DailyDirt: Healthcare Nightmares

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The healthcare industry in the US is crazy, and it's not a simple task to assign blame. Many patients aren't paying out of their own pockets because they rely on insurance, but then this arrangement doesn't provide any incentive for patients to try shopping around. On the other hand, even if patients wanted to shop around, it's nearly impossible to determine what the prices of any medical procedures are because they vary widely based on the hospital and what payment arrangements have been negotiated behind closed doors. If you've ever had medical treatment that required any kind of specialized testing or surgery, you've probably never fully understood the resulting bill (congratulations to you if you do understand all your medical bills). Here are just a couple examples of some not-so-uncommon experiences with the healthcare system. If you'd like to read more awesome and interesting stuff, check out this unrelated (but not entirely random!) Techdirt post via StumbleUpon.
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Filed Under: bills, economics, health, health insurance, healthcare, medicine


Reader Comments

The First Word

Contract law still allows negotiating amounts

I do a lot of consumer debt defense. Some of this includes medical debt lawsuits.

Interesting thing about medical debt: When did you agree to pay the specific amounts charged by the doctor?

Think of it this way—can you tell me another industry where you do not know, up front, what the rates or fees will be before you accept services or goods? Lawyers give you their hourly rates, for example. You get menus at restaurants. Plumbers and carpenters tell you hourly rates or flat fees up front.

And if you do not get these details up front, but they perform the services? Then you have a chance to negotiate the amount.

Typically, for medical services, you sign something where you agree to "pay what is not covered by my insurance company."

But this does not mean you agree to pay whatever the doctor wants you to pay. You still have room to negotiate what are the reasonable fees for this.

When you give thorough discovery requests targeting the question of whether the fees are reasonable, what the fees are for other patients and insurance providers, then you begin to get these medical debt collectors thinking twice about playing hardball.

Then again, it should never get to this point. It seems like doctors and their collection lawyers miss this fundamental aspect of contract law.

It's fun when you get a judge who understands this, as the collection lawyers do not. It stinks when you get judges who are lazy and just award judgments without listening to law or facts.

C'est la vie.
—John William Nelson

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  • icon
    mr. sim (profile), 12 Nov 2014 @ 5:17pm

    you want to fix the problem? you make them all charge the same prices. one hospital might charge 500 dollars for an x-ray and another 1500. the first step is forcing mandatory prices they can't charge more than.

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    • identicon
      Pragmatic, 14 Nov 2014 @ 5:35am

      Re:

      B-bu-but Socialism! Government! The free market!! Wait, there's no such thing as a free market...

      What we actually need is to expand Medicaid to all and let private healthcare providers compete with it on service. This model has proved successful in other countries.

      reply to this | link to this | view in chronology ]

  • icon
    Mason Wheeler (profile), 12 Nov 2014 @ 5:23pm

    The healthcare industry in the US is crazy, and it's not a simple task to assign blame.

    Actually, it's an exceedingly simple task.

    Many patients aren't paying out of their own pockets because they rely on insurance,

    ...and there's the problem right there.

    First off, let's get one thing straight. What we call "health insurance" is not insurance, not by any other standard of insurance with which we are familiar. If auto insurance worked like "health insurance," I'd have to submit a claim every time I filled up with gas or took my car to the car wash. If homeowners' insurance worked like "health insurance..." just imagine Lowe's and the Home Depot billing like hospitals.

    Real health insurance would do what insurance does: cover disasters. Broken bones, cancer, heart attacks, assault victims, etc. What we have is not a system that does that. In fact, when actual disasters come up, our "health insurance" system does everything possible to avoid paying out!

    No, let's call it what it really is: a financial industry takeover of the health care system. Let's start with a very simple axiom: if you pay all the bills for Organization XYZ, this gives you a tremendous degree of influence over Organization XYZ's agenda and priorities. And ever since the rise of the health insurance system, which President Nixon set into motion, that's exactly what's happened. Insurers have taken over the funding of health care, until they control the system.

    There is also the secondary effect of taking the responsibility for payment completely out of the customer's hands: moral hazard. It's an economics term that means that when a person (or a hospital, in this case) is insulated from the risks of their behavior, their behavior becomes worse. If a hospital no longer has to keep their care affordable to its patients, because the patients aren't paying for it out of pocket, they end up not doing so.

    One last thing to keep in mind: Medical costs have skyrocketed in the last few decades, far more quickly than inflation, when their increasing use of improving technology should have been pushing the cost down. As proof, look at one common medical procedure that's not covered by insurance: laser eye surgery. Patients have to bear the cost out of pocket, and it's come way down while the price of insured medicine has gone up.

    No, it's not at all difficult to accurately place blame for the nightmare of our medical system in the USA. It lies squarely at the feet of the financial industry, specifically the medical insurance companies. Remember this next time you hear some politician talking about the uninsured. We don't need 30 million less uninsured people in the US, or whatever number they're bandying about; we need about 300 million more.

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    • icon
      Mason Wheeler (profile), 12 Nov 2014 @ 5:25pm

      Re:

      (Argh, why oh why do we not have an Edit button on here?)

      I meant to end with this:

      We all want progress. But progress means getting nearer to the place where you want to be. And if you have taken a wrong turning, then to go forward does not get you any nearer. If you are on the wrong road, progress means doing an about-turn and walking back to the right road; and in that case the man who turns back soonest is the most progressive man.

