[HN Gopher] Sick and struggling to pay, 100M people in the U.S. ...
___________________________________________________________________
Sick and struggling to pay, 100M people in the U.S. live with
medical debt
Author : pseudolus
Score : 92 points
Date : 2022-06-16 10:37 UTC (12 hours ago)
(HTM) web link (www.npr.org)
(TXT) w3m dump (www.npr.org)
| sirtimbly wrote:
| I hate the way the health-care system works and how it's affected
| me and those close to me. I spent much of my adult life paying
| off medical debt exactly like they describe. Defrayed by parents
| somewhat, but still a significant burden for many years. On one
| hand, we have debt and bankruptcy as a tool to help individuals
| deal with costs that would be impossible to save up for. On the
| other hand, this quote from the article rings true:
|
| > "We have a health care system almost perfectly designed to
| create debt."
|
| This was true before the ACA - and is still true.
| stjohnswarts wrote:
| All the ACA did was help some poorer people with insurance,
| prevent denying accessibility to insurance, and help with
| "kids" up to 26 with insurance.
| bombcar wrote:
| The entirety of the US economy is tuned to create debt;
| healthcare is just one example of it.
| sirtimbly wrote:
| Yes. Debt is the entire story of the American economy, from
| top to bottom, it's not inherently evil. It's useful for
| creating new wealth. But of course it gets misused also.
| p0lp0t wrote:
| jjoonathan wrote:
| Well, yeah -- once you've squeeezed all the money out of poor
| people, how else are you supposed to squeeze even harder?
| bombcar wrote:
| As implied in another comment, the real solution is one
| people don't want to consider - _forbid_ people from taking
| debt on in certain circumstances.
|
| But this immediately appears as "unfair" even if predatory
| lending is a huge problem.
|
| Meanwhile those who already have some money wouldn't be
| affected by it much, for example, a law requiring _all_
| credit cards that charge interest on balances to be secured
| ones (where if you have a $1k credit line you must have $1k
| cash /cash equivalent in the bank).
| [deleted]
| asdffdsa wrote:
| I always figured that the reason why I make as much money as
| possible is so that I can pay for medical expenses when things go
| wrong.
| killjoywashere wrote:
| Unless you make millions, it's unlikely your finances could
| survive an ICU admission.
| avgDev wrote:
| Uncle was in ICU for 2 week before his death with multiple
| organ failure. His stay was more than $350k.
|
| Basically the hospital took the house he worked his whole
| life for.
| dekhn wrote:
| Was your uncle qualified for medicare? We recently had
| several members need end of life care and they didn't have
| to pay any of the hospital bills. Many bills we did
| receive, we called the charging company and they were
| waived immediately "oh I guess we made a $100K mistake" or
| "medicare already reimbursed us, that was just a courtesy
| notice."
| avgDev wrote:
| Honestly, I am not sure. I wasn't well versed in personal
| finance/healthcare/money back then. He destroyed his
| family and his wife left him. His kids don't really want
| to discuss that period of their life at all, so we never
| talk about it.
| Sohcahtoa82 wrote:
| Every time these stories appear on reddit, there's a flood
| of non-Americans appalled at the idea.
|
| They just don't understand the FREEDOM that high health
| care costs provide! /s
| corrral wrote:
| If you're not incredibly rich, you're just temporarily
| holding all your savings & retirement accounts for the
| hospitals and nursing homes that'll eventually take _all_ of
| it. And then some.
| SoftTalker wrote:
| Yep the entire end-of-life industry is incentivized to
| drain all the wealth from the old and terminally ill before
| they die. That is why my plan is to opt out. DNR, living
| will, I will not enter a care facility or hospital I'd
| rather die on my own terms and have my children inherit
| whatever I have managed to accumulate.
| avgDev wrote:
| You can file bankruptcy which will protect your retirement
| accounts. There are other way to protect your assets and
| money as you get older and risk gets higher.
|
| It should not be this way though because mostly the wealthy
| take advantage of protecting their assets as it requires
| some money.
| yalogin wrote:
| Tangential to health care debt, Some times I wonder if the only
| true innovation happens in facilitating debt and making huge debt
| seem like easily tackleable. 30yr mortgage, 15 and 10yr arm, car
| payments sold as "only $199 a month!". Buy now pay later is the
| latest in a long line of these encouraging people to pile on
| debt.
| notch656a wrote:
| Also known as 100M people who may have died without medical care,
| but were provided it despite their inability to pay for it. If
| you remove the ability for medical workers to seek payment for
| their services, most medical workers are just gonna say fuck it
| and not work for free.
|
| Medical care providers have families they have to feed too.
| culopatin wrote:
| Not everything is binary. 10k for an emergency X-ray and
| sitting on a bed for 3hs is very far from not getting paid.
| That gray area in between is what needs to be looked at.
| jasongill wrote:
| Do all of the medical providers in other nations with universal
| healthcare have starving families?
| notch656a wrote:
| The US doesn't have universal healthcare, so there's not a
| great mechanism for health care workers to earn a living
| without charging client for it. Some charities excepted.
| Joeri wrote:
| The money going into medicare is enough to extend coverage
| to all americans provided the system is run with the cost
| efficiency of the typical EU healthcare system.
| notch656a wrote:
| But then people go into debt to pay the tax to pay the
| other guy's medical debt.
| monkey_monkey wrote:
| I'm not entirely sure you understand how taxes work.
| notch656a wrote:
| Yes because no one is in debt as a result of making
| insufficient income after tax deductions, and no one owes
| tax debt.
| mythopedia wrote:
| Well I think that's the entire point of this article: to
| call attention to the overwhelming crisis of medical debt
| in the US, and the need for us to _create_ a great
| mechanism to deal with it.
|
| Just because we don't currently have a functioning
| healthcare system doesn't mean we can't have one ever. As
| more people are made aware of how pervasive the issue is,
| there will be more impetus for those in power to start
| doing something about it.
| lastofus wrote:
| I don't think anyone is suggesting medical providers do not get
| paid.
| kevinventullo wrote:
| Is there evidence that the high cost of healthcare is due to
| paying frontline medical workers?
|
| This is an honest question I don't know the answer to, but
| based on my analogous experience with academia and the high
| cost of tuition, I would guess the answer is "no".
| notch656a wrote:
| I think that's only a fraction. I agree we should eliminate
| licensing and regulations, which in part are responsible for
| burdensome administrative parasites.
| paxys wrote:
| The alternative isn't denying care. It is providing the same
| care _without_ having people get into debt, which every other
| developed country (and a lot of undeveloped countries) in the
| world manages to do.
| [deleted]
| notch656a wrote:
| So just redistributing the cost across the population? I
| think then you just end up with more people in debt, as their
| incomes fall to pay the tax.
| kelseyfrog wrote:
| I think you just end up with less people in debt and
| incomes rise to pay the tax. I guess we'll just have to try
| it out and see.
| namdnay wrote:
| except that you redistribute according to means, seeing as
| tax is correlated to income. so instead of having a random
| dice roll ("ah, you're working multiple low-hour jobs and
| you just got cancer? game over!"), you pay a bit more of
| your income as tax
| alephnan wrote:
| > which every other developed country (and a lot of
| undeveloped countries) in the world manages to do.
|
| Where doctors also make much more modest salaries
| stephen_g wrote:
| Where? Not in my country, they do very well here in the
| public system...
| MisterBastahrd wrote:
| So does everybody else.
| otikik wrote:
| > Where doctors also make much more modest salaries
|
| I would say that they are "less high", but not "modest",
| given that the cost of life is also lower.
|
| Also you have to factor in that they don't have to sell
| their house if they get cancer.
| Sohcahtoa82 wrote:
| The "why are people expecting doctors to work for free?"
| argument is such a bad faith take.
|
| You know damn well that nobody is expecting doctors to work
| without pay. I refuse to believe someone could actually believe
| such an idiotic argument is being made. So why act like it is?
| notch656a wrote:
| Ah I see, doctors aren't supposed to work for free, just
| other taxpayers (who most likely make far less than a doctor)
| working for free to pay the (much higher salary) to cover
| someone elses expenses. Got it.
| rattyc wrote:
| They have 330million people, that's terrifying.
| stjohnswarts wrote:
| Your comment insulting 330 million people in the USA is
| unwelcome on HN.
| maxwell wrote:
| It's sickening that the Democrats control the House, Senate, and
| Presidency and won't hold a vote on Medicare for All because
| they've all been bribed by private health insurance brokers.
| lotsofpulp wrote:
| Democrats do not control the Senate.
| docdeek wrote:
| There are 48 Democrat Sentors and 2 Independents who caucus
| with the Democrats, one of whom has sought the Democratic
| nomination for President. That's 50 votes, plus the
| Democratic VP to break any tie. While it might be correct to
| say the Democrats do not have a majority in the Senate, its
| not incorrect to say they do control the Senate.
| wilde wrote:
| The Democrats control the one spending bill a year subject
| to the Byrd rule. All other bills require 60 senators.
| adgjlsfhk1 wrote:
| unless you want to delete the philibuster, that's a long
| way from the 60 votes you need.
| maxwell wrote:
| I'm not talking about passing anything, just taking down
| a vote of who is actually for and against Medicare for
| All.
| [deleted]
| [deleted]
| lotsofpulp wrote:
| In the context of voting for taxpayer funded healthcare, or
| any other broad population wide benefit program / tax
| increase, it would be inaccurate to label Manchin and
| Sinema as Democrats.
|
| Same as when Affordable Care Act was being molded, a couple
| of "Democrat" senators like Leiberman sank any chance a
| taxpayer funded option. Just like Manchin and Sinema sank
| Biden's universal preschool/daycare and paid parental leave
| proposal last year.
| A4ET8a8uTh0 wrote:
| Eh, both Manchin and Sinema self-identify as democracts,
| which some argue is all you really need these days. More
| importantly to me, however, if we rely on actions and not
| words, they consciously elect to remain members of
| Democractic party ( as opposed to say.. being Republican,
| Independent, Green or whatever ).
|
| For all practical reporting purposes, they are
| Democracts. The moment you apply 'but they voted for X',
| you can cast McConnel as a democract, because he
| greenlighted new gun deal.
| lotsofpulp wrote:
| Context matters. The original post I replied to was
| admonishing Democrats as a bloc for not trying to reform
| healthcare, specifically with a taxpayer funded option.
|
| The reality is that Democrats, as a bloc, are the only
| ones to have even attempted taxpayer funded healthcare,
| and somewhat succeeded. Just because a couple people who
| label themselves Democrats, but do not vote with them
| does not make sense to blame Democrats as a whole for
| holding back progress in taxpayer funded healthcare, and
| ignore the 50 Republicans voting against it.
|
| This is all ignoring the fact that in the context of
| taxpayer funded healthcare, you need 60 votes to do
| anything, so the measure for "control" of the Senate
| would be 60 votes.
| maxwell wrote:
| > admonishing Democrats as a bloc for not trying to
| reform healthcare
|
| Incorrect. I was admonishing them for not putting it to a
| vote.
| lotsofpulp wrote:
| Democrats would not be able to bring a vote without 60
| votes, or without using the nuclear option to rid the
| filibuster.
|
| Which would burn a lot of political good will for no
| reason, considering the likelihood of how Sinema and
| Manchin would vote.
|
| The point being that evidence points to Democrats by and
| large supporting taxpayer funded healthcare options. It
| specifically was removed in 2009 from ACA because of 1
| senator from Connecticut.
| maxwell wrote:
| Let's get a vote in the House to see where everyone
| actually stands. My point is that the _Democrat majority_
| seems to be against Medicare for All, and I want to see
| it in a vote.
|
| It's not really fair to pin Lieberman's opposition to the
| public option or expanding Medicare as some personal
| opinion, he had previously supported expanding Medicare
| until he abruptly... got new orders? Seems like the the
| $930,000 in bribes he accepted from the health industry
| could have played a role:
|
| https://www.opensecrets.org/members-of-
| congress/industries?c...
|
| And the major force against universal healthcare, since
| FDR's Second Bill of Rights (right to health), has always
| been the AMA:
|
| https://www.democracynow.org/2009/6/12/ama_opposition_to_
| oba...
| A4ET8a8uTh0 wrote:
| It is my bad. I did not read down-voted comment closely
| enough. I do have a problem with casting senate control
| as 60 votes, but your rationale makes sense now.
| lotsofpulp wrote:
| Why should Senate control not be considered 60 votes, if
| that is what is needed to accomplish the legislation in
| question?
| A4ET8a8uTh0 wrote:
| I think, because, in theory at least[1], simple majority
| in Senate is all that you should need to pass a bill. To
| the best of my understanding, 60 is just for being
| filibuster-proof.
|
| Your question is qualified enough to relate specifically
| to the bill listed by OP, but, again in theory, if the
| bill wasn't so off-putting that senators decided to
| filibuster, maybe it would pass.
|
| In other words, 60 is not control; 60 is safety. 50+1 is
| control albeit minimal.
|
| [1]https://www.house.gov/the-house-explained/the-
| legislative-pr...
| lotsofpulp wrote:
| I agree with your characterization. I supposed we will
| see more support of getting rid of filibusters via
| "nuclear option" as the bipartisanship gets less and less
| likely.
| wil421 wrote:
| Blame the senator from West Virginia who refused to vote on
| some of the Dems bills.
| refurb wrote:
| Blame bad bills that their own party members vote
| against...maybe?
| maxwell wrote:
| I'm not talking about passing anything, just putting it to a
| vote.
| rayiner wrote:
| Blame Democrats for the college educated urban-dominated
| coalition they've deliberately chosen. I recall some activist
| types talking a few years ago about whether pro life Dems
| like Manchin should be kicked out of the party. Though it's
| the House not the Senate, Dems just lost a longtime majority-
| Hispanic seat in south Texas:
| https://www.texastribune.org/2022/06/14/texas-special-
| electi.... To give you an idea of the temperature of that
| room, the Dem candidate had run as "a 'conservative Democrat'
| and 'pro-life' Catholic." National Dems are making a
| deliberate choice to abandon those Dem voters, just as they
| did with working class white people in the Midwest. Remember
| when Dems had 60 Senate seats, including in states like South
| Dakota? It wasn't ancient history it was 2008.
