The score would almost certainly qualify as a credit report that you are guaranteed access to buy the fair credit reporting act. Pretty much, this article gets the facts wrong in the first two sentences.
I doubt it. The hospital isn’t extending an offer for credit, so the law probably doesn’t apply.
Also, from personal experience, the FCRA reports are useless.
The credit reporting agencies report completely different scores to consumers than banks, and give false information about how to increase your real score.
In particular, doing things that benefit banks (such as opening more credit cards) increases the consumer visible scores, but not the scores used in many real estate transactions.
The entire credit reporting industry should be outlawed.
If I owe you money and won’t pay, sue me. If you want to gauge my credit worthiness, look at my income, and check for court decisions against me.
Two things, having worked for a big Credit Reference Agency although not specifically on consumer credit.
1. The commercial customers can (for a fee of course) arbitrarily customize the metrics they care about. If you're looking for customers for your high APR "accept anyone" card you don't actually want the person with a squeaky clean history who'll never incur interest. But the recommendations do correlate pretty well with getting what most of us would consider better credit. Lower rates, better terms.
2. The CRAs grew naturally out of what happened before this data was available. Experian, for example, is essentially spun out from a mail order catalog company. So what your plan does is just waste everybody's time for a decade or two and then we're back here again but meanwhile the poorest people have no access to credit.
Well, the Equifax hack was way bigger. Probably took a little pressure off of the other bureaus when that happened.
Periodic reminder that there are more bureaus than just Equifax, Experian, and TransUnion, and all of them buy and sell your data every day. One of them [3] even sells your salary data to prospective employers so that they can negotiate against you more effectively.
There is one difference: violence. Laws are enforced on threat of violence. A business cannot force you to follow their procedures, at most they can deny you business. If I start selling drugs I import at a cheaper price, the government will use violence to stop me (including potential enslavement for a few years).
Then healthcare shouldn’t be a business because the natural result of refusing to provide it to those in need is injury and possibly death. That seems a greater and more imminent threat that people in the US face than most forms of state violence.
That's a difference, yes, but orthogonal to the topic.
As a businessman, as much as you can direct the behavior of both your customers and your employees, you can influence the lawmakers. After all, they too want money or things that money can buy.
Violence is just one side of the coin that is power. The other side is voluntary (or technically voluntary but not quite) participation, which is primarily controlled by money. That's what makes politics and markets intertwined.
I don't think that health care (or the things you mention) should be treated as a market. I was only responding to the claim that this is a "cartel market" and not basic market behavior.
Gotcha. I've asked myself those questions to probe my feelings. I think things are going to get pretty ugly as the US starts to grapple with this again.
It's also pretty natural to not want to die because of an error on your credit report. Imagine, for a moment, that some other cwzwarich filed for bankruptcy a few years ago. By some (incredibly common) mistake, their bankruptcy ends up on your credit report. And you go in to the Emergency Room with a potentially life-threatening injury.
The doctor runs credit on you before providing treatment, and because of this erroneous bankruptcy that you may not even know about(credit reports can only be reviewed once per year), you are placed in the hallway instead of being given a private bay despite the increased risk of infection. The hospital wanted to make room for paying customers, you see.
So while it's natural to want to "sell" to "profitable customers" in this case applying free market principals to this makes a complete mockery of our health care system. And given the credit bureaus' track records of high inaccuracy and difficulty in disputing the reports, you're likely to get poorer treatment inexplicably, and entirely by accident.
Maybe finding new ways for the market isn't the best approach. What about publicly shaming the people who profit off of this?
I remember there was a big outrage about Martin Shkreli's actions. Meanwhile the CEOs of these companies probably get lauded in business magazines.
Calling these miserable, greedy, selfish bastards out for what they are could be a first step. God, how I'm hoping for a socialist revolution to take place within my lifetime...
What about publicly shaming the people who profit off of this?
We've seen that this is something that absolutely doesn't work. They (that's the people who matter) just find a scapegoat and everyone else carries on just as before. Shkreli ended up in prison, but Valeant is still busy making profit off the backs of patients, and despite Hillary Clinton's professed outrage prices for such drugs as Syprine haven't gone down a penny. Netflix has a documentary on the case.
Where is the revolution? Where is single-payer healthcare?
Americans don't want single-payer healthcare. If they did, they'd be voting for it. Instead, they (especially poor, rural voters) strongly vote for the party that says they're keeping "socialism" out of healthcare.
Americans are getting exactly what they voted for.
A socialist revolution? Do you mean that you'd like the US to become more like Sweden, a social democracy? Because it bears repeating, there is not a single desirable place to live on Earth that is not primarily governed by free market forces, including Sweden. Sweden, Norway, Canada...these are not socialist states.
Also, let's be clear about one more thing. Martin Shkreli is not a free market capitalist, he's a crony. Leveraging state patent systems to create abusive monopolies is not free market capitalism, that is textbook crony capitalism and the enemy of a free market. Without arbitrary state enforcement of medical patents on insulin and epipens, do you think that these would be exceedingly expensive items? Are you being bankrupted by Benadryl? Hardly.
There are absolutely elements of healthcare that are far better serviced by a command economy than a free market, and I think the weird hybrid system in the US is the worst of both worlds in many such cases. But a socialist revolution? Socialism is an authoritarian nightmare that cannot suitably answer any question related to scarcity or competence.
The thing you're missing about "free market capitalism" is that, in the USA today, our "free market capitalism" absolutely does include state patent systems leveraged to create abusive monopolies. You might call it "crony capitalism", and you claim that it's not "true" "free market capitalism" (which sounds like the No True Scotsman fallacy to me), but the fact is, one of two major political parties in this country does say that what we have now, and what they want to retain, is "free market capitalism".