      -- C. S. Lewis

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      • identicon
        Anonymous Coward, 12 Nov 2014 @ 6:43pm

        Re: Re:

        Dear sir or madam...


        People do not WANT responsibility.

        They WANT to be victims and to blame the system or someone else for their problems.

        Healthcare is no different.

        "Can't you just give me a pill for that doc?"

        Requiring me to pay into a pool where fat people and people that take unhealthy risks with their bodies instead of taking care of their selves is BULLSHIT!

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        • icon
          That One Guy (profile), 12 Nov 2014 @ 7:10pm

          Re: Re: Re:

          I can only assume that you've never found yourself in the position of facing a medical bill that would be utterly impossible for you to pay on your own, due to sheer crap luck on your part(perhaps it takes a number of expensive tests before they can even figure out just what the problem is, perhaps it requires emergency room service which is insanely expensive).

          The lucky ones never 'get their money's worth' from the payments they make on their insurance. You, and others like you, are paying out for those not so lucky, and always remember, all it takes is an instant of bad luck before you might find yourself being one of those 'unlucky few', so lay off on blaming a group of people you're lucky not to be a member of.

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          • identicon
            Anonymous Coward, 12 Nov 2014 @ 8:33pm

            Re: Re: Re: Re:

            You missed the point. Crap happens to everyone... should I be forced to pay for your lost property when it is stolen too? Who is here to save the families of fallen soldiers that died in service to our country? Who should pay for the man down the street that died in a car accident from a drunk driver leaving behind 3 children and a wife?

            It must be voluntary, life is unfair get over it, nothing you say or do will change it. No amount of Obamacare will save anyone... but it will sure suck everyone dry trying and ultimately will kill more than it would ever save because that is bureaucracy for you. The ACA will only do one thing... make everyones care suck balls instead of at least some getting good quality care. And that is the end game... to make sure I have to suffer along with the unlucky, the uncaring, and the stupid unwilling idiots!

            I don't need people like you, whom have not a single clue, telling me I need to participate for the good of your own contrivances...

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            • icon
              That One Guy (profile), 12 Nov 2014 @ 8:52pm

              Re: Re: Re: Re: Re:

              And that is the end game... to make sure I have to suffer along with the unlucky, the uncaring, and the stupid unwilling idiots!

              And you apparently missed my point, that a single stroke of bad luck could put you, or someone you care about into that group of 'unlucky, uncaring and stupid unwilling idiots'. And if that happened to you, or someone close to you, and you or they had no chance whatsoever of paying for the costs yourself, what would your response be?

              Would you accept everyone else looking at down at you, dismissing your plight or the plight of a loved one with a simple 'Well they should have been more careful/saved up more/planned better, it's their own fault they've been driven under financially', despite the fact that some things simple cannot be planned for, cannot be (for anyone without excessive disposable income) 'saved up for'?

              Would you really see nothing wrong or problematic if others looked at your difficulties, the fact that you were facing down more debt than you'd ever be able to repay in your life due to nothing more than a moment of dumb, lousy luck, and simply shrugged their shoulders, and left you to rot with a 'better them than me'?

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            • identicon
              Editor-In-Chief, 12 Nov 2014 @ 9:13pm

              Insurance and what it means

              Let me ask you a question or two:

              Do you understand what taking out insurance means? Do you understand the risk spread and pricing then of insurance? Do you understand that insurance is a form of gambling?

              Because from your statements above, I don't think you do. You could always do what one doctor advised many years ago and set aside your insurance premiums into a high interest account and when needed draw upon it then. For many people this is a more profitable way of using the money.

              The healthcare industry is, frankly, completely and utterly corrupt. It makes those industries we love to ridicule (used car sales, lawyers and advertising [almost forgot politicians]) for being low-lifes and corrupt seem like the epitome of being honest and upstanding.

              Everything from pharmaceuticals to tongue depressors to matches is inordinately overpriced when used in the medical industry.

              Interestingly, in South Australia, some years ago, after a doctor lost a court case over his practise of not displaying his charges for various services, it became necessary for all medical practitioners to display or make available their prices before they serviced their customers so customers could make a choice as to whether or not they wanted to use that medical practice.



              David Oliver Graeme Samuel Offenbach

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              • identicon
                Lawrence D’Oliveiro, 12 Nov 2014 @ 11:17pm

                Re: Do you understand that insurance is a form of gambling?

                Depends on what you mean by “gambling”. Do you mean:

                1. Sucker gambling, as in a casino or lottery, where the odds are carefully arranged to ensure that, on balance, you lose, and that any attempt to improve your odds is ipso facto “cheating”?
                2. Or do you just mean the general sense of “taking a chance”?


                The latter is something we do every day. The former is something only the not-so-bright do.

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                • identicon
                  Editor-In-Chief, 12 Nov 2014 @ 11:37pm

                  Re: Re: Do you understand that insurance is a form of gambling?

                  3. Sucker Gambling as in you pay protection money and in the off chance you "win" you still have to pay (just not as much as if you had no insurance) or you suddenly find out that you are not covered because their interpretation of what the clause means is very different to what you think the clause means.

                  David Oliver Graeme Samuel Offenbach

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            • icon
              Richard (profile), 13 Nov 2014 @ 3:01am

              Re: Re: Re: Re: Re:

              It must be voluntary, life is unfair get over it, nothing you say or do will change it.

