[HN Gopher] Surgery estimated cost $1,300. Then the Bill Came: $...
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Surgery estimated cost $1,300. Then the Bill Came: $229,000
Author : 8bitsrule
Score : 205 points
Date : 2022-05-21 20:04 UTC (2 hours ago)
(HTM) web link (www.nytimes.com)
(TXT) w3m dump (www.nytimes.com)
| lifeisstillgood wrote:
| Ok this is a silly question but would a simple law that's says
| "you must provide an estimate before any medical procedure and
| cannot charge over that". And these charges must be available on
| your website and fixed for 60 days.
|
| then you might see some competition ?
|
| I mean my NHS - born heart hurts at the idea but still ...
| temp8964 wrote:
| If you read the article, the hospital made a mistake, didn't know
| she's an out-of-network patient, so got the insurance wrong.
|
| If you only read the title, it sounds like the hospital scammed
| her. All the reports on this news sound this way.
|
| The downvotes are crazy. I in no way indicated that the woman
| should pay the full amount because of the hospital's mistake.
|
| Also, if you have an open mind, you could see another
| perspective: her insurance is amazingly good, cutting $23k bill
| to $1.3k.
| LeoNatan25 wrote:
| The hospital making a mistake and then over-billing her is
| scamming her. Made a mistake? Take responsibility.
| temp8964 wrote:
| What's your point against my comment? You think I am the
| lawyer of the hospital or something?
| DangitBobby wrote:
| I should not be held liable for your fuckup. You tell me a
| price, were wrong, and sold me something that inherently
| cannot be returned, you fucked up. Not me. Your money is
| gone. Maybe you should be insured against your own fuckups.
|
| I understand that it being an estimate muddies the waters a
| bit, but if a contractor estimated $2k to do my windows and
| it cost him $200k (somehow??!) any contract that holds me
| liable is clearly unconscionable. I would hold that
| contractor in the same contempt as I do this hospital.
| LeoNatan25 wrote:
| Your comment makes it seem as if the title has been
| editorialized unfairly, when, in fact, it is very apt and
| to the point. Also, your attitude.
| mlyle wrote:
| > If you only read the title, it sounds like the hospital
| scammed her. All the reports on this news sound this way.
|
| Well, personally: if I'm told that something will cost me
| $1300, and then there's a mistake, and they'll actually consult
| a big pile of papers _that I 'm not allowed to see_ to decide
| what to charge me... that sounds like a scam.
|
| With an accurate estimate and correct information about the
| hospital not being in network, she would have chosen a
| different provider for her surgery.
|
| > Also, if you have an open mind, you could see another
| perspective: her insurance is amazingly good, cutting $23k bill
| to $1.3k.
|
| ? Hospital estimated $1300 after her insurance, and provided no
| other info. Then she was billed $229,000. No one cut her bill
| to $1.3k, other than the legal system requiring the hospital to
| honor its original estimate after litigation.
| spywaregorilla wrote:
| One should not need to pay $230k for back surgery regardless of
| circumstances.
| temp8964 wrote:
| What's your point against my comment?
| adra wrote:
| Let's say I bought a server from Dell. They quote me a cost of
| $6000. Maybe they assumed I was part of an MVP program that I
| hadn't been aware of. I have it delivered and installed and
| later the rep invoices me the price at 1 million dollars for
| the server because they made a "mistake" on the discount. I may
| have signed a resale agreement telling them that I'd pay for
| the hardware sent to me, so tell me how this is fair and
| equitable trade practices? It may be viable to ship the server
| back and call the sale a wash, but there's no rolling back
| medical treatment.
| temp8964 wrote:
| What's your point against my comment?
| Closi wrote:
| I'm not OP, their point is that in any other consumer-
| facing industry you can't just give someone an estimate,
| provide zero other guidance on pricing, get them to sign a
| contract that says they have to pay you whatever you want
| (and if they don't sign, they don't get potentially
| lifesaving care), and then after delivery of the
| good/service you then charge an entirely different amount
| which is 200x higher because 'oops yeah our bad we got the
| estimate wrong by a factor of 200 but you have to pay that
| now, tough luck'.
|
| In reality, consumers in the USA seem to have more
| protection buying a can of beans than they do in paying for
| cancer care - but this doesn't have to be the case!
| temp8964 wrote:
| Did you read my comment? Where did I support the
| hospital?
| cmeacham98 wrote:
| I can't tell if you're trolling or being serious?
|
| > If you read the article, the hospital made a mistake,
| didn't know she's an out-of-network patient, so got the
| insurance wrong.
|
| Surely you understand putting this with nothing else next
| to it is making excuses for the hospital and implying the
| patient is in the wrong?
| s0rce wrote:
| The fact that the "chargemaster" (never heard of this) is a
| proprietary trade secret is absurd.
| Threeve303 wrote:
| Imagine going grocery shopping because you need food to live. You
| see the prices posted and you pay at the register. Then a few
| months later Trader Joes sends you a bill for $200,000... The
| entire Health care system is absolutely insane.
| ketanmaheshwari wrote:
| These kind of overly simplified comparisons are tired and
| doesn't help anyone. Healthcare billing is insane yes but is
| not same as buying groceries.
| HFguy wrote:
| But here's the thing...it could be made to be that simple.
| geoduck14 wrote:
| Let me give you a comparison from my personal experience.
|
| My wife was pregnant. The hospital she chose to give birth in
| specialized in giving birth. Our health plan was administered
| by a large company, and was used by over 10k employees at our
| company.
|
| During the pregnancy, I tried multiple times to determine how
| much the pregnancy would cost. Neither the hospital nor the
| insurance could tell me _any_ estimate for the cost. I had
| _no_ way to price shop or save or budget. I was _completely_
| at the whims of the hospital and insurance.
|
| Also. They over charged me for _at least_ one procedure.
| peter422 wrote:
| My wife gave birth at a hospital in our network, but our
| daughter needed ICU care (in their opinion). We were given
| no choice in the matter and our child was taken to the ICU.
| And surprise, surprise, the ICU doctor we had no choice in
| selecting was not in network, and a low 5-figure bill was
| racked up for care we didn't really want and our child
| almost certainly didn't need. Also a very difficult thing
| to fight when you've got a newborn.
| Chris2048 wrote:
| > We were given no choice in the matter
|
| How on earth can they charge you then?!
| spaetzleesser wrote:
| "Also a very difficult thing to fight when you've got a
| newborn"
|
| Same for people with a serious disease like cancer. They
| don't have the energy to spend all their time on
| negotiating with hospitals ind insurance. They either pay
| up or go bankrupt.