As for "socialism", again you're disagreeing on definitions. To most Americans, Sweden, Norway, Canada, etc. are "socialist".
Almost no product that you use is subject to abusive state monopolies, which is why almost every product you use is competitively priced. So no, free market capitalism is not indistinguishable from crony capitalism.
As far as definitions go, my definition of "socialism" is actual socialism, not social democracy. This quote is overused at this point, but Danish PM Rasmussen explicitly clarifies "I know that some people in the US associate the Nordic model with some sort of socialism. Therefore I would like to make one thing clear. Denmark is far from a socialist planned economy. Denmark is a market economy." Adding central planning to ameliorate some of the rough edges of market economies does not create a socialist state.
>As far as definitions go, my definition of "socialism" is actual socialism, not social democracy.
Again, most Americans will disagree with you. The definition of a word is whatever most people agree it is.
>This quote is overused at this point, but Danish PM Rasmussen explicitly clarifies
No one in Denmark has any authority to define a word in the English language as used by Americans.
>Adding central planning to ameliorate some of the rough edges of market economies does not create a socialist state.
According to Americans, it absolutely does.
>So no, free market capitalism is not indistinguishable from crony capitalism.
Again, according to many Americans it is.
Here's a challenge for you: pick out 100 different rural counties across America. Go to each county, and take a poll, asking them, "Is Denmark a socialist country?" I guarantee you that a clear majority of those polled will answer "yes".
If this conversation is now between whether "socialism" means "socialism" or "social democracy" to you, I actually don't care. As long as you are not advocating for a revolution that results in actual socialism, then I have no problem with you.
I'm not advocating for anything. All I'm doing is attempting to point out that it's really hard to have a rational discussion about something when people can't agree on basic concepts and definitions. And the problem in America now is this: we can't even agree on what "socialism" is, or whether we want it or not.
Just try having a conversation with the average American voter (esp. in rural districts) about "socialism" vs. "social democracy" vs. whatever, and see how far you get. They're probably going to say Denmark is "socialist" because they saw it on Fox News. But these are the people electing the leadership here (or about half of it anyway). We have two "sides", and even many on your side probably would have a hard time with these concepts. It's no wonder things are so broken here, and I don't see how it can get better any time soon when the two sides can't even have a rational discussion because they can't even agree on basic language or concepts.
I hope the US Federal Government does something to fix the situation for Healthcare. Healthcare and Education seem like the biggest issues in the US currently, just being unlucky on either aspect, even if you make amazing money can throw you into poverty it seems.. seems like a horrible way to live in constant fear.
As a consultant, with a couple of monthly prescriptions (thyroid, asthma, allergies), and a wife with a couple of monthly prescriptions (allergies, asthma), we pay just under $2000/mo for insurance, then about $200 every few months for doctor bills, and around $150/mo for all of our prescriptions.
All in all, we spend about half the median household income each year in health care. When my wife got pneumonia after the flu, we had to drop thousands on an ER visit.
If I wasn't well paid, between our allergies and asthma, we'd probably dead.
This is where my family was in 2017. In 2018 I took a FT job with my biggest client when they offered to pay 100% of a significantly better health plan for my entire family. I didn't regret it then and I don't regret it now.
In the US if you leave your job for any reason you don't lose your insurance. You have access to the same plan for at least 18 months (some situations up to 36 months) through a law named COBRA. You have to pay all the premiums but that's what an emergency fund is for.
Under COBRA, you have to pay the employee portion plus a 2% administration fee, which means that for the average family you'll be paying 3x to 4x as much.
That doesn't address the underlying problem, namely the absolutely bat-shit insanely high cost of health care in the US. I have the cheapest family plan I can get. It comes with a ~$12k annual deductible and still manages to cost more than my mortgage every month.
In most states to qualify for that you have to be very poorly paid. And in many states, like Georgia for instance, Medicaid covers needy children, pregnant women, parents/caretakers, elderly, disabled and blind residents and people in need of nursing home care.
Unfortunately the people who are most impacted by this are the people who are least able to afford the move to another state. Especially when nearly every state in the south decided not to expand medicaid.
Depends on where they live[1], there are several states that didn't expand Medicaid under the ACA. They'd also have to make under 100-138% of the federal poverty level, which is ~$12,490-17,236.20 for individuals and ~$16,910-23,335.80 for couples.
This is the crazy part to me. You have private insurance, but the quality of the insurance is so piss poor that one wonders what the point of it is in the first place. Nothing seems to ever be fully covered under it.
The insurance is there to pay for the $20k+ heart attacks, premature babies needing NICU at probably $100k+, hemophilics needing $500k+ medications, etc. Also, if you're young, you're subsidizing healthcare for the old. If you're not poor (per government definition) and don't qualify for health insurance premium tax credits, then you're subsidizing them too. And if you're a male, you're subsidizing childbirth and other women specific costs. And who knows what else.
In other words, it's the same as a tax to pay for healthcare for the country, except it goes to insurance companies, and you have to deal with in network and out of network. Except this tax goes up the older you get (but capped at 3x what youngest/healthiest person pays).
Presumably, if you add up all the insurance premiums paid for every year of a person's life, it should theoretically add up to close to how much the insurance company expects to spend on you (plus some profit, capped at 20% by ACA).