              Welcome to the 19th century!

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          • icon
            randomjoe (profile), 12 Nov 2014 @ 9:05pm

            Re:

            There's a difference between facing outrageous medical bills and insurance rates because of "sheer crap luck on your part" and "people that take unhealthy risks with their bodies".

            Just sayin'.

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            • identicon
              Editor-In-Chief, 12 Nov 2014 @ 9:23pm

              Re: Re:

              people that take unhealthy risks with their bodies
              Do you mean and include smokers, rally car drivers, alcohol drinkers, bicycle riders, astronauts, car drivers, train passengers, drug takers, genetic inheritance (breast cancer etc), getting out of bed, eating at restaurants, obesity, running, not running, walking, living in cities, getting out of bath or shower, swimming, using ferries, flying, going to school, travelling overseas, crossing state borders, etc.

              David Oliver Graeme Samuel Offenbach

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              • icon
                randomjoe (profile), 12 Nov 2014 @ 9:59pm

                Re: Re: Re:

                I think you are being disingenuous, the keyword is "unhealthy". There are risks you can control and risks that you can't.

                For example risks you can control; smoking, drinking, recreational drugs use, obesity (from overeating, not genetic or physiological), etc.

                Risks you can't control; genetics, eating, walking, getting out of the bath, living in general, etc.

                And even risks in between, risks where the benefits potentially outweigh the risks; driving, biking, running, swimming, flying, traveling, etc.

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                • identicon
                  Editor-In-Chief, 13 Nov 2014 @ 12:17am

                  Re: Re: Re: Re:

                  You are missing the point of your keyword "unhealthy". Irrespective of the risk and whether or not you have any control over it, there are many activities that can have unforeseen results above what risks can be seen.

                  Let's talk about obesity - there are many who keel over and die and they appear to be healthy, fit, eat properly, exercise well and yet still suffer an unexpected health problem. There are also many who are obese and their functional health is such that they never require medical treatment.

                  The intention of my comment was simply to highlight that things can happen in even ordinary situations as well as not happening in what appears to be high risk situations.

                  David Oliver Graeme Samuel Offenbach

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          • identicon
            JS, 14 Nov 2014 @ 9:46am

            Re: Re: Re: Re:

            The problem is that the way things are now, suppose you have been paying your exorbitant insurance and have this bad luck thing happen to you. You think you covered, but then you get to find out about the huge list of uncovered expenses you get to pay anyway because the ER doctor, the expensive diagnostic tests you mention, etc., etc. weren't in the network or in the plan.

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        • icon
          Mason Wheeler (profile), 12 Nov 2014 @ 7:31pm

          Re: Re: Re:

          Oh, I agree entirely. That's the other side of the moral hazard: when people don't pay for their own health care, they take their own health less seriously. It cuts both ways.

          The single most significant thing we could do to improve health care in the USA would be to do away with fake health insurance and replace it with real insurance--disaster coverage.

          The #2 most significant thing we could do would be to smack down pharmaceutical companies and their abuse of patents to charge obscene amounts for drugs that cost them next to nothing.

          Fix those two things, and the rest of the system would fix itself in short order.

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          • icon
            Richard (profile), 13 Nov 2014 @ 3:09am

            Re: Re: Re: Re:

            The single most significant thing we could do to improve health care in the USA would be to do away with fake health insurance and replace it with real insurance--disaster coverage.


            Your whole conversation seems just crazy to me.

            I live in the UK. We have a National Health Service. We don't have any of these cash related problems. When I worry about my health I don't have to worry about what treatment will cost. The problems we do have would reduce if the US would only go down the same road we are on. The US health insurance system (combined with drug patents) is the major driver of medical inflation worldwide.

            Our health system covers everyone free at the point of use and costs less than half what yours does.

            What you need is a war where the enemy is bombing New York, LA, Chicago etc. The Blitz taught us that private healthcare is immoral and unsustainable. Hopefully we will never forget that lesson.

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          • icon
            Richard (profile), 13 Nov 2014 @ 4:29am

            Re: Re: Re: Re:

            when people don't pay for their own health care, they take their own health less seriously.

            Let's analyse this shall we - it sounds plausible BUT..

            Looking after your health has benefits beyond the financial one of saving money. Staying alive is the main one - with feeling fit and able to enjoy life being the next in line.

            Are you seriously suggesting that someone who doesn't care enough about staying alive to eat sensibly and take some exercise will suddenly start doing it because it might cost them some money?

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            • icon
              Mason Wheeler (profile), 13 Nov 2014 @ 6:48am

              Re: Re: Re: Re: Re:

              Yes. It sounds crazy, but remember that people are irrational.

              A rational person takes the long view over a short-term benefit in all but the most urgent of conflicts, because the long-term benefits are greater and last longer. But irrational people controlled by primitive drives "live in the moment."

              Well, eating right and exercising are "long view" issues. They involve self-denial and self-discipline. The Natural Man, the irrational self, hates such things. (Why do you think so few people do them now that modern technology has advanced to a point that they're no longer strictly necessary?) But money is a short-term issue. You need money to pay the bills and put food on the table.

              Fix the conflict of interest between the Natural Man and the rational, long-term goals, and you'll see more people behaving in their own best interests.

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              • icon
                Richard (profile), 14 Nov 2014 @ 3:49am

                Re: Re: Re: Re: Re: Re:

                Well, eating right and exercising are "long view" issues. ..... But money is a short-term issue.