| Freak_NL wrote:
| Man, that kind of experience would really make me lose
| faith in society. My wife needed a caesarian and was
| rushed to the operating theatre, but at no point was
| there any thought about cost -- I just trusted that the
| doctors knew their business (and they did). It's so
| completely natural that anything that can happen while
| giving birth is covered by our mandatory healthcare
| insurance that the thought wouldn't cross your mind in
| the Netherlands (and obviously no bill came).
|
| Hospitals and pharmaceutical companies do funny stuff
| with pricing worldwide, but at least patients aren't
| usually bothered with it.
| peter422 wrote:
| Well nobody really has faith in the system to begin with.
|
| We went into the process battling the system and ended it
| battling the system.
|
| The various types of care that were provided were all
| fine and good but the decisions about which care to do,
| who does it and how much it is going to cost leaves a lot
| to be desired. But you know that going in.
| freedom2099 wrote:
| I live in France... my wife is pregnant and the birth will
| cost us nothing! Regardless what might happen.
| onion2k wrote:
| How is it different?
| folkhack wrote:
| If we're to exist in a capitalistic society where healthcare
| has a price tag, then I have a right to see that price and
| have confidence that it won't change arbitrarily.
|
| Due to the abstract nature and infrequent experience of
| healthcare solutions in the US, I believe people need to have
| these abstractions drawn to illustrate the absurdity of it
| all.
| SkeuomorphicBee wrote:
| It is in my country, so why couldn't it be in the USA? Here
| we always know how much I'm going to pay for a procedure
| ahead of time, no surprises, procedures have sticker price
| just like groceries.
|
| - If you have health insurance: you always know ahead of time
| what hospitals are in network, then the price for all out of
| pocket expenses are listed in the contract with the insurance
| company (prices adjusted yearly). You only ever deal with
| your insurer, out of pocket co-pays came in next months bill,
| just like a phone bill or credit card bill , it is actually
| illegal for a doctor or hospital to charge you directly for
| anything in that case. Any dispute (like the one in the
| article) is a business matter between the insurer and the
| hospital, nothing to do with you.
|
| - If you don't have insurance and decide to go for a private
| hospital: the hospital will sell you a fixed price package
| for each procedure or a big package for the whole stay, each
| with a fixed contract signed ahead of time. There is no
| surprises, no one signs a "blank check" to the hospital like
| those "service agreements" in the USA.
| LeoNatan25 wrote:
| In proper, modern countries, healthcare "billing" is simpler
| than paying for groceries.
| [deleted]
| ModernMech wrote:
| It is only insane if you think the purpose of the healthcare
| system is to provide healthcare. A lot of people make that
| mistake. The whole thing makes more sense when you realize the
| purpose of the healthcare system is to generate profits.
| paulgb wrote:
| No, because the entire purpose of grocery stores is also to
| make profits, and yet they price competitively and
| transparently. The problem is that healthcare has senselessly
| been given a long leash to price opaquely in a way that
| doesn't allow price discovery to emerge.
| spaetzleesser wrote:
| The health care system has somehow figured how to get away
| with extremely predatory practices.
| ModernMech wrote:
| > The problem is that healthcare has senselessly been given
| a long leash to price opaquely in a way that doesn't allow
| price discovery to emerge.
|
| Right. Put differently, the healthcare system has been
| smartly given a long leash to price opaquely in a way that
| maximizes profits.
| midasuni wrote:
| There are 200+ healthcare systems in the world.
|
| Are there any nearly as insane as America's?
| peyton wrote:
| Vietnam's is pretty nuts if you want to do some deep reading.
| Hnrobert42 wrote:
| My experience with it has been decent, but I am an expat
| with Western money.
|
| For some stuff like a rabies shot or my girlfriend's oral
| surgery, we used the public system. It was cheap and and
| reasonably efficient.
|
| For everything else, we used a private hospital. It was
| also cheap, and the quality was comparable to the US. E.g.,
| under $500 total for an endoscopy, a sonogram, doctor's
| visits, etc. to diagnose and treat a stomach ulcer.
|
| All of that was in the last 3 years in Ho Chi Minh City.
|
| Now, there certainly are some squalid hospitals, especially
| in the countryside. Further, $500 is a lot of money for
| most VN people. Having written all this, I guess I realize
| all I have are some anecdotes.
| contingencies wrote:
| I had to find a hospital in Haiphong once. Memories of
| limping in to an emergency ward at dawn begging for
| painkillers only to find the beds and floors covered in the
| blood of the last night's patients...
| rdxm wrote:
| mobilio wrote:
| Archive: https://archive.ph/9ezo4
| punnerud wrote:
| I studied in US and one of my classmates from Norway was mildly
| hit by a car when she was biking. Just to be sure she did not
| break the leg she took an x-ray. The bill accidentally was send
| to her address with a request for $8000 (luckily covered by
| insurance).
|
| We almost don't pay anything in Norway in comparison, I think the
| maximum yearly amount is $150 if you have to go a lot to the
| hospital.
|
| I have operated my arms several times after different action
| sports accidents as a child, with no cost (under 18years you
| don't even pay the $150).
|
| Such a peace of mind to know we have good health service if we
| need it. Possible reasons why we kick ass in winter sports?
|
| Healthcare could be better compared to some of the most advanced
| cancer treatments in US, but not sure if most Americans can get
| them?
| spaetzleesser wrote:
| It's hard to understand that the most predatory industry in the
| US is health care and people are OK with it. It's easier to deal
| with loan sharks or used car dealers vs hospitals and health
| insurance.
| DangitBobby wrote:
| I don't think people are okay with it. It seems very likely
| that our politicians are bought and paid for and that's why
| there's no one truly representing the public's interest.
| paulgb wrote:
| I don't understand how hospitals can ever expect a contract with
| such ambiguous terms to be valid. Contract law requires a
| "meeting of the minds" -- if they withhold price information
| until after the service is performed, and the final price is
| orders of magnitude higher than the expectation it's clear that
| hasn't happened.
|
| Contract law is often seen as existing to protect the seller from
| non-payment, but it equally exists to protect the buyer from
| stuff like this, and it's absurd that these companies expect the
| protection of contract law without giving their customers the
| same benefit.