The biggest joke is that Americans think that the amounts they are charged for healthcare services is what those services really cost to administer. It's really not even close. A heart attack does not cost $20k+ to treat in other developed countries. A broken arm costs maybe $200 equivalent in the UK vs multiple thousands in the US. I'm not talking about how much the patient is charged, I'm talking about paying the doctors for their time and affording the equipment to perform the treatment.
There's always the anecdata that floats around the internet claiming that you can fly to Spain, live their for 6 months, get a hip replacement, and fly back to the US for the same amount as the outpatient surgery costs in the US. It's basically true, though the numbers may have drifted slightly since it first started making the rounds.
> it's the same as a tax to pay for healthcare for the country, except it goes to insurance companies, and you have to deal with in network and out of network
I think this is one of the strongest ways to frame government-provided healthcare. It's no different paying a tax vs paying the company directly, and in the former case you have the whole US government bargaining on your behalf for reasonable healthcare costs (in the case of single-payer a la M4A).
> capped at 20% by ACA
20% is a lot when we're talking about these outrageous numbers.
> 20% is a lot when we're talking about these outrageous numbers.
It’s not 20% net income, it’s 80% of premiums have to be paid out to healthcare providers. There’s still all the costs of operating the insurance organization, and financials of publicly listed health insurance companies show net income in the 3% to 6% range.
For my high wage, my NHS fee would be just under £7k for the year, my taxes just about at 30%.
Granted here in the US, my taxes are ONLY 25%, but my healthcare costs are close to $30k/year.
That $20k difference is ridiculous ($11k more than in the UK when comparing tax+health), and I HAVEN'T gone to the hospital for a heart attack or premature baby or hemophilia, but if my wife did have a baby, it would cost us out of pocket around $8k (according to the likely VERY skewed numbers in my insurance packet).
A colleague I know is 54, he is single, has only catastrophic coverage and pays $1200/mo. Nothing is covered except 40% of any emergency hospitalizations. The bronze plan was $2000 and had a $15k deductible, and also was basically only co-insurance with $30 generics.
The way we are doing this here in the US is literally killing people. Medical debt is increasing.
My little sister-in-law was on vacation and walking along a path on a jetty with handrails, and benches, and dozens of other people. A rogue wave came and hit her and her friend. She was taken under, knocked unconscious and drowned (and died), until a random stranger who was standing near her finally found her and resuscitated her. She was medivaced to a hospital by helicopter that insurance only covered 10% of because she was out of network, she was then treated by a dozen or so doctors for multiple days as she got pneumonia and broken bones, and head trauma, all out of network. She ended up owing close to $100k with her insurance only covering the first $25k. In any other first-world country, she'd be out of pocket maybe a few hundred bucks. Not in collections for being unable to pay $75k for a freak accident.
Interesting that your NHS fees are at £7k for the year. That's about the amount I pay for my family's annual insurance premiums + deductible.
I'm no fan of insurance/hospital bureaucracy, but at least I can go to any specialist doctor I want without having to see a GP first. And I pick the job and insurance provider I want to reduce the amount my family pays each year.
Emergency situations like the last one you mentioned, if they are out of network, are still covered at in network rates, thanks to my insurance plan specifically stating that in their plan documentation. I feel bad for your sister-in-law and am glad she survived, but she did have a not so great insurance plan. I would strongly consider getting a different job or lobbying hard with my workplace HR if I had a plan that would only pay 10% in true emergency situations.
Your employer must be paying for a portion of your health insurance premiums, so you have to include that if you’re going to compare to the $7k GBP figure.
And everyone would get a different job with nice health insurance offerings, if they could.
Not to disprove my original point about how affordable the NHS is compared to my Made in America insurance, but the £7k is only the employee side, the employers also pay a bit (though much less), but a common benefit of most employers is private insurance on top of national insurance.
If my math is correct, employer + employee national health fee for £140k salaried employee is a few quid short of £10k which is still half of my annual health care expense, so my original point still stands.
> That's about the amount I pay for my family's annual insurance premiums + deductible.
Look at what it would cost to cover you and your family on the individual market without government or employer subsidies. As a contractor, I pay double what you do on the individual market, and that is only coverage for myself.
> Men die younger than women, and they are more burdened by illness during life. They fall ill at a younger age and have more chronic illnesses than women. For example, men are nearly 10 times more likely to get inguinal hernias than women, and five times more likely to have aortic aneurysms. American men are about four times more likely to be hit by gout; they are more than three times more likely than women to develop kidney stones, to become alcoholics, or to have bladder cancer. And they are about twice as likely to suffer from emphysema or a duodenal ulcer. Although women see doctors more often than men, men cost our society much more for medical care beyond age 65.
Yes, it's very likely I am wrong about that statement.
I assumed that because before ACA, childbirth was not covered by insurance and insurance pricing based on gender was allowed, and post ACA, childbirth was mandatory and insurance pricing based on gender disallowed, that it must mean that, in general, healthcare costs more for women than it did for men.
But perhaps that's only true for young men and women, if true at all?
> And if you're a male, you're subsidizing childbirth and other women specific costs.
And to that I say: fine. I will happily subsidize, through my tax dollars, health care to pregnant women, addicts, the obese, down-and-outers, whoever, so long as it means that everyone has access to doctors and hospitals when they need it.
I am far less worried about paying a few bucks a year to support someone whose condition I will never have, than I am about sustaining this spider's web of private health insurance, with its unaffordable deductibles and an endless list of shady practices. America doesn't need health insurance companies to act as intermediaries between us and our doctors. They add nothing.
healthcare is getting so bad that eventually medicare for all will be a republican position too. They will call it something else, but it will happen. the party has fundamentally changed.