| lotsofpulp wrote:
| The Dems might have had 60 seats in name only, but even
| that was for a few months (Jul 2009 to Jan 2010). More
| importantly, a couple Democrats like Lieberman do not tow
| the party line, and frequently vote like Repubs, so I would
| not say Democrats ever had 60 seats.
|
| https://en.wikipedia.org/wiki/2008_United_States_Senate_ele
| c...
|
| > Democrats held at least 57 seats as a result of the
| election. When the new senators were first sworn in, the
| balance was 58-41 in favor of the Democrats, with the
| unresolved election in Minnesota causing that seat to
| remain vacant. The April 2009 party switch of Pennsylvania
| senator Arlen Specter from Republican to Democrat and the
| July 2009 resolution of the Minnesota election in favor of
| Democrat Al Franken increased the Democratic majority to
| 60-40 (providing the Democrats, including the two
| Independent senators who caucus with them, a supermajority
| and thus able to hypothetically over-ride any filibusters).
| Republicans gained a seat in a January 2010 special
| election in Massachusetts, thereby making the balance 59-41
| before the start of the next election cycle.
| rayiner wrote:
| They had 60 votes to get Obamacare enacted, which was a
| historic achievement. Obviously your coalition won't
| agree on everything and you have to keep the marginal
| votes on board. That's just how politics works. My point
| is that there is a more potent democratic coalition out
| there even within the framework of the Senate system. To
| the contrary, the Senate system long benefited Democrats
| because it favors working class rural areas over moneyed
| industries (finance, tech, etc.) concentrated on the
| coasts.
| suture wrote:
| The country and politics of the nation have shifted. The
| divide is rural/urban now. The cities have the vast
| majority of the wealth but not the accompanying
| representation. The rural areas of the country are
| overwhelmingly conservative and increasingly white
| nationalist in sentiment. What the state of things 50
| years ago was is no longer relevant.
| suture wrote:
| Republicans abandoned people who are in favor of abortion.
| Republicans abandoned liberal Republicans like Bill Weld.
| Every party abandons people. Democrats consistently hold
| majority views on a wide range of policy issues and
| consistently have more votes in national elections.
| Gerrymandering so that urban centers lose their voting
| power and other election rigging techniques is what is
| holding back Democratic policies. The Democratic Party
| should not abandon its highly popular core principles to
| cater to the deranged apportionment that the U.S. has.
| lesuorac wrote:
| > Gerrymandering so that urban centers lose their voting
| power and other election rigging techniques is what is
| holding back Democratic policies.
|
| I mean gerrymandering doesn't help but the Democrats
| aren't one cohesive unit otherwise they'd have no issue
| doing stuff right now. Sure people claim they only have
| 50+1 in the senate so they can be filibustered but they
| can just remove the filibuster with 50+1 and then do w/e
| they want. Democrats don't achieve their "party
| position's" because they're not the position that each
| member of the party has.
|
| The same is true for Republicans. Look at Trump's
| campaign promises [1] which were often parroted by
| Republicans in congress but they only major thing they
| achieved was the Tax Cuts and Jobs Act [2]. ACA was not
| repealed because some Republicans voted no. One thing
| news orgs commonly bring up with Trump is he appointed a
| bunch of judges but that's just because Republicans
| changed the filibuster so they could; if RBG retired when
| Obama told her too or Democrats made the same changes,
| Obama would have appointed a bunch more judges.
|
| [1]: https://www.politifact.com/truth-o-
| meter/promises/list/?prom... [2]: https://en.wikipedia.or
| g/wiki/Tax_Cuts_and_Jobs_Act_of_2017
| suture wrote:
| Republicans were never going to get rid of ACA; it's
| their plan after all. Republicans were never going to
| build a wall. These were just talking points. What
| Republican lawmakers are great at is being united in
| thwarting Democratic policies and doing what it takes to
| enhance their own power. Republican lawmakers are much
| more united when it comes to core principles:
|
| 1. Thwart Democrats
|
| 2. Oppose abortion
|
| 3. Tax cuts
|
| 4. Cut/freeze non defense spending
| rayiner wrote:
| > Republicans abandoned people who are in favor of
| abortion. Republicans abandoned liberal Republicans like
| Bill Weld. Every party abandons people.
|
| Sure. My point is that the party made this choice
| deliberately. Trying to pin the blame on Joe Manchin, who
| is doing yeoman's work holding onto a key part of the old
| FDR coalition, is disingenuous.
|
| > Democrats consistently hold majority views on a wide
| range of policy issues and consistently have more votes
| in national elections.
|
| The views of the party leadership and donor base and
| closely affiliated NGOs do not have consistent majority
| support. For example, Dems have basically allowed NARAL,
| etc., to be the voice of the party on abortion. But a
| strong majority of Americans oppose second trimester
| abortions, which are guaranteed by _Roe_ , and a quarter
| of democrats identify as "pro life." That's more than
| ones who identify as "very liberal." The party used to
| get that, carving out a space for folks like Manchin in
| WV and Tom Daschle in SD.
|
| > Gerrymandering so that urban centers lose their voting
| power and other election rigging techniques is what is
| holding back Democratic policies.
|
| Republicans have won the Congressional popular vote
| slightly more than half of the time since 1990. They're
| about to do it again. Gerrymandering doesn't affect that.
|
| Even in the electoral college, it benefitted Democrats
| not only throughout the 1960s-1980s, but as recently as
| 2012. Obama would have been able to win a second term
| even if he lost the popular vote.
|
| > The Democratic Party should not abandon its highly
| popular core principles to cater to the deranged
| apportionment that the U.S. has.
|
| Democratic leaders and donors are deeply confused about
| what those "core principles" are, and who is in their
| coalition. The coalition is one of urban liberals who
| vote democrat for ideological reasons, and minorities and
| immigrants who vote Democrat out of self interest. My
| parents are the type of immigrant who turned Virginia
| blue. They care about Obamacare. They'll accommodate some
| things the urban liberals want to get that. But that
| doesn't mean they agree with college educated urban white
| people about what kids should learn in schools.
|
| The fact is that a big chunk of the Democratic coalition
| has social values closer to Republicans than to liberal
| Democrats. Moreover, those are the party's marginal votes
| in states like Arizona and Nevada and Georgia. Urban
| Democrats should live in that reality.
| suture wrote:
| You are absolutely wrong in thinking Gerrymandering does
| not affect Congressional popular vote. It absolutely
| does. Especially in non-Presidential years. There are
| secondary effects you are ignoring with this incorrect
| belief. In recent years, since SCOTUS abandoned voting
| rights, the closure of polling stations also affects
| voting numbers.
|
| We do not have proportional representation in the House,
| and the person with the most votes for President lost in
| 2000 and in 2016. The way Congressional districts are
| made and the weirdness of the Senate representation is
| such that we will soon be governed by a minoritist party.
| Who cares how things were in the 60s and 70s when the
| topic at hand is about the present day?
|
| EDIT: The Republican Party has overtly attempted to
| subvert the political norms of the country and continues
| to do so. Arguing about this or that policy is
| meaningless unless the messed up way the Senate and House
| seats are allocated is fixed. That won't be addressed
| anytime soon so the situation is essentially hopeless.
| Oh, and Manchin sabotaged voting rights legislation.
| rayiner wrote:
| > You are absolutely wrong in thinking Gerrymandering
| does not affect Congressional popular vote.
|
| Gerrymandering does not even consistently hurt democrats
| in the number of House seats. Dems in 2020 won the same
| number of seats as their share of the Congressional
| popular vote.
|
| > There are secondary effects you are ignoring with this
| incorrect belief. In recent years, since SCOTUS abandoned
| voting rights, the closure of polling stations also
| affects voting numbers.
|
| This is the Democrat equivalent of believing the Big Lie.
|
| > The way Congressional districts are made and the
| weirdness of the Senate representation is such that we
| will soon be governed by a minoritist party.
|
| What's Biden's approval rating again?
|
| > Who cares how things were in the 60s and 70s when the
| topic at hand is about the present day?
|
| Because Democrats still claim to be the party of FDR, who
| stitched together a winning coalition. The electoral
| system benefited that coalition--when Biden became a
| Senator, Democrats had 10 percentage points more House
| seats than their share of the Congressional popular vote.
| That coalition is still viable. Obamacare was enacted on
| that coalition. Urban Dems have chosen deliberately to
| prioritize other things instead.
| suture wrote:
| You are very much wrong in your assessments. Closing
| hundreds of polling locations absolutely affects voting
| outcomes and number of voters. That isn't a big lie. It
| is a provable fact. There is no point in discussing this
| topic with someone who refuses to acknowledge
| indisputable facts.
|
| You are completely wrong on your assessment regarding
| Gerrymandering. You clearly don't understand how total
| national vote total has nothing to do with whether or not
| Gerrymandering causes one party to have more seats than
| they otherwise ought to have. Here's a hint: A
| Representative from California res presents far more
| people than the one from North Dakota. Here's another
| hint: Heavily Democratic distinct overwhelmingly votes
| Democrat while three districts with slight majority
| Republican vote elect Republicans and the overall vote
| totals are mostly even. Both hints must be used to see
| why overall vote total means nothing when it comes to
| determining if Congressional representation is skewed.
|
| You are wildly wrong in your views.
|
| https://www.motherjones.com/politics/2019/09/report-more-
| tha...
|
| https://www.theguardian.com/us-news/2020/mar/02/texas-
| pollin...
|
| https://www.salon.com/2019/09/12/report-reveals-
| nearly-1700-...
| rayiner wrote:
| > Closing hundreds of polling locations absolutely
| affects voting outcomes and number of voters. That isn't
| a big lie. It is a provable fact.
|
| It doesn't meaningfully affect turnout in the same way
| Voter ID doesn't affect turnout:
| https://www.vox.com/policy-and-
| politics/2019/2/21/18230009/v.... Both parties are lying
| about the impacts of voting rules on turnout.
|
| > You clearly don't understand how total national vote
| total has nothing to do with whether or not
| Gerrymandering causes one party to have more seats than
| they otherwise ought to have.
|
| You're mixing up completely different things. The
| Congressional popular vote represents the total number of
| people that voted for each party in House elections. It's
| an absolute number of votes, irrespective of number of
| seats. Republicans have won this absolute count more
| often than not since 1990. For example, in 2016,
| Republicans won 63,182,073 votes (49.1%) and Democrats
| won 61,765,832 votes. Also, you can cross check it
| against the generic Congressional ballot, which is based
| on polling and isn't affected by gerrymandering:
| https://projects.fivethirtyeight.com/polls. Republicans
| are ahead right now. That's not a "minority party."
|
| > Here's a hint: A Representative from California res
| presents far more people than the one from North Dakota.
|
| It's actually the opposite, though it's a rounding error.
| California has 53 representatives and 39 million people,
| or 736,000 people per rep. North Dakota has 1
| representative and 760,000 people.
|
| > https://www.motherjones.com/politics/2019/09/report-
| more-tha... > https://www.theguardian.com/us-
| news/2020/mar/02/texas-pollin... >
| https://www.salon.com/2019/09/12/report-reveals-
| nearly-1700-...
|
| These sites are peddlers of election falsehoods, just
| like Breitbart or Newsmax.
|
| The irony of all this is that progressive election lies
| are used to disenfranchise minorities _within the
| Democratic Party._ Disproportionately white progressives
| invoke the notion that Democrats have overwhelming
| popular support but elections are close because of dirty
| tricks, to boost their own power within the party. That
| happens at the expense of disproportionately conservative
| and moderate democrats, who are disproportionately
| minorities.
|
| Political parties aren't one big happy family. The truth
| is that there's trade offs between the interests of
| different factions and we should be honest about those.
| If Obama hadn't run to the right on social issues in
| 2008, we wouldn't have Obamacare today (which cut the
| number of uninsured Black people by half). That's the
| reality of the trade offs between different factions of
| the party.
| flavius29663 wrote:
| did they put the Medicare for all on vote? if not, you can't
| just assume that if they didn't want more reckless government
| spending(thank God they stpped at that, the damage is already
| immense) they also don't want medicare for all.
| jumpkick wrote:
| If you truly think that the Democrats hold controlling
| majorities in the House and Senate, then you are quite
| misinformed.
| nottorp wrote:
| I would read it but i can only agree to tracking.
| blendergeek wrote:
| Try this link.
|
| https://text.npr.org/1104679219
| nottorp wrote:
| But NPR tried their damnedest to hide it from me. A while ago
| you could reject tracking and get the text only version of
| the article. Today I only saw "agree" and "see how we use
| cookies". No official pointer to the text site.
|
| So no, they can keep their article.
| coffeefirst wrote:
| By the way, if you'd actually like to do something about this
| that benefits real people right now, RIP Medical Debt (mentioned
| in the article and has good ratings) buys debt at 1% of its face
| value and immediately forgives it.
|
| https://ripmedicaldebt.org
| [deleted]
| boppo1 wrote:
| Thanks, this is awesome I'll keep it in mind!
| willcipriano wrote:
| Old medical debt (the kind you get for 1%) doesn't have a big
| impact on credit scores and don't they owe income tax on the
| forgiven debt?
|
| I wouldn't pay income tax on something like half million
| dollars for a slightly better chance to be able to take out a
| loan at what will be 10% or so soon.
| [deleted]
| antisthenes wrote:
| How can I submit my debt?
|
| Or is it kind of a site that buys debt that the hospital has 0%
| chance of collecting anyway?
| kube-system wrote:
| "Buying debt" is analogous to "debt sent to collections"
|
| So yes, the latter.
|
| Basically, that site helps people to not get phone calls
| about bills they were never going to pay.
| antisthenes wrote:
| Right, which is nice, I guess, but it's more of a feel-good
| project for those who run it, rather than actual help.
|
| 99% of hospitals have financial assistance programs that
| will either completely eliminate your debt or reduce it by
| a substantial amount if you fall under a certain bracket of
| income (usually some multiple 3x or 4x poverty level),
| which essentially does the same thing.
|
| It doesn't address the fact that hospitals prices ballooned
| out of control due to perverse incentives with insurance
| companies and dumb regulation that limits profits to a
| percentage (incentivizing absolute increases in prices,
| rather than price controls like NHS does)
| silicon2401 wrote:
| If you have insurance with an out of pocket max, how is it
| possible to end up paying for more than that?
