[HN Gopher] Using AI to negotiate a $195k hospital bill down to ...
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Using AI to negotiate a $195k hospital bill down to $33k
Author : stevenhubertron
Score : 726 points
Date : 2025-10-28 15:58 UTC (7 hours ago)
(HTM) web link (www.threads.com)
(TXT) w3m dump (www.threads.com)
| candiddevmike wrote:
| While it's an interesting story, I doubt they needed Claude to
| work a hospital bill down to that amount. Hospital billing folks
| are acutely aware that the initial bill is outrageous and
| indefensible from their end. I've heard a ton of cases where
| folks basically "pay what they can" for the bill and that's good
| enough for both parties. I doubt the reasoning Claude provided
| was ultimately what got the hospital to knock the bill down,
| probably more around the legal action and PR threats. Ironically,
| the hospital will probably count this as charity even though OP
| didn't want to be considered charity, as they had to write off
| part of the bill.
| ddtaylor wrote:
| > Hospital billing folks are acutely aware that the initial
| bill is outrageous and indefensible from their end. I've
|
| I'm sure they also have a long arsenal of various legal tricks
| they bundle into offerings like they did in the linked thread
| with respect to attempting to relabel it a charitable donation,
| etc.
| mbac32768 wrote:
| IMO the pro move is not to get the hospital to accept what an
| insurance company would pay, but get them to accept slightly
| more than what a debt collector would pay.
| ryanjshaw wrote:
| I'm confused why - if this is indeed common practice - it's not
| considered fraud on the part of the hospitals?
| scottlamb wrote:
| I'm getting that most people don't know the sticker price is
| fraudulent (e.g. the overlapping "master procedure" and
| component codes) and/or are so relieved to have the charity
| out that they agree to it without any further questions. But
| OP points out that the charity out is just further fraud,
| victimizing tax-payers.
| istjohn wrote:
| Where are the class action law suits?
| NickC25 wrote:
| the medical insurance industry and the hospitals do this
| whole song-and-dance charade where they pretend that they are
| charitable, public-protecting institutions who serve noble
| goals of helping sick people.
|
| in truth, they are doing nothing but racketeering.
| scottlamb wrote:
| > While it's an interesting story, I doubt they needed Claude
| to work a hospital bill down to that amount. Hospital billing
| folks are acutely aware that the initial bill is outrageous and
| indefensible from their end.
|
| OP agrees: "Ultimately, my big takeaway is that individuals on
| self-pay shouldn't pay any more than an insurance company would
| pay--and which a hospital would accept as profitable business--
| than the largest medical payer in the country. I had access to
| tools that helped me land on that number, but the moral issue
| is clear. Nobody should pay more out of pocket than Medicare
| would pay. No one. ... Hospitals know they are the criminals
| they are and if you properly call them on it they will back
| down."
|
| > I've heard a ton of cases where folks basically "pay what
| they can" for the bill and that's good enough for both parties.
| I doubt the reasoning Claude provided was ultimately what got
| the hospital to knock the bill down, probably more around the
| legal action and PR threats. Ironically, the hospital will
| probably count this as charity even though OP didn't want to be
| considered charity, as they had to write off part of the bill.
|
| I read that OP refused to sign something that fraudulently said
| the full price was $195k but rather insisted on signing on a
| bill that said the full price was $33k or $37k or something.
| (Maybe $4k was called charity.) They might have presented a
| completely different bill to the IRS to justify tax-exempt
| status, but that illegal action would be totally on them; OP is
| not participating in their tax fraud. I applaud OP for that and
| hope this becomes the norm.
| bazmattaz wrote:
| How do the hospital determine how much you're able to pay
| though. You could say $20k is the max I can afford or $2k is
| the max
| jimbohn wrote:
| The real treat would be using AI to stop regulatory capture so
| you don't end up in a country where it's okay to be presented
| with a 195K bill that can be magically lowered if you insist hard
| enough.
| xnorswap wrote:
| It seems pretty messed up when a $30k bill is written up like a
| big win.
| candiddevmike wrote:
| Their brother presumably didn't have insurance, and it sounds
| like some pretty major procedures involving specialists,
| equipment, and hospital intake. While the outcome was
| horrible, all of those people need to get paid for the
| services rendered somehow if we want folks in the US to
| continue receiving this standard of care.
| computerex wrote:
| Except everything in America is ludicrously priced. The
| cost of supplies and equipment is not even close to being
| realistic in America vs what you'd be charged for equal
| care in another country.
| bgirard wrote:
| > Another was a code that was inpatient only and because it
| was an emergency he had never been admitted.
|
| The threads says this was 4 hours of work and they billed
| for things that weren't even used.
| bobtheborg wrote:
| $30K NOT counting some expenses (cardiologist, ER docs)???
|
| > Bills were a few thousand here for the cardiologist,
| another few there for the ER docs, a bit for the radiologist.
| I helped my sister-in-law negotiate these down but they
| weren't back breakers. Then the hospital bill came: $195k.
| This is a story about that.
| clutchdude wrote:
| To a lot of people, that's out of the fire and into the
| frying pan.
| meowface wrote:
| I think there's more than just regulatory capture at play here,
| unfortunately. America is an odd place.
|
| I think a public option is the only feasible path forward.
| giancarlostoro wrote:
| Hospital billing involves the 'mafia'-like influence game of
| having good insurance (which means being hired at the right
| company, with the right 'influence' over the hospital network
| in question) and covering the costs of the other patients who
| cannot afford it and refuse to pay. Hospital billing has the
| least teeth of any debt in the US. If you haggle a billing
| department long enough, they'll desperately take anything you
| give them.
| harrall wrote:
| I'm not sure there is regulatory capture at play necessarily.
|
| I notice regular doctors and dentists do this too. They'll bill
| my insurance for extras in case they'll pay and when insurance
| says no, the doctor doesn't bill me either.
|
| Everyone is just trying to suck the most money out of everyone
| else. It sucks if you're self-pay because you don't have the
| weight of a whole company to do that due diligence for you.
| noir_lord wrote:
| As someone with medical conditions from a country with
| universal publicly funded health care, while it may not be
| flawless (though in terms of actual medical treatment, no
| complaints either) it sure does seem to be a whole hell of a
| lot better than the alternative.
|
| Not once have I had a sleepless night since been diagnosed over
| a decade ago about insurance, co-pay or how to afford my
| drugs/medical treatment.
|
| I'm on two prescriptions per month, total cost to me is PS114 a
| _year_ (about 150 bucks).
|
| Folks over in the US are getting hosed, twice the per capita
| with a worse outcome and it costs you a fortune on top
| personally.
|
| That healthcare is tied to employment is just the insane cherry
| on top (I'm aware of the historical reasons why that happened
| but should have been fixed not long after).
| ryao wrote:
| Are the outcomes in the US worse? Not that long ago (a couple
| months ago in fact), I looked at public data comparing cancer
| survival rates, which put the outcomes in the US at least 10%
| better than those in the UK. That was additive, such that a
| 20% survival rate in the UK for a type of cancer is at least
| a 30% survival rate in the US. The 10%+ better outcome in the
| US applied to all types of cancers for which I found public
| data.
|
| I believe the reason for higher US success rates was that the
| US used more aggressive treatments that the UK would not,
| since neither does the NHS pay for them nor do their doctors
| offer them. It is easy to complain about the US system, but
| the reason that the per capita cost of health care in the US
| is high could be because the US will try expensive things
| that the UK's NHS never would have attempted (since spending
| exorbitant amounts on aggressive treatments with low chances
| of success to attain US success rates would drive the per
| capita cost of medicine to what could be US levels). The high
| US pricing of those treatments could be further amplified by
| attempts to take advantage of ignorance. Amplification to
| take advantage of ignorance was clearly the case in the
| article author's case.
|
| I feel like the opposite viewpoint in favor of the US system
| is not well represented in online discourse, which could very
| well be because those who were not served well by the UK's
| NHS are dead. There are anecdotes about people coming to the
| US for treatments that they could not receive in the UK or
| Europe, which is consistent with that.
|
| That said, I have only looked at data for cancer survival
| rates and not other illnesses, but the cancer data alone
| contradicts what you wrote. Perhaps reality is in the middle
| where the UK system is better for routine issues (i.e. you
| avoid sticker shock), but the US system is better for
| anything that falls outside of that (i.e. you have a better
| chance to live). There is evidence both systems have plenty
| of room for improvement.
| vel0city wrote:
| You're taking quite a small view of healthcare in the end
| looking at only cancer outcomes. Just ignoring things like
| maternal mortality, infant mortality, cardiovascular
| issues, etc.
| ryao wrote:
| You are right, but blanket statements only need one
| counter example to be shown to be false. I had looked
| into cancer data because I read some remarks made about
| cancer between the US and Europe and I was curious if
| they were true.
|
| For what it is worth, I take a prescription medication
| for a non-life threatening condition. I had once called
| Costco in Canada to find out how much the price is there
| out of curiosity. They do not sell it. I then discovered
| that the drug my doctor prescribed is exclusive to the US
| and is not sold anywhere else in the world. Presumably,
| nobody else is willing to pay the exorbitant price that
| is charged for it. Even the generic is expensive. The US
| system is expensive, but it gives people access to more
| expensive treatments that simply are not available
| elsewhere.
|
| That said, I might have an elective operation in the
| future. It would have been covered by insurance as a
| necessity when I was young, but my parents never pursued
| it and the underlying condition's severity decreased when
| I became an adult such that it is now elective surgery. I
| expect to engage in medical tourism to have that done.
| pastureofplenty wrote:
| Look at when all the "No Kings" protests are happening: on
| the weekend. Because there is no way the vast majority of
| Americans can go on strike, because healthcare is tied to
| employment. This is why healthcare is never getting "fixed"
| in America--it's doing its job quite well.
| abathologist wrote:
| What a deeply dystopian future y'all are building for us :( --
| (Including the fact that this link leads to nothing but a logo,
| for me).
| vessenes wrote:
| Interesting. Upshot - bill sent to Claude, Claude generated
| questions, human in the loop to negotiate and summarize.
| Ultimately they suggested a number to the hospital, the hospital
| chiseled them a few grand, and they settled.
|
| Not mentioned, and I'm interested, is how accurate Claude's
| reading of the various medicare rules are. I presume these
| letters went to someone who had only slightly more knowledge of
| medicare billing rules than the author -- hospitals are arcane
| and cryptic places, most especially the billing departments.
| Esophagus4 wrote:
| Yes, wish I could see the Claude conversation here.
|
| The good news is this should be easy to reproduce to see how it
| does - just google around for an example medical bill with
| billing codes and feed it to Claude.
| mikkupikku wrote:
| Just tell the hospital you don't have much money but will pay
| what you can with cash. I got a $2k bill down to $200 like that.
|
| The system is totally absurd.
| SoftTalker wrote:
| They probably pull your credit and have a pretty good idea what
| you can pay.
| aeturnum wrote:
| It seems like the AIs role was in applying lengthy and complex
| medicare billing rules - it did not do negotiating and it doesn't
| seem like the accuracy of its understanding of medicare practices
| was actually checked. The author reasonably accused the hospital
| of gouging and the hospital came back with a much lower offer.
|
| I'd be interested to hear from a charge coding expert about
| Claude's analysis here and if it was accurate or not. There's
| also some free mixing of "medicare" v.s. "insurance" which often
| have very different billing rates. The author says they don't
| want to pay more than insurance would pay - but insurance pays a
| lot more than medicare in most cases.
|
| It's pretty clear that even access to a potentially buggy and
| unreliable expert is very helpful. Whatever else AI does I hope
| it chips away at how institutions use lengthy standards and
| expertise barriers to make it difficult for people to contest
| unfair charges.
| ibash wrote:
| The thing is the prices are all made up anyway. The hospital
| hallucinates prices, so they don't blink an eye when an llm
| does the same.
| mjr00 wrote:
| Yeah, US hospital billing is based on the idea that the
| patient has insurance and won't really care about what their
| insurer gets charged. (The wider implications of this are
| left to the reader.)
|
| For the uninsured this sort of thing is actually really
| common. Had an online friend who had to get emergency
| treatment and they sent him a bill for $20k. His response
| was, "lol I'm uninsured and don't give a fuck about my credit
| score, so, fuck you basically." The bill was revised to $500,
| which he paid just to not have that debt on his record.
| cpursley wrote:
| A large portion of the US economy is based on this entire
| grift pipeline (settling before getting to court). And it's
| very costly and pushes up insurance costs and costs in
| general for everyone else.
| sixothree wrote:
| When people talk about government inefficiency, I always
| think of how prevalent these kinds of shenanigans really
| are. I think they are more costly than inefficient
| government.
| morleytj wrote:
| It's incredibly costly, and I think it's also incredibly
| costly in difficult to measure ways. The main method that
| the average American (read as: not incredibly wealthy
| person who has lawyers retained) uses to deal with the
| early stages of this pipeline is engaging in interminably
| long phone calls, going back and forth between multiple
| stakeholders, and trying to negotiate as to what actually
| needs to be paid or done individually. The incentives are
| aligned for various members of this process to make it a
| complicated and frustrating experience for customers,
| because they often benefit from increasing friction for
| the insured party. I think if you measured working hours
| lost or impacted by this it would be startlingly high.
| lotsofpulp wrote:
| Having to settle because court cases take too long to
| resolve is due to inefficient government.
|
| Not only does the actual court case and appeals process
| take years, but even after you "win", the collection
| process takes years after it has already been determined
| who owes what.
|
| See Alex Jones for a ridiculous example. He should have
| been homeless and shirtless a long time ago.
| Terr_ wrote:
| While you're not wrong that most "justice" processes are
| expensive, I think the parent-poster is referring to a
| _different kind_ of "government inefficiency", things
| like:
|
| 1. Single-payer health insurance.
|
| 2. Laws that insurance-companies must actually use X% of
| their premiums on payouts.
|
| 3. Laws requiring disclosure of negotiated prices, to
| encourage competition via free-market forces.
| potato3732842 wrote:
| The government does it too.
|
| Pretty much every 4+ figure civil violation, fine, etc,
| etc, is assessed on the basis of "what's the most we can
| get away with that won't have them taking us to court
| where it'll get knocked down or cause a public outcry if
| they tell the news"
| otikik wrote:
| The private sector is more efficient at extracting a
| profit. That doesn't mean they will be better at
| providing a service, however.
| fatnoah wrote:
| >The wider implications of this are left to the reader.
|
| IMHO, it's actually worse than we realize. The Medical Loss
| Ratio requirement is good because it requires insurance
| companies to spend 80% or 85% of premiums on health care.
| It's bad because one way for insurance companies to make
| more money is to have inflated health care prices to
| justify increasing premiums so they can get 80% of a bigger
| pie. It also gives them incentives to provide care
| themselves so they can capture some of that 80% spend.
|
| > For the uninsured this sort of thing is actually really
| common. Had an online friend who had to get emergency
| treatment and they sent him a bill for $20k.
|
| I experienced this personally with my own insurance. My
| bill was over $20k, and it took a year to convince the
| insurance company that removing a few feet of my intestines
| was actually emergency surgery. I ended up paying $800. My
| roommate in the hospital had no insurance and ended up not
| paying anything (which I did not begrudge them at all,
| since the reason for no insurance was debilitating back
| pain that led to unemployment)
| Aloisius wrote:
| _> one way for insurance companies to make more money is
| to have inflated health care prices to justify increasing
| premiums_
|
| This only makes sense if they have no competitors since
| another insurance company would just steal their
| customers by having lower rates.
|
| The truth is though, healthcare providers are ultimately
| responsible for prices.
| xp84 wrote:
| > since another insurance company would just steal their
| customers by having lower
|
| LOL. Meanwhile, in real-life America, there are only four
| or five major carriers that control the market, and none
| of them are incentivized to do this "competition" thing
| you speak of by engaging in damaging price wars. Why
| would they when continuing to be part of the problem
| makes them more and more profits each year? See also:
| military contracting. Do you see them constantly
| undercutting each other? No, they buy each other,
| reducing the number of bidders on every contract.
| astrange wrote:
| The military encourages them to buy each other because
| it's much easier to regulate an industry with fewer
| companies in it.
| lotsofpulp wrote:
| >Why would they when continuing to be part of the problem
| makes them more and more profits each year?
|
| In real-life America, they don't even earn enough profit
| to earn their shareholders a better return than SP500:
|
| https://news.ycombinator.com/item?id=45736978
|
| And in real-life America, the only people health
| insurance companies engage in price wars with is the
| state insurance regulator who gets to deny requested
| price increases.
| Aloisius wrote:
| Four or five competitors is plenty for a healthy market.
|
| Where I live, they do compete on price - prices vary by
| about 30% for similar coverage. They can't engage in the
| kind of price war you're thinking of since insurance
| companies, by law, have to maintain a fund able to cover
| costs, have to get rate changes approved by regulators
| and are largely banned from price discrimination.
|
| I understand the desire to shift blame entirely onto
| insurance companies rather than providers. After all, one
| is all about money and the other is seemingly all about
| healing.
|
| Heck, when a provider does bill people directly because
| an insurance company refused to pay, we blame insurance
| companies - even when the charges on those bills are
| highway robbery - like those in the article itself.
|
| The fact is, the net cost of health insurance was about
| $279 billion in 2022. Meanwhile, $3.7 trillion went to
| healthcare providers, pharmacies and the like for care.
| The ones who stand the most to gain from higher prices
| are providers.
|
| Frankly, decades of lobbying from the healthcare provider
| lobby to enrich themselves should have made it this
| obvious, but sadly, people see doctors as selfless angels
| and it blinds them.
| swiftcoder wrote:
| > This only makes sense if they have no competitors since
| another insurance company would just steal their
| customers by having lower rates.
|
| This assumes the competitors are not all colluding to
| raise prices across the board
| lotsofpulp wrote:
| Then they must suck at collusion, given they can't even
| beat a risk-less broad market index.
|
| SP500 10 year annual return: 14.6%
|
| UNH: 13.59% Elevance: 10.79% Cigna 9.42% Humana: 6.1%
| CVS: 0.55% Molina: 9.42% Centene: 0.9%
|
| Or, the likelier explanation, is that health insurance
| prices are highly regulated and have to get their prices
| approved by a government official(s), and B) they don't
| have a lot of pricing power due to the competition and
| they are not colluding.
| datadrivenangel wrote:
| Executives earn more based on revenues and thus prices
| and not stock returns.
| lotsofpulp wrote:
| See almost any of the proxy filings and you will see much
| of the compensation is based on hitting targets other
| than just revenue, and most of the compensation itself is
| equity:
|
| https://www.unitedhealthgroup.com/content/dam/UHG/PDF/inv
| est...
|
| https://s202.q4cdn.com/665319960/files/doc_financials/202
| 5/a...
|
| The executives seem to have a heavy interest in equity
| returns.
| Izikiel43 wrote:
| Aren't they doing some kind of turf non compete agreement
| like isps do?
|
| I had read that comcast won't go into century link
| territory and viceversa, and something along those lines
| for the major isps, in order be local monopolies and set
| prices as they like.
| f1shy wrote:
| Fuck those assholes!!! From 20k to 500... how do you name
| that?
| Izikiel43 wrote:
| > to justify increasing premiums so they can get 80% of a
| bigger pie.
|
| Wouldn't it be 20% of a bigger pile?
| sidewndr46 wrote:
| I used to live with a guy from Guatemala, who at some point
| or another wound up at the ER. At the time his insurance
| apparently had some huge deductible for ER visits so he got
| the whole bill in excess of $1000. He was going to pay it,
| so I suggested he just call and tell them he was planning
| to leave the country and not come back. I told him to tell
| them there was no way he could pay the full amount, but
| didn't want to leave a debt out there like this. They
| lowered the bill to $150 after a few minutes on the phone.
| hex4def6 wrote:
| Many years ago, I managed to stab my face with a
| screwdriver (not my proudest moment), and had to go to the
| ER. After the stitches, I was asked whether I wanted to pay
| with insurance. If I did, it was something like $2,000. If
| I didn't, there was a 75% discount off MSRP. My deductible
| was like 25%, so it ended up basically being the same out
| of pocket either way.
|
| The fact that there seems to be a 4x markup means makes me
| think insurance companies are in bed with these hospitals.
| If you can mark up prices arbitrarily high, the insurance
| "discount" is fake.
| amenhotep wrote:
| There's all kinds of shenanigans that these prices
| enable: https://archive.is/jPE3n
| wagwang wrote:
| There are cases with prescriptions where its actually
| better to claim to be uninsured
| xeonmc wrote:
| From what I heard, doctors' bonuses rates per unit of
| work are entirely calculated based on the specific
| hospital's revenue from medical insurance claims; smaller
| hospitals can't get as many patient payouts so their
| rates are lower and so are not as attractive to doctors
| compared to hospitals that can scalp well. So the prices
| do relate somewhat to what the hospital must spend on
| personnel, even if it's arbitrarily engineered in the
| first place.
| gwbas1c wrote:
| > Yeah, US hospital billing is based on the idea that the
| patient has insurance and won't really care about what
| their insurer gets charged.
|
| Not quite: US hospital billing _is based on the idea that
| the insurance company does the haggling for you_.
|
| Insurance companies negotiate (cough) "the best rate that
| the hospital has to offer," therefore: What the insurance
| company pays is confidential, and the official unnegotiated
| price is highly inflated. That's why hospitals will always
| negotiate with uninsured patients, because they're
| deliberately inflating their fees.
|
| ---
|
| In 2011 I had surgery. The first bill was for $100,000,
| which was sent to the insurance company. Then the insurance
| company got a letter (cough) "reminding" the hospital of
| the negotiated rates. The next bill was $20,000. On a
| follow-up visit, they did an X-ray, and sent me the bill. I
| sat on it, and then called my insurance company. The
| insurance company called the hospital to (cough) "remind"
| them that the negotiated rate for that kind of X-ray was
| $0.
| potato3732842 wrote:
| I know a couple that avoided marriage so she could
| negotiate the childbirth bill on the basis that she was an
| uninsured single mom who didn't own property, etc, etc.
| drdec wrote:
| > Yeah, US hospital billing is based on the idea that the
| patient has insurance and won't really care about what
| their insurer gets charged. (The wider implications of this
| are left to the reader.)
|
| Don't leave out the part where the consumer doesn't even
| shop (or sometimes pay) for the insurance policy either, it
| is determined by their place of work.
|
| So the consumer of healthcare is doubly shielded from any
| price signals the market might supply.
| vincnetas wrote:
| this looks like shopping in Moroccan bazaar with no price
| labels. But here you bargaining not for couple fruits but
| for your health and price range is in thousands. WTF :)
| kasey_junk wrote:
| It's worse than that. In a bazaar there are only 2
| participants and they are looking out for their own
| interests. Most Americans don't choose their own
| insurance their _employers_ do.
|
| The insurance company has no reason to make the health
| recipient happy and the health recipient has little
| agency in pricing.
| mgkimsal wrote:
| > Most Americans don't choose their own insurance their
| _employers_ do.
|
| I don't have an employer, but I still only have one
| company selling health insurance in my county, so...
| that's all I can buy.
| bonoboTP wrote:
| Yeah at this point this is more like a cultural ritual.
| You know like howin some cultures you have to refuse a
| gift 5 times with increasingly stubborn facial
| expressions, and the gift giver has to insist through it
| all, and then accept and say thanks. As the default.
|
| Or where you as a guest announce that you now go home,
| and the hosts have to insist you stay for some more tea
| or whatever and then you have to again and again say
| you're now going really and they insist you stay so you
| chat more in the hallway etc. And it's just how it always
| is and it would be super rude to just leave or if the
| host didn't demand that you stay.
|
| Similarly the US developed this traditional ritual that
| the first bill is outrageously expensive and everyone
| knows that everyone know, but the ritual protocol say you
| gotta start with that, we are civilized people, we say
| hello, so in Healthcare the hello is the huge price, and
| the interaction always ends in a lowered rate, because
| that's also part of the protocol.
|
| It's just a cultural difference.
| gowld wrote:
| It's even weirder than that, because in healthcare you
| consume the product&service _before_ anyone even starts
| to talk about negotiating the price!
| intrasight wrote:
| Health Care Sharing Ministries (HCSMs) are an interesting
| loophole in healthcare regulations that excepts uninsured
| people that participate in an HCSM from paying the tax
| penalty.
|
| HCSMs are membership organizations in which people with
| common religious or ethical beliefs share medical expenses
| with one another. They are not the same as traditional
| health insurance.
|
| Because patients are considered "self-pay", they negotiate
| their own prices with providers and they are likely to get
| an 80% or more discount on "list price" for the service.
| They are reimbursed by the HCSM if the HCSM approves the
| reimbursement.
|
| As of 2025, approximately 1.7 million Americans participate
| in Health Care Sharing Ministries (HCSMs), which amounts to
| about 0.5% of the U.S. population. In Colorado alone, HCSM
| enrollment (at least 68k) is equivalent to 30 percent of
| Obamacare enrollment.
|
| Because HCSMs often exclude essential health services and
| are therefore more attractive to people who are relatively
| healthy, enrollment of this size, relative to marketplace
| enrollment, may increase premiums for marketplace plans.
|
| I am not promoting HCSMs but I did research it when I lost
| my COBRA coverage a few years ago. I do find it an
| interesting alternative approach to paying for healthcare.
| We really do need to explore options in this country.
|
| I can definitely see AI being applied in the HCSM context.
|
| https://www.commonwealthfund.org/publications/fund-
| reports/2...
|
| https://www.youtube.com/watch?v=oFetFqrVBNc
| almosthere wrote:
| So you're saying one solution is to get rid of all
| insurance and make hospitals charge a reasonable price.
| Sounds good to me. You sound conservative!
| patja wrote:
| We are self-employed in the US and buy our own high
| deductible plan on our state's marketplace. One of my family
| members needed a fairly routine planned surgery, so I went
| through the effort to try to determine in advance how much I
| would be billed. What a waste of time. My favorite was the
| hospital who told me the fee for a one night stay would be
| 73k. But, good news! Your insurance has a contracted discount
| that brings it down to 13k. So what does the 73k price even
| mean? At this point I shelved the effort as I correctly
| concluded we would hit our household max out of pocket for
| the year, so anything above that would not affect us.
|
| And hey! Silver lining: in a year when we max the out of
| pocket limit, no more cost-sharing on any other services for
| that calendar year! Time to pack in some care we have been
| deferring mostly due to cost. Except the care providers and
| insurance company are well aware of this, so they don't bill
| you for up to a year from the date of service, so you can't
| be sure you "hit your max" until the subsequent year.
|
| It is enough to induce strong negative emotions.
| BurningFrog wrote:
| The Surgery Center of Oklahoma publishes all their prices,
| and do not take insurance:
|
| https://surgerycenterok.com/surgery-prices/
|
| They're the pioneer, but there are other clinics like that.
| JCM9 wrote:
| The "full" prices are basically just made up. If this was
| like the insurance company negotiates a 15% discount than
| OK. But the reality is crazy stuff like the "full price" is
| $7,623 but "your insurance company paid" $34.12. It's
| totally bonkers and should be illegal.
| atonse wrote:
| Totally agree that even this buggy expert can empower patients.
|
| But you better believe that hospitals all over the place are
| also using AI to find ways around Medicare/Insurance rules to
| maximize their profit too.
|
| The rules are probably going to get WAY more complex because
| they will rely less on a few humans, and more on very powerful
| AIs.
| ToucanLoucan wrote:
| So what you're saying is we've injected a whole smorgasbord
| of electrical dumbasses into a system already rife with
| corruption, greed and exploitation that provides services no
| person can do without and is frustrating to use at every
| juncture.
|
| Yaaaaaaaaaaaaaaaay.
| a4isms wrote:
| Old poker adage: "The more wild cards and crazy rules, the
| greater the expert's advantage."
|
| Poker has nothing on Commercial Lawfare.
| thaumasiotes wrote:
| This reflects a common complaint in social engineering.
|
| People keep trying to enact rules to stick it to the elites
| and make the downtrodden better off.
|
| And as the rules get more and more complex, the position of
| the elites gets more and more solid.
| jlarocco wrote:
| Exactly. The elites hire experts to do it for them, while
| everybody else has to deal with the complex rules
| themselves.
|
| It's like auditting tax returns of the rich - of course
| they didn't cheat, they already lobbied for the loopholes
| making their shenanigans legal.
| mrguyorama wrote:
| >It's like auditting tax returns of the rich - of course
| they didn't cheat, they already lobbied for the loopholes
| making their shenanigans legal.
|
| The IRS disagrees every single year.
|
| They say they can easily recover significant revenue from
| tax cheats if they were staffed and funded enough, to the
| point that every dollar you fund the IRS recovers 1.6
| dollars.
|
| The rich people who say they are just getting their fair
| deductions then refuse to fund the IRS.
