The deductibles you have to pay before you even get the care in question - like your OB's plan - seem particularly cruel.
It seems to be all about shifting risk and financial uncertainty to the person/people least able to tolerate them.
My hospital did this to me, when I went in for a GI check over the stomach pain I've been having. They wanted the $850 dollars that was my share of the cost up front, which, ha. Like I've ever had $850 dollars lying around loose in my life.
I got up to walk out, saying fine then, I just wouldn't do the procedure, if it was cancer I would just die, and the clerk climbed down enough to put me on a payment plan.
She did insist I set it up on my credit card, automatic deduction. I fooled her, though. The credit limit on my card is only $500 bucks, so that topped out fast.
(I'm kidding. I've been paying it off. But Jesus, what are people even poorer than I am supposed to do? I'm not even that poor!)
They say that deductibles encourage patients to shop around for health care which saves everyone money in the long run. Of course, that's bullshit.
What deductibles actually do is provide financial incentive to refrain from seeking medical attention. Which is, you know, evil.
4.1: For that to work, you'd need something close to transparency in pricing.
And providers who didn't all work for the same company.
4.2. Exactly. "I guess I'm not really that sick," she said, coughing up a gout of blood.
5,6: And patients who, facing a health problem serious enough to merit seeing a doctor, are inclined to shop their problem around to multiple providers and compare prices like some goddamn lunatic.
My favorite is that when I got an epidural with hokey pokey, I failed to shop around and make sure that the anaesthesiologist was in-network. The hospital was in-network, but the on staff anaesthesiologist was out-of-network. My bad.
That seems easier because there are lots of good reasons to shop problems to multiple doctors regardless of who pays.
I kind of wish they had done that for us ($400 per visit). We paid a lot less than that, but then when the baby was born, we got hit with a $4500 bill all at once which we weren't entirely prepared for.
(Our deductible was $2250, per person. It was applied once for my wife, and then once for our daughter.)
9: Yes. This is what amazes and annoys me. How is it our job, when we're under care -- often dopey or bleeding or even unconscious -- to evaluate which medical personnel or drugs we're accessing?
I failed to shop around and make sure that the anaesthesiologist was in-network.
Yeah, that's obviously your bad for being preoccupied with giving birth. Maybe next time you will be a little more focused on whats important, hmmm?
Our deductible was $2250, per person. It was applied once for my wife, and then once for our daughter.
Oh, fuck that.
It's obviously too late to help Heebie on the Pokey front, and I'm not sure how widely this approach can help anyway, but all the same:
Last year while visiting family for Thanksgiving I apparently managed to scratch my cornea (ow!). Not knowing what the problem was, I went to the ER in the middle of the night, which my insurance covered with a reasonable-enough copay. The ER doc, who knew jack about eyes, told me to go to the ophthalmologist around the corner the next morning and tell him the ER sent me, so I'd get an early appointment. My insurance viewed this as simply a visit to an out-of-network specialist, so they denied coverage. I appealed the denial on the grounds that it was part of the same emergency treatment, since I just did what the ER doc told me, and wound up getting the visit treated as though it were in-network so I paid only my $20 copay. I wonder if a similar argument could apply to an anesthesiologist who comes in as part of your maternity care, which is covered.
I mean, it's clear that a situation like Heebie's is an example of hospitals and doctors gaming the system in an effort to wring extra money out of helpless patients, and it's disgusting. The insurance company isn't always in on the scam, though, so folks might sometimes be able to get some relief if you appeal the coverage denial. Worst case scenario, you buy some time while the appeal is pending.
(end of probably-worthless advice).
(end of probably-worthless advice)
Have you considered giving commencement addresses?
For that matter, I imagine Texas law may not be super consumer-friendly, but the practice of calling in an out-of-network anesthesiologist, or having surgical teams where there's no one insurance panel that includes every doctor who operates on a given patient, seems like it could be ripe for a lawsuit under a consumer protection statute. The law up here prohibits "unfair or deceptive practices in the conduct of any trade," which sure sounds like what we're talking about.
9, 17,: Kevin Drum says this is common and intentional.
But I might spend some of the deductible elsewhere. My insurance covers acupuncture and chiropractic, for example. Even if I were getting treated for something at a hospital that would inevitably use up some of the deductible, I might spend it on other things elsewhere first.