| DavidPeiffer wrote:
| Sometimes services are rendered which insurance does not deem
| required, and then refuses to pay for, and some items are
| simply not covered at all. For example, insulin may be covered
| by insurance, but needles and syringes are not.
|
| On top of that, it's basically impossible to anticipate the
| cost ahead of time for many procedures. One person I know was
| quoted $2,000 to $30,000 for a portion of a surgery that is not
| covered by insurance, depending on exactly what needed to be
| done. How do you even plan for that? At one end, it's like
| buying ~2 new refrigerators of pain, and the other end is a
| brand new, top of the line Chevy Bolt.
|
| For many people, hitting max out of pocket is simply not
| possible without debt. It's common to see 3-5k MOOP, but taking
| a modest standard of living on an average salary, it's an
| incredible amount of time to make up for it.
|
| E.g. $5,000 household income (60k annual) * $800 rent
|
| * $1,000 childcare
|
| * $250 gas
|
| * $200 utilities
|
| * $500 groceries
|
| * $500 income taxes
|
| * $250 student loan payments
|
| * $100 car insurance
|
| $1,400 leftover, but there have been no incidental expenses,
| $800 is probably lower than you could find a 2 bedroom
| apartment in Iowa, and I'm assuming they own their car
| outright. Once you hit January 1, your deductible and max out
| of pocket reset, so you could be like a friend of mine and get
| MRI's on December 31 and January 1 while staying in the
| hospital for a couple days on either end. They had to pay their
| full max out twice because of the timing in the year when they
| got sick.
| silicon2401 wrote:
| That's terrifying. The healthcare issue with the US is what
| seriously makes me want to live in Europe, at least to try
| it. The thought of your whole life falling apart just because
| you need medical care is horrible. I'm living the double-
| software-engineer-income, no kids life with my partner, and
| even then I think a major medical issue would be life
| changing. As a risk-averse person, the US feels like a place
| to get high rewards as a SWE, but there are massively high
| risks that don't get talked about often enough.
| SoftTalker wrote:
| It's not like you can get whatever, whenever medical care
| in Europe. Whether private or public, the entity that's
| paying the bills will be making decisions on what
| procedures are or are not "necessary" and how much they
| will pay.
|
| My uncle in Denmark had cancer, and they basically put him
| in a hospice-type facility to die, because anything else
| would have not been justified due to his age, the cost, and
| the low probability of success.
|
| In the USA, he or his family would likely have demanded
| aggressive surgery and/or chemo or radiation, he would have
| died anyway, and there would have been hundreds of
| thousands of dollars of "medical debt" created.
|
| I suspect many people who like the idea of socialized
| medicine are not prepared for the reality of the limits on
| care that would bring, particularly for the old and
| terminally ill.
| silicon2401 wrote:
| > In the USA, he or his family would likely have demanded
| aggressive surgery and/or chemo or radiation
|
| In the US, if you can't afford it, medical care basically
| isn't even an option. If you have a lot of money, then
| you're set. In Europe if you don't have much money, you
| at least have _some_ options, and if you have a lot of
| money, you can still go to the US. Or if you 're open to
| $100k's of debt, you could've easily gone to the US for
| treatment, too. Your scenario just proves my point that
| the situation is way better in europe
| SoftTalker wrote:
| Well, I'm saying that he had no options. He went to a
| (very nice) facility to die. They kept him comfortable
| and relatively pain-free.
|
| Any other option he had, should he have wished to pursue
| it, would have been outside of the Danish social medical
| system.
|
| That may be "better" than what would have happened in the
| USA under Medicare/Medicaid, but my point was there
| really wasn't a choice in the matter for him. He didn't
| have to pay for it, other than the taxes he paid his
| whole life, so I guess there's that.
| Sohcahtoa82 wrote:
| > Sometimes services are rendered which insurance does not
| deem required, and then refuses to pay for
|
| This shouldn't be legal.
|
| Do insurance companies even employ actual medical doctors
| that are educated, trained, and experienced in health care so
| that they're qualified to make these calls?
| DavidPeiffer wrote:
| They do employ medical doctors to review cases, give prior
| authorization for specific treatments and diagnostic tests,
| etc. There can also be doctor to doctor calls to explain
| why a particular item was justified. The thought of some
| random doctor reviewing your file and the notes generated
| from a visit and making a determination having never seen
| you sucks. It's been passed ok'd as "ensuring doctors are
| following the best practices and ensuring consistent
| standards of care", which it may to an extent.
|
| As with most aspects of US healthcare, when viewed through
| through the perspective of the recipient, it's atrocious.
| Every medical facility requires you to sign a paper that
| you'll pay all the medical expenses if they aren't covered
| by insurance. They can't give you an estimate that they
| promise they'll stick to in terms of cost. There's no way a
| non-doctor could know what the typical course of treatment
| would be, so they're stuck trying to get straight answers
| from an insurance company if they don't want a surprise
| massive bill.
|
| Provider bills insurance an insane amount which is then
| arbitrarily discounted. Provider can't bill different
| amounts for insured or uninsured patients (illegal from my
| understanding). If insurance doesn't cover something, it's
| between the patient and provider to settle.
| trashface wrote:
| "Surprise" or balance billing was one way.
|
| Basically you go to a hospital that is "in network", get some
| work done, but it turns out that some doctor (often some side-
| channel like a radiologist) who reviewed your case was out of
| network. So your insurance doesn't cover him and the hospital
| sends you the full bill. Out of pocket max doesn't matter,
| because that only limits costs where insurance actually accepts
| the claim.
|
| It was outlawed by US congress this year (The "no surprises"
| bill), but there are some exceptions like ground ambulances, so
| I guess we citizens are supposed to remember not to take those
| to the hospital unless we are rich.
|
| Yes, its insane.
| swarnie wrote:
| Anyone fancy giving universal healthcare another stab?
|
| Either to save lives:
| https://www.scientificamerican.com/article/universal-health-...
|
| Or to save money:
| https://www.pnas.org/doi/full/10.1073/pnas.2200536119
|
| The aversion to it honestly baffles me.
| jioujoijoijoi wrote:
| paxys wrote:
| America has socialized healthcare with a hundred extra steps and
| implemented in the most inefficient way possible so that everyone
| comes out worse.
|
| Hospitals aren't allowed to deny care (obviously). They will bill
| people outrageous amounts and know that they will only ever see a
| fraction of it. So prices for people who do pay are raised
| considerably to make up for it.
|
| People don't get early preventive care due to costs or because
| they are uninsured.
|
| Supply of doctors is artificially limited by the ABMS so that
| demand stays high.
|
| The government doesn't negotiate or mandate prices, so drug
| manufacturers, equipment manufacturers, researchers, hospitals
| and everyone else in the ecosystem squeezes out as much profit as
| they can to make up for all the countries where they are not
| allowed to.
|
| The end result is that the average American knowingly or
| unknowingly pays a lot more for healthcare than any other country
| in the world while receiving sub-par care.
| stjohnswarts wrote:
| I never understood why if they have a cap to at least increase
| it as population increases. Also we need to give more medical
| decisions over to advance level (but not doctors) levels of
| people like Physicians Assistants and Nurse Practitioners.
| MomoXenosaga wrote:
| I think Americans are smarter than that.
|
| In my country doctors don't give a shit about who you are or
| how much money you have. They do triage. You can be a
| millionaire yet have to wait 3 months for a new hip because
| there is someone with more urgent medical needs. It is pure
| unadultared fact based medicine to allocate scarce resources
| instead of market forces that turns you into a drone.
|
| Universal healthcare is beatiful but also utterly terrifying.
| It is pure communism without the "some animals are more equal".
| It will lift up many Americans no doubt but for the prosperous
| it is not an automatic win.
| Sohcahtoa82 wrote:
| > Hospitals aren't allowed to deny care (obviously). They will
| bill people outrageous amounts and know that they will only
| ever see a fraction of it. So prices for people who do pay are
| raised considerably to make up for it.
|
| This supposed truth is widely misunderstood to the point of
| simply being not true.
|
| Hospital ERs will stabilize you. That's all.
|
| If you have something that requires long-term care like
| diabetes or cancer, you're fucked. If you have Type 1 Diabetes
| and can't afford insulin, the hospital won't just give you a
| supply. They'll wait until you're about to die from diabetic
| ketoacidosis.
|
| A friend of mine had testicular cancer but had no money for
| treatment and no insurance. Hospitals straight-up told him that
| they won't treat him unless he's terminal. That's right, they
| wouldn't take care of him until he's on death's door, at which
| point all they'll be able to do is pump him full of painkillers
| to make him comfortable for his last couple hours. Luckily, the
| ACA passed, banning pre-existing condition clauses, and he was
| able to get some affordable insurance and treatment. Of course,
| anyone that has had cancer can tell you it likely never goes
| away [0]. He's always worried that a new tumor will appear
| somewhere.
|
| [0] https://xkcd.com/931/
| maxerickson wrote:
| Emergency rooms at hospitals that accept Medicare are not
| allowed to deny care under EMTALA.
|
| Hospitals that do not accept Medicare can run a 24 hour, high
| level of service department and deny care all they want.
|
| There's no requirement to provide non-stabilizing care.
| noelsusman wrote:
| Which hospitals don't accept Medicare?
| corrral wrote:
| > Hospitals aren't allowed to deny care (obviously). They will
| bill people outrageous amounts and know that they will only
| ever see a fraction of it. So prices for people who do pay are
| raised considerably to make up for it.
|
| They absolutely can. They just can't refuse care if you're
| actively dying or your condition's quickly deteriorating (they
| have to "stabilize" you). This makes the ER loophole, such as
| it is, useless as a backdoor for obtaining most hospital care.
| Plus if you go in for something that's not actually an
| emergency, they'll just make you wait until you leave. They'll
| never treat you.
| heavyset_go wrote:
| This is an important distinction. Nobody is getting free
| chemo or radiation therapy, treatment for chronic illness or
| anything like. For example, diabetics are not going to get a
| supply of insulin from the ER, especially if they can't pay,
| and someone with cancer isn't going to get treatment, either.
| Plenty of people die in the US from the inability to afford
| the medical care they need to live.
|
| If you're brought into the ER because of a heart attack or
| are bleeding profusely, your care won't be denied, but you
| will pay for it in some way later.
| hedora wrote:
| Also, something like 20-33% of health care dollars go to claim
| submission/processing at the doctor/hospital and the insurance
| company. Those people do nothing but argue with each other
|
| There's a highly rated HMO around here. Their costs are
| significantly lower than regular insurance, and they seem to
| pass some of that on to customers in the form of health care.
| nradov wrote:
| The primary limit on the supply of doctors right now is lack of
| federal (Medicare) funding for residency training slots. Every
| year, students graduate from accredited medical schools but are
| never able to practice medicine because they can't get matched
| to residency program. This also impacts foreign doctors who
| want to immigrate and practice here. Ask Congress to increase
| funding.
|
| https://savegme.org/
| david_l_lin wrote:
| Just watched John Q (2002) last night, and can't believe that
| despite all the attention it gets, nothing has changed at all.
| Can't say I'm surprised though.
| hotpotamus wrote:
| Before Michael Crichton wrote fiction, he was a doctor and his
| first book, "Five Patients", was actually an examination of
| different topics in healthcare in the 1960's. One topic was the
| massive cost increases even back then. It's a pretty
| interesting read too.
| AnIdiotOnTheNet wrote:
| Basically the way things work in the US is that even if you can
| get an overwhelming majority of people to agree that something
| is a problem, you will never get them to agree on a solution.
|
| In this instance, the two proposed solutions are: make
| healthcare the government's responsibility like many countries
| that don't have this problem, or do nothing because that
| solution isn't perfect.
| heretogetout wrote:
| Further, neither side (seems to) accept incremental change
| and loves making the perfect the enemy of the good --
| especially, imo, the left -- so they get nothing and complain
| about it.
| AnIdiotOnTheNet wrote:
| You're going to have to elaborate on that one, considering
| that the ACA came from the Obama administration and was
| about the smallest incremental change possible. Not that
| republicans didn't try to repeal it several times anyway.
| heretogetout wrote:
| Sometimes incremental change happens, like the ACA,
| sometimes people go all accelerationist[0]/Bernie-or-bust
| on us and then someone vastly worse[1] gets elected.
| Seems like it's more the latter than the former these
| days considering how divided we are, politically.
|
| 0: https://en.wikipedia.org/wiki/Accelerationism
|
| 1: edited to add: imo. And probably in their o as well.
| hedora wrote:
| No, the problem is that the actions of the federal government
| aren't even correlated to public opinion any more.
|
| When Obamacare was passed, 70% of the population wanted
| Medicare for all instead:
|
| https://thehill.com/hilltv/what-americas-
| thinking/412545-70-...
|
| In 2020, 54% supported single payer health care:
|
| https://www.pewresearch.org/fact-
| tank/2020/09/29/increasing-... overage/
|
| I can't find any post-covid polls, but states are currently
| trying to step in and implement it locally. Don't hold your
| breath.
|
| Edit: the medicare for all poll was under trump
| Sohcahtoa82 wrote:
| I literally linked those two polls just yesterday, hah [0].
| Did you see my comment, or did you just happen to do a
| similar search and get those results?
|
| As I mention in my other comment, I speculate the
| possibility that people think "Single payer" and "Medicare
| For All" are different things [1] and so report a different
| opinion on each, similar to how the ACA was viewed MUCH
| more favorably than ObamaCare despite one being the
| nickname for the other.
|
| [0] https://news.ycombinator.com/item?id=31755822
|
| [1] ACKSHUALLY, single-payer doesn't HAVE to be simply
| expanding Medicare to everyone. It could be done in some
| other way, but the core idea of the government paying for
| everyone's healthcare is still the same.
| rglover wrote:
| That's because a parent hasn't taken a loaded gun into an ER
| and held a bunch of people hostage.
|
| Yet.
| SoftTalker wrote:
| The healthcare sector is still quite profitable despite the
| debt, slow payments, and defaults. What is their motivation to
| change?
| newsclues wrote:
| Nationalization.
| otikik wrote:
| Joseph-Ignace Guillotin invented something that would
| motivate them.
| hedora wrote:
| Yeah, but they're ridiculoisly overpriced, and regulatory
| capture around medical devices means new entrants' devices
| will never be approved by the FDA.