                When the money in question is going to pay (in the future) for the consequences of not eating right and exercising then it is also a long term issue.

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          • identicon
            Anonymous Anonymous Coward, 13 Nov 2014 @ 7:00am

            Re: Re: Re: Re:

            I would add one more thing. Remove the government mandate requiring insurance company profit. One is 'required' to have insurance and no company is going to run at a loss (the IRS makes that a no no), and even worse, if your profits do not rise quarter after quarter Wall Street is gonna take that company to the cleaners.

            I vote for single payer (without profit) and a fixed fee schedule for performance (not service); or nationalized healthcare with insurance companies competing to cover elective treatments.

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          • identicon
            Pragmatic, 14 Nov 2014 @ 5:43am

            Re: Re: Re: Re:

            OR we could just get patents off of medicines and medical devices altogether. There's something fundamentally creepy about trusting the profit motive with your life.

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    • icon
      John Fenderson (profile), 12 Nov 2014 @ 7:35pm

      Re:

      I agree with this so hard. It's my primary objection to Obamacare: that it cements an already dysfunctional financing system into law.

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      • identicon
        Anonymous Coward, 12 Nov 2014 @ 8:38pm

        Re: Re:

        This is sadly the nature of politics... it greatly benefits the elite few at the expense of the poor majority. I just cannot understand why so many people that like Obamacare just are not able to see it it despite it standing in front of them and slapping them stupid.

        Well... I guess I just answered my own question... heh!

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        • icon
          Mason Wheeler (profile), 13 Nov 2014 @ 6:58am

          Re: Re: Re:

          I do understand why. Obamacare makes a lot more people insured, and that feeds into the status quo narrative. We have this idea (pushed by the financial industry "insurers") that coverage = health security, and as long as you accept that premise, it logically follows that being insured is a good thing.

          Unfortunately, that's the point where most people stop thinking. Thinking in a single degree of cause and effect is easy. It's hard-wired into our brains, and even infants can do it. (A lot of what we see as the most frustrating behaviors of young children is them simply experimenting to work out causal relationships in the world around them, things that are obvious to us because we don't have clear memories of the time when we established those relationships by doing the very same things!)

          The problem is, the rest of the world isn't that simple. Effects are causes too, like a train of dominos falling one after another. And not only is thinking about later effects difficult, it is actively discouraged. Seriously. Think back to high school. Remember learning about logical fallacies? Remember how they taught you about the slippery slope fallacy, that trying to predict consequences several steps down the road is officially invalid if the consequences you predict are negative? With that one simple concept, we are actively discouraged from thinking through the long-term negative consequences of our actions!

          A conspiracy theorist could make all kinds of hay from that one simple fact. I simply point out that it is a fact. I don't know the reasons behind it. But as long as that's as far as we're willing to think, Obamacare looks like a very good thing to a very large number of people, when in reality all it does is make the fundamental problem worse.

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        • identicon
          Foggy World, 13 Nov 2014 @ 12:35pm

          Re: Re: Re:

          From what I am seeing the people who like Obamacare haven't been sick yet.

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          • icon
            PaulT (profile), 14 Nov 2014 @ 12:33am

            Re: Re: Re: Re:

            That's funny. A lot of what I've been reading is people who like it because it's the first time they've been able to get insurance because an illness was considered pre-existing. Or people who now have to pay significantly less in co-pays and premiums because their illness forced them into a crappy policy that basically did nothing for the ongoing treatment. Or people who were covered for a post-ACA illness that wouldn't have been covered under a previous policy.

            Maybe you should read more.

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      • identicon
        Anonymous Coward, 12 Nov 2014 @ 10:38pm

        Re: Re:

        When I read stories like this I am glad I live in the UK.

        The NHS will treat anyone and when you are recovering never hit you with a huge bill. Sucks to live in the USA if you are ill.

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        • icon
          John Fenderson (profile), 13 Nov 2014 @ 7:51am

          Re: Re: Re:

          "Sucks to live in the USA if you are ill."

          Indeed. Getting sick is the #1 cause of bankruptcy in the US (even for the insured). Obamacare doesn't effectively address this problem.

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    • icon
      Richard (profile), 13 Nov 2014 @ 4:23am

      Re:

      when actual disasters come up, our "health insurance" system does everything possible to avoid paying out!

      Exactly like all other insurance then.

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    • icon
      Richard (profile), 13 Nov 2014 @ 4:39am

      Re:

      . If a hospital no longer has to keep their care affordable to its patients, because the patients aren't paying for it out of pocket, they end up not doing so.

      If the patients have to pay out of their own pockets that will not help because they are in a uniquely bad negotiating position at the point of use. (Really this is the whole point of the article above).

      In the UK funding through taxation controls costs better - because you are in a much stronger negotiating position as a healthy person paying taxes and hence UK healthcare costs half what US healthcare does.

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    • icon
      John85851 (profile), 13 Nov 2014 @ 7:46am

      Re:

      I read a similar comparison in another article that went something that I'd like to elaborate on:

      Suppose we had "food insurance" that worked like health insurance:
      We would go to the grocery store and buy food with a $25 co-pay. Then the grocery store would bill our food provider and the provider would pay the bill. That works fine for our monthly trip to the grocery store.
      However, because it's Thanksgiving, the food provider won't pay for the turkey. And since the provider won't pay for it, the grocery store has to charge you what it charges them: $2,500. But because prices vary (and aren't listed), you didn't know that 1) your provider wouldn't cover it and 2) that you had to pay this much. And because you've already eaten the turkey ("services rendered"), you're expected to pay the full amount.