|
| If they weren't cheating, they wouldn't have to kneecap
| the IRS.
| photonthug wrote:
| Adding complexity is just one aspect. Everywhere there is
| someone whose job is to ensure the bottom line never
| changes and status quo for the powerful is preserved.
| Insurance, taxes, rents.. in the absence of effective
| regulation, the average number of successful appeals will
| simply get factored in and average costs go up so that
| profit stays the same and grows at the same rate as
| before. Similar to how chains factor in losses due to
| spoilage or theft.. of course they don't actually take a
| profit loss, they just price it in.
|
| I really don't get people who see this kind of thing as
| empowering because in the end your (now strictly
| necessary) appeal with lawyers or AI to get a more fair
| deal just becomes a new tax on your time/money; you are
| worse off than before. A good capitalist will notice
| these dynamics, and invest in AI once it's as required
| for life as healthcare is, and then work on driving up
| the costs of AI. Big win for someone but not the
| downtrodden.
| jayd16 wrote:
| I suppose a saving grace there is that Medicare is
| incentivized to help people or at least not incentivized to
| provide the minimum amount of value for maximum profit.
| SoftTalker wrote:
| Lol. Who do you think makes the Medicare rules?
| hooverd wrote:
| CMS?
| potato3732842 wrote:
| Exactly. You can do this with anything where the racket is
| based around the layman not being able to take in the amount of
| arcane subject matter info they'd need to argue their case, not
| just medical.
|
| Tons of institutions that specialize in screwing people are
| built this way because it's pretty hard to "overtly" build an
| institution to screw people.
| alistairSH wrote:
| Not just arcane subject matter, but numbers so high any sane
| person panics.
|
| Hospital: "Here's your bill for $1,000,000." (a figure which
| is 100% fictional) Patient: <panic> "Oh shit, I don't have
| $1,000,000!" Hospital: "Oh, we'll reduce it to $30,000.
| Aren't we nice!" Patient: <slightly less panic> "I don't have
| $30,000 either, but it might not bankrupt me immediately, so
| I guess that'll do..."
|
| Never mind that the same procedure in most of the EU was
| either "free" (to consumer at time of care) or a fraction of
| the cost.
|
| The whole system is fucked.
| macrolime wrote:
| In the EU you can also generally look up the cost, even in
| cases where the patient doesn't pay, there is a bill and
| fixed costs. The costs are what the government pays or what
| a foreigner with no medical coverage and insurance would
| pay. It's also generally a tiny fraction of the cost in the
| US.
| fucalost wrote:
| This! People underestimate the extent to which lawyers are
| negotiable also. "I'm not paying that" is a surprisingly
| effective method; they're often willing to compromise on
| payment terms, work at-risk subject to a successful outcome,
| significantly reduce their rates, etc.
| sanj wrote:
| > Yes, AI assistants can hallucinate and give you garbage. So I
| didn't rely on it. I spot checked by looking up its big
| findings myself and found it was right.
| enraged_camel wrote:
| The funniest bit about all this is that this is all just
| laziness all the way down. People complain about AI-written
| articles. When the article is written about a human, they
| fall over themselves to point out potential flaws, like "well
| it looks like AI hallucinated" and it gets voted to the top.
| Then it turns out that they themselves did not read the
| article. Just a damning indictment of the quality of online
| discourse in year 2025.
| sidewndr46 wrote:
| having hired an expert in this field, I can tell you they
| aren't really that sophisticated. I found myself with an
| absolute mountain of cash after an accident as part of a
| settlement. My medical insurance won't pay claims until I've
| exhausted that cash. The claims I had were much higher than
| even the mountain of cash. The lawyer I hired use a pretty
| effective strategy: he contacted all of the claims against me
| and told them we could engage in N-way negotiations amongst all
| the parties until we came to a settlement so everyone got their
| nibble of the pie. Or they could get X today, where X was some
| amount that was a bit less than the rate the industry actually
| gets paid for those services. They all accepted.
|
| The discounts he negotiated left me with tons of cash & were in
| excess of the fee he charged me.
| nonethewiser wrote:
| > it did not do negotiating and it doesn't seem like the
| accuracy of its understanding of medicare practices was
| actually checked. The author reasonably accused the hospital of
| gouging and the hospital came back with a much lower offer.
|
| Im increasingly of the opinion that AI gives people more
| confidence than insight. The author probably could have just
| thought of the same or similar things to assert to the hospital
| and gotten the same result. However, he wouldn't have
| necessarily though his assertions would be convincing, since he
| has no idea whats going on. AI doesn't either, but it seems
| like it does.
| embedding-shape wrote:
| I've found LLMs helpful for figuring out what I don't know,
| then I can go and look up how those things work, again
| together with an LLM.
|
| But in the past, once I got to the point where I know I could
| maybe do something about it, but not exactly what, and I
| don't know any of the domain words used, you got pretty much
| stuck unless you asked other people, either locally or on the
| internet.
|
| At least now I can explore what I don't know, and decide if
| it's relevant or not. It's really helpful when diving into
| new topics, because it gives you a starting point.
|
| I would never send something to a real human that a LLM
| composed without me, I still want to write and decide
| everything 100% myself, but I use more LLMs as a powerful
| search engine where you can put synonyms or questions and get
| somewhat fine answers from it.
| nonethewiser wrote:
| Absolutely. It's cheap (as far as the user is concerned) to
| just fire off a question. And it can even be really
| fuzzy/ambiguous/ill-defined sometimes. It's a great
| starting point.
| tclancy wrote:
| "But fight with knowledge. My $20/month subscription to
| Claude more than paid for itself. Yes, AI assistants can
| hallucinate and give you garbage. So I didn't rely on it. I
| spot checked by looking up its big findings myself and found
| it was right. I also had ChatGPT, to which I subscribed for
| one month just to do this, read the letter and fact check it.
| No notes."
| CGMthrowaway wrote:
| >It seems like the AIs role was in applying lengthy and complex
| medicare billing rules - it did not do negotiating and it
| doesn't seem like the accuracy of its understanding of medicare
| practices was actually checked. The author reasonably accused
| the hospital of gouging and the hospital came back with a much
| lower offer.
|
| What exactly do you think negotiating is? Real negotiation in
| business transactions is more often based on agreements around
| certain facts than emotional manipulation.
| kenjackson wrote:
| People want so badly that AI won't be useful that I feel like
| they will diminish everything they do. I also get that they
| probably feel like it's all hype, but there are plenty of
| examples of real value that AI brings to the table.
| aeturnum wrote:
| I guess I would think that negotiating at least involves
| communicating with your counter-party. Its role here feels
| more similar to being a billing consultant. There are plenty
| of people (and systems) that pass messaging over to the
| actual AI - which was my expectation from the title and why I
| noted it didn't happen.
| awillen wrote:
| Often with these kinds of things it's not even as much about
| being specifically accurate as it is about presenting yourself
| in a way that makes the other party believe that have
| sufficient understanding of the issue at hand and the
| escalation paths available that you won't just go away if they
| don't play ball. That is, make yourself credibly as a Dangerous
| Professional, in patio11 parlance.
|
| I just did this with a pet insurance bill, and ChatGPT was very
| helpful. They denied based on the pre-existing condition
| exclusion even where it was obviously not valid (my dog chipped
| her tooth severely enough to need a root canal, and they denied
| because years before when she wasn't covered under the policy,
| she had chipped the same tooth in a minor, completely cosmetic
| way).
|
| I was sure they were in the wrong and would've written a demand
| letter even in the pre-AI days, but ChatGPT helped me
| articulate it in a way that made me sound vastly more competent
| than the average consumer threatening a lawsuit. It helped make
| my language as legally formal as possible, and it gave me
| specific statutes around what comprises a pre-existing
| condition in CA as well as case law that placed very high
| standards on insurers seeking to decline coverage by invoking
| an exclusion (yes I checked, and they were real cases that said
| what it thought they said).
|
| Gave them fourteen days to reverse the denial before I filed in
| small claims court, and on day fourteen got a letter informing
| me that the claim would be paid in full. It's of basically no
| cost to them to deny even remotely borderline cases, so you
| have to make them believe that you will use the court system or
| whatever other escalation paths there are to impose costs, and
| LLMs are great for that.
| atourgates wrote:
| What the author calls criminal is the way hospitals typically
| bill Medicare and private insurance providers.
|
| If the OPs brother-in-law had had insurance, the hospital would
| have billed the insurance company the same $195k (albeit with
| CPT codes in the first place).
|
| The insurance company would have come back and said, "Ok,
| great, thanks for the bill. We've analyzed it, and you're
| authorized to received $37k (or whatever the number was) based
| off our contract/rules."
|
| That number would typically be a bit higher for private
| insurance (Blue Cross, Blue Shield, United Healthcare, etc), a
| little lower for Medicare, and even lower for than that for
| Medicaid.
|
| Then the insurance would have made their calculations relative
| to the brother-in-law's deductible/coinsurance/etc., made an
| electronic payment to the hospital, and said, "Ok, you can
| collect the $X,XXX balance from the patient." ($37k - the
| Insurers responsability = Patient Responsibility)
|
| Likely by this point in a chronic and fatal disease, the
| patient would have hit their out-of-pocket maximum previously,
| so the $37k would have been covered at 100% by the insurance
| provider.
|
| That's basically the way all medical billing to private and
| government insurance providers in this country works.
|
| "Put in everything we did and see what we can get paid for by
| insurance" isn't criminal behavior, it's the way essentially
| every pay-for-service healthcare organization in the country
| bills for its services.
|
| I don't say that to either defend the system, or to defend the
| actions of the hospital in this instance. It certainly feels
| criminal for the hospital to send an individual an inflated
| bill they would never expect to pay.
| dcow wrote:
| I think the argument is that it's criminal to take advantage
| of the patient without insurance and ask them to ruin their
| life trying to come up with 195k when your system is setup to
| reasonably profit off the 37k you get from the insured
| patients. I firmly believe that even in a capitalist society
| the idea of profiting off of anything let alone healthcare in
| the thousands of percentage points is criminal.
| dghlsakjg wrote:
| I think he meant literally criminal.
|
| The hospital double billed for over $100k worth of services
| on the original invoice.
|
| At a certain point a pattern of issuing inaccurate invoices
| crosses the line into negligence.
|
| If a business just have a habit of blasting out invoices
| that bill for services never received, and they know that
| they keep doing this, and only correct it when the customer
| points it out, at a certain point it turns into a crime.
| itsthecourier wrote:
| double charging on purpose systematically sounds slightly
| criminal to me
| woadwarrior01 wrote:
| > What the author calls criminal is the way hospitals
| typically bill Medicare and private insurance providers.
|
| Interestingly enough, the FBI considers double billing and
| phantom billing by medical providers, to be fraud.
|
| https://www.fbi.gov/investigate/white-collar-crime/health-
| ca...
| gowld wrote:
| And yet Florida elected a Senator who earned over $100M
| doing just that.
|
| https://en.wikipedia.org/wiki/Rick_Scott
| atourgates wrote:
| Yes. Though I think technically none of that happened here.
|
| If I sound like I'm defending the morality of the hospital
| for billing a private individual $190k for services they'd
| expect to be paid $37k for, please know that I'm not. But
| it helps to understand WHY the hospital billed that much,
| and whether it's legal for the hospital to bill that much.
|
| The biggest semantic "mistake" the author makes in their
| thread is saying, "Claude figured out that the biggest rule
| for Medicare was that one of the codes meant all other
| procedures and supplies during the encounter were
| unbillable."
|
| The Medicare rule does not make those codes "unbillable" -
| it makes them unreimburseable.
|
| The hospital can both bill Medicare for a bigger procedure
| code, and the individual components of that procedure, but
| Medicare is gonna say, "Thanks for the bill, you're only
| entitled to be paid for the bigger procedure code, not the
| stuff in there."
|
| Neither the FBI nor Medicare is gonna go after the hospital
| for submitting covered procedure codes and individual codes
| that are unreimbursable under those procedure codes. That's
| not crime, that's just medical billing.
|
| Actual double billing would occur if, say, your insurnace
| paid the hospital for a procedure, and then they came after
| you for more money, or billed a secondary insurance for the
| same procedure. Or if they'd said, "Oh no, the OP's brother
| in law wasn't here for just 4-hours, they were here
| overnight so now we're billing for that as well."
|
| NOW - a much better way for the hospital to handle this
| scenario would be to see that the patient is cash-pay, and
| then have separate cash-pay rates that they get billed that
| essentially mirror Medicare reimbursement. That's
| essentially what the author got them to do, and it
| absolutely sucks that's what he had to do.
| SkyPuncher wrote:
| I briefly worked in adjacent space. While I hate the way it
| works, it makes a lot more sense when you understand that the
| billed amount is essentially just a negotiation tactic that
| represents a price well above what they ever expect to be
| paid (and a bit added to that for safety).
|
| Then, they negotiate with all of the in-network providers for
| some number that's well below the billed amount. That number
| varies a bit based on how effective various negotiations are.
|
| Realistically, OP simply found the number that insurance was
| going to pay out anyways.
| pavel_lishin wrote:
| > _The author reasonably accused the hospital of gouging and
| the hospital came back with a much lower offer._
|
| This will always happen, especially if you don't have health
| insurance. I had to have surgery without insurance in the early
| 2000s, and I was able to knock off a large percentage of the
| bill (don't remember how much, it's been decades) by literally
| just writing back to the hospital and asking them to double
| check and verify the line items I was being charged.
|
| (edit: more stories along similar lines in this thread:
| https://news.ycombinator.com/item?id=45735136)
| itissid wrote:
| The author mentioned in a reply in threads that most of the
| fees was Facility Fees. That might be just wrapped up in a code
| for cardiology sure, but its just profit chasing hospitals
| because that practice can wildly inflate the cost and billing
| and that can be fought.
| ageitgey wrote:
| > I'd be interested to hear from a charge coding expert about
| Claude's analysis here and if it was accurate or not. There's
| also some free mixing of "medicare" v.s. "insurance" which
| often have very different billing rates. The author says they
| don't want to pay more than insurance would pay - but insurance
| pays a lot more than medicare in most cases.
|
| I'm a cofounder of Turquoise Health and this is all we do, all
| day. Our purpose is to make it really easy to know the entire,
| all-in, upfront cost of a complex healthcare encounter under
| any insurance plan. You can see upfront bills for many
| procedures paid by various healthcare plans on our website.
|
| The information posted in the thread is generally correct.
| Hospitals have fictional list prices and they on average only
| expect to collect ~30% of that list price from commercial
| insurance plans. For Medicare patients, they collect around
| 15%. The amount the user finally settled for was ~15% of the
| billed amount, so it all checks out.
|
| The reason for fictional list prices (like everything in US
| healthcare) is historical, but that doesn't make it any more
| logical. Many hospital insurance contracts are written as
| "insurer will pay X% of hospital's billed charges for Y
| treatment" where X% is a number like 30. No one is 'supposed'
| to pay anywhere near the list price. Yes, this is a terrible
| way to do things. Yes, there are shenanigans with logging
| expected price reductions are 'charity' for tax purposes. But
| there isn't a single bad guy here. The whole system that is a
| mess on all sides.
|
| Part of the problem is that the US healthcare billing system is
| incredibly complex. Billing is as granular as possible. It's
| like paying for a burger at a restaurant by paying for separate
| line items like the sesame seeds on the bun, the flour in the
| bun, the employee time to set the bun on the burger, the level
| of experience of the bun-setter (was it a Dr. Bun Setter or an
| RN bun setter?), etc. But like the user said, some of these
| granular charges get rolled up into a fixed rate for the main
| service.
|
| However, the roll-up rules are different for every insurance
| contract. So saying the hospital 'billed them twice' is only
| maybe true. The answer would be different based on the
| patient's specific insurance plan and how that insurance
| company negotiated it. Hospitals often have little idea how
| much they will get paid to do X service before it happens. They
| just bill the insurance company and see what comes back. When a
| patient comes in without insurance, they don't know how to
| estimate the bill since there is no insurance agreement to
| follow. So they start from the imaginary list prices and send
| the patient an astronomically high bill, expecting it to be
| negotiated down. In some areas, there are now laws like 'you
| can't charge an uninsured patient more than your highest
| negotiated insurance rate' but these are not universal.
|
| If you find yourself in this situation, there are good
| charities like 'Dollar For' that can help patients negotiate
| this bill down for you. We are trying to address this
| complexity with software and have made a lot of progress, but
| there is much more to do. The government has legislation (the
| No Surprises Act) that requires hospitals to provide upfront
| estimates and enter mediation if the bill varies more than $400
| from that amount. But some parts of the law don't have an
| enforcement date set yet, which we hope changes soon.
| aeturnum wrote:
| Thanks for your insight!
| rancar2 wrote:
| I was going to say please use and donate to 'Dollar For' [1]
| which provides this service, which is likely a better choice
| for this type of problem than trying DIY.
|
| [1] https://dollarfor.org
|
| EDIT: adding in a link to 'Dollar For'.
| themafia wrote:
| > the hospital came back with a much lower offer.
|
| Yes, because, there is an entire department _dedicated_ to this
| function. You just call them and say "I can't pay this" and
| you'll get the same result.
| antisthenes wrote:
| > even access to a potentially buggy and unreliable expert is
| very helpful
|
| Which is a great description of the American health care
| industry, even before its involvement with AI in any capacity.
| A_Duck wrote:
| It's really terrifying that someone less savvy might have spent
| their life savings paying this bill unnecessarily
|
| As OP says: "I had access to tools that helped me land on that
| number, but the moral issue is clear"
| toomuchtodo wrote:
| The direction is clear though; enable healthcare consumers
| using generative AI to appeal their bills, and scale up. If it
| breaks insurance companies and healthcare billing departments,
| well, we could fix this, right? It is a choice not to,
| healthcare consumers will act accordingly as rational actors in
| a suboptimal system. Working systems are rarely changed;
| failing systems at least have the opportunity for change to
| occur.
|
| https://fighthealthinsurance.com/ was previously posted about a
| year ago, but I see no traction. There is no moat, just build
| and distribute, right?
|
| _Show HN: Make your health insurance company cry too Fight
| Health Insurance_ -
| https://news.ycombinator.com/item?id=41356832 - August 2024
|
| (broadly speaking, my thesis is generative AI can be weaponized
| to break down bureaucracy designed to extract from the human,
| from cost efficiency and power asymmetry perspectives)
| nerdsniper wrote:
| It seems like every time consumers automate against the-
| powers-that-be, the powers change the rules.
|
| - Can't just cancel credit cards to reset
| subscriptions/memberships, because new card info now gets
| forwarded to your vendors.
|
| - Chargebacks are now much less successful, even when the
| consumer has clearly been wronged.
| hooverd wrote:
| I think a lot of "let's use technology to solve a social
| problem" takes forget to assume that both sides have access
| to technology.
| toomuchtodo wrote:
| This is not lost on me [1] [2]. I am a technologist (and
| hacker at heart), but also behind the scenes in politics
| (outcomes > status). I've commented, quite frequently
| here, that you cannot fix political and social issues
| with tech: wrong OSI layer of the stack. But, this change
| takes time, months, years, sometimes half a decade or
| more (election cycles, and then policy implementation
| lag). In the meantime, tactical solutions require
| technology, and that is what I am proposing in my top
| subthread comment.
|
| Politics are strategic, long term system improvements.
| Technology serves for tactical solutions in the near
| term.
|
| [1] https://news.ycombinator.com/item?id=40346506
|
| [2] https://news.ycombinator.com/item?id=28571755
| hooverd wrote:
| I like the idea but I'm sure that's a YC startup working on
| juicing revenue from patients being spun at the same time.
| toomuchtodo wrote:
| So build faster and better than YC to defend
| society|humanity against YC portfolio companies (not all,
| of course, just the harmful ones) until politics can close
| the gap. There is no speed limit. There is no moat. The
| only thing you don't have is ~$500k in investment [1].
| Constraint breeds creativity. Be creative, stay curious.
|
| [1] https://www.ycombinator.com/deal
| ryandrake wrote:
| It's very hard to believe that a company setting out to
| fight against one of the major "legs" of the stool of the
| US Economy is going to be playing on a level playing
| field against companies whose mission is to strengthen
| those legs. Even if the business idea is sound. There's
| simply too much money and power wrapped up in ensuring
| healthcare remains a money sponge that soaks the public.
| A company fighting that will never be funded by anyone
| significant.
| sandeepkd wrote:
| Somewhere down the line I have a feeling that there is a human in
| the loop somewhere in between who's expert at reviewing these
| kind of bills. How the expert or their knowledge was added to the
| flow is the engineering art in here
| cm2012 wrote:
| I've just ignored any medical bill I don't agree with or think
| was fair ($10k+ worth in the last 10 years). At least in new york
| state there has been no downside for me. It never went on my
| credit score and I bought a house a few years ago.
| toomuchtodo wrote:
| I want to stress that this is not universal, and in some
| states, medical providers are pursuing this debt aggressively.
| This is not to say you should not be aggressive in countering
| their claims (I do this for folks in a volunteer capacity), but
| you should be knowledgeable as to your potential credit and
| financial risk exposure before proceeding.
|
| _NPR Investigation: Many U.S. hospitals sue patients for debts
| or threaten their credit_ -
| https://www.npr.org/sections/health-shots/2022/12/21/1144491...
| - December 21st, 2022
|
| _Some Hospitals Kept Suing Patients Over Medical Debt Through
| the Pandemic_ - https://www.propublica.org/article/some-
| hospitals-kept-suing... - June 14th, 2021
| jack_tripper wrote:
| _> I've just ignored any medical bill_
|
| As a not-American, I wonder what are the rules of this "game".
| Can anyone in the US just ignore their bills and debt and it's
| all ignored anyway?
|
| Because in most European countries, debt is a very serious
| thing. Even small debt like an unpaid 50 Euro bill can be sold
| to debt collectors who can seize your property or garnish your
| wage, pension or bank accounts to pay your debt plus the
| collection fee, so people here are incredibly weary of unpaid
| bills or taking debt for unnecessary things other than houses
| or cars.
| giancarlostoro wrote:
| Homeless people do. Personally I rather pay something, but
| I'm not spending tens of thousands if that's not what
| everyone else is paying uniform. This is why there's no
| transparency on hospital prices, because nobody is ever
| billed the same, ever. Someone's bill is offsetting the
| losses from someone else.
| jacquesm wrote:
| It would be quite hard to run up a million euros in debt to a
| hospital in Europe, but in the USA that is not at all unheard
| of.
| jack_tripper wrote:
| You're missing the point completely. I was not talking
| about why hospital debt is big, but the difference in how
| debt in general of all sizes gets collected.
|
| Because in most of Europe even a 50 Euro debt will be
| collected, medical or not. while in the US it seems you can
| live just fine with a lot of debt that somehow nobody
| bothers to collect.
|
| And your hospital in Europe DOES collect the half million
| Euro bill, for say a heart transplant, from your insurance
| company. You just never see the massive bill because it
| goes directly to your insurer but someone always pays.
| jacquesm wrote:
| I've paid out of pocket for a medical procedure in Europe
| and the price was a very small fraction of what it would
| have been in the US.
|
| The 50 buck debt in europe will be collected because it
| is an actual debt, not something some hospital made up.
| See TFA.
| jack_tripper wrote:
| _> I've paid out of pocket for a medical procedure in
| Europe_
|
| For a second time in a row now you're deviating again
| from the topic of my point of debt collection just to go
| on an off-topic rant again on how expensive the US is
| compared to what you did in Europe. Why do you keep doing
| this? Are you trolling or is it some attention deficit
| disorder I should account for?
|
| Forget about medical bills. Let's say you have 50 Euro
| debt from an unpaid internet/electricity bill if that
| makes it easier for you to get out of the medical
| conversation into the debt collation US vs EU topic. In
| the US you can doge unpaid bills and rack up debt with
| little to no consequences, while in the EU not since the
| government goes after you, which makes the debt situation
| for US citizens incomparable to Europeans. Are you
| following so far or are you still fixated on how cheap
| medical bills are for you in Europe?
|
| _> The 50 buck debt in europe will be collected because
| it is an actual debt, not something some hospital made
| up. _
|
| How do you decide what is actual debt and what is made
| up?
|
| With that logic then all debt is made up because all
| money in circulation is made up and all prices are made
| up. I'm gonna walk out of the restaurant without paying
| the bill because we all know the 200 Euros for a steak is
| a made up price.
| cm2012 wrote:
| Basically the only thing debt collectors can do in the US (if
| the amount is too small to justify a lawsuit) is harass you
| with phone calls. I have DND except for contacts on anyway so
| I dont notice it.
|
| Edit: also credit score of course. Almost anything does
| affect your score. Except for medical stuff for me for some
| reason - I have a good credit score.
| jack_tripper wrote:
| Damn, well in that case that explains why a lot of people
| in the US can be in debt yet so care free, which is
| unthinkable to us here in Europe as even small debts carry
| consequences.
| alistairSH wrote:
| That was an overly simplistic response. We do have credit
| scores in the US, and defaulting on medical bills can
| (but doesn't always) impact someone's score.
|
| Without a high score, you don't get the best interest
| rates on loans. Or, might not be eligible for a security
| clearance (government work) or jobs in some industries
| (banking and other "high trust" fields). Or might not be
| able to rent an apartment.
|
| But, the other response wasn't incorrect. We don't have
| debtors prisons (unless the debt is owed to the
| government, then they might be able to jail you).
| timeon wrote:
| Credit score is another thing I have hard time
| comprehend. I wanted to borrow car outside of EU and was
| not unable to because there was no record on me with some
| private company that stored data about credit cards. That
| was wild experience - like some social credit in China. I
| just prefer rule of law than these hacks on society.
| alistairSH wrote:
| How do they track credit-worthiness inside the EU? I
| thought Germany had something equivalent? Maybe it's
| government-managed instead of private? Not that I like
| the US system, but it sort of makes sense (barely).
| jack_tripper wrote:
| _> How do they track credit-worthiness inside the EU? I
| thought Germany had something equivalent? _
|
| It's funny that your parent says "I just prefer rule of
| law than these hacks on society", when Germany's credit
| check institution, Schufa, acts like that, not super
| different to China's social credit score he mentioned.
|
| You can't get a rental in China with a bad credit score,
| and like that, good luck getting a landlord in Germany to
| lent you his property with a bad Schufa.
| giancarlostoro wrote:
| Sometimes you can haggle them. Just be careful, because you
| might find yourself in a situation where no healthcare provider
| wants to let you in because you owe them a "fortune" you must
| always haggle the billing.
| harambae wrote:
| I did this once and, while there were no legal repercussions,
| the medical collection agency started calling my aging mother
| in the middle of the night (she still has a landline phone that
| will go off).
|
| Of course, I hadn't actually lived there since I was a teenager
| over a decade ago, and I'm sure they knew that, but the
| harassment tactic worked and I just paid it.
| pessimizer wrote:
| Hot off the presses: _Judge Scraps Rule Eliminating Medical
| Debt on Credit Reports_
|
| https://www.nytimes.com/2025/07/17/business/medical-debt-cre...
| cm2012 wrote:
| I have been doing this since before the initial law was
| passed as it happens
| pessimizer wrote:
| iirc before the law was passed, there were policies at the
| agencies themselves to wait at least 3 years before letting
| medical debt onto credit reports.
| Izikiel43 wrote:
| Unless you live in WA:
|
| > Senate Bill 5480, sponsored by Sen. Marcus Riccelli
| (D-Spokane), will protect Washington consumers by prohibiting
| collection agencies from reporting medical debt to credit
| agencies.
|
| https://senatedemocrats.wa.gov/riccelli/2025/04/22/governor-.
| ..
| timenotwasted wrote:
| It does feel like AI has really started to level the playing
| field for some of these industries that are black boxes. Close
| family members have fed medical data to Claude and ChatGPT and
| had much more useful interactions with care providers than
| previously possible. Was it possible to sort this out before?
| Sure, but not without a lot of research, now it is become much
| more accessible and that is a great thing.
| lovelearning wrote:
| For now.
|
| But not hard to imagine United Health "investing" in OpenAI and
| Anthropic to "curate" the information they generate.
| tecleandor wrote:
| Worst part it shouldn't even be called "negotiation". It was just
| plainly fraudulent.
| thedudeabides5 wrote:
| this is what the doomers want to take from you
| JohnMakin wrote:
| Double billing is an insanely common problem. How it's gone for
| me in the past is like this:
|
| Provider wants to do procedure. You need it right away, or the
| procedure allows pre approval with the assumption insurance won't
| haggle or deny payment
|
| insurance company denies payment
|
| provider bills you
|
| what i learned is, often, the provider will _eventually_ be paid.