| madeofpalk wrote:
| Remove the financial motivation.
| outside1234 wrote:
| The billionaires like it this way so there is no change
| necessary.
| 71a54xd wrote:
| This is not intended to be political - all politicians are
| corrupt. That said, if only we could've saved a few of the
| billions we sent to Ukraine or Iraq and use that to pay for
| healthcare for common Americans.
|
| Fortunately as an engineer, shelling out $4k a year on top of my
| basically "free" health insurance through my employer is more of
| a nuisance than something I lose sleep over. That said, people in
| this country need better healthcare. Doing this will unsaddle
| startups and businesses from having to provide it directly.
| Healthcare is something I would pay more taxes for, but above all
| I command the government to spend in ways that BENEFIT the
| American people not just corporate donors.
| nimbius wrote:
| not that it honestly matters. the whole cabal of private
| healthcare has become such a teetering house of cards post covid
| that credit reporting agencies no longer count medical debt in
| your score.
|
| https://www.forbes.com/advisor/personal-finance/medical-debt...
| colpabar wrote:
| But they still have the debt, right? It's great if it's not
| counted against them, but to say "it doesn't matter" seems
| unfair - won't they still be hounded by collections agencies
| and potentially sued?
| soco wrote:
| I will just chip in to point out the obvious: the _US_
| healthcare is the teetering house of cards etc etc etc. Many
| other countries managed this just fine, so the question is, why
| not also in the US? Follow the money: who gains out of this
| chaos?
| sirtimbly wrote:
| That sounds like a solid improvement. It really is a different
| class of market interaction.
| oceanplexian wrote:
| I don't know why people see this as a good thing. Healthcare is
| expensive for precisely the reason that people skip out on
| paying their debt. Now it's harder to collect so what's the
| result? Costs are going to go up to subsidize the increased
| cost of collection.
| maxerickson wrote:
| Non payment is a moderate expense, at least according to
| hospitals themselves: https://www.aha.org/fact-
| sheets/2020-01-06-fact-sheet-uncomp...
| dathmar wrote:
| My wife had a decent chunk of medical debt when we got married
| which was long before COVID. Even at that time medical debt
| didn't count terribly against her. Maybe a 10 pt drop in her
| score. And eventually the debt fell off her credit.
| SoftTalker wrote:
| So did she/the two of you pay it eventually? If not, were
| there any collection efforts/judgments/garnishments or
| anything like that?
|
| Simply walking away from medical debt if there is only a
| minor impact on credit score seems like a decent option if
| not.
| noelsusman wrote:
| This is one of many reasons why hospitals charge so much.
| Medical debt is extremely difficult to actually collect
| because refusing to pay has basically no consequences.
| Hospitals have to eat those costs and make up for it by
| squeezing patients who do pay for as much as possible.
|
| I did the same thing with an ER bill I couldn't afford a
| while back. I just never paid it and suffered virtually no
| consequences.
| refurb wrote:
| rxhernandez wrote:
| In TFA:
|
| "A quarter of adults with health care debt owe more than
| $5,000."
| orangepurple wrote:
| Would that mean 25 million adults with health care debt owe
| more than $5,000?
| formerkrogemp wrote:
| Yes.
| osrec wrote:
| Yes, assuming the 100m comprises of adults only, which is
| probably how they would have reported it.
| refurb wrote:
| Again, I "owed" that when my kid was born. Deductible plus
| co-insurance added up to about that.
|
| Not saying some people don't have "bad" medical debt (they
| can't repay) but to lump in all debt as "bad" is silly.
|
| Edit: Oh, it's a poll. Similar to the poll that said
| "Households earnings more than $250,000 are stuggling
| financially".
|
| I mean, it's a poll? Did you expect people to say "nah, I
| have medical debt but I can handle it no problem".
| treis wrote:
| If you could or did pay it off then you wouldn't have been
| counted in the survey.
| FreqSep wrote:
| Well, no. You certainly could be someone who *could* pay
| it off but chooses not to for a variety of reasons. Many
| otherwise financially people I know carry some credit
| card debt.
|
| Now is that a large portion of people? I have no clue,
| and my anecdotal evidence certainly isn't qualified to
| answer the question.
| burkaman wrote:
| Please just read the article if you want to argue about it,
| it's not that long.
|
| > And about 1 in 5 with any amount of debt said they don't
| expect to ever pay it off.
|
| That's 20 million people.
|
| > About 1 in 7 people with debt said they've been denied
| access to a hospital, doctor, or other provider because of
| unpaid bills, according to the poll.
|
| That's 14 million people.
|
| > An even greater share -- about two-thirds -- have put off
| care they or a family member need because of cost.
|
| That's 66 million people.
|
| > Half of U.S. adults don't have the cash to cover an
| unexpected $500 health care bill
|
| That's 129 million people.
|
| Again, please read the whole thing, whether or not you want
| to comment more. This is important information for US
| residents.
| FreqSep wrote:
| > Half of U.S. adults don't have the cash to cover an
| unexpected $500 health care bill
|
| I recognize that this is an important discussion to have
| to improve US healthcare, so I'm not outright disagreeing
| with you.
|
| But I think this is a bit editorialized. Paying with cash
| is so rare in society. I don't even have the cash to pay
| for my lunch - I just use a credit card. It shouldn't be
| surprising.
|
| Half of U.S. adults said they _would_ pay it
| immediately.(30% using savings,20% using a credit card
| they pay off that month)
|
| A further 21% said they would pay with a credit card and
| pay it off over time. (Anyone who is already in other
| forms of debt will probably take this option as they, by
| definition, don't have the cash for other things.)
|
| Another 5% said they would make a payment plan with a
| provider / pay overtime.
|
| That's 76% of the country that is knowledgeable about
| reasonable ways to pay for the services. Now, 24% using
| worse off options or not knowing - that's not good at
| all. But it's a far cry from the implication that "half
| of people can't pay"
|
| But still this isn't really a metric on the U.S.
| healthcare system directly - that would be asking _why_
| we have unexpected $500 bills, not which payment method
| people are using. And alternatively, or even in tandem,
| why people are not saving and planning ahead.
| burkaman wrote:
| I disagree that going into credit card debt or
| negotiating a payment plan are reasonable ways to pay for
| essential medical services.
| FreqSep wrote:
| Note that this data is from a poll, not actual investigations
| of medical account balances. It includes the following, very
| broad, categories in the original polling methodology:
|
| "c. Any debt you owe to a bank, collection agency, or other
| lender that includes debt or loans used to pay medical or
| dental bills.
|
| d. Any medical or dental bills that you have put on a credit
| card, and are paying off over time."
|
| Thus, by one interpretation, if you're already in over $5,000
| of credit card debt, and you charge a $10 prescription fill
| or $25 copay to that credit card, their methodology will now
| include you in the medical debt and medical debt amount
| statistics as having medical debt over $5,000. The specific
| wording of the "amount" question seemingly tries to prevent
| this, but considering the above was classified as medical
| debt prior in the polling, it's not hard at all to imagine
| people answering in the affirmative.
|
| Is this really true? I don't know, that's a complicated
| discussion. There are certainly people who are paying medical
| costs with credit cards. They deserve to be included. But it
| does seem possibly a bit too broad.
| chris-orgmenta wrote:
| > I'm assuming
|
| Out of interest, could you elaborate on why you assume you are
| in the mode, rather than one end of the bell curve?
|
| The stereotype of the US medical industry means that a lot of
| us would assume you are one of the lucky few.
| happytoexplain wrote:
| Why would you make that assumption?
|
| Edit: By "that assumption", I mean that the portion of the
| number made up of people who only owe a few bucks and only
| briefly is significant enough to call for a dismissive
| attitude.
| treis wrote:
| The source survey is a few links it but it does support the
| article in that 41% people said they owed money that they could
| not immediately pay off.
| yalogin wrote:
| None of these metrics will change the political stance our one
| majority party took. They have shut their eyes and ears and are
| hell bent on preserving the interests of the lobbying companies
| and fetishizing "free market competition". I can bet a sizeable
| amount of money that nothing will change in the next 50yrs even.
| Today there is still a rule that a hospital cannot say no to a
| patient, I strongly believe that is one rule that will fall down
| next. It makes too much profit for the health care providers to
| not attack that. In fact after Roe fell I can see that as the
| next one.
| otikik wrote:
| In the US, "free market" means that everyone is free to buy any
| politician they want.
| colpabar wrote:
| I make this comment in a lot of threads, but if democrats
| wanted to fix this problem, they would write legislation for it
| and try to get it passed. Instead, all we get (from both
| parties) are massive 1000+ page bills that include a bunch of
| completely unrelated stuff. Why haven't democrats produce a 10
| page bill with a tl;dr of "medical debt is hereby abolished"?
|
| Stop pretending the clowns pretending to be politicians are
| doing anything to help us. This is about the rich not wanting
| to give up their money, and both sides are just protecting
| them.
| themacguffinman wrote:
| 1000+ page bills that include a lot of stuff is an outcome of
| the political negotiation needed to get enough votes. A 10
| page bill is exactly the kind of law that will face stiff
| opposition because you have to make major concessions to get
| votes from both Republicans and the more conservative
| Democrats who are ideologically closer to Republicans on this
| issue.
|
| US Democrats did write legislation for the issue and did try
| to get it passed. They even chose an approach originally
| developed by conservative representatives to try to appeal to
| conservatives traditionally opposed to government
| funded/managed healthcare. It's now known as Obamacare and it
| passed with the slimmest majority then Congress subsequently
| tried to repeal, deauthorize, defund, or otherwise destroy it
| like a 100 times [1].
|
| You could just as easily say that if the majority of citizens
| actually wanted to fix this problem, they would vote out
| anyone who voted against a conclusive bill. But doesn't
| happen because voters actually approve of these politicians
| anyway. You can spend all your money on publicizing "who
| voted against this healthcare bill" and accomplish exactly
| nothing, anyone who cares can easily find out anyway.
|
| But sure, it's always rich people's fault.
|
| [1]
| https://howmanytimeshasthehousevotedtorepealobamacare.com/
| Sohcahtoa82 wrote:
| Short, 10-page bills, don't exist because Legalese needs to
| exist because otherwise people find every loophole in any
| perceived ambiguity in the wording.
|
| Like, imagine a mom seeing her kid jumping on the bed, and
| the kid says "I'm not jumping, I'm hopping. The difference is
| ..." and so the parent tells them to stop hopping and leaves.
| They come back later and the kid is sitting down, but
| bouncing up and down.
|
| Eventually, the parent says something like "You may not jump,
| leap, spring, bounce, hop, dance, or otherwise engage in an
| oscillating vertical motion using the mattress of the bed as
| leverage or propellant."
|
| Bam. That's legalese, and is the reason laws are 1,000 pages
| long. Except in this case, the parent has left open the
| loophole of allowing the kid to jump from their dresser onto
| the bed.
| notacoward wrote:
| Last time I proposed this same thing in a blog comment
| section (Lawyers, Guns, and Money) a couple of people said
| "but filibuster" and the rest went straight to an absolute
| firehose of middle-school-level verbal abuse. I've had
| similar reactions from other self-proclaimed progressives.
| Nonetheless I stand by the idea. These big omnibus bills give
| every single opponent (and some "mavericks" a.k.a. turncoats
| in one's own party) their very own personal reason to vote
| against it without political consequence. A more focused bill
| at least has a _slight_ chance of prying loose a few around
| the edges, if only because they know that their "no" vote
| will be used effectively against them in the next election
| cycle with no room for excuses. When your legislative success
| rate (not counting bills to name post offices) is close to
| zero already, might as well try something different.
| colpabar wrote:
| It just seems like it'd be such a huge win from a PR angle,
| even if the bills fail. You could literally post
| screenshots of the bills in their entirety on twitter
| showing how simple they are (student debt is abolished,
| college is free, medicine is free, etc) and just say "here
| is what we tried to do for you, and here are the people who
| said no."
|
| I think the most productive change we could make to our
| government _right now_ would be to set a page limit on new
| legislation. But this might produce legislation that
| actually helps normal people, which is why it 'll never
| happen.
| leetcrew wrote:
| that doesn't sound like a very good idea to me.
| legislation is not complex only because of pork; there
| are always edgecases and loopholes to be handled. I
| highly doubt a reasonable solution to any of the problems
| you listed could be described in a mere ten pages.
|
| take student debt for instance. imo there's a decent case
| for erasing undergrad debt under a certain threshold, but
| if you took on a six figure debt to attend a fancy
| liberal arts college, that's on you to unfuck. similarly,
| people like lawyers and doctors take on a lot of
| education debt, but that's also priced into their
| respective salaries. a professional paying off an
| outsized debt with an outsized salary doesn't need or
| deserve the assistance of the median taxpayer. a naive
| implementation of such could potentially be net
| regressive.
|
| obviously you might disagree with some of that, my point
| is just to show that "abolish student debt" is
| controversial and complex even among people that agree at
| a high level.
| notacoward wrote:
| A single _sentence_ bill might indeed be too short to
| address edge cases and attract support, but it can still
| be single _topic_ and probably no more than ten or twenty
| pages. Literally no legislator actually reads all of
| these 1000-page entire-legislative-agenda monstrosities.
| At best they have their own aides do it and summarize the
| highlights. More often, they just follow their own party
| 's "leadership" on what parts to use as excuses.
| kube-system wrote:
| This is the expected result of median deductibles being larger
| than median savings accounts. Small amounts of debt <$1000 are
| not necessarily problematic amounts of debt, especially
| considering that they can typically be paid off over time with no
| interest.
| marcusverus wrote:
| The article also studiously ignores the fact that the median
| net worth is more than 100X the median medical debt.
| drcongo wrote:
| The American healthcare system is barbaric.
| thomasjudge wrote:
| Unfortunately a majority of voters in this country reject single-
| payer coverage on the grounds that it is "socialist"
| jioujoijoijoi wrote:
| Nothing is outlawing liberal states from doing it.
| ishjoh wrote:
| Drs and other high earners in the states that introduce
| socialized health care will leave immediately as the state
| institutes price controls. There is a reason so many Drs
| trained in Canada immigrate to the US.
| jmyeet wrote:
| What depresses me the most about this situation is the callous,
| unempathetic disregard a significant portion of the population
| has for everyone not like them. "Just get a good paying job with
| health insurance" is not and should not be the basis for a health
| care policy.
