High medical bill in the ER leaves family reeling (opens in new tab)

The health care market is about as far from a free market as you can get.

Tons of heavy regulation everywhere limiting supplies of doctors, nurses, ability for folks to see pricing info, for pricing info to matter etc. Consumer of the service often is not the one paying. So you can do crazy stuff like make an insurance co pay $10,000 per pill for something that overseas no one would ever pay that because they'd be paying themselves.

I've been in third world countries, cash pay places, no insurance, no govt stuff. You can call and ask how much something will cost, they tell you, you go, pay and done.

My bills in California have like 10 pages of notices and warnings on them for each charge. So it's a 5 page document per copay. Its crazy.

We have partially "free market" healthcare in other countries and it works fine.

The problem with US healthcare is not that it's private, it's that it's more expensive than it has any right to be.

A private system with a good framework of regulation would be good.

It seems like what you’re talking about is the “financialization” of things rather than the “free market”. Essentially, you dislike the “market”ness of healthcare, not the “freeness” of the market for healthcare.

I certainly disagree with you that it being a market is the problem, but I think one can consider downsides to that pretty straightforwardly: the lack of price elasticity when you’re dying makes markets price poorly, discouraging people from healthcare is a societal bad, etc.

The idea that there should be a market but that it should not be free is something I just find really problematic since it’s just a steal-from-everyone-to-enrich-medical-barons thing.

If you don’t want to have the freeness argument then perhaps choosing other phrases will help. If you do want to have that argument, obviously you’ll find yourself discussing whether or not the market is free.

The healthcare market in the US is anything but a free market. It is ludicrously riddled with costly regulations at every single level of care.

I never understand why do people think the government is going to do such a great job at running things. Have you never been to a DMV or had to interact with any federal/state/local authority? You get nothing but unthinking apathetic people who just want you to go away. I assure you government employees will care even less when something goes wrong.

Maybe this is splitting hairs, but it's more a problem with worshipping corporate capitalism. I don't think you can really describe healthcare in the US as a free market.

This is much worse than that. In a free market you would at least be able to find out how much something costs before agreeing to it.

It's not that it's "isn't totally free market". It's as much "not totally free market" as North Korea is "not totally a libertarian state". It's one of the most tightly regulated and controlled areas of the economy. Literally every aspect of anything needs an approval - sometimes multiple ones - from regulatory organs. You can not become provider in the market without passing a myriad of regulatory barriers, which would make an average tech startup founder faint. You can not remain a provider without constantly complying with a mountain of always changing and mutating reporting requirements and compliance checks. Pretty much every regulatory scheme ever been thought up by a man is somewhere in medicine. And yet, we have this insane system. Whatever it is, it's not lack of regulation that caused it.

Except, the people who have taken the time to study how the system works will tell you that's not the issue.

In my experience they are just outright lying and believe that patients will pay anything they bill. When my first child was born I received a monumental bill from the anesthesiologist, with the slight problem that no anesthesia was used and the person in question was not in attendance. Later, after I'd filed the consumer protection complaint with the office of the state attorney general and a formal complaint to the medical board of California it came to light that this person was golfing at the time, in another country. So it was just fraud.

The problem with this system is they act like everything is fine after they drop their claim, but what needs to happen is people going to prison. This is large-scale white collar fraud and it should be getting much more media attention than some guys stealing shampoo at the Walgreens.

Emphasizing this from the article:

> Martand received almost no medical service. A nurse practitioner looked over the toddler, listened to his heart and stomach, and looked in his nose, mouth and ears, according to provider notes prepared by the hospital and shared with KHN by Bhatt.

> The nurse didn't change the dressing on the wound or order any testing.

> Emergency visits are usually classified for billing on a scale from 1 to 5. Level 1 is minor and routine; Level 5 requires complex care for life-threatening conditions. [...] Despite the lack of severity of Martand's wound and the absence of medical care, his visit was classified as Level 3, a moderate severity problem.

> In an email, Zoller Mueller said the charges were "appropriate" based on the "acuity of condition, discharge instructions, vital sign monitoring, traumatic wound care [and] numerous assessments."

> She added: "A patient does not have to receive additional treatment — procedure, labs, x-rays, etc. — to validate an ED [emergency department] level charge."

Just because a hospital is big and has expensive lawyers, that doesn't mean that you have no rights.

My wife got a 4k bill that had no information on it other than the amount due. I called the hospital and asked what the bill was for and they said they would send an itemized bill, they never did, but I did get a letter from collections and I called them and said that I dispute the charges. And I never heard anything about it again.

Non profits aren’t exactly virtuous or efficient with money. In fact, there are so many players involved in operating and running a hospital who want to get paid the fact that the overall hospital itself is a non profit isn’t very meaningful.

I have come to not view a given hospital as an entity. Rather, a hospital is a place (not just in spacetime, but in regulation, and in "the market") where numerous agents are at work in an opaque manner. Some are frantically billing anything that moves. Other agents are losing money on patients who will not or cannot pay and are looking for ways to balance those books so that they can continue to survive (consider the hospitals closing along the border as the "undocumented" end up in the ER). You have ambulance services struggling as people "cleverly" use them as taxis. Pharma slithers in and out, hoping to recoup their costs on nineteen failing drugs with wild sales of the twentieth. All of this occurs in the hospital "zone," and what patients see is a series of bills emitted, like push notifications out of an API.

Making all of this predictable, transparent, and detangled is only step one. Hitting people -- actual humans -- with fraud charges is also a grand idea.