| akomtu wrote:
| It is this reason why I compare the US hospitals to white-shoe
| mexican cartels. The latter use simple intimidation to take what
| they want. Our hospitals identify a potential victim in need who
| needs immediate help, and thus can't negotiate, force you to sign
| a blank check (using verbal intimidation), force you to waive
| your right for protection from racket (binding arbitration), lie
| about costs (they call it a good faith estimate), then estimate
| your net worth and demand half of that. When you refuse, they
| send their white-shoe gangsters (lawyers) and take that half. A
| carnival of greed and moral depravity.
| indymike wrote:
| > A carnival of greed and moral depravity.
|
| This seems to sum up the US healthcare system perfectly.
| DangitBobby wrote:
| > force you to sign a blank check (using verbal intimidation),
|
| Well, in many cases it's more than just verbal intimidation;
| it's threat of imminent physical harm.
|
| You know that you won't get better terms by shopping around,
| either.
| czhu12 wrote:
| Can anyone in healthcare on HN comment on how a surgery could
| cost 229k?
|
| Really curious how that number breaks down in terms of equipment,
| salary, medications, etc.
| ceejayoz wrote:
| It doesn't. Chargemaster rates are meant to be slashed 50-90%
| when they get to the insurance company.
|
| We got a bill for $560 today that $500 worth just...
| disappeared when insurance said "nah", because that's the deal
| the two of them have.
|
| If you don't have insurance, or they pull the "it's not
| covered" you get to fight the hospital yourself.
| x-shadowban wrote:
| It would be nice if this was the public debate we were having.
| Recently they dragged oil company execs in for a light video chat
| based grilling in the house. I would prefer to see the medical
| insurance companies pilloried, but and for those pillorings to
| yield something of substance. I imagine that every minute of talk
| about abortion or immigration has the insurance companies and its
| benefactors thinking "wow, we're still getting away with it!"
| spaetzleesser wrote:
| "I imagine that every minute of talk about abortion or
| immigration has the insurance companies and its benefactors
| thinking "wow, we're still getting away with it!""
|
| That's how the US political system works. We are only allowed
| to debate a small range of issues that don't affect the income
| of the capitalists.
| pcurve wrote:
| In the U.S., insurance would reimburse upwards of $100k to
| hospital for this procedure.
|
| The same procedure in Germany would cost $20-$30k.
|
| I guess that's why some insurance companies are paying for
| medical tourism.
| schappim wrote:
| What would it take to "fix" the US hospital system, and prevent
| others (the UK's NHS, Australia's public hospital's etc), from
| falling into the same trap?
| danielschonfeld wrote:
| What will it finally take to cut this cancer called "healthcare"
| in the United States? There is nothing promoting health or care
| in it
| motohagiography wrote:
| We need a better black market for medical services at least there
| is some honor among gangsters. These hospitals seem to be set up
| to find people in duress and not merely rob them, but loot their
| net worth. It's predation.
|
| Seriously, as a manual skill, how hard are 80% of superficial
| surgeries really compared to learning an instrument or classical
| music, learning to code, baking, cultivating a respectable golf
| handicap, or getting good at a sport? It's hard to reconcile
| stories like this with talking about health care workers as
| heroes, when it sounds like people who work in US health care, if
| they are not themselves, they at least work for someone who they
| know is in fact, dispicable.
| bastawhiz wrote:
| Skilled piercers and body modification artists already perform
| lots of "superficial" cosmetic procedures, sometimes for orders
| of magnitude less than plastic surgeons would (which are, of
| course, not covered by insurance). I've even seen some artists
| correcting procedures that "real" doctors botched and wanted
| even more money to fix--a common one is keloid removal.
| tromp wrote:
| > Before her surgery, Ms. French signed two service agreements
| promising to pay "all charges of the hospital."
|
| > In Centura's view, the service agreements "were unambiguous and
| French's agreement to pay 'all charges' 'could only mean' the
| predetermined rates set by Centura's chargemaster," the court
| said.
|
| > But the court found that Ms. French wasn't responsible for
| paying those rates because she didn't know the chargemaster even
| existed and hadn't agreed to its terms.
|
| > "Indeed, Centura representatives testified that the
| chargemaster was not provided to patients, and in this very
| litigation, Centura refused to produce its chargemaster to
| French, contending that it was proprietary and a trade secret,"
| Justice Richard L. Gabriel wrote.
|
| Beyond ludicrous...
| pevey wrote:
| It's amazing that any of these "agreements" are ever upheld by
| courts. As standard procedure, you have to agree to any and all
| charges, but in most cases they refuse to give any estimate of
| what those charges might be. They are "trade secrets." But if
| you don't agree, you cannot get lifesaving care. It is
| unconscionable. In this case, she is lucky they gave her that
| insurance estimate. Usually they refuse specifically for the
| reason of what happened in this case. They expect you to agree
| to pay whatever they decide later. And people keep trying to
| argue the US has a great healthcare system. It is beyond
| broken. The very rich don't have to worry, the very poor don't
| have to worry. The rest of us can get screwed if we have the
| very bad luck of being US citizens who happen to get sick or
| into an accident.
| user3939382 wrote:
| Totally agree. All these agreements are signed under duress
| and ask the signer to agree to pay an amount while making it
| impossible for the signer to know whether that's possible.
| 88913527 wrote:
| You can always try a different hospital for better service.
| Of course this won't work in situations where timing is
| critical, but most surgery is scheduled. We might as well
| treat it for the business that it is. If they can't give you
| a reasonable estimate up front, then don't sign the
| paperwork. If they care about earning your money they will
| negotiate with you, and it's always better to negotiate terms
| up front proactively than deal with it reactively. The
| strongest power a consumer has is to vote with their money.
| patentatt wrote:
| Maybe in some libertarian dream land only, not in reality.
| You think a hospital will personally negotiate rates ahead
| of time with a single patient? Absolutely fictitious.
| polski-g wrote:
| They could offer a flat rate based on the length of the
| procedure...
| AlotOfReading wrote:
| You can try to comparison shop all you want, but _no_
| hospital will give you details in the chargemaster if they
| aren 't legally obligated to.
|
| Even if you are in a position to shop around, journalists
| have documented their futile attempts to do price
| estimation for routine procedures. Here's one example:
| https://youtu.be/Tct38KwROdw
|
| There have been recent laws that requiring publishing some
| of that information (which are being heavily contested),
| but comparison shopping remains effectively impossible in
| the US.
| Gention wrote:
| You need to wake up and stop accepting this as normal or
| okay.
|
| Hospitals are not just any business and if it starts to
| hurt us as a society we need to interven.