      Then there's the fact that people will buy more than they need simply because someone else is paying for it. I may not need 10 pizzas every week, but my food insurance covers it, so why not?

      This sounds absurd when you really think about it.

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      • icon
        PaulT (profile), 14 Nov 2014 @ 12:30am

        Re: Re:

        A food analogy is not a very good one, since you can choose not only how much you eat (it's your decision to have 20 people over for Thanksgiving, so you choose to pay) and what you eat (steak and champagne, or ramen and water - you choose according to your needs and ability to pay). Nobody gets to choose whether they need $1 million of transplant surgery or cancer treatment - and they can't just make do with some paracetamol because that's all they budgeted for.

        Car insurance is really the better analogy, as long as you remove the obvious caveat that you can opt out of driving. If you're on the road, you have to buy it, and while some people are assholes and crash their cars more often, most people are glad it's there despite many flaws.

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  • icon
    John William Nelson (profile), 12 Nov 2014 @ 5:29pm

    Contract law still allows negotiating amounts

    I do a lot of consumer debt defense. Some of this includes medical debt lawsuits.

    Interesting thing about medical debt: When did you agree to pay the specific amounts charged by the doctor?

    Think of it this way—can you tell me another industry where you do not know, up front, what the rates or fees will be before you accept services or goods? Lawyers give you their hourly rates, for example. You get menus at restaurants. Plumbers and carpenters tell you hourly rates or flat fees up front.

    And if you do not get these details up front, but they perform the services? Then you have a chance to negotiate the amount.

    Typically, for medical services, you sign something where you agree to "pay what is not covered by my insurance company."

    But this does not mean you agree to pay whatever the doctor wants you to pay. You still have room to negotiate what are the reasonable fees for this.

    When you give thorough discovery requests targeting the question of whether the fees are reasonable, what the fees are for other patients and insurance providers, then you begin to get these medical debt collectors thinking twice about playing hardball.

    Then again, it should never get to this point. It seems like doctors and their collection lawyers miss this fundamental aspect of contract law.

    It's fun when you get a judge who understands this, as the collection lawyers do not. It stinks when you get judges who are lazy and just award judgments without listening to law or facts.

    C'est la vie.

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    • identicon
      Anonymous Coward, 12 Nov 2014 @ 6:45pm

      Re: Contract law still allows negotiating amounts

      I never really though of it that way... I learned something today random internet citizen.

      Thanks!

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    • icon
      randomjoe (profile), 12 Nov 2014 @ 9:20pm

      Re: Contract law still allows negotiating amounts

      In a worst case scenario, what sort of consultant or service should we look for? Would a regular debt management service also handle medical debts? Or is that a specialty? Are there lawyers that specialize in medical debt negotiation?

      Just curious.

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    • identicon
      Foggy World, 13 Nov 2014 @ 12:29pm

      Re: Contract law still allows negotiating amounts

      Just a question. At what point in your dealings with a doctor or a hospital are you supposed to negotiate? It's tough when in you are in an ambulance because you just had a stroke.

      Maybe part of this could be helped if doctors and hospitals were required to post their rates on their websites.

      And if there are "right" hospitals and "incorrect" ones that information should be in the front seat of every ambulance.

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    • identicon
      Foggy World, 13 Nov 2014 @ 12:29pm

      Re: Contract law still allows negotiating amounts

      Just a question. At what point in your dealings with a doctor or a hospital are you supposed to negotiate? It's tough when in you are in an ambulance because you just had a stroke.

      Maybe part of this could be helped if doctors and hospitals were required to post their rates on their websites.

      And if there are "right" hospitals and "incorrect" ones that information should be in the front seat of every ambulance.

      reply to this | link to this | view in chronology ]

  • identicon
    Anonymous Coward, 12 Nov 2014 @ 6:32pm

    Inb4 argument over single-payer Medicare program

    reply to this | link to this | view in chronology ]

  • identicon
    Anonymous Coward, 12 Nov 2014 @ 7:17pm

    It's been said before, but:

    Just get rid of the special healthcare privileges that politicians get and force them to use the same system as their constituents. That'd get it fixed, pronto.

    reply to this | link to this | view in chronology ]

    • icon
      That One Guy (profile), 12 Nov 2014 @ 7:28pm

      Re: It's been said before, but:

      So many problems would be fixed using that logic...

      'Oh you don't get any 'special' healthcare, you get the 'standard' that the majority of people in your state/district use. If that happens to be 'none' for whatever reason, sucks to be you. And you have to pay all the fees relating to it yourself, just like everyone else does.'

      'Oh you don't get paid ridiculously insane sums. No, your pay is based upon the median wages of regular, everyday US workers.'

      'Oh you don't get paid after you leave office, once you're out, the flow of money is gone, just like it is in almost every other job.'