|
| Americans are profoundly selfish and that's getting harder and
| harder to ignore.
|
| Many will defend such practices in the name of "freedom".
| "Freedom" will often be an integral part of their identity. The
| sad truth is that these people seem so desperate for someone
| telling them what to do.
|
| Supporters of universal access to health care simply want people
| not to be denied life-saving or life-changing medical care and
| not to be bankrupted by that. That's literally it. Yet such
| people are so often demonized as "socialists" or "communists".
|
| The Bezoses and Buffetts of the world has so successfully
| propagandized and manipulated these people, choosing billionaires
| having a little bit more money over people literally dying in the
| streets.
|
| I really do worry this country will be lost to white Christian
| fascism in the not too distant future.
| oceanplexian wrote:
| > What depresses me the most about this situation is the
| callous, unempathetic disregard a significant portion of the
| population has for everyone not like them. "Just get a good
| paying job with health insurance" is not and should not be the
| basis for a health care policy.
|
| The problem is this is a straw-man argument. We can agree that
| healthcare costs are too high, and have empathy for people who
| are being screwed over, but not agree that massive government
| intervention is a reasonable solution to the problem. In fact,
| there is an argument to be made that the only reason healthcare
| is expensive in the US is because of lawmakers failure to
| account for the second-order effects of their decisions (e.g.
| EMTALA). In the early 90s you could buy decent health insurance
| for less than the cost of Cable TV.
|
| Unfortunately, the oft-repeated "solution" to the current
| crisis always involves forcibly taking tax dollars, and then
| directly funneling them into one of the most dysfunctional and
| corrupt institutions of all time (Healthcare), then lying to
| voters and telling them that doing so would magically turn the
| USA into Sweden or something. The people who don't support a
| public option are so exhausted making these arguments that they
| will tell you "It's socialism" and walk away from the
| conversation.
| jmyeet wrote:
| This is a borderline bad faith argument because the US stands
| alone as pretty much the only developed nation without
| universal health care [1] while simultaneously throwing our
| hands up in the air saying there's nothing we can do.
|
| And that's the problem.
|
| Insulin as just one example is spectacularly expensive in the
| US [2] for absolutely no good reason and the only way this is
| allowed to happen is that the Federal government has been
| successfully lobbied to not negotiate pricing AND to disallow
| the importation of the exact same medication from other
| countries.
|
| [1]: https://www.theatlantic.com/international/archive/2012/0
| 6/he...
|
| [2]: https://worldpopulationreview.com/country-rankings/cost-
| of-i...
| avgDev wrote:
| In the early 90s housing was much cheaper, so were cars and
| everything else.
|
| I would love to see some evidence that US policy has caused
| the skyrocketing medical bills.
|
| US already spends THE MOST tax money on healthcare even
| though it doesn't offer healthcare like ALL the other 1st
| world nations.
| charlie0 wrote:
| I like ACA, but...
|
| Hot take: The only reason ACA passed is because the government
| did not want to foot the entire healthcare bill for our aging
| boomer generation. So ACA became a way to partially distribute
| those costs to the rest of the US population by forcing them into
| a healthcare plan.
|
| Sure, in theory those forced into the ACA are protected from
| financial disaster in case they get sick, but in practice, the
| younger generation won't need healthcare for quite a long time,
| thereby once again kicking this can of worms down the road.
| newaccount2021 wrote:
| willcipriano wrote:
| > Elizabeth Woodruff drained her retirement account and took on
| three jobs after she and her husband were sued for nearly $10,000
| by the New York hospital where his infected leg was amputated.
|
| I'm not sure what sort of retirement they had planned to have on
| less than 10k, but it looks like in this case the hospital knew
| they could afford to pay but preferred not to. When people use
| number of jobs rather than hours worked per week it's typically
| beacuse number of jobs is greater than one and hours is less than
| forty.
|
| > Ariane Buck, a young father in Arizona who sells health
| insurance, couldn't make an appointment with his doctor for a
| dangerous intestinal infection because the office said he had
| outstanding bills.
|
| The emergency room was available to him. What was the total he
| was asked to pay? Why didn't he pay it?
|
| > Allyson Ward and her husband loaded up credit cards, borrowed
| from relatives, and delayed repaying student loans after the
| premature birth of their twins left them with $80,000 in debt.
| Ward, a nurse practitioner, took on extra nursing shifts, working
| days and nights.
|
| Average nurse practitioner salary 115k. Why are they putting
| medical debt on credit cards? The emergency room wasn't going to
| stop care to those kids if they didn't pay immediately. If they
| were poor the kids would get CHIP, so I think they probably had
| too high income and maybe decided to forgo health insurance and
| work as contractors for additional pay. What was the plan for the
| birth? Was the problem that they were early and they didn't have
| a chance to get insurance at the last second?
| lostcolony wrote:
| From both the context and the picture it's clear she's not
| actually, you know, retiring. The amount in someone's
| retirement account is meaningless unless you know their age and
| their income. Yeah, $10k isn't a lot if you're in your 60s and
| living a lifestyle that costs 6+ figures a year; it's a lot if
| you're making $30k a year and are in your 20s, and quite
| understandable if in your 30s at that income level. Three jobs
| are quoted because yeah, they probably are part time (and just
| saying "works 60 hours a week" or whatever doesn't carry the
| same punch), but -they may not be able to get a full time job-.
| Or else...you know, they might have healthcare.
|
| The emergency room has ludicrously high costs, and none of his
| medical history. You're literally saying "don't expect to be
| able to see your primary care provider, go to the emergency
| room instead" -because of existing debt-.
|
| You're making a lot of assumptions...all of which miss the
| point. Why is life shattering medical debt a common thing we
| tolerate in this country, given every other Western country has
| managed to make it a rarity? But, to your assumptions - maybe
| and she gave birth prematurely and ended up being seen by a
| hospital who were out of network and her insurance didn't cover
| it. Or even went to an in-network hospital, but was seen by
| doctors who were out of network, as frequently can happen,
| especially in emergencies when you can't personally vet the
| doctor is in network for you before you see them. Certainly,
| something unexpected happened (maybe even the pregnancy itself!
| Something to look forward to with the Supreme Court set to
| overturn Roe v Wade), and insurance wasn't there. Why is that
| acceptable in this country?
| willcipriano wrote:
| I work in healthcare and grew up poor in the US, and had
| medical debt of my own so I can read between the lines here.
| People absolutely get screwed over by medical debt, I'm just
| saying these are terrible examples of that happening.
| fmakunbound wrote:
| Oh boy, think you might be living in a bubble.
| GiorgioG wrote:
| You don't know their whole story, stop judging people from your
| high horse.
| willcipriano wrote:
| > You don't know their whole story
|
| I'm pretty sure that's on purpose.
| alephnan wrote:
| > number of jobs is greater than one and hours is less than
| forty.
|
| It could also be the companies aren't willing to have someone
| on full-time, because then they'd have to pay for medical and
| other benefits.
| ziddoap wrote:
| > _Average nurse practitioner salary 115k. Why are they putting
| medical debt on credit cards?_
|
| Are you asking why they couldn't afford 70% of an average
| salary (which, there is a 50% chance this person made less than
| the average) in one shot?
|
| Your entire post seems to be victim blaming based on a few
| sentences of context. You don't know what other debts and
| obligations these people had, nor what other avenues they tried
| to exercise.
| culopatin wrote:
| Maybe what they are asking is how someone making an average
| of 115k, who is also in healthcare doesn't have better health
| coverage and still decides to have a kid.
| ziddoap wrote:
| The American Dream. Must make 115k+ (what is that, 2x or 3x
| the average American?) and pay out the ass for coverage
| just so you can have the privilege of having a kid without
| being judged by random people on the internet.
| culopatin wrote:
| I've made much less than 115k for most of my working life
| and I never had such shitty coverage. I don't agree that
| having twins or whatever should be 80k, don't get me
| wrong. But if you're in healthcare and make enough to
| have a decent plan and choose not to, and on top of that
| you decide to have kid/s, you know what you're getting
| into.
|
| At 38k a year I had a max out of pocket of 7k. It can be
| done.
|
| It's as if I opened a web server in my home with all the
| ports open, a password that is "changeme" and then
| complained that someone else should've been protecting
| me.
| nonameiguess wrote:
| That's not at all a normal cost of having a kid. It says
| she ended up with twins and they were born prematurely.
| That said, I have no idea why it wasn't covered or how she
| ended up getting stuck with the bill. I've had catastrophic
| occurrences like this, too, years worth of spine surgeries
| in which I racked up a few million dollars of expenses, but
| my out of pocket max was $4,000 and that was all I ever had
| to pay in a year. Any charges denied by the insurance were
| just dropped by the provider, not pushed to me.
|
| So it raises the question of what kind of shitty coverage
| she had that was able to do this, or if she just had no
| coverage at all for some reason, which as far I understand,
| is supposed to be illegal after PPACA (you can always buy
| from the exchanges and they can't say no).
| lostcolony wrote:
| >> Any charges denied by the insurance were just dropped
| by the provider, not pushed to me.
|
| That's a provider choice, and not guaranteed.
| nonameiguess wrote:
| Sure, but it's not uncommon, either. If you ever find
| yourself in a fight with a chronic or long-term
| condition, check the statement of benefits your insurer
| sends you every month. They're denying massive amounts of
| things that you never get a bill for. I even asked my
| main surgeon's office manager about this once, and he
| explained to me that insurance companies don't have any
| sort of upfront published caps on what they're willing to
| pay and for what, so both sides are kind of winging it.
| The providers simply bill some very large number that
| they know is so ridiculous that it has to be larger than
| the max that will get reimbursed, figuring that by doing
| so they'll at least guarantee they get that max and not
| inadvertently sell themselves short.
|
| So when you see things like a $14,000 charge for someone
| consulting over video for 10 minutes of work, or $800 for
| a bandaid, and you wonder how the hell a charge can
| possibly be that high, the answer is often that it isn't.
| That's just an artifact of this blind bidding thing going
| on between providers and insurers where providers send
| the largest conceivable bill they can to insurers knowing
| damn well they won't actually get that much.
|
| This also feeds back into why insurance companies have
| such a horrible incentive to default deny everything.
| They know the providers are overcharging and charging for
| bullshit. Both sides are forced into taking equally
| extreme baseline negotiating positions by the total lack
| of pricing transparency.
|
| It points at a very specific dysfunction of our system
| that goes well beyond the question of whether the
| government or private insurance purchasers should bear
| the bulk of the cost. This is a totally separate and
| orthogonal problem that both buyer and seller, no matter
| who they are, treat all transactions, no matter how
| mundane, like it's a blind silent auction for a rare
| Vermeer that hasn't seen a public market in 300 years.
| lostcolony wrote:
| Oh, I know the incentives. I strongly suspect there's
| even an additional one you don't list - tax writeoffs.
|
| And you're going onto a tangent that I am very much in
| agreement with (that the whole system is massively broken
| and suffers all sorts of perverse incentives), but -my-
| point, if you'll recall, is that not everything gets
| written off. People still get unexpected medical bills
| -all the time-, for things their insurance didn't fully
| cover; this despite their deductible and/or max out of
| pocket.
|
| Or, as I commented before, and which you're...agreeing
| to, in a whole lot of words, it's a provider choice, and
| not guaranteed. I.e., every time you go to the doc you're
| rolling the die; doubly so for emergency stuff that you
| can't get pre-authorized. "It doesn't happen -that-
| often" seems to maybe be your argument, but it happens
| enough, and the consequences of it happening at all are
| devastating.
| willcipriano wrote:
| She wouldn't of had any coverage at all. Obamacare puts the
| out of pocket max well below 80k. At that income level and
| field, that's a choice. Is the idea that I'm supposed to
| pick up the tab or feel sorry for her? I make less than she
| does and I pay for my health insurance.
| tomjakubowski wrote:
| Your entire post is really rather uncharitable and judgmental
| towards these people but, anyway:
|
| > Why are they putting medical debt on credit cards?
|
| Doesn't say they did - reads to me like they built up debt on
| the credit card with regular living expenses while servicing
| the medical debt.
| willcipriano wrote:
| Medical debt is very low recourse. If you don't pay your
| electric bill they shut the power off, they won't unamputate
| your leg if you fail to pay. If you don't have substantial
| assets, taking the credit hit is the better choice. I can't
| envision a situation where it makes sense to trade low
| recourse medical debt for high recourse credit card debt.
| sahila wrote:
| > When people use number of jobs rather than hours worked per
| week it's typically beacuse number of jobs is greater than one
| and hours is less than forty.
|
| It's hard to imagine a person wanting to take on multiple jobs
| if instead they had the option to work one for the needed
| amount of hours and pay. Hours at one job != hours at three
| jobs, especially when you add in commuting time and lack of
| benefits because you're not full time.
| Bostonian wrote:
| Defining the problem so broadly makes it less likely that it will
| be solved. We already have high inflation in part because of high
| government transfers during the pandemic, and handing out money
| to 100M people with medical debt or student loan debt would
| aggravate this.
| dktokyo wrote:
| Two wildly different issues. Medical debt is still generally
| owed to payers, student loan debt (as considered in debt
| relief) is largely federal. The impacts of forgiveness of
| either would seem radically different.
| suture wrote:
| I find it odd that when talking about inflation or moral hazard
| people bring up money spent given to individuals but not about
| the trillions spent given to businesses. I think it is immoral
| for a country as wealthy as the United States to have so many
| people with medical debt. There should be universal, almost
| free healthcare. The moral imperative is far more important to
| me than considerations about inflation.
| A4ET8a8uTh0 wrote:
| I dislike adding morals into this discussion. However, there
| is a real question of whether society in its current state
| can, in fact, function well. I personally would argue that
| right now society is very dysfunctional and that dysfunction
| is primarily benefiting those at the top. And the usual issue
| with dysfunctional societies is that they tend to fall apart.
| Now, reasonable person would argue that would not be a good
| thing even for those on the top of the pile, but clearly no
| one is scared enough yet.
|
| All I want is balance. That societal balance does not exist
| now. Hence the tension that seems to be increasing.