Oligarchs know that money has to be spent to keep the plebs just well enough to prevent revolt.
There was also a survey (not filtered by party affiliation) asking if people would support a single-payer program with an elimination of private insurance. A majority said "Yes."
I'm not sure where the confidence comes from when in 2017, Republicans in the House and Senate tried to repeal the ACA without a replacement. It's on their radar and part of their platform is removing any type of protections or public access to healthcare.
but what did the president say in his recent address? he said the opposite. he said that because it's popular with his base. the republican party is now his party, and the old core ideals will be washed away.
like I said, they'll call it something else. repeal obamacare and make something new that will basically be medicare for all in some shape or form. it will be a handout to the big insurance, drug, and healthcare companies, I'm sure.
The president also said he had a great healthcare plan, trust him, and that he'd repeal the ACA with that great replacement. When it came time to repeal the ACA, there was no such replacement. The president says a lot of things, many of which aren't true.
Yeah, I know, he's a buffoon. What's important to me is his base. Other than the evangelical vote that is single-issue (abortion), the base is essentially just "rage against the elites" and they need healthcare badly.
I didn't specify before but I'm talking like 8-12 years down the line.
So every other country in the first world offering some form of socialized medicine will inevitably be like this, the US is just "winning" and leading the charge?
Or are we more the token outlier with a "worst of all worlds" system?
Government-run health care systems tend to lead to higher healthcare costs, since the beneficiaries aren't the payers.
Around the world, it appears that low costs lead to universal healthcare, not the other way around.
What America needs to do is make it cheaper and easier to become a medical practitioner without taking on half a million dollars in debt and wasting half of one's pre-retirement life. No fancy government program will work without first addressing that issue.
What is your evidence for this? The US is almost alone amongst developed countries in not having a government-run general heal care system, and has the highest costs (while not covering everyone).
And Medicaid, Medicare, and the Veterans Administration (the three big government run healthcare systems here) all run more efficiently by every measure than any private health insurance system.
Note that I fully recognize the problems that the VA has had, but when you really look at it fairly, they have many parallels to problems in the commercial side of the system, we just don't tolerate that when it comes to government (nor should we).
Both private insurance and taxpayer-subsidized programs pay astronomically high prices for healthcare; I haven't seen any examples of Medicare paying European-level prices for services.
> Government-run health care systems tend to lead to higher healthcare costs
I know this feels true because laissez-faire and commie-bashing rhetoric is still common in the Western world, but there have been numerous studies recently showing that the US is the most costly per capita. The next 3 countries (by 2016 numbers) are all places where most things are more expensive because the country and its citizens are relatively rich: Switzerland, Luxembourg, and Norway.
I suppose "public service" is technically the more appropriate term. But it is a public benefit in the sense that healthy people can contribute more to a healthy economy.
But otherwise I could be made responsible to pay for that other poor soul, the concept of risk distribution is too complicated and strokes of fate never touch me.
The issue in the US seems to be that even if you have a decent insurance plan you can still easily end up getting treatment by someone out of network. An anaesthesiologist or similar.
That won't save you. The doctor left the room and did a quick phone consult with a radiologist about your x-ray. Radiologist is out of network, so you'll get a big, fat, separate bill from them.
How so? Last I checked there are massive laws about who can open a hospital, who can operate as a doctor, who can sell what kinds of insurance, who can sell drugs, and what can be sold as a drug. This is government granted oligopoly.
Edit: Technically oligopoly, not monopoly, though it may tend towards one.
The logical conclusion to private markets + unrestricted lobbying + Citizens United. They literally made the laws that restrict competition. They were only capable of this because of the insane amounts of profit they extracted from an otherwise public service, which they spend on schmoozing lawmakers.
It also requires removal of limits on what laws the government can pass. If governments were limited to what laws they can pass when it involves consenting individuals, this would also not occur.
Interesting. Are you suggesting that in cases where all parties must consent, the law may not be passed until those parties explicitly provide consent?
I meant more that the government has no place legislating the behavior. I take the idea that what two consenting adults do in their own bedroom is their own business and not the government's and apply it even if they are, for example, trading or doing drugs in their bedroom.
Granted, all of this is pretty much meaningless when you have a government overstepping its bounds and doing what it wants. In that case, it seems the blame of the corrupted system would fall on those corrupting it (the corrupt government allowing itself to be bribed in exchange for monopolies).
Limited by what? A constitution? Like the one we already have that taken literally grants far fewer powers to the federal government than they routinely exercise.
Two questions. First, Citizens United is a case about spending money on political advertisements, not lobbyists. Are there political advertisements involved in this rent-seeking process?
Second, what exactly do you mean by "an otherwise public service?" Are you simply saying, in the absence of private medical care, that "medical care" would be purely owned by the government? This seems uninformatively tautological and I get the feeling some other meaning or implication is meant to be attached but I cannot pin it down.
>Two questions. First, Citizens United is a case about spending money on political advertisements, not lobbyists
Those 2 are conflated because Citizens United permits lobbyists to sidestep campaign donation limits by allowing industry groups to effectively spend unlimited amounts of money on behalf of or in opposition to candidates.
I think one needs to blame the First Amendment for this, not lobbyist. If I want to put up billboards advocating for a given politician, that is fully in my right. That I rent the space on the billboards to others and they use it to advocate for a politician isn't a significant difference. Even if we were to say that speech cannot be sold, then all that does is force the contract to become a bit different (instead of me renting the space, I sell it to the one putting up the adds with a promise to sell back or a certain fiscal penalty if I don't).