| do they tell you? not usually. oh woops. I haven't very
| successfully fought these other than just hours of phone calls
| with both companies chasing down what actually got paid and when,
| and they on purpose make it difficult. If you find yourself in
| this situation do NOT pay the hospital until the last possible
| moment it will go to collections. often, you'll find it
| mysteriously disappears. it also doesnt hurt your credit very
| much anyway if it does.
|
| There's no real defense of these practices or of the industry in
| general as it exists in the USA.
|
| anything <$500 now by CA law cant show up on credit report so I
| basically stopped paying those. unethical? sure. will it affect
| the quality of my care? probably. sometimes though being a
| deliberate pain in the ass feels better than letting the system
| fuck you over and over.
| MontgomeryPy wrote:
| Relevant: The End of the Rip-Off Economy
| https://www.economist.com/finance-and-economics/2025/10/27/t...
| cowmix wrote:
| For all my constant freak-outs about AI in general, it turned out
| to be a godsend last year when my wife's mom was hospitalized
| (and later passed away a few weeks afterward). Multimodal ChatGPT
| had just become available on mobile, so being able to feed it
| photos of her vital sign monitors to figure out what was going
| on, have it translate what the doctors were telling us in real
| time, and explain things clearly made an incredible difference. I
| even used it to interpret legal documents and compare them with
| what the attorneys were telling us -- again, super helpful.
|
| And when the bills started coming in, it helped there too. Hard
| to say if we actually saved anything -- but it certainly didn't
| hurt.
| dansmith1919 wrote:
| What it the dystopian fuck is this headline
| dekhn wrote:
| I had an odd but successful experience with medical billing
| recently. My daughter went to urgent care for an urgent problem;
| after things were mostly cleared up, they transferred her by
| ambulance to an ER (even though there was no emergency). Both the
| urgent care and ER were handled by our insurance but the
| ambulance company sent us a large bill ($4K for a short drive)
| which felt too large to us (they had already tried to get my
| insurance to pay, but insurance said it wasn't covered). My wife
| was going to call the ambulance company to try to negotiate it
| down, but I recalled that I had recently received a random piece
| of mail saying that my employer subscribed to a service that
| could negotiate medical bills.
|
| We contacted the service and provided our info (the context of
| the situation, the billing information, the actions we'd taken so
| far, etc) and a couple weeks later, the service reported that
| they had converted the ambulance ride from an uncovered insurance
| to covered by insurance (since the transport was between a
| covered urgent care to a covered EHR) and had our insurance cover
| the majority- we ended up paying $500 to the ambulance company.
|
| While I am not surprised that such a service exists, what did
| surprise me is that it's just a division of my insurance company:
| they literally have a division that negotiates with another part
| of the insurance cmpany to get better coverage for patients. I
| was pretty lucky to notice the mail about this- there's nothing
| on my employer's site saying we have this coverage(!) and the
| vast majority of people in the US likely don't have this service.
|
| If there is anything that will bankrupt the US, it's excessive
| medical charges and a lack of knowledge of how to address them.
| Maybe AI will help, but I really doubt it long term.
| whimsicalism wrote:
| as long as we have a significant portion of healthcare users
| who are basically fully price insensitive but not subject to
| any rationing, absurd US medical costs will continue.
| sixothree wrote:
| Hard to believe you say we aren't subject to rationing when
| pre-authorization is as big as it is.
|
| You should see some of the proposed rules. Pre-authorization
| will start to use a medical language called CQL and there
| will be literally thousands of queries EHRs will need to
| implement to ensure their customers can get the care they
| need.
| whimsicalism wrote:
| > Hard to believe you say we aren't subject to rationing
| when pre-authorization is as big as it is.
|
| If you want to see true rationing, look to the UK
| (especially) or Canada (less so) where I know plenty of
| people who have to wait over a year to see a specialist
| even after doctor referral.
|
| Meanwhile, my parents in the US at a hospital get a CT
| scan, MRI 'just in case' immediately (or close-to for the
| MRI) and pay nothing for it.
| foldr wrote:
| In the US care like that is rationed by wealth rather
| than by need. Your parents are getting MRI scans that
| they may not really need, while uninsured Americans
| aren't getting MRI scans that they may actually need.
|
| I bet we could cut down NHS waiting lists a fair bit if
| we arbitrarily decided that ~10% of the population were
| no longer entitled to a wide range of non-emergency
| treatments.
| whimsicalism wrote:
| This is true to an extent, but with the massive age-based
| confounder that is medicare, which renders the elderly
| close to price insensitive as well as by far the largest
| utilizers.
|
| I think there are lessons to learn and improvements from
| both systems - for instance, catastrophic healthcare is a
| disaster in the US (in terms of cost), but we are better
| at timely care and providing incentives for pharma R&D.
| foldr wrote:
| Medicare has pretty good negotiating power, rather like
| the NHS. Medicare patients may not care how much Medicare
| is paying for their treatment, but the US government
| cares how much it spends on Medicare, and the IRA has
| given it some additional powers to negotiate drug prices
| in recent years.
| whimsicalism wrote:
| Imagine if the U.S. government gave out free smartphones
| to some segment of the population. Over the years, they'd
| get used to replacing their phones for the smallest
| reason -- a scratch, a tiny crack, dropped it a little
| hard -- because it costs them nothing. Some might even
| start swapping phones every month or every week.
|
| "Ah," someone says, "but the government negotiates huge
| discounts with the phone makers since it buys in bulk!" I
| think this misses the forest for the trees when it comes
| to cost control.
| foldr wrote:
| We don't have to imagine how Medicare works because it
| exists, so I don't see the use of such analogies.
|
| I suspect that it's mainly doctors who need to be more
| responsive to cost incentives as they're often the ones
| recommending unnecessary tests or treatments.
| whimsicalism wrote:
| My analogy is not with socialized healthcare but with the
| medicare scheme. Socialized healthcare works in lots of
| other countries due to a combination of rationing and (in
| the case of drug prices) prioritizing accessibility over
| R&D.
|
| > I suspect that it's mainly doctors who need to be more
| responsive to cost incentives as they're often the ones
| recommending unnecessary tests or treatments.
|
| Doctors would recommend fewer tests if their patients
| were more price sensitive, I think. I'm not sure a more
| direct route to making doctors price sensitive when they
| are on the provider-side, why would they want you to
| utilize less? There probably also needs to be
| malpractice/tort reform in the US.
| foldr wrote:
| I edited my post to say Medicare shortly after your reply
| (sorry). But if there's evidence that Medicare is
| especially profligate with unnecessary tests and
| treatments then you should give that evidence, rather
| than arguing by strained analogies.
| whimsicalism wrote:
| I think that analogies are helpful for elucidating the
| point but in terms of concrete evidence, there are two
| gold standard studies that really reveal this issue.
| These studies are very hard to come by because it is
| typically difficult (for good reason) politically to
| experiment with people's healthcare, but we are lucky to
| have two: the RAND healthcare study and the Oregon
| medicaid lottery.
|
| My understanding of both of those studies is that
| (particularly for pre-registered analyses), we saw that
| adding some sort of cost-sharing substantially reduced
| utilization of healthcare services (~30%) without any
| impact on health indicators even multiple decades down
| the line, with the possible exception of mental health
| indicators. Nowadays people try to p-hack their way out
| of these conclusions, but it is pretty strong high-N
| experimental evidence.
| mrguyorama wrote:
| >Imagine if the U.S. government gave out free smartphones
| to some segment of the population.
|
| Obama phones were literally a thing and
|
| >Over the years, they'd get used to replacing their
| phones for the smallest reason -- a scratch, a tiny
| crack, dropped it a little hard -- because it costs them
| nothing.
|
| Did not happen because this is absurd and not how any
| entitlement program anywhere has ever worked, and more
| importantly, in healthcare you WANT THIS TO HAPPEN
|
| It's cheaper for someone to go see their doctor when they
| "think I might have something wrong" then once they
| actually know something is wrong, and so substantially
| cheaper that even US insurance companies try to entice it
| by making yearly physicals free or other preventative
| care, but it doesn't work as well for the US because even
| with insurance incentivizing it, you still end up with
| all the billing BS that can leave you harmed by going to
| the doctor
|
| > I think this misses the forest for the trees when it
| comes to cost control.
|
| Sorry, the actual empirical evidence is that the
| government setting prices has done better all over the
| world than whatever the US does. This magic belief that
| allowing the government to control access magically
| produces bad systems is just wrong. Government is capable
| when you vote for people who want to make good government
| ageitgey wrote:
| Fun fact:
|
| In the UK, you can pay more (say 30%-40% the cost of a US
| health insurance plan), get treated like royalty in
| private care, skip all the lines for specialists, still
| be covered by the NHS to pay 0 for anything catastrophic,
| and still never get a bill in the mail from anyone.
|
| It's not an either/or situation. The US has the least
| efficient healthcare system of any country in the world.
| It provides less treatment per dollar than anywhere else.
| You can provide universal basic coverage and still
| provide luxury insurance plans.
| whimsicalism wrote:
| True of the UK, not true of Canada (where providing
| services covered by the public sector is illegal AFAIU).
| I think this is exactly the sort of model to move to,
| price sensitivity for routine care - government insurance
| and forced saving for the catastrophic. Healthcare should
| be entirely untied from jobs.
|
| US healthcare is a mess and I'm not defending the cost -
| but it does have the highest number of top specialists in
| the world & strong R&D.
| jancsika wrote:
| > Meanwhile, my parents in the US at a hospital get a CT
| scan, MRI 'just in case' immediately (or close-to for the
| MRI) and pay nothing for it.
|
| I live in U.S. and know people on ACA Marketplace plans,
| employer HDHP, Medicaid, Medicare, Medicare Advantage,
| people who are uninsured, people who are overinsured, and
| people who have crazy expensive fly-me-out-of-the-jungle
| emergency plans (one who actually used it in the U.S.).
|
| I have _never_ heard any of them get an MRI or CT scan
| same day "just in case." And for the one who got an MRI
| close to same day for stroke symptoms, it wasn't free.
| (And even in that case, the earliest appointment with the
| specialist to assess the MRI was nearly a month later.)
|
| Someone getting their first colonoscopy had an
| appointment two months out.
|
| Someone getting shoulder surgery four months out.
|
| A person on Medicaid with Stage 4 cancer waiting a week
| and a half for a fentanyl patch because the pharmacy
| couldn't get approval from the Medicaid subcontractor for
| whatever reason.
|
| People from the U.S. who post on HN: please tell HN which
| is more common:
|
| * my stories
|
| * your parents getting free MRIs and CT scans "just in
| case"
| whimsicalism wrote:
| First, I didn't say same day and specifically caveated
| for the MRI. That said, the CT was either same-day or
| next-day, I forget which. It was for hyponatremia and was
| in the Washington, DC region.
|
| My primary point was comparative - wait times are
| considerably longer for the NHS than in the US.
| jancsika wrote:
| > My primary point was comparative - wait times are
| considerably longer for the NHS than in the US.
|
| So we're talking about a situation where a doctor thought
| a patient required an MRI-- using your word--
| "immediately."
|
| In the NHS when a doctor requests a patient get an
| _immediate_ MRI, what are you claiming is the average
| wait time?
|
| Edit: clarification
| flatline wrote:
| I waited over three years to get a routine colonoscopy in
| New Mexico and finally just got one after moving out of
| state. More standard waits for a specialist there are
| 9-18 months, if you can even find someone competent in
| the specialty. Many people have to go out of state for
| care.
|
| Provider availability is non-uniform across the US.
| whimsicalism wrote:
| thanks for that datapoint and that is crazy. were you in
| a rural area?
| flatline wrote:
| In the middle of Albuquerque. Rural areas offer hardship
| pay to attract medical professionals, but it's really
| touch and go. IHS has its own host of issues.
| vel0city wrote:
| I live in the US in one of the largest metro areas. I've
| had to wait nearly a year to see a specialist in the
| past, and that was with "good" PPO insurance (see my
| comment history for trying to find a dermatologist for
| what I thought was potentially skin cancer). Its really
| not that uncommon to have long waits. I've had insurance
| deny prior authorizations over and over delaying care
| many months despite actually meeting their own documented
| criteria for approving the surgery. My kids have had to
| wait months to get an important, medically necessary
| surgery _multiple_ times, because the decent in-network
| providers are massively booked out.
|
| Comparing getting imaging work done to actually seeing a
| specialist is comparing apples to oranges. They're both
| healthcare related things but are massively different.
|
| There's tons of imaging clinics staffed by people who
| only needed an associates degree from a community
| college, radiologists work remotely all over the place
| spending little time on each patient and writing a
| report. Overall its really cheap and easy to build and
| staff an imaging location.
|
| Seeing a specialist requires actually going to the doctor
| in person, that doctor had to spend many many many more
| years and limited spots for an education, and probably
| only sees patients in clinic a few days of the week.
| You'll have a whole staff of nurses & PAs (who quite
| probably had _more_ education than the rad tech) and
| office staff to support the small handful of specialists.
|
| As a personal example, I had an issue with my knee,
| locking up from time to time bending with weight on it. I
| looked up kinesologists in my area covered under my
| insurance. Dozens within a short drive, awesome. Calling
| up, "sorry, we're not taking new patients", "we can see
| you in four months", etc. A few months go by, I finally
| get in to see the doctor. He has me do some motions, asks
| me a lot of questions, takes a quick x-ray in the clinic,
| recommends I go get an MRI and come back. I am able to
| find an MRI clinic that's covered and can get the imaging
| done that same day. However, its several more weeks until
| I can see the doctor again to actually review the
| radiologists notes. I finally go back, the doctor
| recommends surgery, a prior authorization gets filed. We
| wait. We wait. Denial, no MRI, imaging required to
| determine medical necessity. Huh, they paid the bill,
| didn't they wonder what the MRI said? Resubmit. We wait.
| Denial, MRI was inconclusive (it wasn't). Resubmit. We
| wait. Denial, physical therapy is recommended instead
| (except the thing they call out as a reason to have
| surgery is verbatim what the radiologist notes say).
| Resubmit. We wait. Denial, same response. Its now been
| almost a year of intense joint pain every time I crouch
| down, walking is starting to be difficult. I'm in a brace
| and crutches and the pain is getting worse. I finally
| just wait at the clinic all day, we spend hours and hours
| on the phone with the insurance company to try and get an
| approval over the phone directly. I finally get approval,
| and manage to get in for surgery several weeks later. I
| have the surgery in the morning, and I'm back to walking
| without any pain and without crutches or the brace by
| lunch.
|
| And in the end, after the surgery, the insurance company
| complains they shouldn't have covered the procedure
| because supposedly I didn't have an MRI of that knee.
| Idiots.
|
| This is just _one_ of _several_ shitty stories I have of
| dealing with health insurance companies. Multiple over
| the years.
|
| And that's on the insurance side, not even the care side
| of things! One time, while waiting multiple hours in an
| ER complaining about becoming massively lightheaded and
| weak and barely able to sit, I finally passed out and
| fell on the floor out of my seat. The shock of hitting
| the floor woke me up a bit, and the first thing I heard
| was "sir, you're not allowed to lay on the floor, stand
| up." Uh, I would if I could!
|
| All in all it took over a year of joint pain before I
| managed to get surgery to fix my knee, all because the
| insurance company was rationing care. A year I won't have
| playing with my toddler at the time (I couldn't easily
| crouch down to play and expect to stand back up easily).
| Arguments of "bUt RaTioNinG!" ring extremely hollow to my
| ears. We already have rationing in America, _you_ just
| haven 't experienced it _yet_.
| sixothree wrote:
| > we ended up paying $500 to the ambulance company.
|
| I'm sure people from first world countries would be stunned by
| this number. And that makes it even sadder.
|
| > Maybe AI will help, but I really doubt it long term.
|
| I'm guessing it will help up until the point where hospitals
| start using AI for this process.
| ryandrake wrote:
| The idea of an injured patient having to pay at all for an
| emergency ambulance ride to a hospital should stun any normal
| human being living in a civilized society.
| thebruce87m wrote:
| > had an odd but successful experience
|
| > we ended up paying $500 to the ambulance company
|
| I get where you're coming from but that's still a loss to me
| from the perspective of the broken system.
| codegeek wrote:
| I hear you that you didn't have to pay something crazy but the
| fact that you ultimately paid $500 for a short ride and you
| think it was "successful experience" is how they fool us. You
| think you got a deal when they are still laughing all the way
| to the bank for charging you $500 for a short ride.
| dekhn wrote:
| I don't know, I don't run an ambulance company- what should
| the cost be (either to me, my insurance company, or to the
| government)? Can't be cheap to fully staff an ambulance with
| EMTs.
| chinathrow wrote:
| What's "short" in your context? 20min?
| dekhn wrote:
| Yes, but I'm talking about the costs of actually running
| a 24/7 emergency vehicle operation- even completely idle,
| the emergency vehicle has significant costs that they
| need to cover.
| hshdhdhehd wrote:
| Zero to you. Whatever it reasonably costs to government. A
| bit from you later in tax, but much more from Bezos.
| kmfrk wrote:
| I don't know about using AI to win legal and procedural arguments
| outright, but it seems like an interesting way to at least help
| win the war of _attrition_ that corporations and weaponized
| bureaucracies wage on us to make a buck and keep us from claiming
| ours.
| gehwartzen wrote:
| There's something absurd about a hospital charging 195k for 4
| hours of work with the end result of the patient being dead.
|
| Not saying the doctors did anything wrong but... oof
| jacquesm wrote:
| It's a crazy system. You can save frugally your whole life long
| and then two minutes to twelve the health care system swoops in
| and takes your estate away from you.
| 999900000999 wrote:
| Not low enough.
|
| You could probably tell them to eat dirt,the receiver of services
| can't be collected against as he's no longer physically here.
|
| Getting the money from his estate would probably take years, if
| possible at all. I am not a lawyer, so I might be completely
| wrong, but suing a widow for 200k would be a nightmare for any
| hospital.
|
| Anyway, maybe one day we'll join the civilized world and not
| bankrupt families for the crime of being suck.
| bgirard wrote:
| I used AI to deal with customer support when a company tried to
| assign me the rental contract from the previous owner. ChatGPT
| correctly quoted the relevant Ontario Consumer Protection Act
| sections that applied. I just did quick verifications to make
| sure it wasn't hallucinating (it didn't). They tried to push
| back, but I had ChatGPT write a few responses standing first and
| they relented after a few exchanges.
| tonymet wrote:
| We suddenly woke up in the Kafka-esque purgatory of critical
| American healthcare billing. We're in our 50s and had been
| perfectly healthy, then suddenly we got diagnosed with what will
| be over $500k in treatment over the next 12 months-- and multiple
| millions for the foreseeable future. We have insurance, but many
| of the required procedures are "out of network" and there's no
| way to tell (we have "the best" insurance, supposedly). Even with
| insurance it will be at least $50k/yr out of pocket
|
| But the raw numbers like $200k for this poor gentleman's heart
| attack or $500k aren't the most alarming. It's the Terry-Gilliam-
| level of absurdity of the billing process. Absolutely no one will
| tell you how much things are, and when you ask, they sass you
| that it is a ridiculous question. Even though one of my providers
| just recently started offering estimates, those are off by
| 100-200% , and completely missing for about half of what has been
| ordered.
|
| We are both very strong accountants, and despite trying to do
| audits of these services, it's impossible. There are 3-4 levels
| of referred services, bundled codes, nested codes, complication /
| technical / professional codes , exceptional status codes .
| Providers overbill, double bill. On accident and on purpose. When
| we call to get it corrected there is no way to make corrections.
|
| You'll be asked to take a diagnostic not knowing whether it will
| cost $10 or $15000 . Even if you try to be responsible and call
| the provider (who isn't your doctor, clinic, or hospital ) - they
| won't be able to tell you.
|
| The point I'm trying to make isn't to make you sympathetic. It's
| to reinforce in all of the great technical minds here that
| healthcare billing is the most complicated spaghetti code cluster
| flock of a system that you've ever imagined. It's far worse than
| any piece of software you've ever seen. And we all just accept
| the bills and pay them.
|
| Supply and demand and finding a better vendor doesn't work. There
| are some rare exceptions like elective MRIs - but those aren't
| the norm. Nearly every service is something time sensitive or
| your disease will get significantly worse. Moreover, signing up a
| new provider has $1000+ in billing and a few hours in paperwork
| to make the transfer. is it worth saving $500 for one MRI when
| $250k worth of services are unaccountable?
|
| The only thing I'm sure of is that there has to be tremendous
| amounts of incidental and deliberate corruption . Auditing a
| single patient's billing is impossible - so a population's worth
| is a goldmine .
| misiti3780 wrote:
| our healthcare system is so fucked up, someone needs to burn it
| to the ground and start over.
| Valodim wrote:
| Phase 1 is well underway, no worries
| nerdsniper wrote:
| > And we all just accept the bills and pay them.
|
| I got a bill for $250,000. Uninsured at the time. I have
| refused to pay it (due to inability), consequences to my credit
| be darned.
| macintux wrote:
| From other comments, it sounds like you could rescue your
| credit by simply telling them you can't, but you'd like to
| pay something more reasonable.
| tonymet wrote:
| I recommend making a good faith effort to negotiate and start
| a payment plan (reading the fine print on the overall
| commitment). But bankruptcy is a viable option if you don't
| have a ton of assets at risk.
| Izikiel43 wrote:
| Aren't medical debts not supposed to be on your credit score?
| jacquesm wrote:
| That's bad news. Medical billing in the USA is utterly insane.
| What really gets me is that if they do list the prices they
| seem quite reasonable, and then after the fact you get hit with
| a bill that is 10x or even more of what the listed price was
| due to all of these factors you mention.
| joshstrange wrote:
| > Absolutely no one will tell you how much things are, and when
| you ask, they sass you that it is a ridiculous question.
|
| > You'll be asked to take a diagnostic not knowing whether it
| will cost $10 or $15000
|
| I feel this in my bones and it makes me irrationally (or maybe
| it's rational actually) angry. Find me any other industry where
| you can get away with not telling how much something will cost
| (or even a realistic range) before services are rendered.
|
| I had a medical procedure a year or so ago and when I asked how
| much it would cost I got an eye roll, a lengthy and exasperated
| lecture, and in the end the number they quoted was wildly
| different. I knew I was going to hit my out-of-pocket maximum
| so I gave up after a while and moved on but it makes me so mad.
| I _wish_ I could "vote with my wallet" but good luck doing that
| unless you have unlimited time and energy. By the time I
| finally got to asking about the price I had been through
| multiple appointments that took forever to schedule, were weeks
| or months in the future, all while I needed relief. After being
| strung along for 6 months I gave up and rolled the dice even
| though I disliked how they treated me when I asked for the
| price.
|
| People talk about how you need to be an informed customer but I
| have to assume those people are lying snakes, have never used
| the system, or just too stupid to understand that it's
| impossible.
|
| "I don't know" should _not_ be a valid answer when asking how
| much something costs, it's ridiculous.
| EvanAnderson wrote:
| > I got an eye roll, a lengthy and exasperated lecture...
|
| This is the part that is galling to me. Apparently no
| healthcare worker I've ever spoken with about billing has
| ever had the same considerations I do re: finances. My
| inquiries have almost always been met with zero empathy and
| contempt that I would even be so gauche as to ask.
|
| (It's 1000x worse when you're talking to them about your
| child's medical care. My daughter, at 3 y/o, had a short fall
| and received a small cut on her face. It bled profusely so we
| took her to the ER. We ended up with x-rays because I
| couldn't successful "negotiate" that we didn't want that. The
| shaming was intense.)
| tonymet wrote:
| I share the exasperation about the lack of empathy. I know
| these providers are humans and would ask the same
| questions. They probably negotiated their car, housekeeper
| over a few hundred dollars. But when I ask about $10k here
| or there for critical care suddenly I'm greedy or
| unrealistic?
| dboreham wrote:
| A family member had a procedure a few years ago. Provider
| told the patient that they had contacted their insurer and
| received confirmation it would be covered. Went ahead with
| the procedure.
|
| Bill arrives and the insurer denies coverage. Provider says
| "oh well <shrug> you owe us $$$ now".
|
| Since I am the resident argumentative asshole in the family
| I dig into the situation a bit. After many phone calls I am
| eventually told that the hospital routinely _records_ all
| phone calls with insurance companies and furthermore has
| found the recording where they gave advance guarantee of
| coverage for the procedure.
|
| At this point I realized we are being shaken down by a
| corrupt/criminal enterprise. Even with the recorded phone
| call the insurer refused to pay and so the patient had to
| pay off the $$$ over many months.
| EvanAnderson wrote:
| Similar situation with me and a procedure back in 2014.
| Practice took me on with my pre-ACA insurance. Post-
| procedure my insurer decided it was a pre-existing
| condition and didn't cover the procedure. For the
| practitioner, who went into the deal expecting the
| reimbursement rate from my insurer, it was a 10X windfall
| (and he refused to negotiate, citing that he was within
| his rights to demand the full fee).
| tonymet wrote:
| That's exactly what we experienced. There is no way to be an
| informed customer or "vote with your wallet". For many
| diagnostics and services, the "provider" is 2 referrals
| downstream - the patient never elects or engages with them.
|
| Plus, your life is on the line. If they don't run the test,
| it means the wrong treatment and your prognosis goes from 80%
| survival to 80% mortality
| aprdm wrote:
| I am sorry to hear that. A friend of mine who moved from US to
| Canada moved after his mother had cancer on her 60s. She was
| retired by then after having a very successful career (C level
| on some manufacture company).
|
| His mom died poor.
|
| Crazy country.
| the_sleaze_ wrote:
| It's probably unsaid that she died with a good credit rating
| as well.
|
| You don't necessarily need to pay back those loans, and most
| of the time the hospital has to negotiate a feasible
| repayment plan.
|
| Medical bills have to lowest life-improvement rating of them
| all. That is to say paying off someones medical bills will
| have one of the lowest impacts to their lives compared to
| another financial intervention.
| tonymet wrote:
| We had felt invulnerable until we weren't. I'm sorry about
| your friend's mom it's vile and even more infuriating that
| there's no clear "villain". But you reach a point where you
| focus on what you have. Good doctors, admirable and
| compassionate nurses , loving and supportive family. The
| money is toilet paper really - we conceded that a long time
| ago. Make the most of it while you can but you can't hold
| onto too tightly.
| sofixa wrote:
| For such sums, you're probably better off calling the best
| private hospitals in France, UK, Germany, whatever, taking the
| trip, doing whatever treatment there and paying out of pocket,
| having some holiday, and you're still ahead.
|
| Of course that would only work if you can take the time off
| from work, have the same treatment available elsewhere, and
| being able to actually travel with whatever illness you have.
| tonymet wrote:
| you're right it's a great idea for a hip replacement and many
| other procedures. Our condition doesn't fit into that model
| well because of the duration and frequency of treatments.
|
| I'm guessing there has to be a queue on that. Even those
| countries must be getting backlogged right? I haven't looked
| into it besides what I've heard on social media.
| wbronitsky wrote:
| Matt Stoller, a journalist who blogs about monopolies, just
| wrote all about the pricing issue this week:
| https://www.thebignewsletter.com/p/monopoly-round-up-obamaca...
|
| America has doubled down on middlemen controlling the prices of
| medical care and making sure that there is no set price for
| anything. With the ACA effectively falling apart in the new
| budget, we do have a chance to move to a different reality, one
| where medicare prices are the set prices for everything, but
| that is nearly a political impossibility given the amount that
| these middlemen spend in keeping politicians who support that
| from winning primaries. Instead, we are stuck in a situation
| where companies get to dictate prices and access to care while
| we get diminishing returns in health quality and longevity.
| mrguyorama wrote:
| > one where medicare prices are the set prices for
| everything, but that is nearly a political impossibility
| given the amount that these middlemen spend in keeping
| politicians who support that from winning primaries.
|
| You're missing the part where the _Stated and objective goal
| of popular politicians from one party_ is not to let that
| happen.
|
| They don't get elected because someone scheming to control
| their funding (though that is a proximal cause of Republican
| candidates getting more extreme: Align with MAGA or get
| primaried)
|
| They get elected because a huge portion of the USA are
| _divorced from reality_ and _utterly deny_ said reality. They
| say "government is less efficient" as we sit on top of this
| atrocious system, a system where we _already have the
| government version_ and _it 's radically cheaper_ and we
| could literally just sign up everyone for that, save everyone
| time, money, and headache, and then improve service quality.
|
| These people deny that nearly all developed countries _and
| lots of undeveloped countries_ have vastly better healthcare
| outcomes than the USA, extremely better healthcare access,
| and pay way way less overall, taxes included.
|
| These people just consume propaganda, and _purposely refuse_
| to engage with any clear or obvious evidence that contradicts
| said propaganda.
| whimsicalism wrote:
| i don't really disagree with you, but i do think it is
| funny given that the single largest policy targeting
| medical price transparency came from a republican admin.