A lot of it goes to inefficiency. Think of it this way. If you have a factory that makes 1 thing it can optimize around that. It can become cost effective. If you have a factory that can manufacture 10 different things, it becomes less cost effective because you need to be able to switch between the different things. If a factory can produce 100 different things it's even less efficient.

Hospitals deal with thousands of things. Their overhead and complexity are high. This leads to inefficiency which costs more.

I've read that the math around the costs map fairly well to the cost models around factories [1].

[1] https://www.amazon.com/Innovators-Prescription-Disruptive-So...

Pure inefficiency. The medical industrial complex is second only to the government in its byzantine bureaucracy. This is why we will never be rid of it. All those hundreds of billions of dollars wasted are mainly going to pay millions of middle class administrative salaries. I know 2 people whose companies would not even exist in a socialized health system. Woe to whatever politician tries to pass a bill that will put millions of middle class Americans out of work.

Also crazy large doctor salaries. The US pays way more to doctors than for example many European countries.

You can do wonders with accounting when you have control and collusion with your vertical markets.

> The ER visit ultimately cost $38.92.

The ER visit ultimately cost $38.92, after:

1. He tried to negotiate the bill: "Dhaval Bhatt made numerous attempts to get the hospital to reduce the charges. He also appealed to UnitedHealthcare to review the charges."

2. The hospital refused: "His efforts failed....the hospital would not adjust the bill."

3. The hospital sent his bill to collections: "While Bhatt was trying to reach the patient advocate by phone, his bill was sent to Medicredit, a collection agency, which began sending him notices and calling him."

4. The hospital forgave the bill due to bad PR: "After KHN [Kaiser Health News] contacted SSM Health, Bhatt received a call from someone who worked on "patient financial experience" issues at the hospital. The hospital agreed to forgive the $820 facility fee."

> The system worked out exactly as it should have.

Could you clarify?

> and don't understand why anti-government activists want to hand the government the keys to run the healthcare system.

Because it mostly leads to more efficient healthcare systems. For example, the per-capita healthcare cost in the UK is less than half that of the US for broadly similar outcomes.

"66.5 percent of all bankruptcies were tied to medical issues —either because of high costs for care or time out of work. An estimated 530,000 families turn to bankruptcy each year." [1]

The data is very clear Americans pay the most for healthcare out of every other OECD nation and yet receive worse outcomes [2].

[1] https://ajph.aphapublications.org/doi/10.2105/AJPH.2018.3049...

[2] https://www.pgpf.org/blog/2020/07/how-does-the-us-healthcare...

I had my gallbladder removed and was receiving new bills literally 18 months later.

Just because it worked out "this once" doesn't mean it works out in general.

Simple fact of the matter is we pay nearly double per capita what most of Europe, Canada and Australia pays for healthcare, and we don't even have universal coverage. Add in the fact that a majority of bankruptcies are due to medical debt and it paints a pretty damning picture overall.

This system is fundamentally broken. Anyone defending it is either willfully ignorant or shielded from it's worst aspects.

$38.92 for trivial, non-professional services they did not ask for. $1000 reversed only after spending days disputing the charge. Child remains at risk because provider was unable/unwilling to services within a reasonable time frame.

$38.92 for a medical assistant spending 1 minute to take your temperature works out to $2335/hour.

The article is not arguing for government control. Rather that medical services should be subject to the same transparency as any other professional business and without collusion with each other and insurance providers.

The only sane play in the US is

1. Buy an inexpensive high deductible insurance plan to cover only emergency expenses.

1.1. Make sure that for your plan out-of-network expenses count toward your oopm.

(1.2. Cry because your employer's health plan doesn't work for this.)

1.3. Have enough cash liquid to cover your oopm.

2. Max out your HSA contributions.

3. Pay cash for everything.

Sans 1.2. this has been working reasonably well for me. You would be amazed at the discounts you get once you say you're paying cash. Medical expenses suddenly are downright reasonably priced.

tl;dr Surprise! Everything is cheaper when you have money. Oh America.

Healthcare isn't supposed to make money, it's supposed to stave off death. Just like schools aren't supposed to make money, or the postal service, or the military. Framing things in the context of whether or not critical services to society make or lose money puts it in a fundamentally unfair context.

I don't want hospitals to make a profit, or generate revenue. Every procedure should be losing money.

There is more than a slight difference between moving to California and Saskatchewan - just the same, adding another 10% to the state income tax will send quite a few people in the other direction.

I’d agree that universal health care probably wouldn’t come about incrementally, but there is no fundamental reason we can’t improve the system incrementally.

These are good points. Doctors in general are against it because they're from an economic class above most of the population. In the US, you need to spend a lot of money to become a doctor, this make people see the profession as a capitalist investment that needs to pay a good return.

The point about liberals is very true, not only about health care. Just like the current president, they're elected to find a compromise, which essentially guarantees that nothing important will be done. They're in effect a tool of the very wealthy to placate or dishearten the population, disconnecting them from the democratic process. In contrast, right wing politicians are very effective in achieving the goals designed by their elites.

You could also look at how doctors were bribed to accept the introduction of the NHS in the UK, they were against it at the time.

In network hospitals usually can't charge a facility fee, but it will depend on your plan. Honestly, Congress needs to act on this. Most hospitals get Federal funding.

The fact that hospitals are privatized and not owned by the community is IMO the root of the problem.

No one has to pay your debts if you die (other than your own estate, of course).

It's important, however, that your heirs understand this and don't say or do anything that can later be construed as having accepted the debt.

No, if anything they are generally worse.

Everyone! Roads, water, sewage are enormous expensive, but nobody cringe about subsiding them with taxes.