| suture wrote:
| I very much agree overall with your observations and
| points. I do think though that one should always consider
| moral aspects to policies and decision making since
| peoples' lives are affected. Making policy based on
| economic theory without considering moral aspects seems
| like a bad idea in general.
| pjc50 wrote:
| Reminds me of my joke policy that meets many people's stated
| goals yet would be universally unpopular: the government
| should fight inflation by confiscating money from
| billionaires and then destroying it.
| suture wrote:
| Very nice. That would abrogate the concern that taxing the
| wealthy is socialist redistribution. Can't have that
| accusation if you just burn it!
| HarryHirsch wrote:
| _high government transfers during the pandemic_
|
| The government would like you to believe that, but a good chunk
| of the problem is supply-side, not demand-side.
| baremetal wrote:
| Milton Friedman famously said: "Inflation is always and
| everywhere a monetary phenomenon, in the sense that it is and
| can be produced only by a more rapid increase in the quantity
| of money than in output."
| HarryHirsch wrote:
| We have a housing crisis and an energy crisis. There's
| absolutely no need to drag monetary theory in when the
| outcome is due to failed industrial policy.
| A4ET8a8uTh0 wrote:
| Why can't it be all three? I understand that it is easier
| to sell it as a specific political problem, but I am
| genuinely tired of arguing partial inflation problem,
| because discussing it as a whole undermines some
| political angle.
| pjc50 wrote:
| Well, he's wrong, given that output has been knocked about
| by a large number of non-monetary factors such as COVID,
| supply chain issues, the war with Russia, and (yet again)
| oil and gas.
| tdehnel wrote:
| The way I see it, even if there's a war or Covid or
| whatever, if people don't have more money to spend, they
| can't pay higher prices. Then you get a recession.
|
| If they do have the money (because you printed more) they
| pay the higher prices. Then you get inflation.
| NickC25 wrote:
| Anyone interested in this topic who wishes to explore it in depth
| should read Marty Markary's 2019 book "The Price We Pay".
|
| While slightly out-of-date due to legislation that has passed
| since then, the book does an excellent job of explaining a lot of
| the perverse incentives at all levels throughout the medical
| industry that contribute to the outrageously high cost of
| healthcare in the US. Worth a read.
| otikik wrote:
| I like that the article shows how this affects regular people
| pretty much randomly.
|
| One thing I missed on the article was a section about "how did we
| get here" (including things like Hospitals not disclosing prices
| for their treatments and forcing people to sign papers under
| duress). And a section about "who benefits from all this
| suffering" would complete it.
| josephd79 wrote:
| making it insanely difficult to track services on invoices they
| send you. I had a 3 night stay a 2 years ago and received bills
| from 5 different 'companies'. I even paid one that I was
| incorrectly billed for and had to jump through hoops to get the
| money back.
| EricE wrote:
| Still better than dealing with rationing. The rest of the world
| better hope the US never goes socialist with health care - kiss
| innovation goodbye.
| EricE wrote:
| For all the downvoters - this was also on the front page:
| https://news.ycombinator.com/item?id=31767347
|
| Downvote away though :p
| jasongill wrote:
| Go ask any law enforcement officer, fire fighter, or EMT how
| many times a week they hear "please don't call an ambulance,
| I can't afford it" and the answer will be so depressing that
| you may change your tone about this.
| wahnfrieden wrote:
| No point arguing with people about this, they believe those
| who can't afford it are in that situation because of
| personal moral failings
| mikeyouse wrote:
| Fun fact about the US's system too - even when ambulances
| are called for things like heart attacks -- they take much
| longer to show up in poor areas compared to wealthier ones;
|
| https://jamanetwork.com/journals/jamanetworkopen/fullarticl
| e...
|
| There are some common agreed upon thresholds that strongly
| correlate with positive outcomes, e.g. 15 minute response
| time after a heart attack. In wealthy areas, this outcome
| was achieved 97% of the time vs. only 93% of the time in
| poorer ones. That doesn't sound _too_ bad, but that means
| you were something like 230% more likely to miss that
| cutoff if you were in a poor neighborhood. But at least it
| 's not "socialist".
| jasonlotito wrote:
| Yes, I will always vote down comments talking about down
| votes, and the comments they reference, regardless of what
| they are talking about.
|
| Comments talking about voting (including this one) are
| worthless, and deserve every down vote they get.
| [deleted]
| SketchySeaBeast wrote:
| So I guess we need to down vote you? And you need to down
| vote me?
| bcrosby95 wrote:
| My friend who lives in the USA had to deliver her own baby in
| a hospital hallway because all the rooms were full and the
| doctors were too busy to tend to her.
|
| The hospital still sent her a $30k bill for the delivery.
| [deleted]
| jasongill wrote:
| Is having 41% of adults in America in debt really worth
| "innovation" for the rest of the world?
|
| And what exactly is "rationing" - I bet almost every adult in
| America knows someone (or is that someone) who has delayed
| going to the doctor/for a procedure (or just never got it
| entirely) because of how much it is going to cost? Doesn't the
| inability to even get the required care due to the cost really
| count as "rationing" in the system we already have?
| otikik wrote:
| I don't think "The Atrocious American Way of Doing Healthcare"
| and "Rationing" are the only two options available.
|
| Also, note that 63% of the people in debt are already literally
| rationing.
|
| "Cut spending on food, clothing, and other basics" - 63%
| mikeyouse wrote:
| If you think our current system doesn't have rationing, I'm not
| sure what to tell you. "Long wait times" are one way to ration
| care -- but equally effective is just denying 30 million people
| the ability to get any care at all due to unaffordable
| insurance and ruinous costs for any 'touch' with the system.
| Another effective way to ration care is to make routine things
| so expensive that people self-select out of receiving care or
| filling prescriptions even when they are insured.
| AlotOfReading wrote:
| Literally the entire point of copays and other forms of cost
| sharing is to 'ration' healthcare by reducing demand. There
| might be health insurance out there without cost sharing, but
| I've never seen it and it's certainly not the norm in the US.
| wahnfrieden wrote:
| It's already rationing with a different mechanism that you
| personally prefer
| jnwatson wrote:
| We already have rationing. My (expensive FAANG-funded) health
| insurance said no MRI without 4 weeks of PT.
|
| Yes, technically I could pay the couple thousand dollars out of
| pocket, but in most socialized health care systems you can do
| that as well.
| [deleted]
| natoliniak wrote:
| can you elaborate on the "rationing" part? I'm guessing you
| tied "socialist" and "rationing" together, but did you do it in
| the context of other developed economies (i.e most of Europe?)
| MisterBastahrd wrote:
| He prefers healthcare to be rationed according to the amount
| of money they have instead of the amount of need.
| [deleted]
| formerkrogemp wrote:
| Is this just sarcasm? Rage bait? Are you out of touch? Poor
| people already ration care. I experienced it first hand working
| in a grocery store. God forbid you got hurt or sick because
| you'd be losing work days aka income. Then you'd be eating less
| or borrowing money or skipping a few medications. But, sure,
| socialism in healthcare * like every other developed economy*
| will stifle innovation.
|
| U.S. healthcare underperforms in most verticals. High cost is
| the primary reason that prevents Americans from accessing
| health care services. Americans with below-average incomes are
| much more affected, since visiting a physician when sick,
| getting a recommended test, or follow-up care has become
| unaffordable.
| https://www.commonwealthfund.org/publications/issue-briefs/2...
| cpursley wrote:
| I'm no socialist, but you can actually have a system of
| government health insurance but keep private healthcare. Or
| basic free healthcare (government run hospitals/clinics) and if
| you want better, pay out of pocket for private.
|
| For example, in my wife's home country, she give birth in an
| awesome private maternity hospital for about $2k out of pocket
| for everything. I mean everything. But if we wanted, she could
| have done it in the government run hospital for $0.
| pocketero-dan wrote:
| > you can actually have a system of government health
| insurance but keep private healthcare.
|
| This is what we currently have in the US. In fact, the US
| government is the largest healthcare insurer in the US
| (through Medicare and Medicaid) [1].
|
| Interestingly, economists have found the US government
| becoming a healthcare insurer substantially increased US
| healthcare prices. For example: "Finkelstein estimates that
| the introduction of Medicare was associated with a 23 percent
| increase in total hospital expenditures (for all ages)
| between 1965 and 1970" [2].
|
| It turns out making healthcare "free" to certain people
| caused them to demand more healthcare. Higher demand caused
| higher prices. Congress "didn't consider the effect of the
| increased demand that Medicare set off." [3] Now healthcare
| prices are high AND Medicare/Medicaid is being paid through
| deficit spending.
|
| If we want to solve the problem of unreasonably high prices
| for healthcare, and the debt that causes, we can't keep doing
| the same thing and expecting different results. We need to
| fix what we've broken with the healthcare market so it can
| operate like markets do and find a fair price.
|
| [1] https://www.trillianthealth.com/insights/the-compass/the-
| gov... [2] https://www.nber.org/digest/apr06/medicare-and-
| its-impact [3] https://reason.com/1993/01/01/the-medicare-
| monster/
| runarberg wrote:
| idk. Most innovation in the field of medicine comes from
| research in universities, which are pretty socialized for the
| most part. The workers that are doing the innovation are also
| educated in a mostly socialized learning system. And there are
| plenty of economies with mostly socialized medicine that do
| plenty of innovation (including the USA). So I think your fears
| of collective funding of important institutions are unfounded.
| peyton wrote:
| The commonly accepted definition of innovation is the
| practical implementation of ideas that result in the
| introduction of new goods and services. So while the ideas
| may come from research in universities, I struggle to think
| of examples of practical implementations resulting in new
| goods and services. Do you have any examples?
| bombcar wrote:
| Interesting:
|
| > For many Americans, debt from medical or dental care may be
| relatively low. About a third owe less than $1,000, the KFF poll
| found.
|
| I wonder how they'd count me, who puts all expenses on a credit
| card and pays it off each month, technically I'm going into debt
| ...
| peteradio wrote:
| I wonder how they consider my family who receives bogus bills
| that are being mishandled by insurance or the hospital or both.
| bpodgursky wrote:
| Yeah I was going to say, I would be 0% surprised if I had old
| outstanding medical bills somewhere just because of the
| general chaos of the process. I have plenty of cash to pay
| whatever I owe, it's just a low-visibility clusterfuck.
| corrral wrote:
| 2/3 childbirths we missed one (tiny, in both cases) medical
| bill and it ended up in collections.
|
| We were getting like 3-5 letters per provider per visit, and
| many visits resulted in bills from multiple providers.
|
| "NOT A BILL" (so why the fuck are you sending it to me?) same
| thing again from insurance for some reason, incorrect bills
| we had to fight, insurance refusing to pay on things they
| should so that drags out for months and you're getting "FINAL
| BILL" in the meantime but the hospital billing people are
| telling you not to pay them until insurance is sorted out.
|
| Many providers sending a bill exactly once and it goes to
| collections if you don't pay in 30 days, no calls or follow-
| ups (that's how both of ours ended up there--again, they were
| tiny, we'd have paid them instantly if we'd known about
| them).
|
| Bills showing up two months after a visit and you've had 30
| medical appointments in the last year so you can't remember
| WTF it was for. I think in one case we were still sorting
| crap out from the birth and prenatal care when the kid was 6
| months old.
|
| Hospital requiring full payment months in advance for the
| births. And getting it very wrong in one case (on the high
| side, of course--every billing error is in the hospital's
| favor, _super weird_ how that works, bet it 's just an
| accident and not them being actual no-bullshit criminals,
| though _eyeroll_ ) because they refused to use our version of
| what insurance would pay (which was correct) and basically
| just made up a number.
|
| Total fucking mess. Horrible experience every time. Can't
| wait to get to deal with this horseshit when one of us is
| actually, seriously sick. I've added hospital billing
| departments to the list of medical-related folks I truly,
| sincerely wish the worst on, and I mean the _worst_ --show me
| the headline, I'll open the champagne. They're either
| shockingly incompetent in ways that mess up people's lives,
| or they're malicious. Maybe both.
| peteradio wrote:
| > not them being actual no-bullshit criminals
|
| Thou shalt never assume malice so sayeth lord Hanlon
| (brought to you by Carl's jr.)
| corrral wrote:
| I truly don't think everyone involved could be making so
| many mistakes in their own favor if it weren't the result
| of policies tuned to ensure that happens.
| [deleted]
| bombcar wrote:
| The policies are designed to find errors in the client's
| favor, that's manifestly clear.
|
| Penalties need to be attached to misbilling; it needs to
| be made effectively illegal and allow others to help
| collect the penalties, then an industry of scummy lawyers
| will appear to help customers reduce their bills at the
| expense of the hospitals.
|
| And they'd deserve it.
| bombcar wrote:
| We've encountered similar situations (especially the "NOT A
| BILL" fuckery) and the "oh don't pay it when it arrives
| because insurance is always slow" shit - but luckily none
| of our three births have been that bad cost/handling wise,
| even though we used three different hospitals (same
| insurance).
|
| The smaller hospitals _in general_ have been better but it
| 's so obviously a giant clusterfuck.
|
| I can't even imagine how someone without partner support
| (who the hell wants to deal with hospital fuckery post-
| partum) does it.
| electriccatblan wrote:
| My wife and I have good insurance (like $200 out of pocket
| for surgery good) and I still hate going to the doctor
| because I know I'm going to get stuck with an involuntary
| side hustle as a medical billing clerk if I want the
| benefits we're entitled to to actually be honored. Our
| insurance paid maybe ~6k in charges one time, then 6 months
| later retroactively denied the claims and billed us for
| them. There's just no repose ever at any time, and you have
| to deal with a system that is always stacked against you.
| corrral wrote:
| No joke. If we'd been compensated at any kind of
| reasonable rate (not even our day-job rates) for time
| spent dealing with billing and insurance crap, it
| would've covered a good chunk of our (substantial) bills.
| giantg2 wrote:
| Yep. I'm dealing with a situation where speech therapy as
| rehab from a surgery is covered by by plan. But the hospital
| just submitted the claim with some general code. The
| insurance says they need the therapist to change the billing
| code. They won't allow us or the surgeon to submit anything
| to prove it should be covered. We have to wait for the inept
| therapist to change the code. All the while thousands in
| bills hang over our heads and we wonder if insurance will pay
| out.