Yeah, I read Drum's thing and I'm thinking about writing on the admission form next time we have an ER visit that I request all doctors and consults to be in-network and if they're not I only agree to pay them the in-network reimbursement rate. It's basically a way for doctors to get around the insurance negotiated contracts and get paid what they negotiated then also bill you for more on top.
I just found out a kid has to have a tooth out on Thursday and I asked about how much of that insurance covers and the dentists couldn't tell me either what my benefit was or what the overall cost was because it depends on the insurance company so I should call them. Bullshit, when the procedure is done you'll be able to tell me exactly what I owe.
21: that's what infuriated me about my OB. I gave them $2k by August, for a November delivery. If I break my arm tomorrow, I owe someone else up to $2k, and I can just go to my OB and ask politely for my money back.
Well, there are many infuriating things. But basically.
21: You're trying to think about this fairly and the hospital is not. That you might spend your deductible elsewhere is a reason for them to try to get it from you now. Money up front instead of money many months later from an insurance company.
I WILL GLADLY PAY YOU TUESDAY FOR AN ANGIOPLASTY TODAY
Bullshit, when the procedure is done you'll be able to tell me exactly what I owe.
Hahaha if only. We have an outstanding dental bill right now. Right after the procedure, the dental practice gave a rough estimate of how much they thought it would probably be. Then we got a "This is not a bill" notification from them of how much it would probably be. Then we got a "This is not a bill" notification of benefits paid to the dentist from the insurance. Needless to say, none of the numbers match.
Also, since this is the complaining about medical billing and copays thread: We keep getting billed a $25 copay for a doctor visit Zardoz had. I already paid, but they applied that payment to a well child visit that they had mistakenly billed us for. (Well child visits are no copay.) I wrote the reference number on the check and everything, but of course that didn't work. Now I need to go into my bank account and print out images of the cashed check and mail it to them with a copy of the bill. I'm not even convinced that is going to work, and am close to just paying the $25 to make it go away.
Remember that time the insurance company paid for some lab tests for me, and then two years later asked for their money back, and the lab complied and then billed me? And I had no recourse, and since my job had switched insurance companies, the insurance company pretended that HIPAA prevented them from opening my file and figuring it out? And so eventually I paid? More good times.
Dr. Skull went to an out-of-network lab for his lab work. They have sent us four different bills now -- all for the same work -- with four different account numbers, and for four different amounts of money. (Ranging from $130 to $177 dollars.)
I paid on the first bill, twice. They have yet to credit any of the money I paid.
Every time I call their accounts managers, I get a different person who gives me a different answer.
Our patchwork of regulators of network adequacy makes addressing the out-of-network ER doctor thing really frustrating. Exchange insurance (HHS has some authority), non-exchange insurance (state authority), and self-funded employer plans (DOL; no state authority per ERISA). I hadn't realized ERISA imposes no network adequacy requirements on employer plans at all! Thanks, Obamacare, for assuming those plans are decent and don't need more regulation.
One the plus side, my employer is asking me to sign up for text messages to remind me to eat right and exercise. So, you know, caring touch.
Look people, we'll never convince the UK to break up NHS if we keep airing these stories.
My cousin quit nursing to start her own practice as a medical billing advocate. When people are faced with huge, ridiculous medical bills, they hire her to fight with the hospitals and insurance companies to make the bills lower. She takes a percentage of the savings.
Only in America.
33: Medical innovation! What a great country we live in. Of course those socialist Europeans are going to benefit from the latest methods in billing-disputation without paying for development.
My favorite is that when I got an epidural with hokey pokey, I failed to shop around and make sure that the anaesthesiologist was in-network. The hospital was in-network, but the on staff anaesthesiologist was out-of-network. My bad.
If they were really sneaky, they would have brought in an in-network gasman to put you under, and then switched to an out-of-network one while you were woozy.
"Let's see if she notices!"
Parkinson's Law recommends a strategy of tactical insanity in these cases, I think. For a bill of $175, send a payment for $26. Don't sign the cheque. When they return it, point out that the actual bill was for $820 and don't they want you to pay the whole thing? Make up a new account number for every enquiry. Send your next communication in Swedish. And so on.