|
| i'm potentially on board with signing up everyone for
| medicare, but only if we actually can get voters to vote
| for the taxes necessary to fund that. i doubt we will be
| able to given we can't get voters to vote for the taxes
| necessary to fund existing medicare consumption.
| astrange wrote:
| Matt Stoller is properly described as an insane person who
| thinks every single problem in the world is caused by
| monopolies (yes, including whatever random problem you're
| thinking of now).
|
| His most notable attributes on Twitter are he constantly lies
| about everything and that he spends all his time promoting
| Republicans who are clearly not going to implement his anti-
| monopoly agenda.
| dragonwriter wrote:
| I haven't paid a lot of attention to Stoller particularly,
| but the rest of that line of thinking frequently correlates
| with also believing that monopolies are exclusively a
| result of active government regulation, a belief which is
| naturally attracted to Republican deregulatory rhetoric.
| astrange wrote:
| Oh, I don't think that applies. He's part of a movement
| called "neo-Brandesian" aka "hipster antitrust", which
| basically thinks government should promote small
| businesses by explicitly bullying large businesses, and
| that the customer welfare standard was a cop out to give
| up on this.
|
| So not only would they be against deregulation (they
| think painful regulations are good because pain for the
| sake of it is good), but the previous admin actually
| tried this with Lina Khan and it didn't really work.
|
| The issue here is Democrats are "mainstream" coded, so
| all populist politics works by fighting them even when
| they're trying to do your own policy.
| tonymet wrote:
| I'll look into it. From what I can tell it's not a simple
| hero vs villain story. It feels more like an industrial
| disaster or the AWS outage where there are like a dozen
| compounding system failures leading to where we are today.
|
| Medical billing is like a massive centuries-old tenement
| building with a patchwork of legacy plumbing, electrical ,
| framing, sewage all patched together with decades of duct
| tape, wood shards, and rusty couplings. But in this case
| there's massive incentives to keep it all bodged because each
| pipe and crevice hides billions of un-audited income.
| nradov wrote:
| Yes, it is a huge mess. For patients who do have health
| insurance it's worth checking your health plan's online cost
| estimator tool before any elective treatments. Most payers are
| now legally required to offer an estimator to members under
| federal cost transparency rules. It can be confusing to know
| what to search for but at least worth a try for something like
| an MRI.
| tonymet wrote:
| in every single case those estimates have been wrong. In most
| cases by 200% or more. And a many case there are no figures.
| Workaccount2 wrote:
| Last time I had blood work done, my doctor and I decided on a
| set of cholesterol related markers beyond your typical
| cholesterol assay.
|
| It took me a week and hours of phone calls to figure out what
| would be covered, and how much the non-covered tests would
| cost. The doctor pointed at the lab, the lab pointed at
| insurance, insurance pointed at the doctor.
|
| Finally it was the lab that was able to produce numbers.
|
| _And when I was finally billed those numbers were still
| incorrect! (and thankfully cheaper)_
| tonymet wrote:
| It's just so insane that the entire industry accepts that no
| one knows how much things are. Even the "financial services"
| team will just say "yeah that estimate is wrong" and not
| blush. What are you guys all doing?
| throw310822 wrote:
| But then somehow they know how much things are when they
| send you the bill?
| tonymet wrote:
| my exact curiosity. They seem to have a rough scope on
| CPT codes ahead of time, with some buffer. It's baffling
| that the cost per CPT changes between estimate and
| billing. Id like to talk to a billing administrator to
| ask how that process works. Does the admin pad the
| doctor's figures with additional codes and markup?
| bazmattaz wrote:
| I can't help but think there is a huge opportunity here for a
| health care provider that provides routines scans and such with
| fixed transparent pricing.
| tonymet wrote:
| You're right and there are some provider segments like MRIs
| that have succeeded with this model.
|
| From our perspective the real blocker is the "lock in" due to
| timing and the referral process. We're paying bills to
| providers like specialized labs that are 2-3 degrees down the
| chain from our doctor (e.g. radiologist refers pathologist
| refers lab1 refers lab2 - we only see radiologist) .
|
| Even if there was a "amazon for labs" we wouldn't be able to
| order this stuff because the decision is 2 degrees away.
| dboreham wrote:
| Fun fact is that most such obvious innovative solutions are
| prohibited by law. There are many layers of turtles the
| lowest two are: corrupt politicians and, population that
| doesn't care about corrupt politicians.
| JohnMakin wrote:
| I feel a great deal of sympathy for you. A medical event wiped
| out my meager life savings - I'm a tad younger but I worked my
| whole life for much of it just to go "poof" because of exactly
| what you are describing. I don't feel I have a hope at retiring
| anymore and it makes me really depressed.
| tonymet wrote:
| thank you for saying that and I share your sadness / anger .
| A lot of people do. It's not your fault, or ours. Healthcare
| is a truly evil bureaucracy staffed with some of the most
| loving and capable people I've seen. So I've been able to
| admire the beauty of the situation while remaining angry at
| "the system".
| antisthenes wrote:
| 1. There are assistances available for low-net-worth and low
| income individuals. Have you tried those options?
|
| 2. Refuse to pay. Medical debt doesn't count against your
| credit and, based on my own experience, is almost impossible
| for the other party to collect, except some annoying phone
| calls.
| JohnMakin wrote:
| I make a good living. I have some of the "best" available
| health insurance. It's just bordering on scam/fraudulent.
| Not aware of what programs you're talking about other than
| medi-cal (medicaid). Which I do not qualify for.
|
| As I alluded in another post I do often let debt go to
| collections. The issue is often not the collections calls,
| but that your provider will be even more aggressive about
| demanding up front payment to continue receiving care. Or
| stop seeing you. I have a rare neuro muscular disease that
| only a handful of doctors are even very knowledgeable about
| where I live.
| antisthenes wrote:
| > Not aware of what programs you're talking about other
| than medi-cal (medicaid)
|
| I was talking about individual hospital programs. They
| typically have those programs as part of whatever
| hospital system that is.
|
| Something like this:
|
| https://www.adventisthealthcare.com/patients-
| visitors/billin...
|
| But you would probably not qualify for something like
| this due to income. I happened to have a minor accident
| while unemployed (<$10k income that year) about 10 years
| ago, and the hospital financial aid forgave most of the
| cost.
| BeetleB wrote:
| > We have insurance, but many of the required procedures are
| "out of network" and there's no way to tell (we have "the best"
| insurance, supposedly). Even with insurance it will be at least
| $50k/yr out of pocket
|
| I can see them being out of network this year, but can't you
| change insurance in the following year to one where it will be
| in network?
| rkomorn wrote:
| Does that
|
| - turn into whackamole every year?
|
| - expose someone to "preexisting conditions aren't covered"
| issues?
| tonymet wrote:
| There are two "provider networks" in our region: BCBS & The
| United Healthcare network. BCBS is supposed to be better.
| Were we to switch, let's say they did cover the 1/10 out of
| network cases, we risk losing the 9/10 that we currently have
| . The "whack a mole" is a good example. In this case it's
| whack a mole and one could be $50-$100k worth of coverage
| gone. And more importantly, when you find a good doctor, you
| need to hold onto them. The difference between a good doctor
| and a bad one is life or death for this condition.
| BeetleB wrote:
| Ouch.
|
| Is this a somewhat remote location? With all the insurance
| options I've had from work, the "in-network overlap" was
| something like 90-95%. People didn't change insurance to
| get access to providers - it was mostly a better rate, etc.
| tonymet wrote:
| So there's nuance to this. We live near Portland ---
| great provider & insurance networks.
|
| The common perception of "providers" and "network
| coverage" are the frontline doctors you visit.
|
| But in this case, and what is common, is that there are
| many degrees of providers. Your doctor refers to
| pathologist refers to lab 1 refers to lab 2.
|
| So 95% doesn't tell you much. If only 1-2 of your
| providers are out of network (e.g. specialized labs ) ,
| that's $10k+ right there.
| vjvjvjvjghv wrote:
| The stuff you are describing is what bothers me the most. There
| is a lot of talk about how we should have a free market system.
| But there is no real market for patients. Most people can't
| pick an insurance plan for themselves because the employer
| picks. Then it's extremely hard to get an estimate for
| anything. And even if you get an estimate, it's most likely
| wrong. Then the billing is totally opaque. Insurance and
| providers constantly make mistakes or lose things.
|
| I went through this with my ex after a surgery. It was totally
| insane to figure out where the numbers are coming from and
| basically a full time job.
|
| Even if we don't want to go to single player or similar, I
| don't understand why it's not at least possible to mandate
| clear and binding estimates and billing a normal person can
| understand. And let the market work its magic through
| competition.
| kwanbix wrote:
| Having lived in Europe 10 years (I am from south America), it is
| crazy that the rest of the world doesn't follow Europe's health
| coverage: everybody is covered, all the time, you can be covered
| either by public insurance (was my case) or private. There are no
| preconditions. Kids get covered for almost everything up until
| they are 18 or 21 (don't remember), drugs for adults is only 5
| euro each. No matter the cost. And it just works.
|
| By the way, Private is cheaper when you are younger, gets more
| expensive when you are older. So if you choose private, under
| very phew circumstances you can switch to Public.
|
| In the other side, you have the US health care which is probably
| one of the worst in the world. Crazy.
| NotGMan wrote:
| This depends heavily on which EU country you are: some EU
| countries have great and cheap healthcare, others have shit and
| cheap healthcare with 6+ months of waiting time and you can't
| find even a personal doctor in the public system (which you are
| forced to pay anyway for).
| jobs_throwaway wrote:
| > US health care which is probably one of the worst in the
| world
|
| Not really. If you have money, the US system is one of the
| best. It just really, really sucks if you don't have money.
| kwanbix wrote:
| Well, everything is great if you have money. I was talking
| about the health care as a system.
| jobs_throwaway wrote:
| If, as someone with money, you look across systems, the US
| is one of the best. That's the point I'm making. There's
| plenty of places where all the money in the world won't buy
| you the quality of care you can get in the US.
|
| Quality of care available to wealthy people is an important
| factor in evaluating a system. In the US, there are many
| millions of wealthy people who the system is great for.
| bboozzoo wrote:
| Isn't it universally true that if you're rich your life can
| be much easier? With enough wealth the actual health care
| system does not matter much. Neither does the country in
| which health care services are rendered. You just pay and get
| things done, and maybe even take some vacation while at it.
| However, given that not every one of us is rich, the point is
| to optimize the whole thing such that the little folk can
| still survive and get their health issues addressed.
| jobs_throwaway wrote:
| No that isn't universally true. There's plenty of countries
| (eg Cuba) with entirely state-run healthcare systems where
| more money won't get you better care.
| xtracto wrote:
| What % of the US population would you think have to pay to
| get that "best" care?
|
| Would a household making $250,000 have enough to pay for that
| best care? That would mean 2% [1] of US household. Other
| comment in the thread mentioned earning "6 figures" and not
| being able to pay.
|
| A health system that is affordable to 2% of the population is
| definitely not working.
|
| [1] https://www.factcheck.org/2008/04/americans-making-more-
| than...
| Thrymr wrote:
| US health care outcomes are really not great, even if you are
| rich. Yes, you live longer than poor people in the US, but
| still do worse than Europeans, even those with lower incomes
| [0]. All while spending much more [1]. It's a system designed
| to siphon money from wherever it can (individuals,
| governments, companies, etc.), not to provide the best health
| care.
|
| [0] "in some cases, the wealthiest Americans have survival
| rates on par with the poorest Europeans in western parts of
| Europe such as Germany, France and the Netherlands."
| https://www.brown.edu/news/2025-04-02/wealth-mortality-gap
|
| [1] https://ourworldindata.org/us-life-expectancy-low
| dboreham wrote:
| I have money and it still sucks. Perhaps you're thinking of
| billionaire money?
| blitzar wrote:
| The hospital billing system (built by 3 Harvard MBAs) probably
| had $10k as the break even point.
| itissid wrote:
| Hospital pricing transparency is a joke as reported on by WSJ
| here too https://archive.ph/bp2Mc
| abhaynayar wrote:
| The most appalling thing in this whole post is that people are
| still using Threads (TM).
| lukewrites wrote:
| I would commit to using Threads every day for the rest of my
| life if that meant the US had a sane health care system.
| dcchambers wrote:
| Here's the fundamental problem I have with this: This is treating
| the symptom and not addressing the problem.
|
| The problem is that America's healthcare system is ridiculously
| broken. The symptom of that problem is that prices are
| astronomically high.
|
| I am happy AI is useful for things like this, but I want to focus
| on CURING the problem and not just making the symptoms more
| tolerable.
| ecosystem wrote:
| The American Medical Association owns copyright to all the codes
| and their descriptions. They have an extremely restrictive and
| expensive licensing options and they strictly forbid training
| models with the codes.
|
| This month, the practice was called out
| (https://www.help.senate.gov/rep/newsroom/press/chair-cassidy...)
| so the Overton window may be opening.
|
| The AMA (a nonprofit!) clears ~$300M/year revenue from the codes,
| which is the direct cost passed through to consumers, but the
| indirect costs are the byzantine nightmare of OP.
| GrinningFool wrote:
| Reading between the lines, it seems like this is a threat made
| to bring AMA in line with the administration's policies around
| medically supporting transgender people.
|
| I would expect that if (when) the AMA folds on the matter,
| concerns around the codes will be somehow forgotten
| pbhjpbhj wrote:
| A code is not an artistic expression and so can't be
| copyrightable. The layout of a book of codes, for sure, but the
| information in it... might be protectable with other IPR but
| not copyright.
|
| Does not stop people threatening you though.
|
| _This is my opinion only, not legal advice, and does not
| relate to my employment._
| gpm wrote:
| Judging by Judge Alsup's ruling even if the codes were
| copyrighted it would most likely not be copyright
| infringement to train on them either, and as such even if
| they are copyrightable and they do own copyright on them it
| remains beyond their abilities to forbid training on them.
| (Also opinion, also not legal advice, I'm also not a lawyer
| and sort of doubt the person I'm responding to is).
| pbhjpbhj wrote:
| IANAL, you're right.
| themafia wrote:
| > not be copyright infringement to train on them either
|
| Copyright is about reproduction. It does not cover uses.
| Once you bought it, it's yours, as long as you don't
| reproduce it outside of fair use.
|
| The problem with most language models is they will often
| uncritically reproduce significant portions of copyrighted
| works.
| MostlyStable wrote:
| If you buy the codes, yes. If you only license them (which
| is what the original comment claims is the only way to get
| them legally), and that license explicitly forbids
| training, that seems to be less clear-cut. I have no idea
| if such restrictions are legal or would hold up to
| challenge, but it's less clear than the case where you buy
| a book and can then do whatever you want with it.
| onionisafruit wrote:
| And yet people are collectively paying $300M licensing these
| non-copyrightable codes? With that kind of money somebody
| must have looked into not paying for licensing
| mr_toad wrote:
| I'm sure it's crossed the mind of many people in the
| industry. But it's a comprehensive taxonomy of all
| diseases, medical conditions, causes, procedures and
| treatments. Starting from scratch would be much more
| expensive than just paying the licensing.
| onionisafruit wrote:
| What I mean is using it without paying the license,
| because if GP is accurate there is no copyright
| preventing it.
| mr_toad wrote:
| In that case its probably cheaper for most organisations
| just to pay the license fees than risk paying legal fees
| which would probably be more, even if they won.
| Zambyte wrote:
| Software I write at work is not artistic expression yet is
| covered by copyright.
|
| This isn't a counter argument, just pointing out how absurd
| copyright is.
| hathawsh wrote:
| Consider these thoughts: https://wiki.c2.com/?SoftwareIsArt
| embedding-shape wrote:
| Also the collection of essays carrying the name "Hackers
| & Painters" is of relevance.
| Zambyte wrote:
| Our role as programmers being closer to artists than
| engineers does not make code closer to paintings than
| bridges. We _do_ have highly repeatable patterns. Nearly
| every program can be essentially boiled down to some
| subset of CRUD + tranformation.
|
| Even if it is art (I'm not convinced), the recent
| artificial scarcity on art is absurd. Some other thoughts
| to consider:
|
| - https://drewdevault.com/2020/08/24/Alice-in-
| Wonderland.html
|
| - https://drewdevault.com/2021/12/23/Sustainable-
| creativity-po...
| fluoridation wrote:
| A code in this sense is something different. It's a
| shorthand for a longer description of an object. It'd be
| like a hotel copyrighting the relationship between a room
| number and its physical location within the building, or
| copyrighting resistor colors.
| Zambyte wrote:
| I understand. The different meanings of "code" in this
| conversation is why I said "software" in my comment
| instead of code.
|
| Copyrighting software is as absurd the other things you
| listed.
| papercrane wrote:
| In the US copyright just requires a level of originality.
| The bar isn't very high, but for example simple logos,
| like IBMs blue lines logo is not copyrightable.
|
| There are examples of software code that is probably not
| copyrightable, but that's limited to very simple code
| that has only obvious implementations.
| fluoridation wrote:
| >Copyrighting software is as absurd the other things you
| listed.
|
| I don't really agree, and for context I think copyright
| _in general_ is nonsense.
| jimbokun wrote:
| Your software is definitely artistic expression. You signed
| over the rights to those expressions to your employer.
|
| (IANAL)
| Zambyte wrote:
| My software is definitely not artistic expression. I
| signed over the rights to the software to my employer.
| These statements are not codependent in any way.
| maxerickson wrote:
| Artistic expression isn't the standard in US law.
| philipallstar wrote:
| > The layout of a book of codes, for sure, but the
| information in it
|
| Are you talking about copyright here? It sounds more like
| design protection.
|
| Wouldn't the book be as copyrightable as any other non-
| fiction work?
| adriand wrote:
| No - see https://en.wikipedia.org/wiki/Feist_Publications%2
| C_Inc._v._....
| pbhjpbhj wrote:
| The work I know of, I'm not in USA only have an interest in
| copyright laws in general, is Feist v Rural Telephone
| (1991) -- which appears to mirror codes for health
| procedures quite closely; but not exactly.
|
| There's old but more recent law from Practice Management v
| AMA (1997) supporting that AMA's codes can't be
| copyrightable as they're part of legislation.
|
| Berne's Art 2(8), to which USA are signed, related to non-
| copyright of facts.
|
| I'm afraid I'm not appraised of the full situation,
| however.
| fsckboy wrote:
| > _A code is not an artistic expression and so can 't be
| copyrightable._
|
| that was changed
|
| https://www.bitlaw.com/copyright/database.html
|
| _Databases are generally protected by copyright law as
| compilations. Under the Copyright Act, a compilation is
| defined as a "collection and assembling of preexisting
| materials or of data that are selected in such a way that the
| resulting work as a whole constitutes an original work of
| authorship." 17. U.S.C. SS 101. The preexisting materials or
| data may be protected by copyright, or may be unprotectable
| facts or ideas (see the BitLaw discussion on unprotected
| ideas for more information)._
|
| (I did not use AI, but this appeared at the top of my search
| and I think the search engine used AI to generate it):
|
| _In the European Union, databases are protected under the
| Database Directive, which provides legal protection based on
| the originality of the selection or arrangement of their
| contents...Some countries offer additional protections for
| databases that do not meet the originality requirement, often
| through sui generis rights._
| marcosdumay wrote:
| That means the organization and selection of data is
| copyrightable, and only if they are creative. If you write
| your own tags for the codes, and makes a compilation of
| them all, none of that will cover your database.
| BurningFrog wrote:
| It's important to understand that a "nonprofit" can be just as
| greedy as any other organization.
|
| It can't pay out profits to shareholders, but it can _hire_ its
| owners as employees and pay them any number of millions.
| antisthenes wrote:
| Any non-profit can always claim to inflate their expenditures
| up to (and above) their expenses and pay lavish bonuses to
| their employees, like you said.
|
| Doesn't change what it basically is - aka Scamming the
| Public, and privatising the gains.
| broguinn wrote:
| Doesn't the AMA serve the medical industry? They don't have
| to make profits themselves. If a byzantine coding process
| raises medical treatment costs, they'll do it. Just like how
| they intentionally cap med school admissions to keep doctors
| in demand and inflate their salaries.
| tw04 wrote:
| >This month, the practice was called out
| (https://www.help.senate.gov/rep/newsroom/press/chair-
| cassidy...) so the Overton window may be opening.
|
| So you think the same Senate that is planning on gutting
| healthcare for millions of Americans is going to go after the
| AMA billing codes? Is this real life? They _MIGHT_ demand some
| donations to the ballroom, but I doubt they care enough to even
| do that.
|
| Ahh, here's the correct link and as I suspected, this has
| absolutely nothing to do with reducing healthcare costs for the
| average american. It is a direct attack on the AMA for
| advocating for supportive care for transgender citizens.
|
| https://www.help.senate.gov/rep/newsroom/press/chair-cassidy...
|
| With opinions like this, you can rest assured Cassidy is
| concerned with healthcare costs for the average citizen:
|
| >This comes after Cassidy denounced the AMA for defying
| President Trump's Executive Order by promoting gender
| mutilation and castration of children.
| bnjms wrote:
| I have heard this also how some state law works. That it's
| difficult to directly reference state law or relevant
| information which define the meaning of state law.
| datavirtue wrote:
| The codes are data. The restrictions are empty threats.
| RandallBrown wrote:
| Google tells me that the AMA made about 468 million last year
| in revenue. If they made that much from the codes it seems like
| they wouldn't necessarily pass the IRS Public Support test.
| (Unless somehow this licensing counts as "public support."
|
| I seem to remember this test is why the Mozilla Foundation and
| the Mozilla Corporation exist, but I could be mistaken.
|
| Edit: Seems that the AMA is a 501c6, which is a different kind
| of non profit.
| like_any_other wrote:
| So what you're saying is the AMA is openly hostile to
| Americans.
| almosthere wrote:
| It has been forever, what planet are you on? Their official
| policy would be to make any native american cure (upon which
| many of the medications we use from big pharma, are based on
| in origin) to be illegal. They would want all profit going
| through them, whether that is good for you or not.
| antisthenes wrote:
| Anything related to healthcare (except some genuine minority
| of doctors and staff) is almost openly hostile to Americans.
|
| I used to think American healthcare was in part expensive
| because Americans have poor health (e.g. high obesity).
|
| Now I am beginning to think that Americans have poor health
| by design for the healthcare industry to be able to maximize
| their profits. Making some Americans healthy just seems to be
| a side product.
| iAMkenough wrote:
| You could argue the lawmakers that granted copyright
| protections are openly hostile to Americans. Many fine people
| are saying that Congress values profits over people.
| almosthere wrote:
| A subscriber of the code can use it agentically by using
| snomed,icd,cpt etc.. in their official capacity to look up
| meanings.
|
| It would also be permissible to search existing records and
| prices (if an actor has them) to cross check average prices for
| some procedure.
| topaz0 wrote:
| $300M/year is less than $1 per person. This is not why
| healthcare is expensive.
| paulryanrogers wrote:
| The opaque costs add up. If nothing else all the layers make
| things slow, when time is the difference between life/health
| and death/illness.
| newZWhoDis wrote:
| Insurance companies get a lot of (deserved) hate, but the
| doctor cartel seems to skate on by in the eyes of the public.
|
| The white coats are far from blameless here.
| mr_toad wrote:
| > extremely restrictive and expensive licensing options
|
| The license is meaningless if training AI is considered fair
| use, and if you never agreed to the license.
|
| They might be able to lean heavily on medical researchers and
| the like (who probably need a license for other uses), but when
| push comes to shove I suspect Google and OpenAI would win.
| itissid wrote:
| A fit sequel to a line in Dead Souls
| https://www.theparisreview.org/blog/2021/05/17/americas-dead...
|
| A meager amount of AI will insulate you from a lifetime of woe,
| exactly as it was designed to.
| Reptur wrote:
| I also had success, less negotiating, more just helping me form
| the letters in a few minutes rather than hours so I could get
| reimbursed for denied coverage, and it did get reimbursed.
| mykowebhn wrote:
| I really hope this being on Threads is not the start of a trend.
| I don't really need or want to rely on another social media
| outlet.
| beanjuiceII wrote:
| imagine paying 33k in hospital bills when all you have to do is
| ignore it and pay nothing...AI ripped them off here
| LightBug1 wrote:
| Granted, $33k vs $195k is an excellent saving ... but $0k is what
| I, or my family, would pay. Which makes the cost seem insane by
| any measure.
| alistairSH wrote:
| On what basis are you refusing to pay? Services were
| rendered...
| ayewo wrote:
| Services were rendered for just 4 hours is somehow worth
| $30k?
| gnarlouse wrote:
| The irony is they would have been happy receiving $10k for not
| saving a man's life. So at the end of the day, they still
| swindled you.
| itissid wrote:
| What's crazier is that for 80k you can get a jet to fly you
| anywhere in the world and for far lesser than that get world
| class treatment. What's even more bonkers is that the private and
| govt insurance companies, and hospitals have negotiated those
| rates and there is a market to fly people to other countries that
| is just sitting there and no one is really exploiting it.
| higginsniggins wrote:
| Honestly, that's not a bad idea for a start up. Maybe a
| marketplace where people can see what things cost in different
| places and book a surgery directly.
| eqvinox wrote:
| > So the hospital had billed us for the master procedure and then
| again for every component of it.
|
| Uh. Call me naive, but how is this not fraud?
| alistairSH wrote:
| It sounds like it would be only be fraud if the bill was
| submitted to Medicare/Medicaid. But, yes, that practice is
| morally bankrupt, even if they're getting away with up-charging
| on a technicality.
| vjvjvjvjghv wrote:
| That such a thing is even possible shows how messed up the system
| is. Basically they are charging some fantasy amount of money. I
| would love Medicare for All but if we want to keep doing some
| kind of free market approach, let's at least make sure there is a
| real market where everybody knows the price of things and can
| make an informed decision. Right now it seems you have to go to a
| hospital and just hope for the best.
| lifeisstillgood wrote:
| The rest of the western world just looks at this as wonders why
| Americans put up with this.
|
| Using the latest in technology to move an a bill from existential
| to merely crippling
| noisy_boy wrote:
| What I wonder is people are ok paying hundreds of dollars and
| going bankrupt but they haven't heard of taking a flight to a
| location that doesn't bleed them dry? They haven't heard of
| medical tourism?
| dboreham wrote:
| It happens. A friend flew to France to have a tricky heart
| procedure done. But most people aren't going to have the time
| or resources to do that.
| hollerith wrote:
| Did he have French citizenship or similar connection to
| France?
| Workaccount2 wrote:
| Because 92% of Americans have health insurance, and 22% have
| totally free everything covered health insurance. Of the
| uninsured, most either are eligible but don't apply, have
| insurance through work but forgo it, or are not US citizens.
|
| All said and done, you end up with a very small sliver of
| people who are legitimately uninsured, which means the problem
| mostly exists as scary stories rather than people actually
| experiencing it.
| Capricorn2481 wrote:
| Wildly false. This thread is full of people sharing stories
| of being supposedly "insured" and getting fucked anyway. The
| complete lack of transparency around what your insurance
| covers, something you can't be expected to verify while in
| the middle of a dire medical crisis, can lead to a life
| destroying bill.
|
| Nobody should have to be wondering what company an ambulance
| works for. It's crazy. The whole world thinks it's crazy.
| timeon wrote:
| > Nobody should have to be wondering what company an
| ambulance works for.
|
| Is this real?!
| inerte wrote:
| The latest advice is to call an Uber instead of an
| ambulance.
| dboreham wrote:
| Absolutely. General advice is to never ever get in an
| ambulance since they charge $$ and may not be covered by
| insurance. Drive yourself if able or get a taxi.
| Workaccount2 wrote:
| I don't know what I said that is wildly false. Or even
| false for that matter.
|
| People getting surprise bills that their insurance will not
| cover is rare, because being in a situation where it's a
| possibly is rare. Insurance pre-approves or denies care
| before it is done, so you really need to be in the ER and
| getting odd-ball care that falls outside standard
| procedure.
|
| I'm also not defending them system, it is a mess (even I
| posted a story in this thread), but the fact of the matter
| is that the system largely works for most people, so things
| like inflation, wages, housing which have daily reminders
| of shittyness for huge swaths of people gets political
| priority.
|
| A better way to think of this is like bad car accidents.
| They are horrific and most people know someone who knows
| someone with a story, but we don't put a lot of political
| capital into improving vehicle safety. Most people go their
| whole lives with no accident.
| Capricorn2481 wrote:
| I know you were just explaining why America puts up with
| this, but it's not my opinion that everyone does
| prioritize inflation over healthcare. It's a core issue
| for a lot of people.
|
| > People getting surprise bills that their insurance will
| not cover is rare
|
| Define rare. Because millions of people per year are
| forced into uninsured ER visits.