| bombcar wrote:
| And rarely, if ever, can you get the insurance company to
| admit what the secret billing code is before you have the
| procedure done. You have to hear it in whispered
| conversations from those in the know.
| ohwellhere wrote:
| At worst they'd put you as one of the 37% of people who haven't
| had to cut spending on food, clothing, or other basics.
|
| Of course, 63% of the people with health care debt have
| (according to study).
|
| So while your case is interesting from a technical point of
| view, it isn't really practically or morally interesting, and
| can only serve to detract from the important points of the
| study.
| bombcar wrote:
| These studies are always _self-reporting_ and taken at much
| more than they actually say. Checking the methodology is
| important and should be done more often, especially on
| surveys based on self-reporting and not on large amounts of
| data.
| ohwellhere wrote:
| You are right. I tried to caveat my analysis with
| "(according to study)". My prior is not that the study is
| completely accurate, but that it is accurate enough to make
| the broader points described. I may be wrong, and you're
| right that everyone should be more cautious.
|
| But I think there is a difference between cautioning
| neutrally (the comment I'm replying to now) versus
| obliquely cautioning in a way that casts doubt with
| negative consequences (the comment I replied to
| previously).
| Clent wrote:
| You are assuming $1000 is easy to pay off. This is simply not
| true for the working poor.
| notch656a wrote:
| $1000 is $2 / day for les than 2 years (if you can do math
| unlike commenter below, that's including nearly 20% APR). I'm
| sorry but even the poor in america can come up with some way
| to make $14 in a week, if nothing else by picking up some
| cans.
|
| I live in a city where a segment of impoverished people come
| up with ways to spend $20+ a day in fentanyl, and they don't
| seem to have much trouble coming up with that even while
| living in a tent.
| [deleted]
| newsclues wrote:
| People live in tents because 100% of their income goes to
| opiates.
|
| They can't make more money and save it, because their needs
| will always exceed their income short of massive windfalls
| SoftTalker wrote:
| Yes, if you are living in a tent and are addicted to
| opiates, I doubt that "medical debt" would be anything
| that even registers on your radar. You'll get emergency
| medical care as needed at the nearest public ER, and
| since you don't have an address they probably won't even
| bother to try to send you a bill.
| newsclues wrote:
| I'm in Canada and there is no medical debt but homeless
| addict encampments in many cities.
| JaimeThompson wrote:
| 14 per week might be the difference between eating ok and
| not eating.
| notch656a wrote:
| You can eat "ok" on $2 a day?
| JaimeThompson wrote:
| Yes if you are careful, but that isn't what I said. You
| are assuming that the base spent on food is 0 + 2 when
| that wasn't what I said.
| notch656a wrote:
| >difference between eating ok and not eating.
|
| >difference
|
| > eating ok
|
| > not eating
|
| If you're not eating it follows you're eating $0 worth of
| food. So it is what you said, unless you're implying
| someone is spending money on food without eating any of
| it.
|
| I'm interested in the meals you suggest that you think
| are "eating ok" while maintaining the nutrition to work,
| $2 all in per day (food cost + transport to buy the food
| + cost to cook the food + depreciation on any utinsils /
| cookware).
|
| Also keep in mind many poor people live in a food desert
| so if you're counting on discount food you're gonna need
| a bus ticket or a hell of a long walk once in awhile.
|
| As an aside, it's worth noting if your suggestion is true
| and one can truly eat ok on $2 a day, then the median
| medical debt holder who spends say $4 a day on food can
| easily pay off their loans in a few years following your
| cooking advice. You just came up with a way for them to
| produce $2 / day without any additional income.
| JaimeThompson wrote:
| There are multiple meals per day if one has to skip some
| of them to make ends meat then they are "not eating"
| those meals.
|
| It's a bit more complicated than you are making it out to
| be, it would not hurt to remember you are talking about
| fellow human beings and not just numbers in a
| spreadsheet.
|
| As for inexpensive ways to eat please see
| https://old.reddit.com/r/EatCheapAndHealthy/
| notch656a wrote:
| Got it, the typical person can browse reddit, come up
| with an "ok" diet for $2 day, saving them $3+ a day vs
| what even the typical working class person spends on
| food. And simultaneously you believe it is achievable to
| save this $3+ per day eating following your reddit
| suggestion while somehow not being able to use $2 of
| those $3+ to pay your medical bills?
| JaimeThompson wrote:
| Do you find that being this uncharitable is an effective
| way to communicate with others?
|
| You haven't actually been poor like that in the US. That
| isn't a question, it is a statement. I have as have
| others I know so yes even a few dollars per day can
| make/break the budget.
| notch656a wrote:
| >You haven't actually been poor like that in the US. That
| isn't a question, it is a statement. I have as have
| others I know so yes even a few dollars per day can
| make/break the budget.
|
| I don't know how poor you have been or are. And you don't
| know how poor I have been either. I'm not going to play
| oppression olympics with you. I have been homeless,
| sleeping in ditches and parks before, living off of
| minimum wage day labor. Even back then, if I needed $2 I
| simply worked an extra 15 minutes moving drywall at
| construction sites or whatever. Those who can't work may
| end up buying snacks with their foodstamp card and
| hawking them to high schoolers walking to school or
| something (as I see many homeless do near my house).
| There are very few people who aren't already covered by
| medicaid/medicare who are incapable of coming up with $2
| / day somehow, and if they are they are the extreme case.
| Again even _drug addicts_ in my neighborhood, while high
| out of their minds, somehow manage to come up with
| $20/day for their fentanyl habit and that doesn't even
| cover the rest of their necessities.
|
| And as an aside, I'm not buying the argument that being
| broke somehow makes you more of an expert on how to
| budget. The poor in this country are notoriously victims
| of sub-par education which sadly leaves many of them
| poorly situated to navigate managing their own economic
| future. If I want budgeting advice I'd much rather ask
| say a guy who started his own restaurant vs some random
| broke person on the street.
| chaps wrote:
| You're taking one person's experience, who has _mild_
| medical expenses and applying their situation to loads of
| poor people as if their experience exemplifies the
| experiences of millions. Frankly, that 's disgusting and
| while I don't wish you awful medical debt, it sounds like
| you could stand to be humbled by some.
|
| Think of bigger medical expenses over the same period --
| 10k. That's 20/day. 100k -- 200/day. Now add ACA monthly
| costs (300-400/mo). Then rent, then food. Etc etc.
| [deleted]
| notch656a wrote:
| >You're taking one person's experience, who has mild
| medical
|
| "You" being the parent OPs who I responded to who
| introduced the nation of $1000, which happens to be above
| the median for my state and most states shown in the
| article? Remember I'm RESPONDING to the $1000 comment,
| not introducing the figure. But maybe they said something
| about the $1000 you agreed about, so you went with the
| disingenuous approach of only impugning someone
| commenting on it and in bad faith accusing THAT person of
| introducing the figure.
|
| The MAJORITY in my state and most states have less than
| $1000 in medical debt. Millions. This isn't some edge
| case. $1000 "exemplifies" the median medical debt in most
| states, according to the article.
|
| >sounds like you could stand to be humbled by some
|
| Yeah a subtle suggestion I ought to experience medical
| problems. Keep it classy. "Frankly, that's disgusting."
|
| >Think of bigger medical expenses over the same period --
| 10k. That's 20/day. 100k -- 200/day. Now add ACA monthly
| costs (300-400/mo). Then rent, then food. Etc etc.
|
| Yes I thought about it, and then decided my $2/day figure
| still holds as a possible approach for paying off median
| medical debt. Thanks for the thought exercise!
| chaps wrote:
| I'm really not sure how a median of $1000 is supposed to
| make your point any better.
| notch656a wrote:
| I'm not sure how throwing around a $100k figure is
| supposed to make your point any better. If it's worth
| considering the 100k case of the minority it's worth
| considering the half of person's in these states for whom
| the debt is under $1k.
|
| My intention was never to show that someone with $100k of
| medical debt could get out of it as easily as the
| majority with far less.
| culopatin wrote:
| Do you get your loans at 0% APR? Where do I sign?
| kube-system wrote:
| Accounts Receivable at your local hospital.
| bombcar wrote:
| I'm not assuming anything, I'm wondering about their
| methodology (and since it's a self-reporting survey, how
| people were answering the questions).
|
| Medical debt _is_ a huge problem but to craft solutions we
| need to fully understand that problem. Should, for example,
| insurance companies collect "deductibles" ahead of time and
| refund those not used, similar to how you could use an HSA?
| Should healthcare providers and insurance companies be
| required to offer 0% financing for 12 months for certain
| amounts or certain customers?
|
| The vast takeaway is usually "this survey supports what I
| think should be done" which often results in not much of
| anything being done, or getting something _worse_ than what
| was before.
| swatcoder wrote:
| No need to wonder. You can read the poll and results
| methodology yourself.
|
| The answer is two clicks from the article, both links above the
| fold on their respective page. If you're being genuine in your
| curiosity, it would improve the discussion here if you shared
| what answer you find.
| bombcar wrote:
| > The survey was designed to reach _adults who currently have
| health care debt or have had health care debt in the last
| five years_. In order to do this, the probability panel
| sample included an oversample of panel members with annual
| household incomes less than $30,000, individuals with current
| or past health care debt (n=641) were included in the sample.
| In addition, 52 adults with past or current health care debt
| were reached by calling back respondents that had previously
| completed an interview on the SSRS Omnibus poll (and other
| RDD polls) and reported an annual household income of less
| than $25,000.
|
| > The combined online and telephone samples, excluding
| oversamples, were weighted to match the sample's demographics
| to the U.S. population using data from the Census Bureau's
| 2021 Current Population Survey (CPS). On the basis of this
| weighted sample, parameters for the debt and no-debt
| populations were extracted. Weighting parameters for each
| group included sex, age, education, race/ethnicity, region,
| education, and income, as well as patterns of civic
| engagement from the September 2017 Volunteering and Civic
| Life Supplement data from the CPS. The sample was also
| weighted to match population density parameters from the
| Census Planning Database 2020. The weights take into account
| differences in the probability of selection for each sample
| type. This includes adjustment for the sample design and
| geographic stratification of the cell phone sample, within
| household probability of selection, and the design of the
| panel-recruitment procedure.
|
| So they intentionally targeted people _with debt_ , so the
| "63% percent of respondents" is _not_ able to be read as
| "63% percent of Americans".
|
| The 100M in the title is extrapolated, and is likely correct,
| but people are _not_ reading the percentages as they should
| be read.
|
| The _key takeaway_ from the study is that not all medical
| debt is reported as such, and poor people have difficulty
| paying bills, one type of which is medical bills.
| olddustytrail wrote:
| > So they intentionally targeted people with debt, so the
| "63% percent of respondents" is not able to
|
| No, that's not how it works. You oversample a group you are
| interested in and then weight it.
|
| To be honest, you don't know enough about statistics to
| evaluate this. You should either learn more or accept the
| conclusions of those who know more.
| bombcar wrote:
| Even the study itself says "63% of respondents _with
| debts_ ".
| olddustytrail wrote:
| Yes, it does. There's nothing wrong with that.
| hedora wrote:
| > ... _to be read as "63% percent of Americans"._
|
| > _The 100M in the title is extrapolated, and is likely
| correct,_
|
| What's the problem with their comment, exactly?
| kube-system wrote:
| I also intentionally go in to debt for any of my expenses
| subject to deductible, because my hospital offers zero-interest
| payment plans. I then pay their payment plan with a credit
| card, get 2% back, and pay it off at the end of the month.
| ericmay wrote:
| I'm very surprised they do not charge the credit card
| processing fee here. But I guess since you are _actually
| paying_ they are making such high margin they don 't even
| care.
| kube-system wrote:
| Hospitals are incredibly forgiving if you will eventually
| pay. Collections will give them pennies on the dollar at
| best.
|
| If you call them up, they'll usually just say "what _can_
| you pay? " and agree to just about anything you propose.
| bombcar wrote:
| This is 100% the case, the billing side is completely and
| absolutely disconnected from the care side it's not even
| funny. As long as the inflows from customers and
| insurances companies roughly equal the outflows in
| expenses, they really don't care much how everything is
| billed.
|
| Which is why you can often do better paying _cash_ at a
| "expensive" hospital that is overflowing with money than
| at a "budget" one that is having difficulty making the
| numbers balance. The latter is more likely to hard-line.
| secabeen wrote:
| This also ties into that commonly statistic that 60+% of
| bankruptcies are caused by medical bills. The study is more
| complicated than that, and it's not the best summary:
|
| https://www.politifact.com/factchecks/2009/jun/11/chris-
| dodd...
| kube-system wrote:
| A lot of people read that statistic as "medical debt is
| crippling" but there are also correlations with lot of
| other life circumstances going on in that figure too.
|
| Most of the people who file something like chapter 7 have
| little to no income, don't have big bank accounts, luxury
| cars, second homes, etc. This often correlates with people
| who have medical issues and rack up big bills, and can't
| work a job. These people can file "no-asset" chapter 7
| cases, in which case, they lose absolutely nothing. This is
| what happens in the majority of chapter 7 cases filed. So,
| for a lot of the people who do choose to file, this is
| because it is a good option, not because it is a life
| crippling choice forced upon them.
| bombcar wrote:
| This is exactly the kind of thing I'm getting at -
| _absolutely 100%_ of bankruptcies are _caused by debt_ ;
| perhaps 60% of them also have medical debt somewhere in
| there, but that may be a distraction (after all, once
| you're on the path to bankruptcy why bother trying to make
| medical payments, they're not going to repossess your lung
| but they very well may repossess your house).
|
| The US has a _major_ debt problem and the solution at some
| point is going to be curtailing just how much debt you can
| accumulate with just a signature.
| egberts1 wrote:
| Anyone who owes $5 or more in outstanding medical bill is counted
| as part of 1/3rd of country.
|
| Really? How about year-long debt or 30-60-90 day breakout chart
| by amount?
| lotsofpulp wrote:
| It is always the same poor journalism tactic of obscuring the
| distribution of data to make a "plausible" controversial claim.
| Similar to the oft quoted "Americans cannot afford a $500
| emergency".
| jioujoijoijoi wrote:
| crisdux wrote:
| I have issues with how they did their analysis. They count anyone
| who paid for medical services on a credit card and then is
| carrying that on their credit card balance month to month.