Look people, we'll never convince the UK to break up NHS if we keep airing these stories.
Oh, God, if only. The drive to privatise bits of the NHS in England has nothing to do with trying to make it work better. It's a combination of wanting to do favours for their friends, and being connected to the Great Transatlantic Bullshit Conveyor.
Maybe you have to actually be subject to the insanity to realize that 35 isn't funny. It's not like things aren't that crazy already.
While we were in New York we had this mess where RWM ended up having an obgyn who was out of network (the practice had several in-network doctors and several not, and it's not clear where the screwup was). However, since we moved shortly after her first visit we never received any of the huge bills that were sent, and even though she kept going to the same doctor they never bothered to tell her that there were outstanding bills, and instead sent it to a collections agency. We got all that squared away by paying the collections agency several hundred dollars. But recently I checked her credit report because we're thinking of getting a mortgage soon, and sure enough there's still $80 at some NYC collection agency for her even though everyone we talked to before said things were squared away. I'm so annoyed about it that I just can't bring myself to do anything about it.
One the plus side, my employer is asking me to sign up for text messages to remind me to eat right and exercise. So, you know, caring touch.
FFS.
Related: Toward A Scientific Approach To Workplace Wellness
(Follow-up to original article, "Wellness Incentives In The Workplace: Cost Savings Through Cost Shifting To Unhealthy Workers.")
When I had minor outpatient surgery, the anesthesiologists were a weird autonomous unit within the hospital, which I take it is somewhat common. Unlike in all these other stories, though, I was required to meet with them ahead of time to understand the billing, so there was full disclosure at least.
I will say that, 9 months into an epic battle with Blue Cross Blue Shield of NC's goddamned dysfunctional billing database (which absolutely cannot handle a married couple that both have separate employer-provided BCBSNC policies and chokes even worse when they cancel one of them), I discovered that calling the Better Business Bureau got my case kicked up many levels higher up the food chain. Which was fortunate, because my next action was almost certainly going to end with me in handcuffs.
Is that part of your crazy tooth saga?
Actually the seeds of a solution are in this prepayment of deductible mess. That money is still your money, so there should be a requirement that it be kept in a special interest bearing account -- all interest going to some state program for helping the uninsured -- and if a provider ever screws up and takes your money into his normal business account when he's not supposed to do so, his license to practice medicine gets suspended.
It's actually not all that farfetched.
40: At least I have to sign up or I don't get the messages. Plus, free annual physicals and free access to a gym.
43: No, nothing to do with teeth (which appears to have resolved itself! Yay, procrastination!). I have a whole different constellation of complaints about Delta Dental.
We had the kids double-covered last year, but since they were both BCBS policies, turned out that meant precisely jackshit aside from extra premiums and having every. single. claim. rejected pending proof of the secondary insurance. WHICH WAS THEM, and they weren't going to pay any extra anyhow. Okay, so that totally sucked and we cancelled one of the policies at open enrollment at the end of last year.
And until last month, not one single claim had been processed on the kids pending...wait for it... proof of secondary insurance that didn't exist, that would have been them, and that wouldn't have paid anything regardless. And every bill, we'd get on the phone (or show up at the office in person) and explain the situation, which they would agree was their fault and would get it fixed.
Next claim, restart the process anew. The claims are now getting paid but, of course, all kinds of billing at the doctor office level is royally fucked up at this point. I would nuke their corporate headquarters from space given half a chance. But hey, at least now poor people get subsidies so they can enjoy the same predatory/incompetent (depending on the humidity) Kafkaesque billing labyrinth as the rest of us.
I'm thinking about writing on the admission form next time we have an ER visit that I request all doctors and consults to be in-network and if they're not I only agree to pay them the in-network reimbursement rate.
You might come in unconscious, though, so better to get it tattooed across your chest.
nothing to do with teeth (which appears to have resolved itself! Yay, procrastination!)
Yeah, so after putting off the gum/jawbone-shaving surgery until after the next open enrollment so I could change my FSA contributions to cover the cost, the crazy bone growth broke through my gums so that there was exposed jawbone in my mouth. Surprisingly, it wasn't really painful at all, but obviously it's a big infection risk, so I was going to have to get it dealt with sooner rather than later. But then while I was in DC and brushing my teeth, the bone ridge broke off. the gum healed right back over it, and at my last dental cleaning, the pseudopocket had disappeared and all the pocket depths around the area were back to normal.