| est31 wrote:
| > If they can't give you a reasonable estimate up front,
| then don't sign the paperwork.
|
| That's the issue, they don't give you estimates that they
| are actually bound by.
| 88913527 wrote:
| And if you're an hour away from being in the operating
| theater, and they have all the specialists there, and in
| that moment you choose not to sign-- it's more their
| problem than yours.
| Chris2048 wrote:
| They'd likely ask you to sign way before that..
| FredPret wrote:
| ...no it isn't? You _need_ to get surgery, they _want_ to
| provide surgery
| crooked-v wrote:
| That's what makes it your problem. They can just say 'no'
| until you sign the document agreeing to pay whatever they
| bill you later.
| OJFord wrote:
| I think GGP commentor typo'd - it says the opposite at
| time of writing.
| BigBubbleButt wrote:
| You're assuming the hospitals don't all do this. You're
| basically discussing market dynamics with a legalized
| cartel.
|
| This is like when people point out problems with fiat
| currency which are very real, and then people suggest
| theoretical solutions from cryptocurrency. It doesn't
| actually help solve the problem in any meaningful way, and
| you are living in an alternate reality from the problem
| space we are discussing.
| 88913527 wrote:
| People say it's impossible to negotiate prices at modern
| grocery chains. They only had brand name lactose
| supplements. The manager gave me a hard time about it, I
| asked about a price matching policy, shrugged, and let me
| pay the generic price. I'm sharing this anecdote because
| I don't think people try hard enough and you might be
| surprised if you do. You won't win every time, but try
| asserting some authority.
|
| By assuming markets are so rigged against you, it
| discourages people from even trying. Price discovery can
| only happen if you attempt to be firm. If you'll roll
| over instantly, then sure, they can do as they wish.
| BigBubbleButt wrote:
| I've had the misfortune of suing insurance companies in
| the past; I'm very aware of how the system works. You are
| technically correct. It's just that you're grossly
| exaggerating exceptions as though they will ever be
| useful to a majority of people.
| toss1 wrote:
| No, you cannot
|
| I have no time to look it up RN, but I read a few years ago
| about a new hospital President/CEO who literally could not
| get a cost/price list for the services their hospital
| provided - obviously a key management data set, yet it did
| not exist.
|
| Just because you think something _SHOULD_ exist, does not
| mean that it does.
| JJMcJ wrote:
| The cost accounting for most hospitals is totally opaque.
| How do you assign overhead to each activity? Does the ER
| make or lose money?
|
| How much of a nurse's time to give patient a Tylenol?
| Zero? Five minutes? And how much does that nurse's time
| actually cost the hospital?
|
| Nobody has the slightest idea.
| bcrosby95 wrote:
| I'm not sure it exists. Every hospital I've ever contacted
| is a complete shitshow and can never accurately tell you
| the price of something ahead of time.
|
| Dealing with our fertility doctor was great though. They
| knew the price of everything. But they were ran out of an
| office, not a hospital.
| pevey wrote:
| It's funny how anything elective or cosmetic is like
| that. To be clear, infertility is a serious medical
| condition, and I'm not making light of it. The
| distinction I'm making is an economic one. When patients
| have more choice as to whether to even be a patient, you
| see much, much more consumer-friendly openness about
| pricing. So it is possible. Fertility treatment is a
| great example. So is elective eye surgery. These areas of
| healthcare are very different from the "sign your life
| away now and we'll send you the bill later" standard of
| most healthcare.
| lstodd wrote:
| This reminds me of the situation with the telecoms in the
| east europe - it's almost the same. There were no
| incumbents, so both internet access and private
| healthcare are leagues above US. It's just not
| comparable. Also include online banking here.
|
| You need stuff done - you go and get it, end of the
| story. No bullshit, no courts, no nothing, and it's
| orders of magnitude cheaper.
| JJMcJ wrote:
| Dentists can usually give precise charges.
|
| Kaiser Permanente usually has a precise copay for just
| about anything they do. So you have a good idea what the
| charges will be going in. And nothing like an extra
| $10,000 because one of the surgical team was "out of
| network".
| johnnyo wrote:
| I tried this exact thing when my wife was going to have a
| baby.
|
| None of the hospitals within 100 miles, the doctors, or the
| the insurance company would give me so much as an estimate,
| and this is for something that they do every day.
| pclmulqdq wrote:
| This whole nonsense with chargemasters is an industry
| standard practice. It's hard to find a hospital that will
| open the book for you.
| chimeracoder wrote:
| > And people keep trying to argue the US has a great
| healthcare system
|
| I've never heard anyone argue that the billing and payment
| aspects of the US healthcare system are great.
|
| I _have_ heard people argue that the quality of care (by
| various metrics) or availability of services are great, but
| that 's a different argument, and not mutually incompatible
| with having a broken payment and billing infrastructure.
|
| > The very rich don't have to worry, the very poor don't have
| to worry.
|
| I'm not sure how you're arriving at the conclusion that "the
| very poor don't have to worry"
| agiamas wrote:
| agreed. You are under huge distress and don't have a viable
| alternative and your life is in danger and you sign what is
| really, a contract to pay with the amount to be paid being
| blank. So essentially and legally speaking, how is this
| different than blackmail?
| SemanticStrengh wrote:
| is there a limit? Can you legally enforce a hidden 1
| billion dollar debt to someone?
| drdec wrote:
| It would be dischargeable in bankruptcy so there is a
| practical limit.
| JJMcJ wrote:
| Usually courts won't uphold "unconscionable" charges.
|
| Charge someone $1 billion to change a tire. Nope, nope,
| nope, as an example.
| prepend wrote:
| > And people keep trying to argue the US has a great
| healthcare system.
|
| I've never heard anyone argue this. The common argument is
| that it really sucks and that proposed changes suck as well.
| So the argument isn't "don't change because it's great." The
| argument is "It's terrible and I'm worried that if you change
| it, it will get worse."
| tomxor wrote:
| I've come across a number of people on HN claiming that
| it's better than health care in other countries, or the EU
| or UK. "other countries" is kind of meaningless, but I'd
| argue it's pretty broken from what I've heard compared to
| the UK, which while far from perfect, serves the majority
| of people pretty well without bankrupting them. The EU
| comprises many countries with varying quality of
| healthcare, but I'd still be less uncomfortable in any EU
| nation compared to the US because of my fear of it being
| driven by corporate incentives, which can cost you more
| than money (i'm sure there are some good counter examples,
| nothing is perfect).