|
| > A better way to think of this is like bad car accidents
|
| A hard disagree.
|
| Most people avoid the hospital until they need to go to
| the ER, because taking time off work to find out if
| you're even allowed to be treated is prohibitive. I can't
| talk to any medical professional anymore without going
| in. And with the doctor shortage, if I go to a hospital,
| I will be dismissed unless I'm experiencing severe
| sickness or pain because I'm wasting their time.
|
| People are driving all the time. People avoid the
| hospital as much as possible, because they are
| understaffed and predatory, and there are many pitfalls
| where you can be ripped off. This is all assuming you
| even know how this stuff works. Not everyone realizes an
| uninsured visit could cost as much as a house. You don't
| get the bill until it's done. That's the fucked up part.
|
| I don't know a single person making under 100k who is
| comfortable with their healthcare situation. They are
| terrified to be unconscious or misinformed, making a
| mistake that could financially cripple them for life.
| There are no guardrails for this. Yet there is more
| vitriol for AWS bills then there are for the healthcare
| system.
| LawnGnome wrote:
| As a non-American, I think the thing I'm hung up on in what
| you said is that I don't understand why a developed country
| should allow anyone to be "uninsured".
| lawn wrote:
| Except if you have health insurance and the medics choose the
| "wrong" medicine which isn't covered by your particular
| insurance.
|
| Or when an ambulance from the wrong company shows up.
|
| Or as in OP when the hospital makes up the charge.
|
| And add the 8% of uninsured Americans, which is still almost
| 30 million people!
|
| Only in America will this all add up to "scary stories" and
| they will shrug and defend the system.
| snovymgodym wrote:
| Even if you're insured it sucks.
|
| The American healthcare system creates an immense amount of
| waste and is a parasite on society.
|
| You go to the doctor and then the provider comes up with some
| reason why the service isn't covered by insurance. Then your
| insurance comes up with some reason why they don't need to
| cover you. Sometimes you contest it and the bill is removed
| or lowered.
|
| But regardless, at every step in American healthcare, people
| are being paid full time salaries to overbill or missbill you
| for services, to invent arbitrary reasons to deny coverage,
| and to do everything possible so that people who pay
| thousands a year for a healthcare plan get as little out of
| it as possible.
|
| The only silver lining is that medical debt is legally hard
| to collect, so non-payment is a real option for those who
| don't mind trashing their credit.
|
| It's awful and the only hope for change is either a left-wing
| populist who guts the whole system, collective action where
| people withhold paymet, or an increased rate of Luigi-esque
| incidents that motivate the industry to self-reform. But
| these all seem unrealistic and liable to worsen the
| situation.
| culebron21 wrote:
| Such a case when one must pay a good portion of a home price for
| a man dying in a hospital, is why I won't ever try to move to the
| US, and will retell story to everyone considering.
| stuffn wrote:
| These wild cases aren't worth considering as far as "do I move
| to the US or not". They are exceedingly rare and while they can
| happen so can the wing falling off your plane on the trip here.
|
| The bigger concern, IMO, is insurance is tied to employment.
| The time you get your massive bill is when you get very sick
| after being fired/laid off and your COBRA is up.
|
| The next biggest concern is the ACA which is the greatest scam
| ever pulled on Americans. It started out as, what would've
| been, universal healthcare. Instead, it simply played into the
| insurance company profit centers by forcing people (now by law)
| to hold some kind of insurance or pay a large tax fine. So
| you're stuck paying $1,500 for sub-par care on a bronze plan
| with a massive deductible and no limit. So much for "increasing
| the competitiveness of the market".
|
| Healthcare spends more money on lobbying than any other sector
| in America. The solution isn't to start breaking it down with
| crap like the ACA. That will get gutted by the bought and paid
| for politicians (which it did). What we need to do is begin by
| repealing citizen's united, limiting campaign contributions to
| 0 from industry professionals (in both their professional and
| personal capacity), and fire the congressmen taking the most
| money from them.
|
| They don't have hearts. They have large wallets. Hit them where
| it hurts.
| dragonwriter wrote:
| > The next biggest concern is the ACA which is the greatest
| scam ever pulled on Americans. It started out as, what
| would've been, universal healthcare.
|
| No, it didn't. Universal coverage between the mandatory
| coverage and the Medicare expansion was the goal, but
| universal coverage _separate from_ the mandate you criticize
| was never part of the ACA or Obama's proposals before
| Congress actually crafted the ACA (which differed somewhat
| from what the President proposed, and actually was closer in
| many ways to Clinton's proposal from the campaign.)
|
| > Instead, it simply played into the insurance company profit
| centers by forcing people (now by law) to hold some kind of
| insurance or pay a large tax fine.
|
| ...except the tax penalty was small, and it only existed for
| three years (first coming into play in 2014 and being set at
| 0 since 2017.)
|
| > So you're stuck paying $1,500 for sub-par care on a bronze
| plan with a massive deductible and no limit.
|
| "No limit" for...what? This sounds like you are talking about
| out-of-pocket limits, but there are out-of-pocket limits for
| bronze plans.
| m_fayer wrote:
| One of my most successful uses of ai is dealing with various
| obtuse German bureaucracies, private and public.
|
| I don't think the ai is being particularly smart in my case, and
| its occasionally flat wrong.
|
| What it does give me is persistence and motivation. I have a nice
| workflow cobbled together that lets me dump OCRd scans and
| digital comms into "workspaces" organized by topic. With that
| workflow, I can basically dump a letter in, say "wtf is it now?",
| and have the llm spit out a response. I do basic due diligence
| and send. Done. They don't have to be that accurate, and neither
| do I.
|
| I feel like I have a new superpower now: outlasting it, whatever
| it is this time.
| mcoliver wrote:
| Used Claude to negotiate a 50% bump in a car insurance payout
| citing laws I didn't know existed. Yeah you have to cross check
| things and direct the prompt for tone and angle, but what an
| incredible leveling mechanism.
| ratelimitsteve wrote:
| with or without AI you'd be shocked at how much of a medical bill
| can disappear if you just ask. Ask for an itemized bill, then ask
| what programs they have available to help. The real fact is that
| the hospital barely knows what they did to you, has no idea what
| it should cost overall, has a foggy idea of much you'll pay vs
| your insurance (but only a foggy idea because of all of the
| constantly-shifting backroom deals that insurers and providers
| make with one another), and then whatevertf price they arrive at
| with all of this gets an arbitrary number tacked onto it designed
| to mitigate the fact that a lot of people just don't pay their
| bill at all and it's not like the hospital can reach into them
| and claw back their $80 tylenol if they don't get paid, so they
| just bill it forward and hope that most people will look at their
| bill as the final word on the subject and pay it despite the fact
| that they're being badly overcharged. Combine this with the
| "reject all claims and hope they don't follow up" model of
| insurance and you can see where this all clearly needs to burn to
| the ground so that something that works can grow in its place,
| but also where a lot of people get really rich doing it this way
| and no one gets super rich when services are provided at a
| reasonable price so there's no real will to unruin this system.
| So what we end up with is a system where we pay a lot more than
| everyone else in the developed world and, for our money, we get
| to die earlier, which may or may not be preferable to dealing
| with the american healthcare system. When I was figuring out what
| I actually owed for my 4 days in the hospital for diverticultitis
| I strongly considered just dying next time.
| ancorevard wrote:
| Rookie mistake. Should have identified as an undocumented
| immigrant. $0 bill.
| siliconc0w wrote:
| Never pay the first hospital bill if it's a non-trivial amount
| and you've waited a few months to get all the bills. 100% of time
| there is an error, mis-code, up-code, outright fabrication, etc.
| In California you cannot be taken to collections for less than
| $500 and they have to wait at least 180 days. If insurance denies
| a claim, you can ask for an internal appeal and then ask an
| independent medical review(IMR) (always do this, the internal
| appeal never works). With today's context windows, you can shove
| the whole insurance coverage booklet into the LLM and have it
| draft everything.
|
| I've had $10k+ bills brought down to $200. $2k+ tests re-coded
| and fully covered, etc.
|
| There is definitely a business in a LLM-powered medical billing
| agent that could handle this end to end (esp, contacting
| hospitals/insurance, waiting on hold, etc).
| SubiculumCode wrote:
| Well this is a depressing forum. I'm going to go back to work and
| pretend that I will live a hundred more years, thank you. :(
| stivatron wrote:
| how the hell is that possible. Why isn't someone taking
| economical advantage of offering lower prices. Costs can't be
| that high.
| alistairSH wrote:
| Because there's no incentive to stop extorting the uninsured.
| That's all this is.
|
| Medicaid and Medicare pay fixed fees set by the government.
|
| Insurance companies negotiate "reasonable" fees for services.
|
| As I have insurance, my medical bill usually looks something
| like...
|
| Procedure A...... Amt Billed: $2000.......Paid by insurer:
| $100.... Amt Owed: $25
|
| Where $25 is my co-pay and $100 is the fee the insurance
| company negotiated as "reasonable". For in-network care, the
| contracts disallow "balance billing" (trying to collect the
| $1900 in make-believe charges). For out-of-network (no
| negotiated rates), the hospital often will balance bill (except
| where prohibited by law).
|
| It's a completely ridiculous system in which "non-profit"
| hospitals make billions (and write off those imaginary
| "losses") and insurance companies (who have to pay our ~80% of
| revenue on care) are happy to have inflated numbers all over
| the place because 20% of 100 billion is more than 20% of 10
| billion.
| eks391 wrote:
| There is no economic advantage of offering lower prices in the
| US medical sphere, as there is no way for a patient to know
| that you charge less than another provider. Most medical
| practices do not provide any form of costs until after a
| procedure except ones usually not covered by insurances, such
| as dental and chiro, which do offer transparent and low prices
| because they compete in the free market.
| philipbjorge wrote:
| > We asked for a bill with the standard CPT codes. No reply.
| Asked again. "Oh, we meant to send it. We upgraded our computers
| five months ago and nothing works." Uh-huh. Finally got the CPT
| codes.
|
| I work in healthcare RCM. I have no trouble believing the staff
| here that nothing in their system works.
| itissid wrote:
| Does someone here understand how exactly to fight Facility Fees
| -- outside of indiana or a state where its outlawed -- which is
| what the author mentioned most of their fees were? Could one when
| signing admission forms accidentally agree to paying them without
| fully understanding it? After one gets the the bill can one
| simply get an itemized breakdown, spot these fees and negotiate
| them down?
| Sharlin wrote:
| Good news, everyone! We don't need single-payer healthcare after
| all, just use an AI!
| selfawareMammal wrote:
| I'm too european for this.
| xp84 wrote:
| > Long story short, the hospital made up its own rules, its own
| prices, and figured it could just grab money from unsophisticated
| people
|
| This is the core truth that all of healthcare in the US spins out
| from. A few personal experiences which back this up:
|
| 1. I received a $1500 bill because an ambulance that was sent
| when I called 911 was an "out of network ambulance". I looked it
| up: One small ambulance company in SF is in-network with that
| insurer. The SFFD runs the vast majority of ambulances and is
| "out of network." Insurance companies of course are not allowed
| to penalize you for accepting the first ambulance that arrives in
| an emergency. I filed a formal complaint with the California
| regulator that regulates that insurer and within 2 weeks the bill
| had been properly taken care of.
|
| 2. Our family has met its family Out of Pocket Maximum this year.
| Twice in the past month I've had doctor's offices lie to me and
| say that we still have to pay a copay. The last one claimed
| "well, you still have to meet your individual one though." Lie.
| That's literally the opposite of the way it works. We've paid
| copays to these people accidentally in previous years and they
| would never give the money back, they just keep it and also
| double dip since insurance pays them anyway.
|
| In all cases, both hospitals and insurance companies simply ask
| for the maximum possible thing they can ask for, knowing that a
| frightening majority of people are afraid of them, and will pay
| whatever they're told. In OP's case, an unsophisticated payer
| would have gotten a $195k bill, been sent to collections, the
| hospital would have sold the bad debt, and then the person would
| have maybe "gotten a good deal" by getting it cut down to $50k
| over many years of high-interest payments and having ruined
| credit.
|
| Insurance and hospitals are both filthy, money-grubbing machines.
| To paraphrase a famous cartoon character, their business is bad
| and they should feel bad.
| altshiftprtscrn wrote:
| Can you elaborate a little on point 1? I also somewhat recently
| had an expensive ambulance ride in SF that I'm dealing with -
| Insurance told me it was out of network, but would negotiate
| down on my behalf. They were able to negotiate away most of the
| bill, but since then the ambulance company has just come back
| to me asking for all of the money that the insurance company
| had told me they negotiated out of the bill.
| throw310822 wrote:
| I find it curious that people are celebrating when they manage
| to not pay (part of) an absurdly wrong bill that can only be
| either the result of gross incompetence or- much more probably-
| an attempt at fraud. The actual happy ending of such a story
| would be that the healthcare provider is sued for damages and/
| or attempted fraud, and has to pay back a large multiple of
| what has asked.
| lateforwork wrote:
| When UnitedHealthcare CEO was killed the public sentiment was
| that the health insurance companies are the bad guy--and the CEO
| deserved what he got. Then when stories like this come out we
| realize no, it is actually the hospitals. In reality the whole
| system is broken. Some people think single payer system is the
| solution but then when they talk to Canadians they realize that's
| not the solution either.
|
| I think the correct solution is stronger laws for price
| disclosure, strong penalties for the kinds of abuses mentioned in
| this thread, and incentives for patients to question every
| charge.
| ryandrake wrote:
| > Some people think single payer system is the solution but
| then when they talk to Canadians they realize that's not the
| solution either.
|
| I don't know a single Canadian who would swap their system for
| the USA's. Theirs might not be perfect, but nobody argues that
| it isn't at least better than the literal worst system the
| world has ever come up with.
| pcthrowaway wrote:
| Canadian here; our system has some pretty extreme issues. The
| vast majority of Canadians still prefer it to the U.S.
| Wealthy Canadians (>$500M net worth) would likely prefer the
| U.S. system in all cases though. Even moderately wealthy
| Canadians ($1M+ net worth) would likely get better treatment
| from the American system 95% of the time (when they don't
| have extreme issues which result in exceptionally costly
| treatment)
|
| One thing to consider is that _doctors_ seemingly prefer
| things about how the U.S. system works (I 'm not just talking
| about the amounts charged, but inefficiencies and red tape in
| the Canadian system, some of which seem to be a consequence
| of socialized health care). Ultimately this does lead to some
| brain drain which then compounds the issues with our system.
| spelk wrote:
| >Some people think single payer system is the solution but then
| when they talk to Canadians they realize that's not the
| solution either.
|
| I'm sorry but I don't understand this discourse. While we have
| gripes with the state of some hospitals that fall short of
| first world standards (e.g. Gatineau Hospital) and wait times
| for specialists for non-urgent care (it can take 2-3 months to
| see a dermatologist after referral for non-cancerous skin
| conditions in Manitoba for example), I really can't think of
| more than 3 Canadian residents having ever said in my lifetime
| that they prefer the US system (and for all of them, their
| objection had to do with the fact that the government funds
| treatments they don't like for gender dysphoria and abortions,
| not that they felt the US system was an effective economy of
| scale).
|
| On top of that, there is a myth perpetuated in the US that we
| are constantly at the brink of a healthcare system collapse. We
| are certainly not - there is room for improvement and health
| inequalities that we must address, but to say that we're all an
| ER wait away from dying is simply untrue. [1]
|
| I have been on the receiving end of health care inequalities
| here in Canada (in Manitoba and Quebec), but I don't go as far
| as to write off the achievement of having set up an effective
| single payer health system in a federal state.
|
| [1] https://www.npr.org/2020/10/19/925354134/frame-canada
| lateforwork wrote:
| The wait time you alluded to is indeed the issue. The issue
| is not limited to dermatologists.
| spelk wrote:
| Then it'll come down to an individualist vs a collectivist
| take.
|
| Triage priorities in referrals are an acceptable trade-off
| for broadly improved access to health care. The reality is
| that my eczema doesn't need to be seen before someone
| else's melanoma.
|
| While I appreciate being able to see a specialist earlier
| in the US with my health insurance, I know that many
| ordinary American citizens aren't able to at all and that
| my insurance displaces incentives to serve underserved
| communities. I'm not yet an American citizen so I will not
| preach what the US should or should not do, but I do think
| it is unfortunate that is the case and I hope that
| improves.
| pastureofplenty wrote:
| Many Americans desperately want to believe that other
| countries' healthcare systems are "just as bad" as a form of
| coping.
| NickC25 wrote:
| the canadian system might suck but it's infinitely better than
| what we have in the USA.
|
| we have a capitalist bastard child of for-profit "insurance"
| companies who are heavily subsidized (yet are still allowed to
| profit massively and turn profits over to shareholders) and in
| cahoots with hospitals who often employ more "billing
| specialists" and lawyers than they do actual doctors and
| nurses.
|
| the whole thing is a racket.
| pcthrowaway wrote:
| They're both the bad guy, but from the sound of it, the
| insurance companies are worse. They will delay cases and deny
| claims which result in people dying sooner rather than going
| through a long, costly, but ultimately life-saving treatment,
| to save themselves money in the long run.
|
| The alleged shooter was clearly referencing this book which
| talks about it:
| https://en.wikipedia.org/wiki/Delay,_Deny,_Defend
|
| I haven't read the book, I'm just recalling what I've read
| _about_ it.
| dakpapa wrote:
| 1000
| ruralfam wrote:
| I had a 20 minute appointment with a doctor at Kaiser in WA. I
| thought I had set up a free, yearly wellness meet. However due to
| Epic's really epically bad UI (they provide Kaiser's online
| presence), I had setup a standard meeting. My bill was nearly
| $1,700 discounted to $200 which I was fully responsible for as
| I/We (family) had not yet reached our deductable limit. Funny
| things: 1) Doctor wanted me to approve the use of AI to take
| notes of the meeting so she would not have to (I agreed). 2) The
| one issue I cited caused my doctor to say (pretty close
| paraphrase), "I have an idea what the problem is." I asked what
| it was, but the appointment was over so was advised to setup
| another meeting. I decided to keep working on it myself as I am
| pretty sure it is a stiff-ligament issue. Thanks Doc. Also: I
| like Kaiser overall. This one doc (who is not my regular one) was
| not as asset to Kaiser imho.
| dboreham wrote:
| This is a common bill stuffing scam.
|
| After having this same thing happen a few times I now ask at
| the beginning of the appointment to confirm that it's a
| wellness visit. Then I ask the provider to tell me if I
| inadvertently ask a question that will turn it into not a
| wellness visit. Then I ask at the end to confirm it will be
| billed with the wellness visit billing code.
| huevosabio wrote:
| "figured it could just grab money from unsophisticated people"
|
| This sums up my experience with US Healthcare. They bill
| expecting you to autopay, and either have no incentive to bill
| correctly or they outright are trying to scam but the result is
| that every hospital bill is sus.
|
| This also makes insurance a lot less inherently valuable: you are
| paying for someone to do this untangling shitshow on top of the
| actual insurance. As if the hospitals just put the billing burden
| on the client.
|
| There has to be a penalty for sending wrong bills, or they should
| pay me for my time wasted.
|
| Finally, the prices are so inflated that often the price without
| insurance in Europe is the same as the copay/coinsurance in the
| US.
|
| Its a fucking catastrophe.
| mannyv wrote:
| The estate of the dead person would be on the hook for the bill,
| unless the spouse co-signed. You might want to check that.
| claytongulick wrote:
| For folks who aren't healthcare tech nerds, what happened in this
| case is called "unbundling" which is a fraudulent practice that
| can have steep penalties from CMS.
|
| CMS maintains a service and set of tools to help prevent payers
| from getting hit with this called the National Correct Coding
| Initiative (NCCI) [1]. NCCI only applies to provider services and
| outpatient billing codes, but is still applicable for emergency
| room services.
|
| There are a bunch of technical details for implementing the edits
| in the NCCI, but I think it's worth taking a moment to reflect on
| this.
|
| It's pretty popular to point to the insurance company as the "bad
| guy" in healthcare, but this is the sort of stuff they deal with
| thousands of times _per day_.
|
| As frustrating and horrible as this story is, it's not unique to
| an uninsured individual. A big problem in US healthcare is
| provider overbilling.
|
| One of the most tragic jobs I held in healthcare tech was
| developing software for billing negotiation between providers and
| insurance companies. It was pretty eye-opening how terribly
| everyone behaves, and I learned to have a lot more sympathy for
| what insurance companies/government payers have to deal with.
|
| As a patient trying to have necessary treatment paid for, it's
| incredibly frustrating to have a claim denied, and these are what
| we see in the news and experience personally.
|
| As an insurance company, building robust systems that authorize
| necessary care while catching overbilling, overutilization and
| outright fraud is unfathomably complex and error prone.
|
| This one of the reasons I've become a fan of DPC (direct primary
| care) models [2] with HSAs and supplement high-deductible
| catastrophic insurance to protect against hospital stays. It puts
| primary care back into a direct relationship with the patient,
| and lets insurance companies do what they are good at: pricing
| risk.
|
| Some of the unintended consequences of how insurance companies
| are currently regulated is that in some states it can be
| difficult or impossible for an insurance company to provide a low
| cost, high deductible plan. They are forced to cover things that
| drive the costs up, so it's hard to do a DPC + catastrophic
| insurance option.
|
| [1] https://www.cms.gov/national-correct-coding-initiative-ncci
|
| [2] https://www.aafp.org/family-physician/practice-and-
| career/de...
| rwc wrote:
| There's a nonzero chance his AI bot was just talking to their AI
| bot to reach this happy conclusion.
| bloat wrote:
| Why is the man's wife worried about being sent to collections?
| She owes nothing to the hospital, the dead man's estate owes
| money. Let the hospital line up with the other creditors. She
| shouldn't be paying her late husband's hospital bills out of her
| own funds.
| dangus wrote:
| I don't think she likely had to pay a dime and wouldn't have
| faced any consequence besides a few months of annoying calls.
| Her credit score wouldn't have even been impacted.
|
| I think given this story they totally messed up.
| ryandrake wrote:
| A lot of people are unaware of who is responsible for what,
| and may be convinced to pay debts they don't owe. And
| creditors absolutely take advantage of this. Any debt
| collector worth his salt will hound everyone they can
| identify until they are told to stop in the particular way
| the law prescribes.
| codedokode wrote:
| These exorbital numbers are due to government and voters not
| willing to regulate the industry and rely on free market instead,
| correct?
| dragonwriter wrote:
| Not really. The healthcare market is a _very_ heavily regulated
| market, not an unregulated free market. The prices are not a
| result of there being a free market without regulation, but a
| product of what is and is not regulated. Both government and
| insurers take into account the "sticker price" of service in
| setting their reimbursement limits (they either have negotiated
| discounts from the sticker price, limit reimbursement based on
| the general charge to the public along with other factors,
| etc.)
|
| As a result, the nominal general charge to the uninsured public
| is generally inflated, but also tend to be very easy to
| negotiate down.
| ambicapter wrote:
| > Long story short, the hospital made up its own rules, its own
| prices, and figured it could just grab money from unsophisticated
| people.
|
| America in a nutshell.
|
| To be fair, I'm taking this whole twitter thread at face value.
| ddmdd wrote:
| AI is finally leveling the playing field on all those long and
| confusing documents that were designed to make regular people
| give up and pay whatever
| anonu wrote:
| The problem is the insurance+hospital industrial complex. The
| insurance companies will negotiate this down on your behalf. They
| basically operate on fear of walking into a hospital and getting
| a 6-figure bill.
|
| My SO had to take a medevac helicopter once: we got a $65k bill
| just for the 20-minute helicopter ride which suddenly became
| under $4k with insurance. The discount made me feel like I was
| getting a deal, so I gladly paid.
| dontshutupnerd wrote:
| This reads like an ad for Claude
| keernan wrote:
| I assume the law will only award a medical provider in a fee
| collection dispute for fees that are reasonable and within what
| the provider usually charges and receives in the normal course of
| business.
|
| Every EOB I receive shows medical charges many multiples of what
| insurance actually pays (and the provider actually accepts). IMO
| that is not only prima facie evidence of fraud, but - since every
| provider does the same thing - of collusion on fees amongst and
| within the medical industry - worthy of anti-trust investigations
| (I have no anti-trust experience).
| chrisgeleven wrote:
| I fought insurance over this past summer after they declined
| covering a life saving surgery for my 6-year-old child at the
| last minute. We were in despair that my child's life was at risk
| each day we waited because of insurance incompetence.
|
| ChatGPT literally guided me through the whole external appeal
| process, who to contact outside of normal channels to ask for
| help / apply pressure, researched questions I had, helped with
| wording on the appeals, and yes, helped keep me pushing forward
| at some of the darkest moments when I was grasping for anything,
| however small, to help keep the pressure up on the insurance
| company.
|
| I didn't follow everything it suggested blindly. Definitely
| decided a few times to make decisions that differed from its
| advice partially or completely, and I sometimes ran suggested
| next steps by several close friends/family to make sure I wasn't
| missing something obvious. But the ideas/path ChatGPT suggested,
| the chasing down different scenarios to rule in/out them, and
| coaching me through this is what ultimately got movement on our
| case.
|
| 10 days post denial, I was able to get the procedure approved
| from these efforts.
|
| 21 days post denial and 7 days after the decision was reversed,
| we lucked into a surgery slot that opened up and my child got
| their life saving surgery. They have recovered and is in the best
| health of the past 18 months.
|
| This maybe isn't leveling the playing field, at least not
| entirely. But it gave us a fighting chance on a short timeline
| and know where to best use our pressure. The hopeful part of me
| is that many others can use similar techniques to win.
| egorfine wrote:
| Non-US person here.
|
| Happy for your happy-end to that story!
|
| Though why do you Americans put up with all this? I have heard
| the US is a democracy. So then insurance-based healthcare is
| what American people truly want?
| zarmsdos wrote:
| Decades of right-wing propaganda, unfortunately. They tend to
| have an emotional reaction against any sort of socialized
| anything, including healthcare.
| gosub100 wrote:
| Left wing won't solve it either. They profit from the
| crisis by promising each election and not delivering.
| zarmsdos wrote:
| That's true. I wouldn't even call them left-wing, to be
| honest.
| zzzeek wrote:
| not sure why you're getting downmodded. People will say M4A
| ("medicare for all") polls at super high levels, and they're
| right, it does. But poll those same people telling them
| "would you favor that your employer-based healthcare would be
| rescinded and you would instead get healthcare from a new
| government controlled plan, where there would be no other
| options", which is the assumption M4A's viability is based
| on, and that poll turns right upside down.
| Projectiboga wrote:
| Every actuarial study about the switch projects total cost
| savings even during the first year. This scarsity of
| providers is artificial there haven't been enough medical
| student slots ever in America. American life expectancy
| isnt in the top 25 nations, while having the largest
| percapita GDP.
| Aurornis wrote:
| > Every actuarial study about the switch projects total
| cost savings even during the first year.
|
| This is missing the point about why people don't like the
| past M4A proposals: It's not about cost savings, it's
| about losing access to their existing health care with
| scarce details about what would change.
|
| The surprising reality about American health insurance is
| that many people's plans cover a lot of things,
| procedures, and medications that would be harder for them
| to obtain under Medicare or even in other socialized
| medicine systems like the NHS.
|
| If politicians would lay out a Medicare buy-in option and
| let everyone opt-in to it, it would be far more popular.
| The past proposals that involved shutting down the
| private insurance industry and handing it all over to the
| government is resoundingly unpopular.
| Aurornis wrote:
| > "would you favor that your employer-based healthcare
| would be rescinded and you would instead get healthcare
| from a new government controlled plan, where there would be
| no other options", which is the assumption M4A's viability
| is based on
|
| No, that's just the condition for one proposal for Medicare
| For All.
|
| As much as Americans complain about healthcare in general,
| most people don't want to give up _their own_ health
| insurance once they have it. This is a known political trap
| that the previous M4A proposals walked right into, before
| crashing and burning.
|
| When you say "Medicare for All" to people without details,
| they assume it means a Medicare _option_ for all. When they
| start reading the details and realize they have to give up
| their current insurance, they don 't like it.
| zzzeek wrote:
| what are the other proposals? I like everyone else would
| love the _option_.
|
| though at the moment I'm super happy DJT does not control
| my healthcare.
| ransom1538 wrote:
| Medicare has a total enrollment of approximately 69 million
| people, while Medicaid has around 83 million people. That is
| 152 million people. We already have socialized medicine we
| just run it poorly and don't apply it to people that can pay.
|
| Moving our system to 340 million people + letting our
| corporations out of paying would put the US into an economic
| death spiral. US corporations would love this plan. But at
| 340 million... I don't see doctor visits but once every 2
| years -- many would just die waiting for appointments.