Which just reinforces my admittedly not-entirely-rational belief that doctors are a giant waste of time and money compared with just letting my body fix itself through benign neglect.
When I had to go to the ER, I tried to pay my co-pay at a downtown academic medical center. They were not equipped to do it.
I needed to get the money out of my FSA, and it was pretty hard for me to do that until they sent me a bill--which was going to take forever, because there was some bogus charge that my insurance was disputing.
My experiences with annoying company bureaucracies, especially ones set up to save them money, has led me to believe in dragging in other parties (like the better business bureau), or just unreasonably escalating things* is often a good way to make problems go away. It's feels awkward being that guy with the company, but it turns out that that it's usually easier for companies to just solve that guy's problem rather than dealing with him.
*E.g., Paypal had a glitch that wasn't letting a payment through (for some reason), and a week's worth of hassling their tech support people in India was did absolutely nothing because from what I could tell it was a genuine glitch in their system which they weren't qualified to deal with. I looked up the names of their CEO, vice-president, guy in charge of customer service, and sent a bulk email complaining about the problem to as many variations on Firstname.Lastname@companyname.com as I could think of. They covered the payment themselves to make the problem go away as quickly as possible (and later fixed whatever it was that was causing the problem).
48: the crazy bone growth broke through my gums so that there was exposed jawbone in my mouth... while I was in DC and brushing my teeth, the bone ridge broke off.
I'm going to hide under my desk now until I can stop making this involuntary whimpering noise.
6: Yeah, I'm sick of the lack of transparency anyway. Are megachain which charges above average rates just bought up a couple of hospitals in areas where there's limited competition. They charge above average rates for their teaching hospitals and have historically jacked up rates when they took over community hospitals.
I do not know why the AG approved the deal when there is a law intended to keep health care inflation to the rate of economic growth. The Health Policy Commission did a thorough report--essentially opposing the deal. What's in it for her is not clear to me. This is one area where I think the Republican gubernatorial candidate, who previously ran a non-profit health insurer, would be better. But, of course, I can't vote for him for other reasons.
22: I don't think that this out-of-network bullshit is as common here. I think that if you have Blue Cross or Tufts here you're fine. Harvard Pilgrim too. You are in trouble, if someone needs to be hospitalized psychiatrically, however.
the crazy bone growth broke through my gums so that there was exposed jawbone in my mouth. Surprisingly, it wasn't really painful at all
I suspect that apo has reached the stage in his life where he begins transformation into a Protector-stage human. If I am right, it will soon become much safer to click on his links.
52: Reading it makes it sound horrible, but the whole thing was really painless. It was sore *before* it broke through--like teething pain, I guess--but then it was just there. Apparently this sort of exostotic growth (silver dollar word!) often develops past where blood can support the bone spur and so then it dies and falls off. This had happened to me once before, actually, and I can already feel where the next one is starting.
This had happened to me once before, actually, and I can already feel where the next one is starting.
I'll be under here for another hour or so, thanks.
57: not me, I'm a hereditary coward. I'll pay a kzin to do it.
I also have large mandibular tori on the outside of both sides of my jaw. So far they haven't caused any problems aside from occasionally getting stabbed with the edge of a Dorito or something, so the dentist just leaves them alone. The kids think it's where I retract my fangs.
"Scream and click" doesn't have the same ring to it, somehow.
51: What I would really prefer is to just pay someone else to be that guy. I'd happily pay someone a couple hundred bucks a year if they'd call uverse once a year to threaten to cancel, send some letters to get rid of this bill in collections, etc. But I think you can't really have someone who's not a lawyer represent you like that, and lawyers are just too expensive.
I wonder though, maybe it's less expensive than I think to pay a lawyer to write some letters to the collection agency. If it was say $150, that'd totally be worth it to me to not think about it.
Now I'll never get LB to make out with me.
65: The only thing anyone reads this blog for is the simmering sexual tension. We screw that up, and the ratings are going to take a dive.