|
| I suspect those making broad claims that US healthcare is
| better are able to pay quarter of a million without
| blinking, and for them perhaps it is better - although they
| still run the risk of unnecessary surgery no matter how
| wealthy.
| emilsedgh wrote:
| Every time the Single Payer option is this discussed, you
| hear people say how care in Canada and UK is broken,
| indicating that it's fine in US, which is not the case.
| bshep wrote:
| I wonder what would happen if a patient swapped the form with
| an identical looking form with different verbiage, making the
| hospital responsible for any overage past what insurance would
| pay.
|
| I very much doubt anyone would catch it until the bill was
| contested later. What would a court say? Would it be as legally
| binding as the standard document?
|
| Edit: Or imagine a disgruntled employee in the copy room
| changing the form?
| b3morales wrote:
| The hospital would most likely have a very easy argument that
| since it's not actually their standard form and you didn't
| tell them about it, they didn't accept the agreement in any
| way. And they'd probably try to get you for fraud as well.
|
| See also https://xkcd.com/1494/
| nrmitchi wrote:
| So I guess the standard "you should have read the terms and
| conditions before you signed the form" only applies in one
| direction eh?
| ajross wrote:
| If you present a contract to the hospital and explain
| that these are your terms, and a reasonably understood
| officer of the business signs it, then sure: they're on
| the hook. Contracts are contracts, and the law gives
| great weight to consent, even in circumstances like this
| where it's not clear a real negotiation happened.
|
| The idea above was about "swapping" some random document
| in for the standard form and presenting it to them as if
| it was their document. That's not good faith negotiation,
| that's just fraud.
| rowanG077 wrote:
| If you gave back a different form and the hospital
| doesn't bother to check it's their fault. Sending back
| amended contracts back to back during negotiations is
| completely normal.
| resoluteteeth wrote:
| There is a difference between informing them you are
| modifying it or sending back a clearly edited version and
| stealthily modifying it in the hopes that they won't
| notice.
|
| I don't think it's going to hold up if you
| surreptitiously modify it in bad faith.
| drdec wrote:
| You don't need the new document to hold up in court, the
| gambit is to deprive them of having your legal agreement.
|
| Granted, a court might still see that as fraud, IANAL.
| ajross wrote:
| And again, refusing to sign a contract while presenting
| to a business _as if you did_ for the purpose of getting
| out of the payment agreement is simply fraud. It 's not
| even arguable.
| kadoban wrote:
| Negotiating the terms of contracts isn't fraud. Neither is
| refusing their insane terms, no matter how "standard" they
| want you to believe they are.
| brazzy wrote:
| Swapping forms in secret is the opposite of negotiating.
| jtc331 wrote:
| It's not secret. This is standard contract negotiation
| (sending along a new draft).
| kadoban wrote:
| That's true. But then again, "sign this or you're dead"
| isn't negotiating either.
|
| The most honest behavior would probably be to mark
| additions or changes on the form they give you, if
| they'll fit.
| ClumsyPilot wrote:
| What do you mean in secret? The person explicitly talks
| about providing the hospital with alternative agreement.
| It is their responsebility to read everything they sign,
| just like it is the patient's
| Chris2048 wrote:
| IF they sign first there's no way to do the switch: the new
| form would be either missing their signature, or be an
| (illegal) modification if original terms.
| TheOtherHobbes wrote:
| IANAL, but I suspect it's deceptive if the changes were
| deliberately hidden and there is no notification of them.
|
| For example - if someone agreed a contract, changes are made,
| and they were pressured to sign without reading the document.
|
| If changes are flagged and/or highlighted it would stand a
| reasonable chance of being valid. Likewise if the patient
| sent a cover email/letter saying "This is _my_ standard
| contract. "
|
| Because these exchanges are bureaucratic, it's quite likely
| the changes wouldn't be noted - or might possibly be
| automated.
|
| It could be argued that's a failure of diligence by the
| hospital rather than fraud.
|
| And it's also clearly unconscionable to expect patients to
| sign a literal blank check with an open amount without
| anything resembling a credible estimate. That's simply
| unenforceable.
|
| All of this underlines why single-payer is the only viable
| system. Without it a few people get extremely rich with huge
| financial and social costs to everyone else - which is not
| freedom, it's forced tribute and subsidy.
| ipython wrote:
| Can't do that at our local hospitals. The forms are all
| computerized and your signature is captured on a small
| tablet.
| est31 wrote:
| What protects you from _them_ swapping the forms then? All
| you gave them was a picture of your signature, they could
| add it to any form they 'd want.
| missedthecue wrote:
| There really isn't anything anyone can preemptively do
| about someone else committing outright fraud. If that's
| their intent, all they need to do is photocopy a paper
| form with your signature on it, and move your signature
| anywhere they want.
| Peku wrote:
| There is a story is someone doing something similar with
| their credit card [1].
|
| Not sure how well something like this would fly in the
| states, but it would be interesting.
|
| [1] https://www.nasdaq.com/articles/updated-russian-man-
| turns-ta...
| Vecr wrote:
| It would have to be signed by both sides to count. I've done
| it before, but you can't just try to sneak things through if
| they don't sign.
| criddell wrote:
| When I was registering as a new patient at a dentist, they
| gave me the standard form that would let them do things
| like contact my employer if I didn't pay my bill on time. I
| stroked a bunch of that stuff out and initialed it.
|
| If it ended up in court and they produced that form, would
| my amendments mean anything? Is it a contract when only one
| part signs it?
| bshep wrote:
| In my experience these forms are only signed by patients,
| so why are they valid in those cases?
| lisper wrote:
| The signatures _per se_ don 't really matter. What
| matters in contract law is if there was an actual
| agreement. The signatures are just evidence that there
| was an actual agreement. They are neither necessary nor
| sufficient. This is why verbal agreements can be binding
| contracts, it's just that these are harder to enforce
| because it's harder to show that a verbal agreement was
| actually entered into.
| DennisP wrote:
| Well if the patient swapped the form, it would be pretty
| clear they didn't actually agree to the terms of the
| original form.
| cperciva wrote:
| And if they swap the form in secret in order to trick
| surgeons into performing an operation which they haven't
| agreed to pay for, it's pretty clear that they're
| committing fraud.
| jtc331 wrote:
| People keep saying "in secret" but that'd only be true if
| it happened after it were filed or some such. Giving
| someone an amended contract isn't fraud.
| cperciva wrote:
| Giving someone an amended contract isn't fraud, no.
