sources. Alternatively the patient or their guardian(s) may apply for aid directly to the organization. But this would be of course the last choice. Money transfered cannot exceed a percentage or a set amount (Which ever is greater), this is so that accounts cannot be wiped clean and if transfers are made, then the charitable sources still have an amount to take care of themselves.

Money is taken from taxes and the amount is inversely proportional to your wealth; the wealthy pay more etc. The accounts would pay for anything medical, dentist trips, doctor appointments, perscriptions etc. The scheme would be treat first and the organization claims the money. All efforts would be taken to limit or prevent abuse.

But the system has alot of flaws though. The biggest thing that came to me is that it creates alot of beauracracy amongst other things.

[Vexx]

Most people don't actually get any real choice in their insurance plans. Since for some cock-eyed reason we tie it to the employer - the employee gets to choose between what plans the employer could afford its part of. As companies are absorbed by other companies, the benefits usually decay (in order to make their expenditure pay back faster). And of course, if you lose your job and have any sort of chronic condition --- forget any other insurance company picking you up.

You're also likely not to get hired these days if you have a pre-existing condition - the employer doesn't want to get dumped by the carrier.

So you have to wonder who the customer is and what competition is being talked about anyway?

[yezhanquan]

@ClockWorkAngel: Well, yeah, I don't have any solutions for people with exisiting conditions. However, if you're healthy NOW, then look through that policy today and patch the holes, because if tomorrow brings an illness, then you are screwed.