      Tie political healthcare, and political pay to what the average citizen has to deal with, and you can bet their priorities would change mighty quick.

      reply to this | link to this | view in chronology ]

      • icon
        Mason Wheeler (profile), 12 Nov 2014 @ 7:33pm

        Re: Re: It's been said before, but:

        The problem is--in a bizarre bit of meta-circularity--they don't get their wages and benefits set by their bosses (us!) like every other job; they set their own! So fixing it is a chicken-and-egg problem.

        reply to this | link to this | view in chronology ]

  • identicon
    Whoever, 12 Nov 2014 @ 7:38pm

    Out of network providers

    My family has experienced this. We had someone in my family go into hospital for an operation. Hospital was in the network, surgeon was in the network. Anesthesiologists were not in the network. We never met the anesthesiologist. Never had any contact with them until we received the bill. We had no choice of who performed this service.

    Personally, I think that this is not an accident -- it's a scam.

    reply to this | link to this | view in chronology ]

    • icon
      PaulT (profile), 13 Nov 2014 @ 12:02am

      Re: Out of network providers

      Of course it is. But, some Americans have been conditioned to think this is good and "socialism bad", so any attempt to fix the system is met with howls of outrage. Even though the average American spends more taxes on healthcare than the average European - and then has to pay more to an insurance company to access it themselves - there's so much disinformation and pure idiocy out there.

      Meanwhile, it wasn't until a relative who had moved to the US was ultimately bankrupted by your idiotic system that I'd even heard the terms "out of network" or "copay". Whether it was for general healthcare, emergency care, or 3 months of intensive care for my father when he was dying a few years back, the last thing anyone had to worry about was how much it cost.

      That was OK, all of my family had paid into the healthcare system all of their lived, and we used it when necessary - and nobody whined about "soshulismz", or was blocked from getting improved private healthcare if they could afford it. We paid our dues, and the system was there when we needed it. The only problem was Tory idiots trying to kill the NHS when they were in power, especially during the Thatcher era where she tried her best to gut it. But, even the biggest right-wing moron understands that it's too important to attack directly. It's far from perfect, but it's far better than the alternative we see your country demonstrating.

      reply to this | link to this | view in chronology ]

      • identicon
        Pragmatic, 14 Nov 2014 @ 5:54am

        Re: Re: Out of network providers

        ^This. Stop treating essential services as a business; they're a utility, damn it!

        And for the love of God, stop fearing Socialism. It's a misguided philosophy, for sure, but that's no reason to visibly jump when somebody says the word. We're like Pavlov's dogs, aren't we? Conditioned to wet our pants in abject terror and tremble when somebody says... Socialism!

        It doesn't matter if a policy is Socialist or not. It either works or it doesn't. If a policy works, keep it. If it doesn't, try to fix it, and if it can't be fixed, get rid of it and do something else. It seems crazy to me that we can easily shut down all debate on everything by blowing the "Socialism!" whistle every time.

        reply to this | link to this | view in chronology ]

  • identicon
    MedicalQuack, 13 Nov 2014 @ 12:33am

    It's more than crazy...

    Ok I'm a healthcare blogger and what you pointed out is a huge problem. Contracts are nuts out there. Try to find an insurance plan that has both your doctor and the hospital where he/she is on staff and it's getting to be nuts. Right now insurers can't even get it right and they are the ones who tell everyone else which doctors are in network. Yes I don't have a ton of kind words for the insurance business.

    As a matter of fact we have in healthcare (and this is like markets if you will except no need for speed) a Battle of the Quants. Insurers have hired them like crazy and hospitals are hiring quants to try to keep up and not lose money. About every 2-3 weeks we have another hospital in the US close, most are going broke, and a few for other reasons.

    We are being pushed through a system like the data in markets except people don't work that way. You can read this post I did on that topic and I'm the only one out there addressing this! People don't like math or the mention of a math model so they don't tune in.

    http://ducknetweb.blogspot.com/2014/10/data-scientistsquants-in-health.html

    Models are being used against you and United Healthcare is the worst as they have been firing doctors across the US that take care of Medicare patients right and left with no particular system other than a quantitated model. Then they try to give patients the name of a replacement doctor for them to see and end up sending patients to OBGYNs and neurosurgeons. These are of course data errors but that's what's going on and then the patient has to call and navigate and look sometimes desperately for a new primary md.

    It's so bad that United has gone out and bid and won contracts for Medicare Advantage, only to have to give them up as once they get into the contract, people are finding they fired too many doctors and there's none in their area to see them, messed up, yes! It's a case of the right hand not knowing what they are doing. In the UK the NHS did a documentary which I posted to where they are angry at United/Optum taking over the NHS. You can watch that too if you like. It's very sad too as patient safety is suffering over there.

    http://ducknetweb.blogspot.com/2014/11/the-take-over-and-sell-off-of-nhsby.html

    It's a really bad company that does everything by the numbers and they want young developers to write code for them for free with this come on marketing so they can have new apps to collect more data on people over 50, again so they can turn around and sell it as they are a huge data seller. I made a post and told young developers don't do that to make this company richer when you don't even get a penny to pay your rent from them. Again nobody else gets this out there. I used to be a developer so I get it right up. AARP is right in there with them and wants free code to!

    http://ducknetweb.blogspot.com/2014/10/aarp-and-united-healthcare-form.html

    United Healthcare has had an open door to the HHS for years and has mentored many of their models too. I have a couple former CMS folks that have told me a lot. Anyway, yes the parameters of the models are being tightened down so much it's ridiculous and it's all numbers to them.