| SV_BubbleTime wrote:
| Is this a comment for or against socialized medicine?
| tptacek wrote:
| Medicaid is apparently 77MM including CHIP. The underlying
| compromise in the system that you're describing is sane:
| people's health care costs rise dramatically and
| unpredictably at retirement age, just as their ability to
| pay plummets, so socializing health care at that point
| makes a lot of sense.
| umvi wrote:
| > I have heard the US is a democracy
|
| It's not a simple democracy, no (i.e. "enact a national-level
| vote for every issue and majority vote wins"). It's a
| constitutional republic where basically you have 50 mini
| countries each with different weight in the house of
| representatives and in the electoral college and a bazillion
| checks and balances that make repealing existing laws and
| enacting new ones very difficult. I think the majority of
| Americans do not like the current healthcare status quo, but
| getting changes that everyone is on board with through the
| political machinery is very difficult and Americans are
| polarized and tend to distrust change plans proposed by the
| opposite party (since parties tend to propose legislation
| that favors their own first).
| LeoPanthera wrote:
| > It's not a simple democracy, no (i.e. "enact a national-
| level vote for every issue and majority vote wins").
|
| But it's worth remembering that, if it were, Trump would
| still have won. He won the popular vote. So, assuming that
| enough votes were legitimate, a majority of Americans
| actually _do_ want the current health situation in the US,
| in fact arguably they want even less coverage.
| ar_lan wrote:
| We don't know if that's really accurate, because you're
| conveniently ignoring 2016. If Trump were never initially
| president, would he have ever become one?
|
| Maybe, maybe not. But 2024 surely would have looked very
| different.
| LeoPanthera wrote:
| This only serves to reenforce the fact that the US is not
| a functioning democracy, if the will of the voters is not
| reflected.
| georgeecollins wrote:
| I think the reason is that people know it is a problem but
| ideologically they really disagree about what to do about it.
| The impasse creates an opportunity for profit driven actors
| to fight reforms. Also, democracies do dumb things sometimes.
| See Brexit.
|
| But also, sometimes people from other countries-- I am
| thinking parts of Europe-- underestimate how well paid people
| in the US often are. They compare the averages, like the US
| only makes 20% more per household, why do they put up with
| this or that. But that comparison is for the whole country,
| so imagine if you were comparing all of Europe or China.
|
| I had a friend in Spain at a similar company as mine say, how
| can you put up with no safety net, etc. But I look at his
| company and every one at my company at any level gets paid
| 2-5x as much. So like these are less serious issues if you
| are paid an extra $1-200k/ year. It doesn't explain the
| inaction, but I believe it is why a lot of politically
| influential people don't care.
| tptacek wrote:
| Yes, a challenge for major structural alterations to the
| American system is that the median American family is
| probably better off under this system than they would be
| under any of the European-style systems: the wage premium
| enjoyed by many Americans and the lower tax level offsets
| the cost of insurance and copays.
|
| So when you're talking about how bad the American system
| is, you're really talking about a minority of its users.
| That doesn't make everything OK, but does highlight the
| political difficulty of enacting seemingly-popular changes.
| teaearlgraycold wrote:
| I don't know if the median American would be worse off
| with a European style system. Certainly the 1% don't need
| it. I've been on the Google health insurance before and
| it made me feel like I had $10 million in the bank.
| arjvik wrote:
| Can I ask what the Google health insurance is like?
| teaearlgraycold wrote:
| I've been lucky with my health so I don't have a huge
| list of interactions:
|
| * Free tele psycho-therapy. Not sure what the limit is
| but it's >= 2 hours per week. I even cancelled same-day
| once with no fee. The quality of the care was also very
| high.
|
| * I developed wrist pain from typing, holding a Steam
| Deck, starting pull ups. I was able to see a physical
| therapist at the Google office (through an embedded One
| Medical) after 1 week. No referral needed. Saw them once
| per week for 5 weeks paying $20 co-pay each time. They
| fixed my issues permanently.
|
| * I also occasionally used the Google One Medical
| locations (and public ones) for injuries from a low speed
| bike crash, vaccines, etc. Don't think I ever paid more
| than $20 for anything. On a Google income that amount is
| completely inconsequential.
| egorfine wrote:
| > about how bad the American system is, you're really
| talking about a minority of its users
|
| It sure seems that way if a wealth family with top level
| insurance can still get bankrupt by medical bills.
| Examples of that are right here in comments.
| tptacek wrote:
| Are you referring to the comment that roots this thread?
| TheOtherHobbes wrote:
| No need. It's a known phenomenon.
|
| https://www.npr.org/sections/health-
| shots/2022/06/16/1104969...
|
| https://rooseveltinstitute.org/publications/medical-debt/
|
| https://www.marketplace.org/story/2024/03/27/health-and-
| weal...
|
| As for income distribution
|
| https://worldpopulationreview.com/country-rankings/gini-
| coef...
|
| State GDP figures are skewed by high earners. The US is
| _massively and systemically_ unequal, with far less
| economic mobility than the EU.
| tptacek wrote:
| I asked a question about the comments on this thread.
| This isn't responsive to that question.
| wing-_-nuts wrote:
| >the median American family is probably better off under
| this system than they would be under any of the European-
| style systems: the wage premium enjoyed by many Americans
| and the lower tax level offsets the cost of insurance and
| copays.
|
| If you had said the median tech worker? I might have
| believed you, but the median family? No way.
| tptacek wrote:
| The median family of 4 with private health insurance has
| a household income of around $115k not counting the gross
| cost of their employer-provided health care. Remember:
| being on private insurance puts you in a cohort that:
|
| * Excludes everybody on Medicaid
|
| * Excludes fixed-income seniors on Medicare
|
| * Makes it overwhelmingly likely you have subsidized
| employer-covered health insurance.
|
| Figure your employer "covers" half the gross cost of your
| $24k/yr health insurance (they aren't, really: that's
| money they'd be paying you directly without the
| distortion of employer-provided health care). Do the
| take-home pay math. Put them in, like, Ohio, or Iowa, or
| Colorado; just not SFBA or NYC.
|
| Now move that same family to Manchester, take the wage
| hit for moving to the UK labor market, and work out the
| take-home pay. They'll of course pay $0 for the NHS.
|
| Are they better off or worse off?
|
| I'm not valorizing the arrangement, I'm making a point
| about how political tractable changing it is.
| Uehreka wrote:
| Idk, speaking as a big Medicare-for-all supporter, this
| would definitely explain why MfA always polls well at
| first, until people start asking if they can keep their
| current plan. I know at this point in the debate we're
| supposed to write those people off as either innumerate,
| a minority, or too risk-averse for their own good, but
| honestly if it turned out that that stat was true, that
| would explain a lot.
|
| And it would be exactly the kind of political engineering
| minmax scheme large corps in the US are great at:
| petition legislators to cut regulations so you can cut
| costs and maximize profits, but keep juuuust enough of
| the right perks in the right places so that a slim
| majority of people in Wisconsin, Michigan and Georgia
| oppose shaking things up.
| tptacek wrote:
| The people who want to keep their own plan are almost
| definitionally not innumerate! They would be worse off
| financially under M4A.
|
| That doesn't make M4A bad policy (I think it's bad policy
| for other reasons), but it does take "people are being
| irrational" off the table in a discussion like this.
| supertrope wrote:
| Even if you keep your plan it's getting enshittified
| every year.
|
| It's that time of year again - enroll for 2026 benefits.
| My employer raised employee premiums by 10%, raised the
| deductible, added more administrative burden such as
| "step therapy" (the insurance company denies your claim
| for a drug until you've tried a cheaper but less
| effective drug, even if you've already done "step
| therapy" while on another health plan!) Your employer
| will change the plan premiums and structure every single
| year. They can lay you off, exclude expensive drugs,
| exclude doctors, etc. Some specialties like
| anesthesiology and psychiatry are usually not in network.
| In extreme cases an employer can change health
| administrators mid-year and your deductible will reset.
|
| https://www.pwc.com/us/en/industries/health-
| industries/libra...
| https://kffhealthnews.org/news/article/workplace-health-
| insu...
| fredophile wrote:
| Why does Medicare for all mean I can't keep private
| health insurance? There are countries that have systems
| like this in place.
| tptacek wrote:
| There are countries that have single-payer systems and
| widespread _supplemental_ insurance. But if you
| universalized Medicare, you 'd immediately do at least
| two big things to the market:
|
| (1) You'd eliminate the system of advantages and supports
| that cause employers to offer private insurance, which is
| where most people get their insurance from.
|
| (2) You'd create a huge adverse selection problem --- the
| more effective/useful Medicare is, the fewer families
| will want to spent $24k/yr on private insurance, meaning
| the families left on private insurance have a _reason_ to
| want it, meaning the composition of the risk pool would
| shift dramatically.
|
| Like, if we ever did M4A, we'd probably end up with a
| widespread system of supplemental insurance; we already
| have it with Medicare! But that's not the same thing as
| keeping your existing plan.
| dragonwriter wrote:
| > Yes, a challenge for major structural alterations to
| the American system is that the median American family is
| probably better off under this system than they would be
| under any of the European-style systems: the wage premium
| enjoyed by many Americans and the lower tax level offsets
| the cost of insurance and copays.
|
| The US spends nearly as much _in taxpayer funds_ as a
| share of GDP as other developed countries (and vastly
| more on a per capita basis), with even more in private
| costs on top of it. It is simply dishonest to say that
| the "wage premium enjoyed by many Americans and the
| lower tax level offsets the cost of insurance and
| copays", because neither the US wage premium _nor_ any
| lower tax burden are attributable to differences in
| healthcare systems, but rather are in _spite_ of the far
| greater burden of the US healthcare system.
|
| OTOH, it is true that a major challenge is that people
| _respond with this line_ to any proposed major structural
| changes to the US system.
| tptacek wrote:
| Again, you can just do the math on this. You're making an
| argument about the macro costs of our system --- I think
| those costs are fucked, too. But I'm not talking about
| that; I'm talking about the actual experience of an
| ordinary middle-income family with private health
| insurance. That family would likely (in fact, almost
| certainly) be worse off in a single-payer system.
|
| I'd appreciate if you'd avoid using language like "simply
| dishonest" with me in the future. It's easy to tell me
| I'm wrong about something without accusing me of
| commenting in bad faith. This is in the guidelines.
| Thanks in advance!
| dragonwriter wrote:
| > Again, you can just do the math on this. You're making
| an argument about the macro costs of our system --- I
| think those costs are fucked, too. But I'm not talking
| about that; I'm talking about the actual experience of an
| ordinary middle-income family with private health
| insurance.
|
| Yes, you can just do the math, and changing nothing about
| the US _except_ transition to a European style universal
| system, the median family would face _lower_ aggregate
| tax, out-of-paycheck, and out-of-pocket costs than they
| do now, with less health insecurity around unexpected
| events (either health or employment), unless the tax
| increases necessary were deliberately and perversely
| targeted to avoid that.
|
| That's a direct consequence of the difference in the
| macro-level costs: they aren't separate, orthogonal
| concerns. People just have a hard time accepting that the
| US health care system is structurally constructed right
| now to waste vast hordes of money _preventing_ people
| from accessing health care, but that's exactly what it
| does.
| tptacek wrote:
| Provide numbers. Sanders, for instance, funded his
| proposed system by (among other things) taxing capital
| gains at the level of ordinary income.
|
| I'm critical of the US system, but I have exactly the
| opposite diagnosis you do: my concern with the system is
| that, by the numbers, it appears to function by driving
| way too much spending on "actual" care.
| dragonwriter wrote:
| > Provide numbers. Sanders, for instance, funded his
| proposed system by (among other things) taxing capital
| gains at the level of ordinary income.
|
| Not tax penalizing non-capital income is sort of an
| essential reform in the era of increasing automation
| anyway; I'm not sure what point you are trying to make
| there. The average middle income family isn't making a
| substantial share of their income in forms taxed as long-
| term capital gains, so that seems...unrelated to the
| focus of your argument.
|
| > I'm critical of the US system, but I have exactly the
| opposite diagnosis you do: my concern with the system is
| that, by the numbers, it appears to function by driving
| way too much spending on "actual" care.
|
| It does both (particularly, in the "actual care" angle,
| as regards low-benefit, high-cost measures near the end
| of life.) We have a system based on denying and
| economically incentivizing younger people to avoid and
| defer care, but then doing much less of that with (most
| of) the elderly.
| tptacek wrote:
| You're contradicting yourself. You took me to task
| earlier for factoring in the wage penalty for working in
| the UK market --- fair enough, though really I'm making
| the simple descriptive point that people in the US are
| accepting of a dysfunctional status quo in part because
| they would be worse off in Europe.
|
| But taxing capital gains at the level of ordinary income
| would be an _immense_ change our tax code. All sorts of
| things the broader economy would change as a result. If
| you accept Sanders plan, you 're not holding to your
| original constraint of changing _only_ the health
| financing system.
|
| I want to be clear that I'm not stipulating that families
| would be better off under M4A if you didn't do this: I
| _still_ think your argument has the fuzzy end of this
| lollipop. I think it 's unlikely that you will come up
| with a set of numbers for any proposed single-payer
| health system that leaves the median family with private
| health insurance better off on a take-home basis. I'm
| making a strong claim, so you should be able to knock it
| down straightforwardly if I'm wrong, and I'm interested
| to see if you can.
| TheOtherHobbes wrote:
| The counterargument is simple - it works in other
| countries.
|
| Other countries have healthcare systems that don't
| generate medical bankruptcies, and don't put a slaver's
| chain around the necks of employees who risk financial
| destruction if they have to give up an employer-funded
| plan.
|
| You're essentially arguing that 500k medical bankruptcies
| _every single year_ , out of a population of 340 million,
| is a small price to pay for an imaginary financial
| benefit that you're convinced exists, for some loosely
| defined demographic, but which you've failed to quantify.
|
| This is, very specifically, the problem that destroys
| your argument.
|
| _Some_ people in the US are better off _until they aren
| 't._
|
| One serious medical crisis - like an extended bout with
| cancer - is enough to wipe out the benefits, and leave
| people who used to be prosperous out on the streets.
|
| Literally. Not as an exaggeration, not as rhetoric, but
| as a cold, hard reality that affects half a million
| people every year.
| tptacek wrote:
| You're responding persuasively to somebody's argument,
| but it isn't mine. I'm talking about the large cohort of
| American voters who would be worse off under a single-
| payer system.
| throwaway0123_5 wrote:
| > So like these are less serious issues if you are paid an
| extra $1-200k/ year
|
| Ok but to be fair most people in the US aren't making
| "extra $1-200k / year" over a person in Europe. They aren't
| even making $100k / year to begin with.
| mothballed wrote:
| Almost 40% of the USA is on medicare, medicaid, or
| entitled to VA benefits or military healthcare. It's only
| a narrow majority that depends on unsubsidized private
| healthcare, and those people skew in the upper income
| levels.
| yieldcrv wrote:
| And while European countries have various forms of
| nationalized welfare, their salaries are so low that they
| would be automatically eligible for the US' welfare too!
|
| our blocs aren't that different
|
| except in the US middle class and upper middle class
| nosianu wrote:
| So what about this? It is a question, not meant as a
| counter.
|
| Although I have to say the rosy picture some paint here
| about the high incomes is counter to anything I ever
| heard - and saw, although I left the US in the early
| 2000s, after having lived there for almost a decade
| (still mostly paid from Germany, never ready to make a
| complete move).
|
| "Medical Bankruptcies by Country 2025"
|
| https://worldpopulationreview.com/country-
| rankings/medical-b...
|
| "Healthcare Insights: How Medical Debt Is Crushing 100
| Million Americans"
|
| https://www.ilr.cornell.edu/scheinman-
| institute/blog/john-au...
|
| By the way, Europeans don't quite all have a
| "nationalized healthcare system". Germany, for example,
| has "Krankenkassen" but also private insurance, and the
| "Krankenkassen" are private organizations.
|
| We pay health insurance and get to choose the provider,
| those with higher incomes can switch to complete private
| insurance. We also have lots of our own problems and
| increasing costs because of immigration but more so aging
| population.
|
| However, I personally know several people who had severe
| illnesses for a long time, and their normal
| "Krankenkassen" insurance never made any problems. One
| person with plenty of money, whose wife was dying, even
| asked US medical experts if he should come to the US with
| her, and those US experts said he should stay where he
| is, the German univ3ersity hospital right next door had
| some of the leading therapies in the field. She lived
| five more years instead of dying after less than half a
| year with the standard therapy, every single expense paid
| for with the standard insurance, additional private
| insurance unnecessary. Similar with my stepfather, who
| had soooo many severe conditions, and yet every single
| item down to the special medical bed brought into our
| house so that he could finally die at home was paid
| without question.
|
| The problems are with more mundane expenses, e.g.
| glasses, or the dentist, where only some of the
| treatments are covered. The really expensive illnesses
| seem to be better covered than the more common and much
| simpler problems.
| onli wrote:
| Careful there, thats a rightwing propaganda point.
| Immigration into an aging society does not raise
| healthcare costs, it lowers it. See
| https://archive.is/XxfTH (and note that this is a NZZ
| article, a right-wing publication by now, so not slanted
| towards being immigration friendly).
| nxor wrote:
| Are people ever allowed to criticize migration?
| bleepblap wrote:
| Sure, but it helps to not misrepresent the facts while
| you do it
| epistasis wrote:
| Who's not being allowed to criticize immigration?
| Critique of a critique is pretty much the furthest thing
| from "disallowing" critique.
| jkartchner wrote:
| You believe the top 60% of the nation skew in the upper
| income levels? Median pay is $61k a year for the entire
| country. The top 1% skews to the upper income levels. The
| rest are charged $30 for a dose of aspirin and can't
| afford it.
| tptacek wrote:
| There are numbers on this, and their comment is probably
| directionally correct; the median household with private
| insurance earns more than 400% of household FPL (KFF). By
| subtracting Medicaid and fixed-income seniors from the
| picture, you are sharply biasing the median upwards.
| gusgus01 wrote:
| I would say if you ignore the poorest 40% of the
| population, you've got quite the slim margin to go before
| you are no longer talking about "Most" Americans, which
| the OP was pretty explicitly talking about.
|
| He was saying "Most people in the US" don't make 100-200k
| more, and that they probably don't even make 100k. This
| was in response to the generalization that "people from
| other countries ... underestimate how well paid people in
| the US often are".
|
| Now there was talk of getting the political motivation to
| change things, so I guess everyone is assuming
| Medicaid/Medicare/VA recipients don't want to change the
| system, but that wasn't really established, nor was that
| really being refuted.
| tptacek wrote:
| I don't think I could be any clearer that I am (1)
| talking about Americans with private health insurance and
| (2) not making a normative judgement about which system
| is better, but rather a positive claim about the
| political challenge of changing the system (its large
| group of stakeholders who are better off under it).
| gusgus01 wrote:
| Oh I'm clear about the demographic you are trying to
| discuss, my point was I'm not sure this all stemmed from
| a discussion about that specific demographic. It started
| at "people in US", then went to "most", then by the time
| you got involved in the thread you were defending a
| statement about people with private health insurance.
|
| I could have made this comment at the level where it went
| off the rails, but I thought making it at the leaf level
| would help everyone involved see the deviation between
| what was said and what was being argued.
| nxor wrote:
| People in the US can't afford aspirin? Where do you live?
| It's just not true
| davidcbc wrote:
| They are referring to the price that hospitals charge for
| aspirin, which is massively inflated, not the off the
| shelf cost of aspirin
| tptacek wrote:
| Where in their comment do you see them referring to
| hospital care?
| GuinansEyebrows wrote:
| i think in this case, if you're at all familiar with what
| US hospitals charge for the small stuff, it's a safe
| assumption that when someone says aspirin costs $30 a
| dose, they're not talking about buying it at a CVS. of
| many folks on hacker news dot com i trust you to bridge
| that gap instead of nitpicking!
| tptacek wrote:
| That's an odd argument to make in this thread, because
| whatever the drivers of burdensome consumer health
| spending are, they're _not_ overpriced hospital aspirin.
| GuinansEyebrows wrote:
| maybe so; it's a symptom, not a cause.
| davidcbc wrote:
| I'm capable of understanding context.
| fukka42 wrote:
| It's hilariously out of touch, but it's what you should
| expect from the HN bros. They live in a bubble.
|
| I'm from the eu and earn far less than these American
| techbros do, but far more than my American friends who
| work normal jobs. They work at the DMV, a supermarket, or
| general office work. You know, normal people. The vast
| majority.
| smaudet wrote:
| Yeah, just because the US has 300 billionaires that does
| not make the median salary anywhere near six figures.
|
| In fact it's quite low, somehow people are expected to
| survive on several thousand a year, after the rent,
| utilities, transport costs are all paid.
|
| https://www.fool.com/money/research/average-us-income/
|
| These are official stats, but unofficial employment puts
| the number lower:
|
| https://investorshangout.com/carlyle-group-unveils-
| alarming-...
| tptacek wrote:
| It helps to understand the difference between the mean
| and the median.
| egorfine wrote:
| > they really disagree about what to do about it
|
| What is there to disagree with? Are there any option other
| than introduction of universal healthcare?
| mothballed wrote:
| There's already a soft alternative many people use, which
| is the deregulation option via geo-arbitrage, go to
| Mexico and get the same thing for 10 cents on the dollar.
| epistasis wrote:
| Universal healthcare is a very different thing from
| controlling costs.
|
| Obamacare attempted to make the US healthcare system into
| a universal system by mandating that people purchase
| coverage, heavily subsidized to become affordable to
| every income level, in addition to massive expansion of
| Medicaid to those with the lowest levels of income or no
| income at all. Automatic enrollment in health insurance
| exchanges, even if people did not make their own choices
| on the health insurance exchanges, is what would make the
| US system universal health care.
|
| Universal means that everyone has coverage, that the
| question to the patient is "what insurance plan are you
| on," rather than "do you have insurance." And making
| coverage universal has no connection to lowering costs.
| We need larger structural changes in the logistics of how
| care is delivered and how the money flows.
|
| Single payer is another choice to be made, but that
| doesn't necessarily mean that health insurance is cheap,
| that all the care gets delivered that people want
| delivered, etc. Medicare is often cited as one direction
| for this, but most don't realize that private health
| insurance costs are partially high because they help
| subsidize the care of those who are covered by Medicare,
| because Medicare reimbursement rates are far lower than
| any of the private insurers have been able to negotiate.
|
| Other routes are full decoupling of insurance from
| employment, full price controls that normalize Medicare
| and private insurance rates, which either make health
| care more free market or less free market depending on
| how you define those terms.
|
| However every year that passes makes any of these reforms
| more difficult because administration of the costs and
| billing is getting more complex each year. ICD codes, PLA
| codes, all that stuff grows in complexity.
|
| HMOs, like Kaiser, may provide a route towards greater
| simplicity of administration of health and costs.
|
| But implementing any large change will require political
| buy-in of people, and when we have our current low-trust,
| high-misinformation political system there's been no way
| to make any political traction for changing anything.
| Until we regain a functional democracy or turn to full
| dictatorship, it seems unlikely that we will see
| structural changes that improve anything. Hell, we had
| Republican states actively trying to prevent poor people
| from receiving coverage from federal dollars. How can we
| ever come to terms with a change unless that sort of
| attitude no longer has traction?
| kwanbix wrote:
| As a non-american (from South America) who lived in both
| USA an Europe:
|
| Yes, in USA you get much more money, like you said 2x~5x,
| but then:
|
| University is expensive as fck. Health care is expensive as
| fck. You have 5 days of paid sick leave per year in most
| companies. You have 10 days of paid holidays per year in
| most companies.
|
| In contrast, in Europe: University was cheap or free.
| Healthcare is cheap and universal. If you are sick you are
| sick, either the company or the health insurance pay. You
| have between 20 and 30 days of paid holidays.
|
| This is why quality of life in Europe, is so superior. And
| again, I am saying this as a non-European.
| basisword wrote:
| >> University is expensive as fck.
|
| While healthcare is brought up all the time this is
| usually ignored. The idea of parents saving a 'college
| fund' for their child is something I only know from
| movies. It's such a strange idea that access to education
| would be something you either need to be able to afford
| or need to get a 'scholarship' for (another strange
| concept).
| BolexNOLA wrote:
| I set up an education fund for my kids when they were 2
| and I still can't be sure it'll be enough. It's really
| bad.
| tptacek wrote:
| Implicit in all these stories is that "education" means
| "access to highly selective universities". In-state
| tuition at Directional State University is much more
| manageable.
| davidcbc wrote:
| Not really. I went to a public land grant university 20
| years ago and paid about $12k a year in state. That same
| university is now $44k per year.
| tptacek wrote:
| Both my kids went to UIUC and we paid about $15k/yr, and
| both my kids graduated within the last couple years. And
| UIUC isn't a Directional State University; it's the
| flagship of the UI system. You can just look this up:
| tuition numbers aren't secret.
| davidcbc wrote:
| Ok I will. This claims the cost of attendance is
| $36,930-$42,310 per year:
|
| https://www.admissions.illinois.edu/invest/tuition
|
| This claims $21k per semester:
|
| https://cost.illinois.edu/Home/Cost/R/U/10KP0112BS/15/120
| 258...
| Aurornis wrote:
| > something I only know from movies. It's such a strange
| idea that access to education would be something you
| either need to be able to afford or need to get a
| 'scholarship' for (another strange concept).
|
| Like most things learned from movies, you're not getting
| the full picture. Most US universities charge on a
| sliding scale based on family earnings. For larger
| universities, tuition can actually be free depending on
| parental earnings. At the extreme end, some Ivy League
| universities like Harvard have $0 tuition for families
| earning less than $200K/year.
|
| We also have community colleges and state-run
| universities with subsidized in-state tuition. It's still
| more expensive than free, but the tuition is in the range
| where as long as you're smart with your degree selection
| the ROI of getting the degree will more than make up for
| any loans you have to take on. That said, you can get
| yourself into trouble if you take out loans to study for
| a degree that doesn't translate to a job.
| tptacek wrote:
| And, in fact, the median amount of college debt for
| adults who don't hold degrees is sharply lower than the
| overall median (it's around $10k). It's not nothing, but
| it's also not a life-changing amount of debt.
|
| (By way of policy bona fides: I'd strongly support
| forgiving student debt for all for-profit schools, but
| would oppose forgiveness for degree-holders from
| universities, which would be a sharply regressive
| policy).
| Aurornis wrote:
| > University is expensive as fck.
|
| One thing that's hard to understand from the outside is
| that almost nobody actually pays those mind-blowing
| $60K/year tuition prices. US universities charge on a
| sliding scale based on the applicants' families' ability
| to pay.
|
| For an extreme example: Harvard's tuition is nominally
| $60K per year, but for families earning $200K or less
| it's $0. Many prestigious universities follow similar
| patterns resulting in a large percentage of students
| paying no tuition, the middle ground of students paying
| some fraction, and a small number of students from
| wealthy families subsidizing everyone else.
|
| For those who don't attend the prestigious universities
| with large endowments, average in-state state-run
| University tuition is under $10K, though again a large
| percentage of students receive some form of aids or
| grants to bring that number down even further.
|
| That said, it's entirely possible or someone to go out
| and sign up for bad investment private university with no
| aid and rack up $300K of debt by graduation if they're
| not paying attention to anything, but it's a myth to
| think that everyone does this.
|
| The average US college student graduates with around
| $30-40K debt depending on whether they go public or
| private, which isn't all that hard to pay off when our
| wages are already significantly higher than other
| countries. We're especially lucky in tech where our
| compensation differential relative to other countries
| more than makes up for the cost of university education.
| nonfamous wrote:
| One thing that's hard to understand from the outside is
| that almost nobody actually pays those mind-blowing $200K
| hospital bills. US hospitals charge on a sliding scale
| based on the applicants' families' ability to pay.
|
| (I don't mean to belittle your comment about universities
| which is factual and helpful. I'm just pointing out that
| US education system is just as fucked up as the US
| healthcare system the OP is talking about.)
| Aurornis wrote:
| Also very true, and a good point.
|
| Even people in the US don't understand why those $200K
| hospital bills aren't real.
|
| Insurance providers (including government programs) have
| a fixed limit for what they pay for procedures. They pay
| min(billed_amount, allowed_amount) so providers don't
| want to risk leaving money on the table by having
| billed_amount < allowed_amount. To ensure this doesn't
| happen, they bill an arbitrarily high number with the
| expectation that insurance will lower it down to some
| much smaller number.
|
| So every time you see posts on the internet where people
| talk about their "$200K hospital bill" they're always
| talking about that arbitrarily high value. If you have to
| pay cash for some reason, they will reduce the value to
| the cash pay amount which is in line with the insurance
| paid numbers.
|
| Nobody ever pays those high hospital bill amounts.