At the core of this problem is that speech can be amplified with money. Even if we ban selling of speech to others, organizations can still spend the money to host/print/post/billboard/telecast their own messages. Those with money will out message those without.
Is there a way to fix this that doesn't result in government control of political speech?
>I think one needs to blame the First Amendment for this, not lobbyist.
The first amendment has only been loosely upheld throughout our history. There are many types of speech that are regulated in spite of it.
>Is there a way to fix this that doesn't result in government control of political speech?
We had a system in place prior to Citizens United that didn't turn into government control of political speech. Many other developed countries have limitations on spending money on political speech that don't turn into complete government control of political speech.
There's no reason to assume that a few men in the 1780s got everything right. And a slippery slope argument is no reason to throw up our hands and stop trying to advance egalitarianism.
I'm saying that it's good for a citizenry to be healthy. When a government is encouraging its citizens to stay away from treatment because of prohibitively high costs to access it, that is not good. It is a public service since it serves the public to keep everyone healthy.
Absolutely untrue as the only markets we see this in are ones which are heavily regulated. And we're not talking safety regulations, but regulations to shape the market, which is likely impossible to keep from being corrupt (easy to believe if you've ever met an actual human being). I'd bet 50% of states have explicit laws limiting the number of hospitals in areas to protect county/state hospitals from competition, leaving many urban areas without high quality care, and yet somehow, through some chain of conspiracy theories, capitalism is to blame.
Nonsense. A public good is something that doesn't run out when more people use it, such as knowledge. Medical care makes use of limited resources such as drugs, hospitals, doctors and nurses.
What I don't like is low-effort memespeak on HN (even if I agree with the sentiment). This is one of the last places that has kept that at bay - until recently.
I'm aware of that guideline which is why I didn't say that exactly.
Regardless, I don't think silent downvotes really cut it anymore either - nowadays I tend to run out of them after reading only a couple submissions with active comment threads.
I think one-offs like this are ok, and I'd like to think mine was a step above "low-effort" ;) Besides, check out the discussion it spawned!
It's those long chains that end up being an out-of-order recital of some famous TV/movie scene that really irk me, personally. Those and similar are cases where the value is only in recognizing the source and getting that dopamine hit, and not in any further contribution to the discussion.
I have seen estimates that as much as two thirds of healthcare spending actually traces back to the govt when you count subsidies too. It is a mostly-socialized system at this point.
And of course even where the govt is not funding the product, they are stipulating in detail what it must include. E.g. insurance must include a long list of things from mental health care to nicotine patches, forcing people to go through their insurance rather than through a market where they would negotiate prices.
Huh? Medicine is highly regulated. If this was a market you would have hospitals posting prices and negotiating with customers directly on price / quality.
Instead health plans market to EMPLOYERS (not the consumers of the actual product). Trust me - the service there is pretty amazing! Tax law is designed to in many cases benefit these employer negotiated plans.
The market conditions as they stand today were constructed by the participants in that market. This is an outcome that one can reasonably expect, since lawmakers can be bought and a large proportion of health services are pretty much completely inelastic.
Buying people off isn’t a result of capitalism, it’s always going to be a problem because of fundamental human incentives. Any system will fail if it’s administrators are corrupt and simply abandon the system. You’re basically blaming capitalism for the government failing to uphold capitalism, it’s absurd.
This comment broke the HN guidelines by taking the thread on a generic ideological tangent. Those are predictable and boring, and lead to flamewars. Please don't post them here.
I'm not sure, but the underlying principle is that we're trying to avoid repetition. Especially the kind of repetitive arguments where people turn mean.
I wasn’t lying, I commented when that was the only comment with upvotes and the only comment here was also upvoted. My point was true at that point in time.
You do understand the awful people who control the government at the moment, right?
There are no bumpers now, ISPs now— just ‘cause!— can sell browsing data. You have a crummy leader at the top & just think all about the ghouls & industry monsters who if they’re not running/control an agency get to run ripshit & fulfill their wishlist by other means.
While I agree that the current leadership is probably the worst we've had in this regard (at least in recent memory), there's no way this all just started in 2017.
HIPAA does not preclude hospitals from sharing data with business partners as needed to conduct their business affairs, assuming those partners likewise comply .
IANAL. It is not a HIPPA violation if Experian has signed a BAA with the hospital. It's on the hospital to perform the due diligence checks, to verify that Experian's capable of upholding the terms of the BAA.
This article talks about how Experian have SOC-2 issues, which is a cause for concern, but smaller hospitals with tighter budgets could be inclined to look past it.
In general, it's important to understand that HIPPA doesn't prevent data from being shared, it gives it a legal framework to be shared within. When things go bad, the HIPPA-associated paperwork provides a roadmap for assigning liability.
Minor point, but it's HIPAA with two A's, not two P's.
HIPAA pertains to PHI and PII (protected health information and personally identifiable information, respectively). The fact of your office visit is not either of those if it's not linked to health information (labs, medical records, notes, itemized bills).
Further, it may be allowed under permitted uses and disclosures as-is, without authorization under the language for payments. I couldn't tell from the article, but the health systems could simply decline to treat you without your authorization for the credit check.
Separately, people love to make healthcare into the bad guy, but it's not a monolith and there are hospitals closing down because they are losing money. There is a systemic problem in the US here, and I bet this is those 2nd/3rd tier markets in smaller systems that can't absorb defaults like nationals can.
> HIPAA pertains to PHI and PII (protected health information and personally identifiable information, respectively). The fact of your office visit is not either of those if it's not linked to health information (labs, medical records, notes, itemized bills).