33 reminds me of a detail in Imperial Life in the Emerald City - for some reason, the CPA suddenly needed advice about health systems, and got two experts from something called the Department of Defense Pharmaco-Economic Center flown over post haste. The point that the very existence of a government agency dedicated to keeping the military from being robbed by the medical industry was evidence that the US shouldn't be trying to give Iraq advice about how to run its health ministry was obvious, but sadly not stated.
Every single discussion of medical billing in the US simply reinforces the conclusion that "KILL IT WITH FIRE!" is the only solution.
Honestly, it really does seem like a system that has become so Byzantine that incremental reform is doomed.
64: I've done this with some success with my energy supplier (roughly the British equivalent of a health insurer), so much so I did wonder if I should hang out a sign. An app would be nice, too.
Flowing tresses, facial bone spurs, amazing healing ability: evidence is mounting that apostropher is a Klingon.
64: With those guys (and lots of other companies, incl. some insurers) the trick is to threaten to invoke your arbitration agreement. This will, at minimum, escalate your problem to the legal department (who will have discretion to get the issue resolved), and it can give you some leverage if the agreement requires the business to foot the arbitration fees (which unless they changed it recently is true of that one, and pretty common though certainly not universal elsewhere). Mandatory arbitration agreements are of course seriously evil, but consumers can often use them to their advantage in smallish individual disputes.
For reasons not worth going into (other than to say they are related to health issues I was having 5 or so years ago), my doctor strongly recommends that I get annual colonoscopies as a preventative measure. But of course, annual colonoscopies are only generally recommended as a preventative screening for men over 50. Which I'm not, which means that my insurance company won't consider these preventative, despite the fact that my doctor is ordering them for that reason. So, I have to pay for them all myself (against my deductible which is $7,000--with an out-of-pocket max of $14,000). (Assuming of course that everyone involved is in-network.) Or, I would have to pay for them, I mean, if I ever got them done, which I haven't, because I haven't yet been able to find anyone who will tell me how much it would cost me to have the procedure done. I get the same answer as 22: it depends on the insurance company so I should call them. If I call the insurance company they say they can only quote me a giant range of potential prices (like $1,500-$10,000, even at a particular facility) because (they say) it is a complex procedure and there are too many variables involved in what the actual procedure could entail.
51
Yeah, a threat to report something to the BBB or the Attorney General usually can get good results. Also just being an intransigent PITA is necessary. A lot of insurance companies purposely deny stuff they cover and hope you'll pay it without questioning. Also calling multiple times until you get the answer you want can sometimes work. I had a 9 month fight with BCBS and eventually it ended when I got a strangely friendly man who probably lost his job not long after I talked to him, since he basically admitted they were entirely at fault and would pay the disputed amount.
The sleaziness of medical billing is shocking and ought to be illegal. I had a friend who was charged double for a surgery, because it was billed as two procedures--one to cut her open, one to stitch her up. Imagine if a store charged you double the marked price on a sweater, saying one price was for the front and the other for the back. And you only found out the price after you'd put it on and worn it around, but you if you don't buy the sweater you'd freeze to death.
The fact that it's "free market" AND we have no fucking clue how much anything costs with 0 transparency and major there's corruption/collusion/racketeering so a kleenex cost 100$ is just the absolute worst of all worlds. In China (which now has a system resembling ours, but with more comprehensive govt provided insurance) prices of all procedures are listed on giant boards outside the hospital and in all the lobbies. In places where there's not a national healthcare system, listing prices upfront should be required.
*blood pressure slowly receding"
a government agency dedicated to keeping the military from being robbed by the medical industry
That's not that agency's mission, FWICT, even in veiled language. The website says they do stuff like manage the DOD formulary, contract for pharmaceuticals, evaluate pharmacy benefits, etc. - Tricare, the private insurance side of things, is involved, but it seems much more in the domain of the military-owned doctors and hospitals.
They could possibly limit robbing by the pharmaceutical industry, though.
64: Filing a suit in small claims court is usually pretty cheap and easy, and wouldn't take a lawyer either. In some states I think they're not supposed to be there at all. Unless it's a fairly substantial amount of money I suspect that even a company with a mandatory arbitration agreement would rather just give you money to go away rather than send someone to the court room to tell the judge that you can't actually sue them.
Or, you know, military-owned hospitals and military doctors.
YOU HAD IT RIGHT THE FIRST TIME, BROTHER.