| throwway120385 wrote:
| That depends a lot on your insurance. For example, our
| out of pocket for my son's birth was somewhere in the
| neighborhood of $10k after insurance. I've met tons of
| people who would be bankrupted by that amount. What
| you're describing isn't true for people on High
| Deductible Health Plans, and those plans are a bit of a
| racket because they're frequently paired with HSAs where
| the employer gets to pocket anything left in the account
| at the end of the year. My son was essentially unplanned,
| in the sense that we gave up on trying to have a kid but
| weren't using birth control because over the previous 3
| years we had not had a successful pregnancy. So an HSA
| would have been no help for us.
| tptacek wrote:
| HSA funds are meant to roll over. Your employer generally
| should not be pocketing whatever's left over in the
| account. The idea is that many (most?) people are better
| off with a lower premium and higher deductible given that
| most years (for most people) aren't characterized by high
| medical expenditures; HDHP+HSA is closer in nature to
| actual "insurance", rather than a structured financing
| plan for health care.
| lesuorac wrote:
| FSA's not HSA's are use-it-or-lose-it.
|
| If you have a FSA I strongly suggest that you get an HSA
| instead.
|
| https://www.fidelity.com/learning-center/smart-money/hsa-
| vs-...
| maxerickson wrote:
| A lot of people with FSAs will have insurance that
| disqualifies having an HSA.
|
| I have the paranoid idea that they designed FSAs in such
| a goofy way for budget scoring and it drives me nuts.
| phil21 wrote:
| HSA is your money like a retirement account is. It's one
| of the most tax advantaged ways to save money.
|
| More or less all high income earners who do not have a
| chronic health issue are better off choosing a HDHP
| paired with a HSA - especially if the company provides
| any sort of matching benefit. Keep that account as an
| additional retirement account and pay out of pocket for
| most healthcare needs.
|
| Think of it also as actual insurance vs. a pre-paid
| health plan.
|
| The math of course changes for folks who are not highly
| paid, or have expensive chronic health conditions that
| would result in maxing out the deductible each year.
|
| You are likely thinking of a FSA which is use it or lose
| it.
| mindslight wrote:
| Note that another word that straightforwardly describes
| this behavior is "fraud". Medical bills aren't like a
| bill from a car mechanic where there is a contract
| (either written or at least implied because the mechanic
| will readily give you estimates and quotes).
|
| In the medical context, the only contract in the picture
| is possibly between the medical provider and the
| healthcare management organization. It would be fine if
| providers only sent the fake bills to them as they're
| both willingly playing this perverse game.
|
| But the problem is when they send their fake numbers to
| patients as if they're some kind of legitimate bill.
| Medical bills to patients are presented on a "cost
| reimbursement" basis - helping you cost them this much,
| so you are responsible for reimbursing them. By inflating
| the numbers 3-5x they are straight up lying about the
| costs they incurred. That's fraud.
| TheOtherHobbes wrote:
| If the bills aren't real, why are there half a million
| medical bankruptcies every year?
|
| Why do 41% of Americans have some form of medical debt?
|
| https://www.kff.org/health-costs/kff-health-care-debt-
| survey...
| throwforfeds wrote:
| Yes, but Americans have an incredible amount of student
| loan debt too. Something like $1.7 trillion. If you can
| get into one of the best schools in the world that has a
| huge endowment, then sure, you'll get grants and whatnot.
| It may even be free, in the case of Harvard. But then
| there's a long tail of schools that are honestly not that
| great, charging only slightly less than the top schools
| per year, with smaller aid packages, and kids sign up for
| crazy loans because they think they have to.
|
| Personally I think the government should get out of the
| business of these loans, fully fund state schools to make
| them all free, and let the private schools and the
| private banking market deal with the rest of it. We were
| going down that path in CA until Reagan killed it when he
| was governor. [1]
|
| [1] https://newuniversity.org/2023/02/13/ronald-reagans-
| legacy-t...
| sxg wrote:
| Public service loan forgiveness (PSLF) exists and a huge
| number of people in medical professions actually take
| advantage of it. I know of multiple medical students and
| residents with over $500k in debt that are in the process
| of having all of their loans forgiven after 10 years in
| training and a total cost of approximately $75-150k for
| their entire education. Sure, that's still a decent
| amount of money, but it's very much worth the ROI.
|
| https://en.wikipedia.org/wiki/Public_Service_Loan_Forgive
| nes...
| lesuorac wrote:
| How successful are those people being?
|
| IIUC, there was a bit of a scandal where the companies
| the DoE where paying to manage those 10 year forgiveness
| plans where giving incorrect advice and so a lot of
| people aren't going to qualify.
|
| https://oag.ca.gov/news/press-releases/attorney-general-
| bece...
| tptacek wrote:
| American student loan debt skews sharply towards the top
| income quartile.
| gedy wrote:
| Yes, granted it was over 20 years ago, but I came from a
| pretty broke household in the United States, and I went
| to a cheap state school instead of a nicer university or
| private school because I couldn't imagine borrowing for
| school. The folks I know who were much more well off,
| seem to have had no problem borrowing what I considered
| to be exorbitant sums to both pay for school and live off
| of.
| tptacek wrote:
| In a redistributive sense it is very much like American
| homeowners complaining about their mortgage debt.
| StackRanker3000 wrote:
| > For an extreme example: Harvard's tuition is nominally
| $60K per year, but for families earning $200K or less
| it's $0. Many prestigious universities follow similar
| patterns resulting in a large percentage of students
| paying no tuition, the middle ground of students paying
| some fraction, and a small number of students from
| wealthy families subsidizing everyone else.
|
| As someone from a country (Sweden) that to a larger
| extent has decreased people's reliance on their families,
| and grown the welfare state instead, it's weird to think
| that your parents wealth or income should have any impact
| on things like tuition, once you've reached the age of
| majority
|
| Once I finished high school, my parents had nothing to do
| with my business as far as any institutions were
| concerned, and vice versa. But uni was tax-funded and
| free at the point of use. And when they get too old to
| care for themselves, it will likely be the government
| supporting them financially, not me (unless I strike it
| rich first, in which case I suppose they'll spend their
| sunset years in style)
| arwhatever wrote:
| Perennial "What Armenians should know about life in
| America (2014)" from days of HN past
| https://news.ycombinator.com/item?id=22777745
|
| And which today must be read via internet archive
|
| https://web.archive.org/web/20200404172130/https://likewi
| se....
|
| Basically explaining to Armenians at home why their
| relatives who moved to America don't send better
| remittances back home despite their $X pay rate. Here's
| why ...
| j-krieger wrote:
| > University was cheap or free
|
| Ha! I wish. It's not free. You will pay the same that
| Americans pay for Uni over your life many times over
| since tax rates in the EU are really high. Healthcare
| isn't exactly cheap either.
|
| And everything you wrote is just the result of decades of
| prosperity that are now coming to an end. This will be a
| shock for many.
| stronglikedan wrote:
| > This is why quality of life in Europe, is so superior.
|
| That's very subjective, and I would rather have my
| freedoms instead of your/their liberties, thanks!
| vecinu wrote:
| This is a really bad time to flex our liberties in the
| US. Let's be real. Also please don't tell me your skin
| color, I already know.
| kQq9oHeAz6wLLS wrote:
| > Also please don't tell me your skin color, I already
| know.
|
| Also, please don't tell me you live in a major city/vote
| Democrat/are probably white with a savior complex.
|
| I already know.
| georgeecollins wrote:
| If this were true, the number of Americans I have known
| who moved to Europe would be roughly equal to the number
| of Europeans I have known who have moved to the US.
| That's not data, that's anecdote. But what is the
| European country where more people go there from the US
| than come to the US from there?
| no_wizard wrote:
| The two things are not equals. The US has, in particular
| for a western country, relaxed standards for
| immigration[0], in particular if you were coming from
| Europe, it's quite a bit easier to establish residency
| here.
|
| The reverse is not true. European nations aren't very
| immigration friendly by comparison. On top of that, the
| US government, assuming you keep your citizenship, does
| not make it easy to live abroad. US government tax policy
| for citizens who live overseas is much more aggressive
| than any other western country, from what I understand.
|
| Combined with the fact its alot harder to go the other
| way, and the US government does a fair amount to
| discourage it, I'm not shocked more US citizens aren't
| moving to Europe.
|
| [0]: At least before Trump returned to office, I'm unsure
| how much of this has changed.
| frikskit wrote:
| Annoyingly ignorant argument. High fractions of Europeans
| speak English, eg Poland has 50% of population speaking
| English (for those of working age it's probably much
| higher) whereas the fractions of Americans speaking non-
| English European languages is much lower.
|
| If 50% of Americans spoke polish by the shake of a wand,
| I bet there'd be more Americans in Poland than Poles in
| Poland.
| nawgz wrote:
| > people know it is a problem but ideologically they really
| disagree about what to do about it
|
| Can we really say this is true about individuals in the US?
|
| I think it's pretty clear the propaganda machine has
| successfully privatized health care to the great detriment
| of the populace and have the clamps on it.
|
| After all, if you told everyone you had a solution where
| insurance rates would be cheaper, their healthcare system
| would cost less overall, and the health outcomes would be
| superior, they would all be like "sounds great". Then, when
| you reveal this solution is the complete destruction of the
| insurance "industry", insurance payments are "tax", and the
| health provider is the government, they would balk, scream
| about socialized healthcare, and say how they don't trust
| the government.
|
| That's a trained response, not a real thought.
| epistasis wrote:
| Oddly enough the big rhetorical push against a universal
| system from prior decades was about "death panels" deciding
| what care somebody would get. And guess what's happened
| with insurance? Death panels!
|
| The propaganda spin on the health care system in the US has
| been on overdrive ever since Hillary Clinton wanted to
| implement some reforms in the 1990s, leading to absolutely
| massive resistance to any change whatsoever. Even the
| changes implemented by Obama, which were a HUGE improvement
| in access, barely made it across the legislative line, and
| dismantling that access to the health care system has been
| a huge rallying cry for one of the major political parties.
| I won't say which one because mentioning that fact results
| in people turning off their brains and downvoting.
|
| The US healthcare has optimized for availability and higher
| access to the most treatment options. This does not mean
| _evenly distributed_ treatment options, but that people
| have the chance to get access to things more quickly.
|
| And for most people, the healthcare system works fairly
| great. There are exceptions, like the denial described in
| this thread, and they usually get lots of attention because
| holy hell is that a messed up situation. But the everyday
| care that most people get is better than adequate.
| rkomorn wrote:
| > And guess what's happened with insurance? Death panels!
|
| The insurance death panels already existed at the time.
| It didn't even happen after.
|
| That's what made the whole thing so ridiculous in the
| first place.
| nonfamous wrote:
| >>> And for most people, the healthcare system works
| fairly great. There are exceptions, like the denial
| described in this thread, and they usually get lots of
| attention because holy hell is that a messed up
| situation. But the everyday care that most people get is
| better than adequate.
|
| As an individual who has lived in multiple countries in
| three continents, I dispute that "the care most people
| get is better than adequate". Perhaps better than the
| world average, but certainly not better than in most
| first-world countries. And that's not even counting the
| impact of delayed decisions and denied care, and the
| stress of dealing with the system overall.
|
| And if you're looking for more than anecdotes, there are
| plenty of studies that show that Americans have lower
| expected lifetimes than citizens of peer countries,
| despite much higher per-capita health care costs.
| epistasis wrote:
| While I don't doubt that there are endless stories of bad
| care, especially among the non-unionized working class,
| the bulk of voters with middle class lifestyles do have
| good care. Which is why it's so hard to make it into an
| issue that drives political change.
|
| > there are plenty of studies that show that Americans
| have lower expected lifetimes than citizens of peer
| countries, despite much higher per-capita health care
| costs.
|
| Americans aren't dying earlier of diseases that are
| solvable with a doctor visit, surgeries, pills, or other
| easy medical interventions. The medically related early
| deaths are primarily because of overnutrition and lack of
| exercise leading to pre-diabetes, diabetes, high blood
| pressure, and heart disease. That comes from public
| policy mandating car dependence throughout society and
| huge subsidization of empty calories in the food system.
| Overeating and lack of exercise are problems that have
| been stubbornly resistant to the medical system's efforts
| to change behavior. There's also other heightened early
| death risks like car crashes, drug overdoses, and
| suicide, but few of these deaths could be prevented by
| increased access to the medical system.
| tptacek wrote:
| Life expectancy tells you basically nothing about the
| quality of health care in the US. It's dominated by car
| accidents, homicide, and then CVD --- but CVD varies
| dramatically across the United States (from states in the
| south with drastically worse CVD outcomes to states in
| the north with outcomes on par with the Nordics) despite
| the same health care structure across all those states.
| xnx wrote:
| Like Ticketmaster, health insurance companies get paid to
| be the "bad guys". This is a reasonable function since
| Americans can't seem to understand that someone must
| decide where limited resources go. However, there's no
| reason their cut should be so large.
| epistasis wrote:
| Health insurance companies have had their profits capped
| at a percentage of revenues. That means that to grow
| profits, they must increase revenue. Which means
| incentives to increase care and increase costs.
|
| Oddly enough, all the plots I have seen of cost increases
| don't show a massive skyrocketing of costs since the
| profit caps were introduced. If anything, they have been
| somewhat reduced.
|
| However a reckoning must happen at some point, health
| care can not consume the entire economy's efforts.
| tptacek wrote:
| Their cut is in fact very small; it's around 6.5% of
| total US health care spending.
|
| https://nationalhealthspending.org/
| xnx wrote:
| But for what? Why not something closer to credit cards,
| like 1%?
| tptacek wrote:
| I don't know how to answer that. I think the system is
| pretty inefficient in a variety of ways. If you
| universalized Medicare, eliminating insurance entirely,
| you'd get costs somewhere in between Medicare's current
| admin overhead and the overhead of private insurance (you
| mechanically would not get Medicare's current overhead,
| because the majority of your customers would have much
| lower claims than Medicare's all-seniors patients do, and
| overhead is a ratio).
|
| But the largest inefficiencies are all on the providers
| side. We simply pay practitioners too much, enforce
| artificial scarcity of practitioners, and prescribe too
| many services.
|
| So if we're talking about "The American System" as a
| whole --- which is what the thread is about --- it
| behooves us first to consider the question "how much
| better would things be if we simply zeroed this category
| of expense out". The answer is, to a first approximation,
| we would get a 6.5% price break. I would not drive even a
| couple blocks out of my way to get a 6.5% price break on
| a pack of chicken breasts.
| xnx wrote:
| > But the largest inefficiencies are all on the providers
| side. We simply pay practitioners too much
|
| I agree. The complex insurance billing system enables his
| by obfuscating prices and limiting ability to comparison
| shop.
| tptacek wrote:
| That's true, but it's a problem single-payer doesn't fix;
| that's my big issue with it (it locks in rapacious rates
| and preferences for the health provider industry, making
| them palatable to consumers by hiding the payer).
| epistasis wrote:
| The complexity is far higher than credit card processing,
| including extensive price negotiation with individual
| health care providers. Though we call it "insurance" it's
| just as much a "buyer's club" for health care services.
|
| Large employers (e.g. Google) are also generally "self-
| insured" meaning that the "insurance" component is
| offloaded to the purchaser, the employer of the insured
| individuals. In those cases, the health care insurer
| processes the claims from health care providers,
| determines if they were justified, or if the
| treatment/diagnostic/drug is justified by coverage
| determinations of the provider, etc, but the employer
| (e.g. Google) just pays the claims in the end too.
| nkmnz wrote:
| > ideologically they really disagree about what to do about
| it
|
| I really don't understand this sentiment. It's not like the
| current state of the US insurance market were based on the
| principles of a free market. On the other hand, not
| coupling your health insurance to an employment contract
| that can be cancelled at will has nothing to do with
| socialism.
| banku_brougham wrote:
| Wrong - sorry. The reason is that politically the US public
| is very skillfully managed from above via divide and
| conquer strategies and beaureaucratic techniques (i.e.
| identity politics, gerrymandering voting districts). The
| public polling is very clear about US citizen preferences,
| but US Govt policy is rarely aligned that way.
| tptacek wrote:
| No, it's not clear at all: it's been tested in actual
| referenda and failed. What's actually happening is people
| don't intuitively grok the distinction between opinion
| polling, where questions are asked in the abstract (and
| often in the best light preferred by the org sponsoring
| the poll) versus actual voting, where the questions are
| very specific and include details like "your taxes will
| increase by X%" or "you will lose access to your current
| insurance plan".
| j-krieger wrote:
| In fact, US Americans are paid so well, the GDP per capita
| of the poorest state (Missisipi) is about the GDP per
| capita of _France_. In fact, the gross average wage of
| Missisipi is just barely lower than the average salary in
| Germany. Americans are paid really, _really_ well.
| tverbeure wrote:
| I think you are underestimating the number of Americans who
| make less than what Europeans make.
|
| In both systems, the upper X% can afford it. But it makes
| no sense to focus on that. What matters is how many _don't_
| have access.
|
| That number is much larger percentage-wise here than in
| Europe. And it will only increase the way things are going.
| georgeecollins wrote:
| Probably true. But if you think about who votes,
| professionals and home owners have much higher
| participation rates. I am not saying this is good.
| testing22321 wrote:
| You could offer me 10x my current salary and I wouldn't
| take it if it meant I had to stress and be terrified about
| the life of my 6 year old daighter because a company wants
| to make more money.
|
| That is the definition of not worth it.
| keybored wrote:
| A Princeton study showed over a decade ago that the policy
| preferences of the vast majority of Americans have no
| correlation with actual policies. That you put forth these
| completely detached theories is quite impressive.
|
| I don't know if this a case of ideological delusion to go
| along with political impotence or just the usual upper
| middle class playing their part in obfuscating the on-the-
| ground realities. Structurally the latter is more likely.
| tptacek wrote:
| Scarcity is a fact of every country's health system and
| you'll quickly find stories with similar fact patterns with
| e.g. the NHS. There's not a lot to recommend the US system as
| implemented today, but the problem isn't "insurance-based
| health care"; lots of countries have insurance-based health
| care.
| tracker1 wrote:
| It's largely a side effect of a couple things... first the
| ACA (ObamaCare) limited the percentage of profit that
| insurance and medical providers can make... so they instead
| just grow the pie larger by inflating everything. Second is
| that they are allowed to have effectively vertical monopoly
| investments controlling multiple layers of healthcare as a
| whole from insurance, providers, pharma and pharmacies.
|
| Trust busting and multiple supply lines really need to be
| established in order to have a chance at restoring
| normalcy. Which is all but impossible as Pharma alone is
| the single biggest spender of advertising alone, let alone
| policy influence over politicians.
| lotsofpulp wrote:
| > so they instead just grow the pie larger by inflating
| everything
|
| So why would they deny coverage? All they have to do to
| earn more money is keep paying for more and more
| healthcare.
| tracker1 wrote:
| Because they make more by not paying than by paying...
| When the payouts are larger, they raise premiums, make
| money on both sides.
|
| Not to mention, if they can delay payment for a month,
| that's a month worth of interest on the money in an
| interest bearing account.
| tptacek wrote:
| How exactly do they make more money by not paying?
| They're required to spend 80% of their funds on provider
| expenses. The only obvious way to sustain the narrative
| that insurers are distorting the system for profit is the
| preceding comment's hypo that they'd be _over-paying_
| (and then driving rates up as their expenses increased).
| You propose the opposite fact pattern here.
|
| (Net cost of health insurance, all expenses, is around
| 6.5% of total US spending, as against 51.5% of direct
| provider costs for doctors, nurses, and procedures, not
| counting prescriptions.)
| tracker1 wrote:
| They keep the 20% that they don't pay out... what they do
| pay out, they get the invested fraction of, which is less
| than than what they paid out.
|
| Even if they only get to keep up to 20%, doesn't mean
| they will pay a dime of what they can get away with not
| paying.
| tptacek wrote:
| "What they do pay out they get the invested fraction of"?
| tracker1 wrote:
| If an insurance company owns 20% of the service provider,
| they only make a fraction of what the insurance arm pays
| to the provider arm.
| spacechild1 wrote:
| The problem is that the insurance is provided by private
| companies whose incentive is to earn as much money as
| possible, at cost of the people in need of medical care. In
| my country, I never heard of anyone going bancrupt over a
| hospital bill. It just isn't a thing.
|
| Here's a fun story: my sister was living with an exchange
| student from the US. Some day the student was complaining
| about intense intestinal pain she's had for the past few
| days. My sister told her to go the hospital. The student
| asked her if she was crazy. My sister then had to explain
| her that hospitals are free and won't bancrupt her...
| tptacek wrote:
| In fact many of the largest insurers are nonprofits, and
| insurance itself is a small faction of our total
| expenditure. People believe a lot of weird things about
| US health care economics.
|
| https://nationalhealthspending.org/
| spacechild1 wrote:
| There's another aspect: In my country, hospitals and
| (public) health insurance are both operated by the state
| and work together. If I break my arm, I go to the
| hospital, show my e-card and that's it. All the
| financials are directly handled between hospital and the
| (public) insurance provider. I don't have to worry about
| cost of treatment because I know it will be fully
| covered.
| LeoPanthera wrote:
| The US is only ostensibly a democracy. It's not a functioning
| one, due to widespread voter disenfranchisement.
|
| Voter ID laws, voter roll purges, registration barriers,
| polling place accessibility, early and mail-in voting
| restrictions, and perhaps most importantly gerrymandering,
| misinformation, and intimidation all serve to reduce the
| power of the ballot box.
|
| And that's before we even get to US citizens in Puerto Rico,
| Guam, the US Virgin Islands, and American Samoa being unable
| to vote in Presidential elections at all.
| nickff wrote:
| Most other countries have voter ID, and the controversy
| surrounding it is puzzling to most foreigners.
| Additionally, parliamentary systems which result in
| majority governments are much more 'dictatorship-like' than
| the US system where individual representatives retain some
| autonomy.
| hydrogen7800 wrote:
| A large number of Americans do not have ID's, which is
| strange to many people. If the need for voter ID and risk
| of fraud were so great, the efforts would be to make it
| trivial for these folks to get one, rather than
| preventing them from voting.
| mothballed wrote:
| In part because hospital bills are monopoly money and most
| people just play a game of chicken with debt collectors, and
| the only actually sue a small fraction of the time and mostly
| either settle for a small fraction, give up besides annoying
| phone calls, or it gets discharged in bankruptcy.
|
| Almost no one gets a bill from the hospital and just pays it,
| and in most cases if you do it's totally financially
| illiterate.
| dclowd9901 wrote:
| No one is "putting up with it." We don't have a choice.
|
| The way our government is designed right now, the populace
| doesn't really have elected representatives. More accurately,
| they have a corporate bought-and-paid for stooge that managed
| to be more likeable in a political race than their opponent,
| so we don't actually have anyone representing our interests
| _as a country_ at the federal level.
| _heimdall wrote:
| I don't think this has much to do with being a democracy. I,
| for one, wouldn't trust our federal government to competently
| run an efficient, most uncorrupted healthcare system for all.
|
| The incentive structures that have built up around US
| politicians simply doesn't leave any room for it to
| realistically happen. Until the incentives are changed I'd
| vote against nearly any major government program.
| wing-_-nuts wrote:
| I hope you refuse Medicare at 65 under those same
| principles
| tracker1 wrote:
| Just Pharmaceuticals not even all medicine is literally over
| half of all advertising spend in the US. And that is just the
| tip of the iceberg and doesn't go into the incestuous and
| conflicting interest relationships between pharma,
| pharmacies, medical providers and insurance companies all
| inter-invested in each-other to simply grow the pie larger
| since ACA limited profit percentages.
|
| It's the single most powerful lobbying group as a whole, and
| nearly every politician is bought and paid for by them. Good
| luck getting a majority or super majority to work against
| them.
| nickff wrote:
| Pharmaceuticals are only a (high) single-digit percentage
| of medical spending in the USA, and the (likely) reason for
| the ads is the highly competitive nature of the market.
| Most of healthcare spending is on labor, specifically
| doctors and nurses, who are protected by highly effective
| trade and lobby organizations.
| tracker1 wrote:
| My point stands... as a whole, they (medical industry as
| a whole, including pharma) are the single largest
| lobbying group and nothing you've said refutes that. My
| use of pharma ad spend was an example of how much money
| they put out as an indication of how much lobbying power
| all of medicine as a whole has.
| emeril wrote:
| -Democracy in name only
|
| -Currently a dictatorship
|
| -Historically more of plutocracy
|
| -Our history has effectively yielded the current healthcare
| situation especially since those who would be most vocal tend
| to have better coverage and thus are less invested especially
| since the high costs are largely obfuscated
| willio58 wrote:
| The United States is a democracy, but more specifically, a
| representative democracy. That means citizens don't directly
| vote on most laws or policies--aside from certain state or
| local measures--but instead elect representatives to make
| those decisions on our behalf. The idea is that we trust them
| to act in our best interests.
|
| You can probably see where the problem comes in. Take, for
| example, a politician who campaigns on Medicare for All or
| universal healthcare. To win an election, they often need
| massive campaign funding--much of which comes from wealthy
| donors, including those in the medical or pharmaceutical
| industries. And once in office, they're targeted by powerful
| lobbying efforts worth billions of dollars from those same
| industries.
|
| In the end, the issue is that politicians can legally receive
| millions in donations and support from industries whose
| interests might directly conflict with the needs of the
| people they're supposed to represent.
|
| Ultimately though, it is known by most people irrespective of
| party affiliation that medical costs are out of control. One
| recent example of this collective understanding was when the
| united healthcare exec was killed. Before there was even a
| suspect, people generally knew why he was assassinated. Most
| people in the U.S. have either been directly affected by the
| insanity that is our healthcare system, or one of their loved
| ones has. Those that haven't yet, it's just a matter of time.
| It's just so pervasive.
| egorfine wrote:
| Ah, so Americans are okay with that system as well. Got it.
| willio58 wrote:
| As stated near the end of my comment, most Americans are
| not okay with the system as it is. It's legalized
| corruption that perpetuates the system.
|
| For further reading, I recommend learning about the
| Citizens United vs FEC case that vastly increased the
| amount of money going to politicians, far over individual
| donation limits.
|
| https://en.wikipedia.org/wiki/Citizens_United_v._FEC
| svobodovic wrote:
| How did you come to this conclusion from the previous
| answer/comment?
| egorfine wrote:
| Because they don't want/don't change the electoral system
| mothballed wrote:
| Not Americans OK with it, just that right-wing wants
| hypercapitalist low-regulated helathcare while left-wing
| wants basically "free"/communist health care.
|
| Both of which are infinitely better than what we have
| now, which is bastardized worst elements of both.
|
| But because both sides will never agree we'll get
| neither, only the current hellscape.
| BrenBarn wrote:
| > The United States is a democracy, but more specifically,
| a representative democracy.
|
| As your following explanation makes clear, it's actually an
| unrepresentative democracy.
| jb1991 wrote:
| There are very few countries in the world that are _not_
| a representative democracy. Switzerland is a well-known
| example of a country where citizens directly vote on most
| legislation, but in most other countries, you have a
| parliament, congress, etc that represents the people.
| BrenBarn wrote:
| That doesn't really have anything to do with the ways in
| which the US is an unrepresentative democracy.
| stOneskull wrote:
| unfortunately, they represent a party before representing
| the people
| supertrope wrote:
| As Lawrence Lessig put it: before the general election and
| before the primary election, there is a "Lester" election
| where donors choose who is able to mount a campaign.
| Candidates are effectively pre-qualified by 0.0005% of
| Americans. It's probably an even smaller crowd than that as
| that includes Joe Nobody who gives $20. Those who "bundle"
| $1 million in donations or write a mega check themselves
| have exponentially more access.
| wrs wrote:
| Ideologically, just enough voters in the right places believe
| that unless you're old, or a military veteran, in which case
| government healthcare is just fine, your sickness should not
| be their problem, even if it means they pay more for their
| own care.
|
| Also, if healthcare wasn't tied to having a job, then the
| inherent laziness and moral degeneracy of people without jobs
| would be encouraged by letting them not be sick. (BTW, being
| self-employed does not count as "having a job" in this
| mindset.)
| thesuitonym wrote:
| The US money machine has one of the most sophisticated
| propaganda networks in the history of the world working to
| make sure nothing ever gets better for working class people.
| In George Orwell's vision of a dystopian future, "The party
| told you to reject the evidence of your eyes and ears. It was
| their final, most essential command." In the US, the party
| didn't even have to issue the command, they just asked a few
| thousand talking heads to do it.
| wafflebot wrote:
| To the extent that U.S. voters want to maintain the status
| quo, which many (though not most) voters do wish to do, it's
| largely driven by an individualist mindset in which the worst
| thing that can happen is somebody else getting something that
| they didn't "earn".