HIPPA protects you from gossipy front desk people. The rest is a joke.
Your prescriptions, hospital admissions, radiology orders, etc are in the hands of any of a dozen third parties before your claim is processed. It is trivial to un-anonymize the data.
"Private hospitals are now consulting a secret medical credit score from Experian before you even see a doctor. As a patient you do not have access to this score, nor can you see how it is generated. All you know is that you may be denied care, or receive different care, because of it."
Could we classify 'not being able to afford, either time wise, emotional labor wise, or money wise, to deal with the messed up medical billing system' as a pre-existing condition?
The one bright spot to this is that, since it's a ratchet that can only go in one direction and find more reasons to deny people as it gets more data, privatized health care will eventually be its own undoing when enough people are frozen out of coverage that they can form a voting bloc and give this system the bullet to the head it deserves.
> The Privacy Rule permits covered entities to continue to use the services of debt collection agencies. Debt collection is recognized as a payment activity within the “payment” definition. See the definition of “payment” at 45 CFR 164.501. Through a business associate arrangement, the covered entity may engage a debt collection agency to perform this function on its behalf. Disclosures to collection agencies are governed by other provisions of the Privacy Rule, such as the business associate and minimum necessary requirements.
According to Experian, it looks like they claim they do not collect medical or health information on California Consumers. https://www.experian.com/privacy/ccpa-privacy-policy.html I would love to send them a request to see if that is in fact true.
I’m confused, so what exactly do the hospitals want to gain from this “medical” credit score?
If the hospitals simply want to gain insight on your ability to pay your medical bills, wouldn’t your “normal” credit score be able to provide that insight.
What’s different between your “medical” credit score and your normal credit score?
Edit:
Additionally, there are laws in place in the US that state in emergent situations, no hospital (public or private) can deny care - regardless if you can pay or not. So the article title might be a bit sensationalized.
It is possible that in non-emergency situations, the vast majority of situations, a hospital may deny or change the quality of care based off of your likelihood of paying it off. No one knows the difference between a "medical" credit score and a normal credit score, but we do know that this special, secret credit score is being used to calculate patient treatment.
Wouldn’t the easier solution be to not accept patients without insurance (and low co-pays).
And given that it’s now a US requirement to have medical insurance, I’m still struggling to understand what this medical credit score is accomplishing.
That's patently not true. Acne is a medical problem faced by a substantial portion of the population at one time or another. In all but the rarest of cases it is not life threatening.
"There is good evidence to support the idea that acne and associated scarring negatively affect a person's psychological state, worsen mood, lower self-esteem, and are associated with a higher risk of anxiety disorders, depression, and suicidal thoughts."[1]
While Acne probably won't kill you, it certainly won't make you happier and could contribute to suicide if left untreated. We are lucky that acne meds are cheap, but there is nothing stopping those companies from shooting up their prices tomorrow.
In that case depression is the life-threatening ailment, not the acne. Just like pneumonia is the reason you go to the ER, not a common cold on the off-chance it might later become pneumonia.
Also by the way, the requirement to provide care to any walk-in patient only applies to ER's, and only until they have stabilized the patient.
Well, the requirement is more specific: the hospital must treat you if you are in immediate danger of dying. They only have to treat to enough to stabilize you, though, then their legal responsibility is complete.
I agree with the OP in a stronger spirit. It’s in society’s own best interest to ensure a basic level of quality of life to its members. There are many illnesses out there which can severely, negatively affect a persons life but otherwise aren’t always treated because of mitigating factors. Sleep apnea is a good example. Many can get by without treatment, but eventually complications from it or side effects of it can lead to chronic fatigue/reduced productivity at work, and even lead to death. Back pain can do similar. It’s not life threatening but can lead to reduced work productivity which could contribute to being terminated.
Medical insurance only covers treatment from specific medical practitioners, of which an entire hospital may contain a wide array of medical practitioners under and also not under any specific patient's insurance company. Having a routine surgery from a surgeon that is covered can still rack up an intense medical bill from an anesthesiologist who is not covered.
Similarly, if the insurance company for any reason disputes a hospital claim for any reason, up to and including disagreeing with the hospital that the issued treatment was appropriate in lieu of a cheaper treatment, the hospital goes to the patient to foot the bill.
So it is entirely possible to be fully insured and still be forced into unpayable medical debt through factors completely outside of one's control.
> So it is entirely possible to be fully insured and still be forced into unpayable medical debt through factors completely outside of one's control.
It's frustrating to me that this point is very often overlooked in the discussions about health insurance in the US. A lot of people who go bankrupt over medical bills are fully insured and suffer for reasons entirely beyond their control like the hospital an ambulance decides to route them to when they're unconscious.
Which sometimes makes me wonder, why pay for insurance at all? Sure sounds like a racket, "pay us and you may get into medical debt, don't pay us and we'll make sure that you do"
It's a requirement to have medical insurance, but the cheaper qualifying plans have enormous deductibles.
A Bronze family plan will typically have a $13k deductible. You pay that entire amount out of pocket before insurance kicks in, and it resets annually... so if you're in the hospital December 31 through Jan 1, you might be on the hook for $26k.
The high deductible plans were originally for healthy young individuals with an health savings account to pay for the occasional deductible. These plans could be used as tax free investments if you got lucky. These days families end up getting the high deductible plans because that is all they can afford. And they do it without savings to back it up.
This is incomplete. A bronze family plan will typically have a deductible of $6k for an individual, and 13k for the family, but it also has an out of pocket max of slightly over that, so once you meet the deductible that is all you pay. Also almost all bronze plans cover the first 3 doctor visits with a normal copay, and any preventive care has no copay. Gold and above plans typically do not have a deductible, and the out of pocket max is lower.