| Giving someone an amended contract _while making them
| think it hasn 't been amended_ is a different matter,
| though.
| rowanG077 wrote:
| What do you mean "in secret"? The hospital received the
| form in full detail. There is nothing secret about it.
| It's like claiming the ToS are secret because none reads
| it.
| Chris2048 wrote:
| > contending that it was proprietary and a trade secret
|
| surely once a patient gets a bill (preferably itemized) the
| secret price of something is no longer secret.
|
| Further, what ensures there even is a consistent price if they
| refuse to disclose it?
| ryanSrich wrote:
| There have been lots of discussions lately on various crypto
| scams, but the biggest scam no one wants to fix is the American
| health system. Until you've experienced it yourself it almost
| sounds unbelievable how bad it is. Calling it a scam is an
| understatement.
| Havoc wrote:
| US healthcare is a cruel joke.
|
| You even see this in international coverage - global except for
| US.
|
| Though my current one excludes canada and caribbean too for
| reasons I don't quite understand. Tainted by proximity perhaps
| eecc wrote:
| Ah thankfully it's not a Libertarian world yet, where the State's
| only purpose is to guarantee the rule of law, and the freedom to
| engage in whatever contract.
| wafriedemann wrote:
| "hospital (...) told her she would be personally responsible for
| paying about $1,337"
|
| LUL 1337 scammers
| ed25519FUUU wrote:
| No good precedent set with this case. Hospitals will simply
| update their service terms to be really clear that you're
| agreeing to what the "chargemaster" says you owe. They'll mention
| it like 5 times so they don't lose on these terms again.
|
| Really a shame.
| DangitBobby wrote:
| The judge specifically mentioned that they chargemaster is not
| shared with the patient as a protected trade secret, so I think
| this sets a precedent that you can't be held to terms about
| price if you aren't going to disclose the price.
| upbeat_general wrote:
| These are the extreme cases but this happens all the time,
| including to myself (albeit only for a few hundred dollars).
|
| It's shocking that somehow the system we've come to amounts to
| "we don't know the cost, we'll talk to your insurance after and
| bill you some amount."
| nopenopenopeno wrote:
| It's not that shocking if we take seriously the logical
| conclusions of a society that mediates relations between people
| by way of their relations to capital, i.e. capitalism.
|
| Insofar as the domestic American economy functions as the core
| of a global empire, it is uniquely prone to these seemingly
| nonsensical conclusions. The United States is on its 4th
| generation into being the most unchecked industrial capitalist
| empire in history. I think it would actually be more surprising
| if we had a sensical healthcare system.
| dahfizz wrote:
| When my car breaks, a mechanic can give me a detailed
| estimate which is very close to the final cost every time.
|
| There is no reason inherint to capitalism that healthcare
| couldn't work the same. Every other industry under capitalism
| has sane billing practices.
|
| Regardless, healthcare is far from being an "unchecked" free
| market. The government deals more in healthcare than any
| other market, except maybe student loans.
| dghlsakjg wrote:
| Car mechanics are also bound by estimate accuracy laws in
| many states. If they go over without approval then they
| aren't entitled to more money.
|
| I understand that medicine and mechanics aren't the same
| thing, but I also have gotten elective procedures where the
| cost, down to the penny, was quoted up front.
| BlackjackCF wrote:
| Yeah, it's either that or "we'll cover what we think is a
| _reasonable amount_ for your zip code ". Which is usually
| SEVERELY UNDER the market rate in that area.
|
| As an American, I was shocked when I lived in Ireland and saw
| prices for stuff upfront.
| Fernicia wrote:
| Getting stuff done privately in Ireland is great and fairly
| cheap. But relying on the HSE can leave you waiting years for
| basic treatment.
| throwaway742 wrote:
| Actual quoted cost was 1,337.
|
| Nice.
| PragmaticPulp wrote:
| Some good news: As of 2022, we have a new "No Surprise Billing"
| law that covers many of these surprise billing scenarios. There
| is a specific provision for being charged significantly ($400)
| more than a "good faith estimate"
|
| More detail about the No Surprise Billing law here:
| https://www.cms.gov/newsroom/fact-sheets/no-surprises-unders...
|
| Sadly this case occurred prior to the law going into effect.
| JamesUtah07 wrote:
| I'm worried that the hospital forms will start to include a
| clause to agree to "waive" the affects of this bill
| DangitBobby wrote:
| Seems to me that ultimately this will have little to no effect
| since they gave them an escape route.
|
| > Require that health care providers and facilities give you an
| easy-to-understand notice explaining the applicable billing
| protections, who to contact if you have concerns that a
| provider or facility has violated the protections, and that
| patient consent is required to waive billing protections (i.e.,
| you must receive notice of and consent to being balance billed
| by an out-of-network provider).
|
| All hospitals will simply make you wave your rights as part of
| their onboarding process. These rights need to be something
| that cannot be waived or they actually just add more work for
| hospitals (ie, more cost for patients) and more work for
| patients.
|
| Edit: After further reading, in all emergency care scenarios
| and certain non-emergency care scenarios, they cannot ask you
| to waive these protections. Though, I wonder who gets to decide
| if it was an emergency? Certainly not the patient.
| asperous wrote:
| The disappointing thing to me is all the time spent on this case:
| lawyers, administrators, jury members, and so on that could be
| doing something different, hopefully more meaningful to society.
|
| People blame the hospitals but this the game they have to play in
| order to cover their costs [1]. Just seems like a tremendous
| waste of resources and social cost.
|
| https://truecostofhealthcare.org/hospital_financial_analysis...
| joe_the_user wrote:
| _People blame the hospitals but this the game they have to play
| in order to cover their costs..._
|
| If you do things that literally ruin people's live, I don't
| care if you "have to do it" to keep your business going.
|
| As to lawyers, in a society with money and contracts, these
| exist. What I would hope for would be a statue with in the case
| of the abusive billing, the victim can sue for ten times the
| amount of the bill, just for starters.
| macintux wrote:
| I'd be curious how much money is spent each year on the
| bureaucracy of healthcare, from employees who do little besides
| manage health insurance, insurance company employees, billing
| specialists in medical establishments, etc, etc, etc.
| ktzar wrote:
| Private medical services are a very profitable business for
| certain professions that buzz around doctors and nurses. People
| without knowledge about medicine and whose only interest is a
| private company's benefit.