| bobro wrote:
| I'd love to see a poll asking Americans: "Do you want to
| maintain the status quo?"
| codegeek wrote:
| Great question. No one "wants" insurance. Everyone wants to
| be able to get covered for care. The problem is that Govt
| decided decades ago that Health Insurance is the only way to
| get care even for mundane things like a regular doctor visit.
| To make it worse, they tied it to Employers needing to
| provide insurance. Insurance companies love this bureaucracy
| and became too powerful over the last few decades.
|
| It is a sad state and I have almost given up on the hope that
| someday it will change. I m lucky enough to afford healthcare
| and feel for those who can't.
| egorfine wrote:
| > I m lucky enough to afford healthcare
|
| Up to a point, I guess? Correct me if I'm wrong.
| codegeek wrote:
| Yes and it still sucks because I hate wasting my hard
| earned money because of a random number thrown at me for
| the so called "Claim". Fk the entire insurance industry
| especially health insurance mafia.
|
| And don't get me started on the inefficiencies and waste
| of time that you have to go through to fight a "claim"
| that is incorrect.
| fukka42 wrote:
| Yes, it is what they want.
|
| In the end there are more of them who want to "own the libs",
| or "not pay for freeloaders" than those who want to
| contribute to another's child surviving.
| tpurves wrote:
| America is trapped in a cycle where political parties have
| discovered that fear and anger drives voters whereas
| contentment with status quo does not motivate turnout. This
| leads to a scenario where parties will actively sabotage the
| resolution of painpoint issues such as immigration,
| healthcare, gun control etc. so long as it continues to
| create anger and fear that they can successfully blame on the
| other party. This behavior extends to voting against their
| own proposed policies in the interest of seizing/maintaining
| power over problem solving. And now deliberately creating
| crises (both real and fictional ones) has become the game-
| theory dominant strategy in American politics.
| egorfine wrote:
| So much this.
|
| Also, this works for every people, not just American.
| supertrope wrote:
| Even for politicians who are not absorbed in wedge issues,
| meaningful reform is a long term task. It would require
| multiple elections in a row showing that there is a durable
| political coalition for universal healthcare.
| elif wrote:
| We are a "binocracy", where our democratic function has been
| reduced to a binary choice, and unfortunately both choices
| have been fully captured by the healthcare industry.
| ponector wrote:
| One can argue what people wants is to be ruled by old
| convicted felon dictator.
| saghm wrote:
| Without making a claim about whether it's what most people
| actually want or not, there's not much that an individual can
| do about this by changing their voting preference. The US
| doesn't have proportional representation, and the
| overwhelming majority of elections are "first past the post"
| rather than one of the more "modern" alternatives like ranked
| choice votes, so in practice very few elections ever swing to
| anyone outside of the two major political parties (neither of
| which have a particularly large contingent of politicians who
| have come out in favor of something like single-payer
| healthcare). Even for a purely single-issue voter who only
| cares about this, from a game theoretic perspective you're
| likely to be essentially throwing your vote away if you vote
| for someone outside of those two major parties because it's
| unlikely enough others will.
|
| Presidential elections are even worse because they're
| determined by electoral college vote rather than popular
| vote. Even ignoring the potential for "faithless electors",
| all but two states allocate the entirety of their electoral
| votes to the candidate who wins the majority of their vote,
| which means that if you live in a state with a majority who
| reliably vote for a specific party's candidate every four
| years, your vote for president is effectively meaningless.
|
| The only obvious way to fix these issues with how elections
| work would be to elect people who make different decisions
| about how to run them, which is hard to do because of the
| issues themselves. The system is self-reinforcing in a way
| that makes it extremely difficult for the average person to
| do anything about it, and any desire to do so gets weighed
| against the concerns about the policies that you might
| actually get to influence by voting for one of the two
| candidates who might actually win. At the end of the day,
| people who are concerned with the fundamental systemic flaws
| in things like elections and healthcare still likely end up
| picking pragmatism over principle (with the expected value of
| a vote for a candidate who is almost guaranteed not to win
| being lower than one who is might be less desirable than a
| third-party one but still has an actually realistic chance of
| winning and is preferable to the other major party candidate)
| or just check out of the system entirely (with people not
| bothering to vote at all already being a fairly common
| phenomenon in the US).
| throwforfeds wrote:
| > Though why do you Americans put up with all this? I have
| heard the US is a democracy. So then insurance-based
| healthcare is what American people truly want?
|
| It's because our politicians are largely owned by our
| corporations and spend a ridiculous amount of money
| protecting their interests [1]. We almost had a public option
| with the original "Obamacare", but it was forced out of the
| bill [2].
|
| Also, just turn on Fox News for an evening and realize it's
| been the number one news channel in the US for 20-something
| years. They've been a right wing corporate propaganda machine
| for a long time, all while brilliantly portraying themselves
| as the "underdog" fighting the mainstream media. Americans
| aren't very educated and take pride in their ignorance,
| unfortunately. [3]
|
| [1] https://en.wikipedia.org/wiki/Citizens_United_v._FEC
|
| [2]
| https://en.wikipedia.org/wiki/Public_health_insurance_option
|
| [3] https://www.youtube.com/watch?v=QFgcqB8-AxE
| seanmcdirmid wrote:
| FoxNews has only been the number one TV news channel for
| the last 20 something years because almost everyone under
| 40 doesn't watch TV anymore. Yes, there are a lot of
| conservatives in the US, but the demographics is really
| skewed if you just look at people who watch TV and have
| cable.
| ajkjk wrote:
| We fucking hate it don't worry
| goodluckchuck wrote:
| I think you're just believing whatever the author says, and
| not considering the fact that reasonable people can disagree
| and be wrong and make mistakes. For all we know the procedure
| was entirely unnecessary and they agreed because he pushed
| for it. Also, what's the alternative? The only system where
| you can go get procedures that authorities think unnecessary
| is a free market where you self-pay. A government-run system
| could equally decide that the procedure isn't recommended.
| blitz_skull wrote:
| This frame assumes several things:
|
| 1. Americans are not displeased with the situation.
| Ironically, I think this is one place most Americans agree
| there is a problem. The solution is the hard part because:
|
| 2. This presumes a drop-in solution where no one loses. This
| is where the fight is.
|
| 3. This presumes that democracies do what is logical or
| beneficial for the vast majority, which is a very naive view
| of democracy.
| robrenaud wrote:
| A lot of employed people like the status quo for the
| healthcare that they receive.
|
| "In contrast to their largely negative assessments of the
| quality and coverage of healthcare in the U.S., broad
| majorities of Americans continue to rate their own
| healthcare's quality and coverage positively. Currently, 71%
| of U.S. adults consider the quality of healthcare they
| receive to be excellent or good, and 65% say the same of
| their own coverage. There has been little deviation in these
| readings since 2001.
|
| Compared with their counterparts, older adults and those with
| higher incomes register more positive ratings of the quality
| and coverage of their own healthcare."
|
| https://news.gallup.com/poll/654044/view-healthcare-
| quality-...
| egorfine wrote:
| So basically they accept and approve of them being
| bankrupted by an unfortunate medical event no matter how
| top tier their health insurance package. Right?
| wouldbecouldbe wrote:
| Well there is lot of shit we Europeans put up with, for
| instance EU moving court every few weeks voor 200m per year.
| But systems are hard to change.
| micromacrofoot wrote:
| It's precisely as many have said over decades at this point:
| the poor in our country hate themselves to the extent that
| they view being poor as a personal failing, and voting for
| free services for everyone is therefore dishonorable. I talk
| to people like this every day and it's frustrating.
| ziofill wrote:
| Non-US person here too. From what I understand the majority
| of Americans want a single-payer healthcare system, but too
| many people in government are paid by insurance companies and
| affiliates to not change how things work.
| dragonwriter wrote:
| > I have heard the US is a democracy.
|
| It is certainly not a direct democracy where each individual
| policy is resolved by separate independent voting, no.
|
| > So then insurance-based healthcare is what American people
| truly want?
|
| Pretty consistently, no, but there is not any single
| alternative that a majority of the American people prefer
| recently (for a while, as far back as the 1990s, there was a
| clear popular majority for universal single-payer), and more
| importantly, it is not the only issue that factors into
| people's voting decisions.
| baby wrote:
| As soon as someone introduce these ideas people think they're
| a communist. See Mamdani in NY right now.
| j-krieger wrote:
| The US is _gigantic_. Imagine if every EU member, however
| rich, poor, or corrupt from Bulgaria to Germany had to enact
| one healthcare system.
| egorfine wrote:
| India is larger and yet.
| j-krieger wrote:
| And yet even its major cities are filled with sewage, 400
| million are without healthcare and less than 50% of its
| people have reliable access to clean drinking water?
| andy99 wrote:
| Edit: just saw an earlier better comment saying the same
| thing: https://news.ycombinator.com/item?id=45737190
|
| Countries with "free" also healthcare ration it and don't
| cover everything.
|
| Socialized insurance is still insurance, and at least in
| Canada it's the only game in town, so if you have a procedure
| that is denied or not available your choice is basically to
| go to the US and pay for it and be in the same position as an
| uninsured American.
| stronglikedan wrote:
| Yes, but we also want universal healthcare. What we don't
| want is _only_ universal healthcare with death panels like
| the UK and Canada has. Give us universal health care where we
| can also get insurance if we want, and we 'll vote it in.
| That's never what comes up though. I firmly believe we could
| gut medicare/medicaid and the savings from the bureaucratic
| administration costs alone could pay for universal
| healthcare.
| somethingsome wrote:
| Hum.. At least where I live in europe, you still need to
| battle with insurances for any non trivial problem.. We get a
| health care coverage for the common stuff, but many things
| are not covered, or not covered enough.. Then you need
| insurances.. And it's always a battle..
|
| Same for other kind of insurances such as issues with the
| house, etc..
| FpUser wrote:
| Non US as well. Life saving saving surgeries get denied,
| delayed and otherwise screwed all the time. Not sure where
| exactly it is worse since absolutely atrocious cases can be
| found in every G7 country never mind the rest
| frogperson wrote:
| The are advertised as a democracy, but ever since Citizens
| United was passed we became an Oligarchy. Money now takes the
| place of votes since the rich can donate unlimited funds to a
| candidate. Candidates have zero incentive to serve the
| public.
| msla wrote:
| The same way European people put up with the insane NHS and
| its refusal to care for the people who support it financially
| and supposedly support it politically.
|
| https://edition.cnn.com/2024/03/13/uk/england-nhs-puberty-
| bl...
|
| The NHS and its bizarre political agenda is an example of
| what can happen when a government controls access to health
| care.
| pjc50 wrote:
| A good example that "public" campaigning can work, but not
| necessarily for the better - there's been a systematic
| campaign to delegitimize trans healthcare.
|
| There's comparable examples from other places; Ireland has
| come a long way in getting the church out of reproductive
| health, but there are still problems. And of course it
| doesn't matter whether it's public or private, abortion
| care is at risk in many US states.
|
| The UK does allow you to go private, remember.
| qgin wrote:
| We have a lot of people being constantly brainwashed that we
| have the most amazing system in the world and that any
| attempt to change it is communism.
| zulban wrote:
| You've implied the answer to your own question. The USA is
| not a democracy. The opinions of almost all Americans have no
| impact on policy. It's a well researched fact.
|
| Having an election day where people vote doesn't mean you
| live in a democracy.
| bluesounddirect wrote:
| Then what sort of feel good stories about AI would we have .
| The US needs to adopt a single flat income / corp tax,
| government provided healthcare, and move on to the rest of
| life.
| thatfrenchguy wrote:
| Add a French and American person, in the US you hear
| "insurance did not approve", in France it's more "you can't
| get an appointment / the surgery provider does not have any
| spots unless you go to their spots in their private
| hospital".
|
| The French system is more predictable (because any vaguely
| sane healthcare system has a price for a code instead of
| negotiated rates, negotiated rates is the most inefficient
| way to run this market) & you can get cost estimates though.
| And in both countries, if you live in a small town in both
| systems, the healthcare you will receive will suck.
| lotsofpulp wrote:
| I was under the impression that if you were to go to an
| emergency room, life saving surgery would be scheduled
| regardless of who is paying (or not paying), due to EMTALA. I
| can't imagine a hospital waiting for an insurance company's
| approval to pay for a procedure to schedule a child's life
| saving surgery.
|
| Is this incorrect?
| dboreham wrote:
| Presumably parent is describing a non-emergency situation.
| tptacek wrote:
| Good reminder that "life saving" and "elective" are
| orthogonal.
| evan_ wrote:
| if the kid has a steel spike through his abdomen then they
| will perform that surgery. If he's having seizures because of
| a brain tumor all they're required to do is stabilize and
| release.
| dweekly wrote:
| I am so glad to hear your child got the care they needed.
|
| I've found that people often forget to call their state senator
| or assemblyperson. It has consistently amazed me how quickly a
| large company that's sitting on their butts about a topic will
| move lickety-split once their Government Affairs and/or PR
| teams are on the thread...
|
| Another tip from having worked at a regulated entity: a
| physical letter to the CEO mailed to HQ creates a mandatory-
| response paper trail that will produce a very, very different
| (better) outcome than e.g. asking to talk to a supervisor while
| on a call that's not going well.
| lanfeust6 wrote:
| Great story, and encapsulates what I find most powerful about
| LLMs.
| Brainfood wrote:
| Thank you for sharing. I can personally say this same process
| has driven me to the brink of sanity. 10 years of managing a
| chronically ill child's healthcare with multiple surgeries.
| Being a developer with the ability to navigate complex
| problems, social engineer people who have turned into robots,
| and enough income to make it through unforeseen lump sum
| payments - I cannot fathom how the average person deals with
| this. I made more $ than I ever did before to cover the costs
| and afford the best healthcare possible but the system is
| designed so we still get screwed and have nothing left.
| Thankful for the people who dedicate their lives to helping
| others. To everyone else who can justify profiting off of
| someone else misery, while being the richest and most advanced
| society on every other level? I have nothing nice to say to
| you.
| bmurphy1976 wrote:
| How comfortable are you with naming and shaming the company? I
| don't think things are going to change if we don't call this
| stuff out loudly and publicly.
|
| That's awful but I'm glad you were able to figure this out.
| I've had my own problems with insurance companies, but nothing
| to this level. I can't imagine the frustration, especially with
| YOUR CHILD'S HEALTH on the line.
|
| Five years back I ended up getting surgery for a herniated
| disc. I was in immense and crippling pain. Before having the
| surgery, we decided to go through a round epidural shots. I had
| done that 20 years previously and it resolved the problem, so
| why wouldn't I?
|
| Turns out my insurance company (who I will name: BCBSIL)
| delegated the approval for the epidurals through some kind of
| extra bureaucratic process with a 3rd party. It took days and
| additional effort on our end to get approved.
|
| I remind you, I was in crippling pain at the time.
|
| The delays getting this approved lead to me taking more
| Ibuprofen than I would otherwise have taken, which in turn lead
| to signs of internal bleeding. I had to ease off the Ibuprofen
| and significantly increase the amount of codeine (a drug which
| does not sit well with me) just to get by. Now not only did I
| have to wait for the approval, but I then had to wait for the
| signs of internal bleeding to go away before the doctor would
| give me the shot (which was the right call, even though it
| sucked).
|
| Delays, compounding delays, compounding delays, all while I was
| absolutely miserable.
|
| Anyway, I finally got approved and got the shot and it kinda
| helped, but didn't fix the issue. I had a second shot, got
| worse, and then decided we had no choice but to schedule the
| surgery.
|
| The most frustrating thing (but something I am glad for) is
| that the surgery was approved immediately.
|
| It's so maddening how inconsistent the whole thing is.
| like_any_other wrote:
| > How comfortable are you with naming and shaming the
| company?
|
| Don't forget about the _individuals_ responsible. Both the
| ones that made the denial decision, and the ones that
| instituted the internal system that incentivizes such
| denials.
| magicalhippo wrote:
| Relative recently had their baby come several months early. The
| baby needed intensive care for a couple of months, and
| breathing support (CPAP) for another two. Mom lived at the
| hospital hotel for the duration.
|
| Baby got regular inspections of the heart, lungs and eyes (too
| much oxygen in the blood can lead to problems with the cornea
| or something), including after checkout.
|
| They got billed exactly zero.
|
| Both parents even got full pay during the hospital stay, so
| didn't have to worry about the economy.
|
| Ok, so I pay a fair bit of taxes here in Norway, and some of it
| is used on stupid stuff. But overall I like knowing my life
| won't be ruined because of some random event forced me into
| insolvency.
| ksclarke wrote:
| The whole time I was reading this, as someone from the U.S.,
| I was wondering what country the writer was from, because it
| sure as #$@! wasn't written by someone in the U.S. When I got
| to that part, I was, "Oh. Okay. That makes sense."
| thatfrenchguy wrote:
| In the US, you'll be billed the maximum out of pocket for
| your health insurance whether your little one is in the ICU
| for months or whether it was a easy delivery though, so at
| least birth is a predictable medical expense.
| game_the0ry wrote:
| Happy to hear this all worked out. Have you thought about
| reaching out to local news to get the word out? That insurance
| company should be called out.
| ethbr1 wrote:
| Amazingly happy to hear you were able to drive the process!
| FWIW, surgical centers usually have to do the exact same thing
| for their patients (typical role: coordinator), and they do it
| the same way you did (plus knowing a few counterparties because
| they work together regularly).
|
| The lack of data standardization in health insurance is
| atrocious. (In the US, CMS/Congress pushing what it can, but at
| a glacial pace)
|
| The strongest argument for single payer is that a diverse
| marketplace has demonstrated a fundamental inability to
| interoperate.
| nmz wrote:
| > incompetence
|
| No, that's the goal. Denying coverage is how insurance
| companies make money. The less money they give, the more money
| they keep.
| miki123211 wrote:
| This is why AI is an equalizing force.
|
| Eventually, we'll just have a free (or at least much cheaper)
| psychiatrist in our pocket.
|
| Sure, AI advice _is_ workse than the advice of a competent
| professional, but it 's very often better no advice, and that's
| what you get if you can't afford the professional.
| ASalazarMX wrote:
| I shudder to think when insurance companies use AI to
| counteract customers using AI to navigate through their
| system. They'll eventually catch up, and people who don't use
| any kind of AI will be disadvantaged.
|
| That is, until someone sells them a turnkey AI service to do
| insurance claims... and decides to play both teams so
| resolutions come back at pre-AI levels, and the free
| market(TM) is happy because a new equilibrium has been
| reached.
|
| Maybe I just need more sleep.
| BeetleB wrote:
| It's nice they succeeded, but a word of caution: Medicare is not
| a good standard - it's often lower than what it costs them to
| provide the care. If everyone paid Medicare rates, lots of
| providers would go out of business.
|
| The usual benchmark is the "usual and customary" charges for a
| procedure. You can look it up for a procedure for your area. You
| then go to the hospital and point out these charges. My guess is
| they're much more likely to agree with this than the Medicare
| rates.
|
| It's also the rate your insurance will use if you go out of
| network. So if your insurance pays 40% out of network, and you
| get billed $1000 for a $100 procedure, your insurance will pay
| only $40 (4%).
|
| (Although by all means, you can _start_ your negotiation with
| whatever is lower).
| atourgates wrote:
| I broadly disagree.
|
| Yes - Medicare is typically lower than private insurance plans,
| but if you can't deliver care for the reimbursement that
| Medicare offers as a health system/plan/office/provider, you're
| probably overcharging.
|
| More than that, Medicare is the de facto starting place for
| most reimbursement negotiations between providers and payers.
| One of its benefits is that it's transparent and readily
| available. Blue Cross isn't gonna tell you what it's contracted
| to pay an individual provider (and that individual provider
| often won't know what they'll be reimbursed untill after they
| submit a bill) - but with Medicare the data's out there.
|
| I know a good number of private clinics that'll offer cash pay
| discounts that effectively mirror Medicare or even slightly
| below Medicare, since you're saving them the trouble and
| expense of going through the medical billing process.
| BeetleB wrote:
| > One of its benefits is that it's transparent and readily
| available.
|
| So is the usual and customary rate - I think it's been
| available since before Obamacare.
|
| > Blue Cross isn't gonna tell you what it's contracted to pay
| an individual provider (and that individual provider often
| won't know what they'll be reimbursed untill after they
| submit a bill)
|
| You'll find out when you get the bill :-) The bills I get
| have:
|
| - Cost the provider is charging (e.g. $1000)
|
| - Agreed upon cost with the insurance company ($600)
|
| - Amount due ($60 assuming 10% and deductible met).
|
| I don't know if they publish it transparently, but for common
| procedures, it's easy to find out. They're not going to
| prevent you from posting your bill online.
| ericlang wrote:
| Give me a break.
| cowsandmilk wrote:
| It isn't clear to me that the OP's sister-in-law would be
| responsible to pay these debts and they couldn't have just
| allowed payment from the estate. Since insurance had lapsed, I'm
| assuming the estate was not large.
| abdulhaq wrote:
| To me, in the UK, it sounds like there is an opportunity here for
| some sort of centralised representation and/or app that can fight
| claims for people
| andybak wrote:
| I will never understand why people tolerate the US healthcare
| system. If anything points to complete ideological capture of the
| general population then it's this. (I live in the UK if that's
| relevant)
| liendolucas wrote:
| $33k is still lot of money! What happens if you don't have that
| sum? How does the system allow to be arbitrary charged on health?
|
| I'm Argentinian and while we might be a country lagging behind in
| so many things these kind of ripoffs do not happen.
|
| How come the US government allows this? From other stories
| sometimes posted, the US seems to be one of the worst countries
| in the world to either die or get sick.
| mirthflat83 wrote:
| You just don't pay. Hospitals eat the cost.
| pcthrowaway wrote:
| I assume it'd get sold to a collection agency for something
| like $500, which would then try to get you to pay as much as
| possible, possibly settling for as low as $2000).
|
| So the hospital is still _getting paid something_ , and the
| billee has the option to take a bigger credit hit or to
| negotiate down
| sdsd wrote:
| >How come the US government allows this?
|
| Allows? The government works for the wealthy and powerful. That
| includes the masses, who (if they organize) have their own
| power, but it also includes every other powerful group or
| individual.
|
| Why would the government want to stop this? It's the average
| person who would want to disallow this, and they'd have to
| pressure the government enough that the pain of popular
| opposition outweighs the brazillions of dollars they're making.
| ellisv wrote:
| The most impressive part to me is finding the right channel to
| communicate with the hospital. We had to dispute a billing issue
| with our hospital and it simply wasn't possible to talk to any
| person that wasn't part of the "patient relations" team. Billing
| problems went through patient relations who talked to the
| billers.
| tracker1 wrote:
| I was hospitalized about two decades ago, before ACA passed, so
| my insurance was limited to 500k, I was on the hook for about
| 180k beyond that... because I was making decent income I was
| ineligible for Medicaid or any other assistance... I worked extra
| jobs for a number of years after, every tax return, the couple
| bonuses that I'd earned all went towards paying it down... Anyone
| who was willing to negotiate the amount or take reasonable
| payments got paid... the rest could wait... after the 7 years
| before it was no longer eligible for being on my credit
| statement, I stopped (still owed about 40k iirc).
|
| The past few years, I've been receiving some very expensive
| treatments for my eyes... given the job market, I've been without
| and switched jobs a couple times... been caught with a few
| unexpected bills for around $15k... it just sucks. I'm currently
| making about 2/3 of what I was a couple years ago, with no better
| job prospects, the insurance I have is "emergency" based and
| doesn't cover my regular doctor bills... I'm at my max at this
| point, thinking about bankruptcy for a while now.
|
| The system sucks... the billing system(s) suck and the fact that
| it's as messed up as it is, is so much worse. From monopoly
| positions, to messed up billing, to everything else... I don't
| even know. Even on a six figure salary, I cannot afford private
| insurance and the multiple $300-400 doctor and pharmacy bills
| each month are seriously destroying me.
| lvl155 wrote:
| And it's going to get progressively worse for everyone. My rule
| of thumb is that for every perceived 15% increase in care
| outcome, cost doubles for patients. This is how drug or
| procedure costs exploded over the past two decades.
| flenserboy wrote:
| Can't wait for it to be AIs arguing back & forth with all sorts
| of unforeseen consequences arising. We have much to think
| through, & strong, simple rules to put in place, or things are
| going to get rather out of hand.
| lvl155 wrote:
| I would like to think our children will one day live in a society
| where healthcare is nominal.
| majorbugger wrote:
| Another day thanking God I don't live in the United States.
| Ylpertnodi wrote:
| But I heard God was there...
| donatj wrote:
| I'm confused about some particulars here. Who was on the hook for
| the bill here? The wife?
|
| What state is this? At least in Minnesota my understanding is I'm
| not on the hook for my wife's medical bills if she were to pass.
| ericlang wrote:
| probably the insurance payout can be grabbed from
| mv4 wrote:
| Only in America.
|
| Why are we accepting this?
| mv4 wrote:
| Getting it down to 33k may seem like a success story. It is not.
| 33k is still messed up.
| huqedato wrote:
| 4hrs of hospitalization => $195k. America is great!
| yieldcrv wrote:
| interesting, the alternate headline "using AI to negotiate a $33k
| hospital bill down to still $33k" would have been pretty
| egregious too
|
| what would the outcome of the charity option have been? they did
| not change any practice here, the hospital _almost_ got caught,
| once, for one bed that was occupied for 4 hours in a single day
| user3939382 wrote:
| I have a better idea
| huqedato wrote:
| This explains why a friend of mine, anesthesiologist, emigrated
| to US about 15 years ago and now has an annual income of a
| million USD. While my wife, anesthesiologist, same age and
| experience here in EU, has less than EUR 100k.
| mhuffman wrote:
| Next up: A start-up that spins up AI instances to negotiate
| against AIs trying to negotiate hospital bills down!
| jnskender wrote:
| What a terrible medium for long form story telling
| mawadev wrote:
| This is probably the first instance AI has provided real world
| value, I'm cheering on this
| gv83 wrote:
| AI good or US health system trash?
| tsoukase wrote:
| Health care is an extremely sensitive, personal, diverse and
| vital part of our life. It cannot be exploited in the USA like
| you are in a casino, because health is a roulette. It makes us
| Europeans our jaw to drop. It plays no role how much you earn. It
| is inhuman, cruel, mocking and severely impacting the society.
| Developing countries surely have better systems, I don't know
| about underdeveloped ones.
| whatever1 wrote:
| Can we ask why do we even have to freaking negotiate ? Many of
| them are non profit, the costs and margins should be transparent.
| kronk wrote:
| I find it odd that his brother in law was married to his sister-
| in-law. How exactly does that work?
| kronk wrote:
| So, his brother in law was married to his sister-in-law?
| A1kmm wrote:
| One thing here doesn't seem right. I thought the whole thread
| that this was about them negotiating down how much the executor
| of a deceased estate would pay to one hospital making claims
| against it. But the thread included things like: "She had been
| afraid of being sent to collections and asked why we wouldn't
| just take their counter-offer", which suggests a
| (mis)understanding that it is a personal debt of the sister's.
|
| This suggests an 'AI can't see gorillas' problem here in that,
| during an AI-human interaction, identification of relevant big-
| picture context that a human advisor could have helped with is
| also missed.
| stackskipton wrote:
| Depending on the state and their laws, spouses can be
| responsible for debt. Along with that, hospital could maybe not
| sue her but sue husband estate and those liabilities would
| trickle down onto shared assets so if they had a house, it's
| now got a lien attached to it.
| wiseowise wrote:
| Related: https://www.economist.com/finance-and-
| economics/2025/10/27/t...
| mcv wrote:
| I don't understand how this is not wildly illegal fraud. They
| intentionally bill you incorrectly, charge you twice for costs
| that they know they're not allowed to bill you twice for. This is
| blatant fraud. Why is that not enforced?
| thih9 wrote:
| I hope this will have an impact, but I worry it will be "AI can
| fix US healthcare".
|
| I appreciate the author's disclaimers about that and especially
| about double checking AI output.
| vzaliva wrote:
| For those of us who do not access Thread, if there is a copy
| elswere we can read?
| RadiozRadioz wrote:
| It's always interesting to hear stories from third world
| countries, it's good to be mindful about how different their
| lifestyles are to ours. Having lived in Europe my whole life, I
| couldn't imagine this scenario.
| nick_travels wrote:
| Gotta up vote here, well done!
| FireBeyond wrote:
| Apart from anything else, family has zero obligation to pay their
| brother-in-laws medical bills after death (or before).
|
| Hospitals will pull all sorts of shady stuff to strongly imply
| that you should pay for a family members medical bill, however.
| From very strongly hinting that you're obligated to, through to
| impugning honor, "It would be doing the right thing by your dad",
| etc.
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