I suspect that even a company with a mandatory arbitration agreement would rather just give you money to go away rather than send someone to the court room to tell the judge that you can't actually sue them.
I have been the lawyer sent to small claims court to tell the judge that my giant evil client could not be sued.
I'm not sure small claims is relevant in this case. The issue here isn't the money (I'm happy to pay $80 to make it go away), but rather that I want off the credit report that it ever existed. From a little poking around, this typically involves sending some letters doing some combination of forcing them to document that we really do owe the money, and/or agreeing to pay the amount in full if they'll stop reporting it. But I don't think they can be forced to do this easily, and at any rate I now live in a different state so they'd likely just ignore any judgement.
Also, doesn't small claims court require waiving your right to appeal?
The US health care system works great when all the glibertarian assumptions required to make the free market seem like a good idea are actually true.
I get cysts on my skin regularly - I've definitely had at least 8 over the past 15 years, probably over a dozen. When they get big enough to be a problem (say, in the way of haircuts, if they're on my scalp), I make an appointment and get them removed, no fuss. When I didn't like how one doctor did it, I Googled another one and I've been happy with them ever since. My insurance covers most of it - maybe because I have unusually good insurance, maybe because sometimes these procedures aren't just cosmetic, or maybe because insurance companies find it profitable to cover stuff like this, I'm not sure. The co-pay is trivial. I get a bill in the mail for like $100-200 in the end, so I'd get these things removed less often if I was poor, but it's all cosmetic to begin with.
All of this is not intended to be a defense of the system overall. An illustration of just how few medical situations there are in which the system is actually justified, maybe?
prices of all procedures are listed on giant boards outside the hospital and in all the lobbies
I love this image. On the other hand, after hearing about a couple of M/tch's interactions with the Chinese medical system (Did you know he'd been in China? Yeah, well I bet you didn't know he's in Cuba right now.), I might pass.
79: I wrote to whatever bank took over WAMU, because they claimed to have a debt against me. They wrote back saying they had no record of it. My FE (who is *very* thorough about shit like this) found some stuff online suggesting that when WAMU went under, some rogue employee sold a bunch of names and made up fake debt. So, it's probably worth looking into.
"I got a strangely friendly man who probably lost his job not long after I talked to him"
You got to talk to Mr. Incredible?
82
Oh yeah, the Chinese medical system has its problems and I would avoid anything but the most routine stuff outside of a major city, unless it's an absolute emergency. Also not speaking Chinese would be a major issue, outside some of the better hospitals in major cities. I'm curious as to what his experience was. I've had fine experiences dealing with a range of maladies (some very serious, but nothing requiring surgery or cutting edge treatment), though all the hospitals I've time in as either a patient or a helper have had very basic facilities and don't really inspire great confidence in their hygiene.
People in my office have started getting the chikungunya virus. I suspect I'm doomed to get it myself, unless I can manage to stay away from mosquitoes.
Oh yeah, that's here in central Texas.
Yeah, it's definitely worth looking into, I just don't want to do it because it seems like the most annoying thing ever to deal with.
Yeah, its been "here" for a while, but has only recently progressed to the knocking-everyone-on-their-ass stage.
On the plus side, this means my Director is out of the office all week.
Also, people have been saying they need to cancel Carnival because of ebola.
Upet, you might try letters to the credit reporting agencies. Kill it where it matters.
(There's a statute that makes the reporting agencies have to investigate with creditors, and fix wrong shit on pain of a fee shifting lawsuit.)
Apparently, we have one of only 4 medical facilities in the US that's set up for ebola.
Commenters think it's ease of quarantine that makes our location attractive for such a thing.
Incidentally, it might get results to invoke the name of the Better Business Bureau, but aren't they a rather lousy organization in terms of what they actually do?
92, you're near the NIH's Rocky Mountain Laboratory, right? That's one of the few facilities allowed to handle things like Francisella, Q Fever, and yes, Ebola.
We're starting s drug discovery project for Chikungunya, mostly so that we can say it more often.
94- Yeah, and they put another one in not-quite-downtown Boston.
Yeah, and they put another one in not-quite-downtown Boston.
Yes, and after years of alarmist from local alarmists, the Boston City Council finally voted to allow it to exist in May, years after it was built. Maybe it will actually do something soon!