| PaywallBuster wrote:
| > Hospitals over-bill persistently and excessively to the point
| where hospital billing charges have ceased to have much meaning
| beyond their ability to shock and frighten people. The
|
| > While Medicare and Medicaid control their costs by tying
| their payments to the actual cost of medical services, private
| insurance companies appear to be just paying a fixed percentage
| of what they're billed. That alone gives hospitals a strong
| motivation to inflate their billing charges by more each year
| independent of their costs.
| geoduck14 wrote:
| Medicare isn't that great, too. My wife worked health care
| and Medicare patients were difficult because of the weird
| paperwork
| lr4444lr wrote:
| Very few medical practices or hospitals can survive solely on
| patients paying Medicare rates.
| planetsprite wrote:
| This is true. Capitalism is at it's best when it manageably
| distributes supply and demand forces in a minimal surface,
| maximizing net utility via the price level and transactions.
| It's at its worst when those at one side of the transactions
| (healthcare buyers) are systematically denied information and
| held hostage via contracts.
|
| The American healthcare system operates on this, and it's such
| a valuable tactic that it's worth more to waste resources on
| managing this degree of litigation than just charge reasonable
| amounts.
|
| In more cases on average, the healthcare providers must be
| making a net profit via these tactics, otherwise they wouldn't
| do it. The fact that this tactic is even theoretically
| profitable means the system is fundamentally broken.
| thr0wawayf00 wrote:
| As long as the public isn't interested in seriously considering
| alternative systems like Medicare for All, nothing is going to
| change.
|
| There's a reason that private equity has consumed our
| healthcare sector: it's incredibly lucrative and inherently
| disadvantages both the patient and provider through vast
| amounts of process.
|
| Pretty much every healthcare startup in the US is just trying
| to figure out how to insert itself into this endless
| bureaucracy and draw money out of the system while trying to
| add value in some way.
| gedy wrote:
| Thing is, we didn't have socialized medicine in say the
| 1970s, and I don't remember things being this bad or
| regulated. What happened?
| Epa095 wrote:
| Maybe just "time" happened? It takes time for the rot to
| properly develop.
| pooper wrote:
| >> Thing is, we didn't have socialized medicine in say
| the 1970s, and I don't remember things being this bad or
| regulated. What happened?
|
| Or even more simply, we grew up. I was born in the late
| eighties. I was simply too young to understand that the
| civil war was not about states' rights. It was about
| slavery. I thought adults knew everything and as I became
| an adult I realized I knew nothing.
|
| That or a lot of what was previously swept under the
| carpet or dog whistled is now out in the open.
|
| Back to the topic though, I agree with you Probably the
| easiest explanation is healthcare is now a bigger slice
| of a bigger pie about 20% of a USD 20T GDP iirc. There is
| simply too much money to be made here. There is only so
| much investment opportunity that has any good return so
| smart money will chase anything that resembles guaranteed
| returns.
|
| Thoughts?
| WoahNoun wrote:
| EMTALA was passed under the Reagan administration. This
| forced hospitals to treat the uninsured, but it provided no
| funding to pay for those treatments. So the uninsured who
| don't pay are subsidized by high costs to the insured who
| do pay. In the 1970's, hospitals would just let the
| uninsured die in the parking lot / street.
|
| So that's the change.
|
| https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_a
| n...
| spaetzleesser wrote:
| "This forced hospitals to treat the uninsured, but it
| provided no funding to pay for those treatments. So the
| uninsured who don't pay are subsidized by high costs to
| the insured who do pay. "
|
| They are way overcompensating for this. I think it's just
| a BS excuse like pharmaceuticals having to be
| outrageously expensive in the US because other countries
| are negotiating better prices. I have read some studies
| where they concluded that the losses through uninsured
| people aren't really that high. They are only high on
| paper because they account for them with their
| chargemaster prices which are way higher than what they
| would get from insured people.
| spaetzleesser wrote:
| Greed happened. Hospitals consolidated and bought up small
| practices.
| thr0wawayf00 wrote:
| There are a ton of reasons why, but here are a couple of
| the big ones.
|
| The US is still at the forefront of medical research and
| technology development in the world. However, many other
| countries won't pay "market" rates for newer technology
| developed here at home, so companies often overcharge
| domestically as a way to recoup revenue they can't collect
| in other places. Note that American hospitals (particularly
| newer ones) tend to be obsessed with having state-of-the-
| art technology, and they're damn sure gonna get paid for
| that.
|
| Another major factor driving healthcare costs is the
| increasing barriers to access for millions of people. Lots
| of folks don't realize this, but the US already has a
| quasi-socialized healthcare system mandated through Federal
| law. Basically, it's illegal for hospitals to turn ER
| patients away that cannot prove ability to pay, so folks
| without insurance often come to the ER for routine medical
| treatment because its the only way they can be seen, and
| they know the hospital isn't going to chase them down for
| their bill because they can't pay for it anyway. Who winds
| up eating those extra costs? Folks with insurance. I used
| to work in an ER and I saw this happen all the time.
| joe_the_user wrote:
| The glory days of the semi-welfare state in the US were
| indeed the 1950s-to-mid-1970s. A lot of those were
| regulated monopolies - in the case of health care, Blue
| Shield was a single, private but regulated insurance
| company owned by hospitals (some portion of which weren't
| for-profit). The main way Blue Shield was regulated (and it
| was definitely regulated) was it allowed to maintain
| complete control of the health insurance market, so that it
| operated like "single payer" without officially being
| "socialized medicine". The elimination of this system
| indeed brought us to the disaster that we're looking at
| now.
| kevin_thibedeau wrote:
| Boomers are old enough now to fuel the growth of medical
| profiteering. In the 70's 65+ was 10% of the total
| population and they spent less time in that age bracket
| before death. Now they're 16% and living longer.
| [deleted]
| DennisP wrote:
| There are quite a few countries that do not have single-payer
| and do just fine. According to the book _The Healing of
| America_ , these include France, Germany, and Japan, all of
| which get top-ranked results at much lower cost. The key
| difference is that the government sets the price list for all
| services.
|
| That would be a big change for the US, but not as big as
| nationalizing the entire industry.
| misslibby wrote:
| "doing fine" is a pretty bold claim. I doubt there is a
| healthcare system without issues. Germany is changing a
| lot, and not for the better, because the system was not
| really sustainable as it was.
| DennisP wrote:
| Well ok, "doing among the best in the world, as of the
| book's publication." If our standard is perfection then
| nobody measures up.