    Now I have one more thing to bring up and if any of you want to help me that would be great. I'm tired of these two sites, Healthgrades and Vitas putting such flawed data out there for consumers. 4 years ago the AMA even interviewed me about this and nothing has changed. My latest post, well you'll get it. Healthgrades puts out these MD and hospital ratings which are a joke.

    Fact of the the matter is they only want ad revenue and don't even update any MD or hospital listings very often. They know who I am very well as I keep poking holes in what they do as it's so bad. My last post was about a hospital that was closed by the Feds, CEO is waiting for sentencing as he albo bribed a CA senator and the hospital was putting fake spinal screws in patients. So did you get all that?

    Ok here's the kicker, Healthgrades still shows the hospital being opened and the shut down from the Feds was done in 4/2013, plenty of time to at least make a note but no such luck. Instead, you see the hospital still open and they have some 5 star rating! On top of that the now closed hospitals has a few other awards on there! They still show all kinds of doctors still on staff there. Pretty good is it not for a hospital that has been closed since April of 2013.

    This hospital made national news a few times on the fake spinal screws so not like it was a secret. This is just one instance and other listings are so bad. According to the site you can still go see Michael Jackson's old bankrupt doctor, he's still on there and they finally just took Rand Paul off about a year ago as accepting new patients.

    I got into this finding my old doctor who had been dead for 8 years, 4 years ago and when I blogged it, the AMA came knocking on my door, so yeah there's dead doctors on there too. You can't of course believe one word about the insurance on there about the doctors either. Doctors hate this site too and at Harvard Med, they have taken on their rankings a few times too but nobody has been able to either get them to fix it up a bit or shut down. As a matter of fact people were talking about Healthgrades having an IPO before the end of the year...so yeah healthcare is screwed:) Read this...

    http://ducknetweb.blogspot.com/2014/11/why-does-hospital-that-was-closed-by.html

    Fact of the matter here is that nobody except me is taking them on and all the fake PR stuff about the site, people suck it in!

    Back on contract though if anyone signs up for a United policy via an exchange, the doctors who are in network get paid a shade above Medicaid so the number of MDs might be pretty slim there too. That's awful.

    The contracts are out of control and sometimes too the ER doctor group is different than the rest of the doctors at the hospital so the hospital make take your insurance, but the MD group operating in the ER room may not take it so surprise, there's that huge bill showing up.

    Again it's the quantitated business models they are working with and it gets down to piece by piece for the money and it's splitting things up like this. You can't do least cost routing on everything in healthcare for goodness sakes but that's what they are doing. Go look at the classifieds with insurers and look at the tons of quant openings and see what I mean and it's getting worse as it's numbers and algorithm to where they see can maximize profits this way, I hate it.

    Sorry for my bit of a rant here but trying to pass on some helpful information as I live, breath and eat this stuff and tr to put the truth out there. Do read the Healthgrades link if you have time, you will fall off your chair with how bad the information is out there and don't use that site when looking for a doctor other than for just a name and address.

    reply to this | link to this | view in chronology ]

  • icon
    joncr (profile), 13 Nov 2014 @ 4:40am

    Sorry, We're Not Paying

    After surgery several years ago in an in-network hospital and and in-network surgeon, I was dinged for the entire anesthesiology bill because my insurance carrier and the anesthesiology firm that hospital used had failed to reach an agreement on new contract terms. That had occurred prior to my surgery, but no one at the insurance carrier or the hospital thought I needed to know.

    All the different people that attend you during a hospital stay work for a variety of businesses, not just the hospital. At least in this instance, the hospital did the billing and collection for all of them. I received a single bill with many line items on it, with no identification at all to indicate who was billing for what.

    It's impossible for a for-profit market-driven health care system to provide the care everyone needs. Unaffordable profit-producing prices will inevitably prevent some people from getting needed care.

    One example of the hidden taxes of our current way of doing health care: The director of a large local non-profit university hospital acknowledges it pads bills to insured/paying patients by $250-$300 million annually to recover losses incurred providing mandated free emergency room care. Six other hospitals of comparable size in this two-county metro area are doing the same thing. Do the math, and then extrapolate nationwide.

    reply to this | link to this | view in chronology ]

  • identicon
    more for less, 13 Nov 2014 @ 5:41am

    "Moore's law" and medicine

    In most every other commercial industry, as an expensive new technology ages, the price drops significantly. But the US medical field seems to be the sole exception to this rule.

    For instance, why does MRI cost roughly the same high price as it did 25 or 30 years ago, even though the patents have long since expired? It's as if there is no incentive for manufacturers to make these machines cheaper, and/or no incentive for health care providers to buy the cheaper machines and pass along the savings to the customer. Or even if buying expensive MRI machines, to run them 24/7 to not only lower the cost, but to make scans more convenient for people's busy schedules. Yet this rarely seems to happen.

    Besides MRIs the examples are endless. It just seems that in medicine, all the standard rules, models, and theories of business and technology simply don't apply.

    reply to this | link to this | view in chronology ]

    • icon
      Richard (profile), 13 Nov 2014 @ 6:03am

      Re: "Moore's law" and medicine

      For instance, why does MRI cost roughly the same high price as it did 25 or 30 years ago, even though the patents have long since expired? It's as if there is no incentive for manufacturers to make these machines cheaper, and/or no incentive for health care providers to buy the cheaper machines and pass along the savings to the customer. Or even if buying expensive MRI machines, to run them 24/7 to not only lower the cost, but to make scans more convenient for people's busy schedules. Yet this rarely seems to happen.