Many states have surprise billing laws to limit what bills you can receive from out of network providers.
> so once you meet the deductible that is all you pay
There are a lot of subsidized folks on the Bronze plans with zero ability to pay an unexpected $400 bill, let alone a $13k deductible. They're insured, but only technically.
> Also almost all bronze plans cover the first 3 doctor visits with a normal copay, and any preventive care has no copay.
Sure, but I'm referring to the sorts of bills that bankrupt people, not an annual physical.
>And given that it’s now a US requirement to have medical insurance
It became a "requirement" in 2014 with Obamacare, but since the repeal of the individual mandate in 2019, there is no financial punishment (except well, the increased possibility of medical bankruptcy) for not having insurance:
"Emergent" is the term used in the trade. Webster has this to say:
> “Emergent” properly means “emerging” and normally refers to events that are just beginning—barely noticeable rather than catastrophic. “Emergency” is an adjective as well as a noun, so rather than writing “emergent care,” use the homely “emergency care.”
Since you're nit picking already and because it's a "today I learned" opportunity, parent's usage fits one of the definitions of emergent, the first one here: https://www.merriam-webster.com/dictionary/emergent.
TIL indeed. Must be industry jargon or trade usage as another reply put it. As a lay person I’ve only ever heard it referred to as “emergency services”.
Standard Credit scores are more lenient for medical debt. It takes 6 months for unpaid debt to show up and fully removed if paid in full even after it is sent to collections.
"Specifically, the NCAP prohibits adding medical debt to credit reports until after 180 days from the time the account was reported to the credit reporting agency. It also mandates the removal of previously reported medical collections that have been or are being paid by insurance." [1]
Medical debt can still be added to your credit report.
In Switzerland private hospitals will calculate the possibility of success in your case and if it is too low you will not be accepted, because they want to keep their success rates high... Maybe such "Medical Credit Scores" could be used for the same reasons...
I'm with you, not paying medical bills affects your credit score the same way as any other bill. To me, it seems like it's just another service for the credit unions to make money on, while giving private hospitals some legal protection.
I will add credit unions are chartered banks...but unlike "banks" they are not owned by shareholders, they are non-profits made up of the members (account holders).
Ideally in 2008 all the "banks" should have gone bankrupt and the vacuum should have been filled with credit unions, instead lawmakers gave the banks $2T as a reward for ruining the US economy so they could float their own debts instead of declaring bankruptcy and enough so they could buy up their competitors to further consolidate the marketplace.
Medical debt is regarded less harshly in FICO 9. I am not sure how widespread the use of FICO 9 is currently among credit bureaus but it is the latest standard.
I bet 'Likely to be litigious' score is part of that Score. Physicians and hospitals would kill to see such a score before they start treating new patients
> Edit: Additionally, there are laws in place in the US that state in emergent situations, no hospital (public or private) can deny care - regardless if you can pay or not. So the article title might be a bit sensationalized.
This is true, but many life-saving treatments (such as chemo or radiation treatment for cancer) are not "emergency" treatments, despite being necessary and somewhat urgent.
The legal obligation hospitals have is that they must treat you if you are have a life-threatening emergency happening. That treatment can be the minimal amount needed to stabilize you so that you aren't at immediate risk of death. There is no obligation to treat you beyond that, nor to engage in follow-up care.
Yes, that is the current legal obligation. This is not enough, and important life-sustaining healthcare (such as cancer treatment) should be available to everyone, even if it is not an immediate emergency.
I think you’re viewing the problem backwards. It’s not that they intend to send out a standard bill and know in advance who can pay. It’s that they intend to send out bills scaled to people’s ability to pay.
It’s probably more profitable for them to send a small bill to a poor person than a large bill that is never collected. It’s definitely more profitable to throw the most ludicrous bill at those who can and will pay whatever cost is sent at them. You can also adjust the kinds of treatments given according to likelihood of profit.
I wouldn’t be surprised if the latter case is illegal (or happening or not). I’m pretty sure the former case is perfectly legal, though symptomatic of a bigger problem.
They might want people to be afraid that if they don't pay their bills, they might die. Since the threat of debtors' prison is no longer viable, I guess.
Moves like this erode my opposition to nationalizing the entire US health-care sector. If they're going to cartelize or confederate, patients--which is to say everyone in the country that lives and breathes--will also want a seat at the table.
From a more generous perspective, this may be a tool for price discrimination. Hospitals will charge based on what they think the patient can pay, rather than the actual costs of providing the care. When you receive care, you will be billed for a number that is calculated to make you sigh, flinch, or wince, but not call a bankruptcy lawyer.
This is a symptom of illness in the system, and leaving it untreated seems like a bad idea.
I believe medical bills over $100 no longer count against your credit score so of course that created an opportunity to break them out and market them specifically
I usually don't give medical providers my social security number. It's on all their forms, but I just skip that section and no one has ever come back to clarify that it's required.
I have no idea if they can require it or not, but I always assumed it was optional because they wouldn't turn away foreigners without SSNs.
> Experian doesn't match information to a person's credit history using only the Social Security number. Experian matches information using all of the identification information provided by the lender, so the account will be accurately shown in your report, even if no Social Security number is provided.
I guess that makes sense. I have been doing it just because I figure it's an easy way to limit my potential data breach exposure. Didn't know about this medical credit score thing.