| joe_the_user wrote:
| Public support isn't the question. The public does support
| Medicare For All[1] but that doesn't matter given the
| election and decision making process of congress -
| essentially that it's controlled by forces that profit from
| the present system.
|
| https://morningconsult.com/2021/03/24/medicare-for-all-
| publi...
| toomuchtodo wrote:
| This 100%. You have to flush out the reps who won't vote
| for it regardless of constituent support and desire.
| Determine how many you need to replace, identify the
| weakest incumbents/most likely races to win, select
| challengers, fund them, and you hopefully unfuck US
| healthcare in the end. Maybe you need a few candidates to
| pull a "reverse Sinema"; run as a Republican, win, and then
| turncoat and vote for Medicare for All (with the
| understanding you're probably only serving one term, but
| who cares if you get the policy done, 1.8 million voters
| over the age of 55 die every year, you're just pulling
| progress forward with some political sacrifice versus
| waiting for cohort succession). Politics hacking and social
| engineering at its core.
|
| If you're not one to wait, the only other option is moving
| to a better country.
| hemreldop wrote:
| confidantlake wrote:
| Value optional.
| spaetzleesser wrote:
| "As long as the public isn't interested in seriously
| considering alternative systems like Medicare for All,
| nothing is going to change."
|
| I resent the Democrats and Biden for not embracing Medicare
| For All. This would be the most straightforward path to a
| halfway sane system.
| khuey wrote:
| Even if they did completely embrace it it still wouldn't be
| happening. There are plenty of current Democratic Party
| priorities that are dead on arrival in the Senate.
| mikeyouse wrote:
| You can pretend like they're the problem and resent them as
| much as you want but which 10 Republican senators are going
| to vote with the Democrats? It's endlessly frustrating when
| ~48/50 democrats would vote for something and 0/50
| Republicans and people either "both sides" it or
| inexplicably blame the democrats?
| amelius wrote:
| It's a shame that the Hippocratic oath didn't contain the
| sentence "I shall not overcharge my clients or bring them in
| financial jeopardy".
| UnpossibleJim wrote:
| It isn't doctors who do this. Doctors, by and large, would
| love to just treat people. And while doctors do make quite a
| bit compared to other countries [1], the litigious nature of
| the American patient and the high cost of education make
| these wages almost a necessity in order to pay off insurance
| and student loans =[
|
| https://www.investopedia.com/articles/personal-
| finance/08061...
| criddell wrote:
| The AMA is a professional organization for doctors and they
| have opposed all kinds of changes designed to reduce
| medical costs because it would hurt their members' bottom
| line.
|
| The system is a racket and doctors are in on it.
| alamortsubite wrote:
| > The system is a racket and doctors are in on it.
|
| This is a bit much. You're right that the AMA is a big
| part of the problem, but fewer than 1 in 5 U.S. doctors
| are paying AMA members. [1] That's down from about 75% in
| the 1950s.
|
| [1] https://www.physiciansweekly.com/is-the-ama-really-
| the-voice...
| epistasis wrote:
| Doctors are also very self-interested and want to advance
| their careers.
|
| So if the top surgeons at a hospital want the newest, most
| expensive toys, and will leave for another hospital unless
| they get them, it might be that the hospital administrators
| buy unnecessary machines just to keep their best people
| around, at the cost of increased bills for everyone.
|
| In this story, the surgeons may not be explicitly greedy,
| but the system sets them up to cost everyone quite a bit.
| bradleyjg wrote:
| How true is that really? What's the difference in lifetime
| earnings between a UK and US orthopedic surgeon net of
| insurance and loan payments?
|
| My sense is that the difference in pay dwarfs the
| difference in costs.
| bradleyjg wrote:
| Covering their costs is a bs framework. Hospitals are de facto
| partnerships run for the benefit of certain insider employees.
| Their "costs" are whatever the market will bear paid to those
| same employees.
|
| Ditto for universities.
| vinyl7 wrote:
| Universities get away with absurd pricing because the
| government guarantees the loans. If the govt stopped backing
| the loans, the tuition costs would plummet and the govt
| wouldn't need to back them anyway.
| robin_reala wrote:
| They don't have to play this game. For reference, see most
| other countries who have taken the slightly more enlightened
| step of a socialised healthcare system.
| Chris2048 wrote:
| It's kind of useless to say this an not name at least one
| such country. Notably, many of the places with "better"
| healthcare aren't obviously sustainable e.g. France.
| markus_zhang wrote:
| This is the nature of the US society.
| [deleted]
| nobodyandproud wrote:
| Your own link disagrees with your conclusion.
| quadrifoliate wrote:
| The biggest problem here is this "full cost, because it was out-
| of-network" nonsense. I don't understand how healthcare networks
| are legal - they essentially create two separate medical systems,
| one of might not accept your so-called "insurance" at all.
|
| I know that universal coverage is a pipe dream in the US, but
| making these coverage networks illegal and forcing insurers to
| cover procedures at the same rate regardless of network would be
| a good first step. And it _should_ be a bipartisan issue as well,
| somehow I don 't see conservatives clamoring to keep paying
| higher prices for ambiguously defined "networks".
| yes_really wrote:
| The most revolting part of the US medical system IMO is the
| complete lack of transparency in prices.
|
| In the ideal case, people would know what they would pay in each
| hospital when they are still deciding where to go.
| otikik wrote:
| Single player now
| jokoon wrote:
| It still boggles my mind how the US is the "first world power",
| and yet there is so much gun violence, those healthcare problems,
| homelessness, high co2 per capita, obesity, the prison system
| (especially in Louisiana where it's almost still slavery for
| inmates), money in politics, inability to get abortion...
|
| All those issues are usually found in third world of developing
| countries, so I'm often quite confused...
| 22SAS wrote:
| >Obesity
|
| Sadly, in the US, there're obese people who're strongly into
| nonsensical movements like HAES (Healthy At Every Size), fat
| positivity. They think being obese is good, healthy, and doing
| nothing to address is a great thing. If one so happens to tell
| them about the health risks due to obesity, they are termed as
| fatphobic.
| DangitBobby wrote:
| Surpisingly it's easier to just un-learn what you know about
| personal health to protect your self-image than it is to lose
| weight and keep it off. I say this as someone who has lost
| weight and kept it off.
| DangitBobby wrote:
| From the inside, it very much feels like the decline of an
| empire. We're really getting it from all sides, and people just
| in general seem pretty unhinged.
| albertopv wrote:
| There are many things for which I envy USA, health care system is
| not one of them, not at all.
| [deleted]
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