97: I wasn'y keen about that lab, because they lied about a lot of safety stuff, so I didn't really trust their assurances that an urban environment was the right place to do that kind of research.
Yeah, its been "here" for a while, but has only recently progressed to the knocking-everyone-on-their-ass stage.
As far as I know, it really hasn't hit that stage here yet. Let us know how it goes!
Chikungunya is like having 10 drinks a day.
Someone at church had a grandson who was 7 months-old and got the enterovirus with about 3 other things including a bacterial infection in the ear. He had to be hospitalized. Scary stuff.
Another judge rules that subsidies on non-state exchanges are illegal.
This won't make me popular in this crowd, but the solution* is to make Health Savings Accounts mandatory for anyone with a deductible over a certain threshold (probably equal to the threshold that qualifies you to optionally contribute to a tax-free HSA today). I haven't worked out the specifics of the proposal, but I would probably require annual contributions to the HSA equal to about 30% of the applicable deductible, with the requirement waived once the HSA balance reaches 2.5X the annual deductible. Health insurance premiums have become so costly that most individuals and a lot of businesses have "traded down" to policies that cover only the tail risk. The vast majority of people with high deductible plans (that's about 20% of employer group lives and a larger proportion of Obamacare lives) will not qualify to have any services reimbursed by insurance in any given year (apart from preventive services provided without cost sharing). That means those folks need to self-insure all their reasonably expected medical expenses, which for most people means saving more. Either that or buy the gold or platinum insurance policy that provides first dollar coverage. In effect, we need an individual mandate for self-insurance.
*I am on the record as preferring a wholly different type of solution, but working within the boundaries of the politically feasible, this is the sensible path.
102- He certainly sounds like he has no political bias:
"The administration and its bureaucrats in the IRS handed out billions in illegal tax credits and subsidies and vastly expanded the reach of the healthcare law because they didn't like the way Congress wrote the Affordable Care Act," White said at the ruling, according to Politico. "That's not how our system of government works."
I might be ok with 103 if the government paid for the HSA contributions for lower and average income levels.* Most people can't afford to self-insure.
* even then, it has the perverse effect of discouraging people from seeking medical care until they are in crisis, which is exactly the wrong incentive if we're trying to control costs.
if the government paid for the HSA contributions for lower and average income levels.
Totally on board with that. I would even offer extra top-up contributions for people with chronic conditions provided they substantially comply with their treatment plan.
106 is of course a baroque monstrosity that no sensible person would design from scratch, but you know, that's where we are in this country.
107: sometimes, Kermit, you have to just call the mob out on the street and kill people until the head of state declares a coup and gets rid of the reactionary institution standing in the way of modernity. and on this one I'm with you all the way.
Also just being an intransigent PITA is necessary
so true! in so many contexts! Diego Gambetta's Codes of the Underworld: How Criminals Communicate is a key source book here.
75: This American Life did a story recently about how showing up in court to dispute a debt is a near-guaranteed win, since the collection agencies almost never get the proper documentation when they buy your debt.
New plan! Someone here has to volunteer to get ebola. Then when the government freaks out and tries to quarantine you in their spiffy facilities, you say, "um, too expensive, can't afford it, healthcare sucks, I'll just treat this on my own at home." Then use your status as a personal biological terrorism weapon to get us a real national healthcare system.
In China (which now has a system resembling ours, but with more comprehensive govt provided insurance) prices of all procedures are listed on giant boards outside the hospital and in all the lobbies.
Also, this.
http://chinahopelive.net/2014/09/07/anti-bribery-signage-at-our-hospital-in-huangdao-china
Appropriate to this thread, Jammies told me last night that as of 2015, his insurance is covering nothing out-of-network. Absolutely nothing. What if you're out of state? Sorry fuckers!
At first I was outraged, and then I remembered that I have a separate 4K out-of-network deductible which is entirely independent of my 2K in-network deductible (and separate from each of the kids), which amounts to basically no out-of-network coverage anyway.
Anyway, it looks like the way to go is to put Jammies on my plan. Aren't you all fascinated.
Do you not have options for better plans?
The best health plans of mice and men go oft awry.