| Folks... that's how many Americans pay for all goods and services
| and run their finances. The last time I checked, 60% of Americans
| carry a credit card balance from month to month. The findings in
| their report seem aligned to that.
|
| I think people are reading too much into a poor analysis, created
| and reported on by institutions with an obvious agenda.
| sparklingmango wrote:
| Some standout stats for me:
|
| - Hospitals recorded their most profitable year on record in
| 2019, notching an aggregate profit margin of 7.6%
|
| - From 2012 to 2016, prices for medical care surged 16%, almost
| four times the rate of overall inflation
|
| - Last year the average annual deductible for a single worker
| with job-based coverage topped $1,400, almost four times what it
| was in 2006... Family deductibles can top $10,000
|
| Facilities charge exorbitant prices for procedures and insurance
| companies pass more and more of these costs on to patients via
| higher deductibles and premiums. It will continue to get worse
| unless there is colossal change.
| pocketero-dan wrote:
| Proposed colossal change: a common practice of paying for
| healthcare out of pocket, instead of through healthcare
| insurance.
|
| Yes, this sounds unreasonable right now because prices are so
| high. But bear with me for a second.
|
| Most healthcare in the US is paid through insurance. Insurance
| creates moral hazard. Insured patients generally don't even
| need to know the prices of what they're buying, much less
| negotiate those prices. And here's a dirty secret: insurers
| don't care much either. They simply add a margin on top of
| their actuarially-forecasted cost. So healthcare prices rise
| dramatically over time, because relatively few people are
| directly exposed to them and push back on them. From this
| perspective, healthcare insurance is a problem, not a solution.
|
| Don't get me wrong, there are admittedly some obstacles to
| patients paying out of pocket right now. My point is that we
| know properly functioning markets set fair prices, and we know
| our healthcare market is dysfunctional. Healthcare insurance
| plays a part in that dysfunction.
|
| Patients negotiating directly for better prices eliminates
| moral hazard and restores market function. Strategically, that
| would finally restore pressure on healthcare providers, who
| have become accustomed to raising prices with very little push-
| back. Without some kind of push-back, providers will continue
| raising prices - because they can.
| mindslight wrote:
| Without competition, there is no avenue for "negotiation".
| And you don't even have to go as far as you've described -
| simply mandating that providers can only charge uniform
| prices across all payers (ie end their collusion with
| "insurance" companies), along with eliminating the laws that
| allow providers to substantiate bills without needing to form
| contracts (ie agreeing to prices or shop rates up front),
| would go a long way towards triaging the immediate insanity.
| BeFlatXIII wrote:
| IMO, your proposal should separate emergency care, "capital
| investment", cosmetic, and routine healthcare. Cosmetic &
| routine should be more market-driven. However, emergency care
| is unplanned by definition (so can't be properly budgeted
| for). "Capital investment" would cover the range of expensive
| procedures ranging from "needed within the next five years to
| prevent an early death from cancer, but otherwise not time-
| sensitive" to expensive quality-of-life upgrades, such as
| knee replacements. Emergency & investment services would need
| something other than pure market pricing.
| burmer wrote:
| hm, interesting. Even better: potentially, instead of
| negotiating prices one on one, we could form some sort of
| large collective enterprise that was beholden to us so that
| it could negotiate prices on our behalf. I'd bet if there was
| such an group that represented a large enough % of us, we
| could get some pretty good deals. Now, what would we call
| it...
| nradov wrote:
| High deductible health plans are widely available and members
| pay for most routine care out of pocket (often via an HSA).
| However in practice this does little to hold down costs. Most
| patients aren't able to do effective price comparisons, and
| can't really switch providers just to save a few dollars.
|
| https://www.healthcare.gov/high-deductible-health-
| plan/hdhp-...
|
| There's pretty much a free open market for cosmetic medical
| procedures not covered by insurance. But markets can never
| really work for medically necessary treatments. Demand is
| essentially fixed regardless of price. Patients who are in
| pain or at risk of death will pay everything they have and go
| into debt besides in order to get treatment. On a large scale
| basis the only effective means of holding down costs is some
| combination of rationing and price fixing.
| Amezarak wrote:
| Not only are HDHPs widely available, they are widely used!
| I've seen numbers to where a third to half of all private-
| industry health insurance coverage is under a high
| deductible health plan.
|
| These people, me being one of them, are _extremely_ cost-
| conscious, believe me. It doesn 't help for basically the
| reasons you mention.
| sparklingmango wrote:
| Medical patients are not really "consumers" in the normal
| sense of the word. A patient may be unconscious when they
| arrive at a hospital and doctors will just start to treat
| them (as they should). A patient's doctor may refuse to
| change where they'll do the operation even if it'll save
| their patient a lot of money. A patient may decide they're
| going to have a procedure done at a surgery center, a
| facility that is typically much cheaper than a hospital, but
| they can't predict if they'll have a complication that will
| drastically change the cost of their procedure. Patients
| can't just walk up to a menu and decide that because they
| have chest tightness they want a stent put in. That's not how
| medicine works. The doctor typically sets the treatment plan
| and there's very little veering off that plan. The doctor
| really isn't even the one that sets the prices. Insurance
| companies are heavily involved in that and it varies by
| health insurance and plan.
|
| The cheapest prices in US healthcare are the prices paid by
| Medicare. There are so many people on Medicare so this leads
| to a lot of bargaining power. Hospitals would never refuse to
| treat Medicare patients (because there are so many). So,
| Medicare decides "We're only going to pay $10,000 for a total
| knee replacement." And hospitals have to say "Okay, sounds
| good. Can't really say no to 60 million patients." Insurance
| companies do not have that type of bargaining power. They say
| "We only want to pay $20,000 for a total knee replacement."
| And the hospital goes "Nope, we're charging you $30,000." And
| the insurance company sheepishly goes, "Okay..." and then
| sets really high premiums, deductibles, and out of pocket
| maxes so they don't have to bear the weight of the cost.
| dragonwriter wrote:
| > My point is that we know properly functioning markets set
| fair prices
|
| For frequently-repeated purchases of goods with robust
| competition for close alternatives where the approximate
| total infinite-horizon costs and utilities resulting from the
| decision are both entirely experienced by the participants to
| the exchange and very clear before or quickly after it occurs
| so that behavior can rapidly adjust to more optimal
| alternatives when suboptimal choices are made, in other words
| where the perfect knowledge assumption underlying rational
| choice theory is, while it is never actually accurate, at
| least closely approximated in the relevant market, and there
| are no externalities making inefficient in the global sense
| actions efficient from the perspective of participants.
|
| Medical care very much does not fit this pattern.
| josephd79 wrote:
| It's ridiculous in the year 2022 we still have people making a
| decision to not seek medical treatment of any kind because they
| are afraid it will bankrupt their family, they won't be able to
| pay their rent or mortgage on time, they might have to go without
| food, take out loans or borrow money that puts them in even more
| debt causing more health issues. I'm not sure what the solution
| is but I feel like there's got to be a better way.
| [deleted]
| pastor_bob wrote:
| Urgent care had my girlfriend go to ER when she went in for
| Epinephrine shot. Because, apparently, they call an ambulance for
| anybody who shows up with something potentially dangerous
| (including EKG readings they can't read, according the the
| ambulance driver who took us).
|
| We just sat on a chair for a couple hours for 'monitoring', and
| sure enough we got a $1700 bill from them, since she hadn't met
| her deductible yet.
|
| Of course people are in debt if they get hit with bills like
| that.
| zikduruqe wrote:
| Not my family.
|
| We filed for bankruptcy, so screw the whole medical industry.
|
| Honestly, it wasn't bad and within 18 months bought a new car,
| new house and started life over again.
| starik36 wrote:
| Doesn't the bankruptcy stick around on the credit report for 7
| years?
| egberts1 wrote:
| Yep but if you add a note for the reason of bankruptcy into
| your credit application, the credit provider would still take
| that into consideration and STILL charge you a higher
| interest rate.
|
| Depending on the absolved medical debt (being discharged by
| your bankruptcy), and its would-be crushing monthly payments,
| the higher interest rate of your new (mortgage/credit) credit
| lines and its monthly payments are often less than the impact
| by (then dissolved) medical payments therefore your living
| standard would still improve after such medical-related
| bankruptcy.
| agubelu wrote:
| As someone from the other side of the Atlantic, I've always
| been surprised at how much people in the US rely on debt
| and credit lines for their daily lives (besides very
| infrequent, very expensive purchases such as a house). I'm
| personally extremely wary of spending money I don't have.
| abledon wrote:
| so 30% of the country's population has medical debt.. what the
| hell
| thablackbull wrote:
| And 70m of the population is 18 and under. So apparently the
| percentage of people with medical debt who are over 18 is quite
| substantial. Didn't realize it was so significant myself.
| treis wrote:
| It's an entire industry based on fraud and deception. My wife
| recently had surgery and we got hit with a $1500 surprise
| facility fee. It likely won't be covered by insurance due to
| some fuckery around not reimbursing the fee if the in plan
| physician owns the facility.
|
| We knew enough to ask about the anesthesiologist and any
| surgery assistants. But they came up with some new bullshit and
| got us. When the world gets wise to this nonsense they'll come
| up with something else. It's a business deeply rooted and based
| on scamming their customers.
| geoduck14 wrote:
| I don't see why this is a bad number. It is easy to get on a 0%
| payment plan for medical procedures, or to contest a medical
| bill that is "a debt" that will get paid eventually.
| draw_down wrote:
| justinzollars wrote:
| I see any suggestion to the contrary of Socialized medicine being
| downvoted. Honest question. How do you propose to expand
| healthcare with 130% Debt to GDP and 8.9% inflation? It seems we
| are broke and there is a demand from the HN community to spend
| more? Feels like hitting the accelerator as one drives off a
| cliff and invokes memories of Thelma & Louise
| stephen_g wrote:
| We have a hybrid system here in Australia where there are tax
| benefits for having private health insurance but we also have a
| high quality public system. The public system actually comes
| out consistently as being more efficient than the private one,
| so the cost to society is less.
|
| The rebates for private health insurance (to convince people to
| take out private insurance to "take pressure off the public
| system) have actually made things worse, for most people it's
| subsidised by 30% by the Government (and you avoid an extra
| health levy), but over the last decade or two, the premiums
| have just gone up significantly and the amount of things
| covered has been dropping. It would have been better to just
| put that money into the public system (which is a bit
| overstretched due to underfunding). So mostly the subsidy has
| just gone into profits for insurers. It's hard to get people to
| take out the private insurance without it and tax offset, but
| as I said before, since the public system is more efficient,
| the cost to society would be less without subsidising private
| insurance.
| LinuxBender wrote:
| I agree and have always felt all of this is the wrong debate.
| The focus should be on fixing the root cause of most medical
| issues. _" An ounce of prevention...."_ yada yada... Just
| Type-2 diabetes alone will bankrupt the US by 2040 or sooner
| according to the CDC as reported in an interview on Joe Rogan.
| [1] There are a myriad of other CDC studies that show us going
| bankrupt sooner regardless of who pays for medical issues. I
| have no idea where all this money will come from short of
| conquering some other countries. For me personally, I will just
| focus on proactive measures. Here [2][3] are a couple of the
| reports.
|
| As a side note I am about to go feed Thelma and Louise. Ill pet
| them and say hi for you.
|
| [1] - https://www.youtube.com/watch?v=5LTWJOi3bCo [video] [joes
| t-shirt nsfw, minimize browser]
|
| [2] - https://www.cdc.gov/media/releases/2017/p0718-diabetes-
| repor...
|
| [3] - https://diabetesjournals.org/care/article/41/5/917/36518
| killjoywashere wrote:
| "Socialized" explicitly means government ownership of the means
| of production (1-3). Weaker definitions include ideas like
| regulation, administration, or control. But let's stick with
| ownership. Your word, so let's work with that.
|
| If the government owns the system, the government can establish
| all sorts of controls (4). What do you think the margin is in
| these sectors (% is of $3.5T in 2017)
|
| Hospital care (33%)
|
| Physician and clinical services (20%)
|
| Retail drugs (10%)
|
| Other health, residential personal care services (5%)
|
| Nursing care facilities (5%)
|
| Dental (4%)
|
| Home health (3%)
|
| Other professional services (3%)
|
| Other non-durable medical products (2%)
|
| Durable medical equipment (2%)
|
| (1) https://www.britannica.com/topic/socialism
|
| (2) https://www.merriam-webster.com/dictionary/socialism
|
| (3) https://en.wikipedia.org/wiki/Socialism
|
| (4) https://www.cms.gov/research-statistics-data-and-
| systems/sta...
| jjoonathan wrote:
| We pay nearly double for our privatized monstrosity, compared
| to the most expensive socialized systems. Such savings! So
| cheap! Very efficient! Can the treasury possibly bear the
| expense of spending less than double?
|
| ------
|
| Yeah, a transition is going to be an expensive shitshow and now
| is not a good time, but just about any other time in the last
| decade _was_ a good time and in a year or two it will be a
| decent time again. We 'd better rip this bandaid before it
| soaks _all_ our blood out.
| justinzollars wrote:
| Politics aside, money puts a cap on everything: wars, social
| services, etc.
|
| The issue at hand is to take something the public spends
| nothing on, that the government gets for "free" and to put
| that on the public balance sheet - a huge cost. I guess we
| could balance that out with a tax, but who would like that?
| And even if we were to raise taxes - it wouldn't help our
| balance sheet since we already spend 30% more than we take
| in. Looking at the balance sheet as it stands today, we can't
| even afford what we currently spend. And inflation is on the
| rise.
|
| I just don't see it ever happening. Save a collapse and total
| reset of the current monetary system.
| jjoonathan wrote:
| > Politics aside, money puts a cap
|
| What part of "we pay nearly double" didn't make it through?
|
| We can't afford the enormous premium we are paying for
| privatized care.
|
| > I guess we could balance that out with a tax
|
| Payroll tax. In the vacancy left by private insurance.
| Scribble off one memo line, write in another. Come on, this
| is a 101 level objection.
| corrral wrote:
| We would have to colossally and _uniquely_ fuck up any version
| of "socialized" medicine for it not to be a substantial net
| _savings_.
| p0lp0t wrote:
___________________________________________________________________
(page generated 2022-06-16 23:01 UTC)