      The need for liquid helium is one reason - and that is only going to get worse as supplies dwindle in future.

      However outside the crazy US system the machines are in 24/7 use. This doesn't really help the patient as it means appointment times may be awkward. When I had a scan (in the UK) the following patient was a no-show - so they scanned a bit more of me instead, just to make sure that the equipment was being utilised to the full.

      reply to this | link to this | view in chronology ]

      • identicon
        Anonymous Coward, 13 Nov 2014 @ 7:28am

        Re: Re: "Moore's law" and medicine

        "The need for liquid helium is one reason - and that is only going to get worse as supplies dwindle in future."

        Unlike perhaps the rest of the world, the price of helium in the US (where the lion's share of the world's mineral deposit is found) is quite low, a quick googling shows a cost of about $10/liter. Perhaps helium (like petroleum products) is heavily taxed in the UK?

        "However outside the crazy US system the machines are in 24/7 use. This doesn't really help the patient as it means appointment times may be awkward."

        Or it could mean waiting weeks to get an MRI appointment during convenient hours, as is often the case in Canada.

        reply to this | link to this | view in chronology ]

        • identicon
          Anonymous Anonymous Coward, 13 Nov 2014 @ 8:25am

          Re: Re: Re: "Moore's law" and medicine

          Or the doctors could order fewer MRI's, as I have heard (anecdotally) that many MRI scans are not necessary, but ordered to placate the patient (and provide another 'service' that needs to be paid for).

          There was one article (long time ago) where it was argued that having an MRI machine in every hospital was to 1) help them (the hospitals) stay competitive, and 2) help the MRI's salespersons stats.

          Except for profit, why do hospitals need to be competitive?

          reply to this | link to this | view in chronology ]

          • identicon
            Anonymous Coward, 13 Nov 2014 @ 8:47am

            Re: Re: Re: Re: "Moore's law" and medicine

            Besides the fact that MRIs are cash cows that make money for hospitals and everyone else, US doctors order them and many other expensive diagnostic procedures in order to defend themselves from the possibility of a lawsuit, rather than because the patient really needs it.

            reply to this | link to this | view in chronology ]

          • icon
            PaulT (profile), 14 Nov 2014 @ 12:22am

            Re: Re: Re: Re: "Moore's law" and medicine

            "I have heard (anecdotally) that many MRI scans are not necessary, but ordered to placate the patient (and provide another 'service' that needs to be paid for)."

            That might be part of it, the other reason I've read about is to avoid malpractice lawsuits. One major reason why there's not as many MRIs per capita in other countries - apart from the type of health system - is that people in other countries are far less likely to sue the doctor or hospital is something is not diagnosed correctly. In the US, they are more likely to be sued even if it is diagnosed correctly (for example, why wasn't it found sooner?). So, doctors order far more MRI tests than are actually necessary so they can say they did all they could in the event of a future lawsuit.

            reply to this | link to this | view in chronology ]

        • icon
          The Wanderer (profile), 16 Jun 2016 @ 9:23pm

          Re: Re: Re: "Moore's law" and medicine

          Extremely belatedly: I'm told that the reason helium is so relatively inexpensive in the US is that the US government has for years, per directive of Congress, been selling off its strategic helium reserve, thus depressing prices.

          Of course, this just ends up meaning that the helium gets used for frivolous purposes like party balloons instead of for critical purposes like the one cited here, but that's political football for you...

          reply to this | link to this | view in chronology ]

  • identicon
    Anonymous Coward, 13 Nov 2014 @ 5:54am

    People do not need Health Insurance, they need Health Care

    reply to this | link to this | view in chronology ]

  • icon
    Paul Somebody (profile), 13 Nov 2014 @ 8:38am

    Another perspective.

    I'm an American living in Tokyo.

    I have a certain health issue which requires regular doctor visits. My daughter was born here three years ago with several complications.

    So I have some experience with the US and Japanese systems. Here are some of the differences:

    All ambulance rides are free of charge.
    All hospital fees are set each year by a government panel. So when I need my yearly MRI it costs $150 no matter what hospital I go to.
    The co-pay is 1/3 of the bill. So my MRI is $50 to me.
    There are caps on what hospital can charge for extended stays. My wife had to stay in the hospital for a month, C section, then my daughter needed surgery and she was in the hospital for 3 months. When the bill came I was surprised that we only had to pay $600. After you stay in the hospital over a certain number of days, they can't charge for additional days.
    Healthcare is basically free for children under 15.
    My individual insurance costs me about $60/month.
    And, somehow, amazingly, the healthcare is excellent.


    The only reason it is so expensive, so convoluted and exasperating in the US is because it has been politicized.

    reply to this | link to this | view in chronology ]

    • identicon
      Pragmatic, 14 Nov 2014 @ 6:02am

      Re: Another perspective.

      Nine. Eleven.

      Sorry, OMG!SOCIALISM!!!

      There, FIFY.

      As soon as we stop doing that, problem solved. Only I don't think we're gonna stop doing that any time soon because each of us is afraid that the other guy will get something we don't approve of while we're paying out for something we're not using at the time. This state of affairs will continue until we realize that selfishness is not in fact a virtue of any kind.

      reply to this | link to this | view in chronology ]


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