I'm not sure exactly why my plan got so monumentally worse this past year - my deductible doubled and my premiums increased. (I remember Kermit and Minivet had some theories, but nothing fully explained it.) There is more than one track - I could have opted for a higher premium/lower deductible - but I crunched the numbers and it seemed like it would all come out in the wash.
Anyway, Jammies's employer's plan is probably doing that deliberately. Coverage like that pushes all of the people who are paying attention and have alternative sources of coverage onto that alternative coverage. I'm sure somebody has figured out exactly how much more likely those people are to need health care than people who don't pay attention.
113: So, what if you have a heart attack while you're in California. Are emergency services covered differently?
But I mean, not that Jammies is statistical evidence, but he's great for a health care plan. He gets essentially no health care, aside from new glasses once in a while and teeth cleanings. How does this purge separate out the sick from the healthy?
119: I seriously have no idea. I assume under Jammies' plan we'd be on the hook for the whole thing.
Maybe I'm too quick to assume the worst, but the incentives for health insurance companies are to figure out how to push sick people into other plans.
No, that's my assumption as well.
Maybe they're just trying to keep you from going on his plan because of all the traveling you do and all the obstetrics you consume.
Right, I'm the one that should be getting ditched.
And your deductible and premium increased. It wasn't enough, so they'll have to up their game.
A pregnancy is a great way to max out your deductible, it turns out.
Two full months before you've incurred any bills, in fact.
We just got a bit worried about Mrs Digest's migraines so she went to see a GP, then a neurologist, then have two MRIs. Not sure how much I'm going to be able to claim back on the travel insurance, but it looks like the total cost is going to be about €220; about US$265. That's how much these things actually cost, outside the reach of the US doctors' cartel. As I say, this translates to roughly a TARP's worth of public funds every three or four years, which public money they extract by a process that kills a few tens of thousands of poor people every year.
We also spent another something like €22 on six months' worth of anti migraine medication, but pharmaceutical industry economics is more complicated and the case more arguable, depending on how you allocate research overhead. So I stuck to the direct physicians' costs. The American health insurance industry is very much a second order problem. The real problem is that the actual health care costs so outlandishly much. Not sure why, but in most of the rest of the world, doctors drive lower-spec Audis.
I think it's actually a third order problem. Doctors have to make five times as much money as anyone else, because our educational system forces them to go $300,000 in debt to become doctors.
That's the same problem as the second order one. If the cartel didn't enforce itself by refusing to recognise foreign qualifications, that cost would also be reduced
I don't know about the details of their immigration or green card-obtaining, but I have worked with many doctors with foreign qualifications. The cartel does enforce rules but it is hardly unchecked or monolithic.
131: You can go to a foreign medical school; you just have to do a residency in the US.
If you want to bark up this particular tree, you're better off to talk about limits on what physician assistants can do.
On the other hand a Bangladeshi doctor can just rock up in the UK and start practising. In any case, res ipsa loquitur; whatever American doctors do in order to raise their incomes to multiples of international norms, and to extract huge amounts of public subsidy at the expense of avoidable pain and death for poor people, it works.
Where were all these apologetics for profiteering when I needed them?
You guys used to own Bangladesh. That's different.
because our educational system forces them to go $300,000 in debt to become doctors.
By the way, also not going to hunt. My brother had a six figure medical school debt. He manages, however, on his £1xx,000 salary from the NHS as a consultant surgeon. The guy in Athens who saw Mrs D actually went to medical school in America. There's no way that the US cost base can be justified as a sensible ROI on a $300k investment.
I'm going to go cross-bench on this one and say, contra dsquared, that overpaid physicians do not fully explain* the fuckedupedness of U.S. healthcare, and contra cryptic ned, anyone who denies that excessive physician compensation is a major part of the problem is selling you a bill of goods.
* The bigger problem is how they get paid those exorbitant amounts (for volume of procedures) and which ones get paid the exorbitant amounts (specialists). We've created a world where the only way for primary care docs begin to close the yawning income gap between them and their specialist peers earn is to practice primary care very poorly (see as many patients as possible and refer them out to specialists as quickly as possible).
My global health insurance covers care everywhere in the world except the United States. Their argument is that its too expensive there. And if they are basing that argument on the list prices, they have a point. But it means my family can't get non-emergency medical care when they go home in the summer.