It's common for people to not give SSN, but they don't need it. A name and date of birth is enough to match you to existing records the overwhelming majority of the time. Phone, address, insurance, and so forth, resolves the majority of what remains.
Usually the only time they'll fail to ID you is when you show up to the front desk with no identification and lie about your personal details, which I don't particularly recommend doing.
> So wealthy people get access to better care and everyone else has to take whatever is available.
That's how Canada's healthcare system works, too.
> Government health insurance plans give you access to basic medical services. You may also need private insurance to pay for things that government plans don’t fully cover.
Not really. In the US, you get medical coverage if you are old, an honorably discharged veteran, or indigent (either through ER or Medicaid).
In Canada, you get Medicare-like primary care, benefit from price controls on drugs, and can buy secondary coverage to get more. In the US, you get to subsidize drug development for the world and enrich a variety of different cartels.
Universal care is no different. If your surgery is deemed unnecessary, you really have no chance at getting it.
All of my relatives in Canada come over to the US for any major surgery. The reason? The wait time is in years, instead of weeks and some can't get the surgery at all.
"Once you start running a hospital like a business, you create an environment of perverse incentives. Care is no longer solely based on what's best for the patient, but how that patient's care relates to the hospital's finances."
Government-run care is no different. It doesn't magically solve the issue of treating patients as a number.
"So wealthy people get access to better care and everyone else has to take whatever is available"
The alternative is that everyone gets access to sub-par care.
The answer is an actual free market, rather than another, large middleman monopoly over our health care. We need to get rid of all insurance companies, allow hospitals and doctors to compete over price (which will reduce prices for everything to true values (instead of $80 Aspirin), and only have insurance for surgeries that are rare and can't benefit from the free market.
Monopolies are bad for everyone, whether it's big business or the government.
A free market requires informed buyers, there is no way 98% of people can be sufficiently informed about medical issues, nor do they have time to research them. The closest option is to hire an agent of equal ability (i.e. a doctor) to verify the claims of your doctor. Obviously, that's too expensive, so the next closest alternative is to use health insurance companies who do employ many doctors to verify proper treatment options (aka prior authorizations).
Same with the NHS that's often derided. Cancer, heart attack, stroke? You'll be treated very quickly with the very best treatments.
Need some physio, but delaying it isn't going to cause ongoing problems? You're going to wait.
If you want to skip the queues then there's affordable private healthcare as well for non-urgent issues ... my plan with BUPA costs my employer £1,600 per year.
> Contrast that to the US which could leave a person bankrupt for the same emergency.
Indeed. Even if you have good insurance, getting something like a heart attack, cancer, etc. in the US makes it likely that you'll be bankrupt in the end. I know three people that this has happened to.
Can you be more specific? Which procedures would they have to wait years for? And how many relatives do you have? All of your relatives doesn't say much if you only have one living relative in Canada.
I waited 8 months to see a Neurologist in Toronto for a slipped disk in my neck (he was in disbelief and shocked). By the time he saw me, it had healed on it's own. If you are dying the Canadian medical system is great (most of the time). If you suffer from things like back pain, injuries, condition, etc, it will be a long and arduous journey before you get the attention or treatment you need.
I have many more stories, (family member being sent home with an Abdominal aortic aneurysm on the verge of happening (Friday) because the Surgeon didn't have time to perform the surgery until Monday. Guess what happened on Sunday? Guess what else happened a couple of days later?
Wife almost died because she had to wait a month for a specialist. She just couldn't get anyone to take her seriously. Finally got the treatment in an Emergency room (she went septic).
I live in the USA now and have the best medical care in the world for my family.
> At the beginning of the year, the wait to see a cardiologist at three of Vermont’s rural hospitals was more than 100 days, according to data from state regulators.
> At Southwestern Vermont Medical Center in Bennington, hospital officials reported patients would need to wait nearly 200 days to see a dermatologist.
> As of March, some of the hospital’s specialists, including cardiologists, ear nose and throat doctors, gastroenterologists and psychiatrists could only see between 20% and 30% of patients requesting appointments within 10 days.
Canada's system is deeply imperfect (it falls short of France in most measures), and arguably underfunded, however such a finite limitation in resources is a reality in every country and every system. Such anecdotes about a condition being misdiagnosed exist everywhere.
I was in such incredible pain for so long that I finally realized why people kill themselves. I had asked my wife to cut my arm off with an axe at one point.
No, he needed surgery to avoid being in excruciating pain and incapacitated for months.
If you look at it in terms of economic productivity, the inability of the doctors to schedule this properly was taking some useful out of the workforce and jeopardizing their continued employment and financial stability.
>
I waited 8 months to see a Neurologist in Toronto for a slipped disk in my neck (he was in disbelief and shocked). By the time he saw me, it had healed on it's own.
There are plenty of multi-month waitlists in the US for common medical procedure. My wife sees a sleep doctor. Our insurance is fantastic. He has a nice, expensive office in an upscale regional medical center. I don't know which car in the parking lot is his, but there's a lot of nice cars in that parking lot.
It is a ----ing nightmare. Multi-month waiting lists to first see him. Month-long waits for scheduling anything. Three-month wait to schedule a minor surgery. [1] He screws up her prescription changes, the pharmacy won't dispense because he didn't tick some box on a form, and he goes on holiday for a few weeks. His on-calls aren't able to fix the problem, because, well, they aren't on-call for his sleep practice. Guess who can't get her prescription?
And for this privilege, we and my employer pay ~$20,000/year. I suppose we could fire his ass, and switch doctors, with no guarantee that the next one won't be any worse. [3]
[1] Cherry on top - despite being fully covered for the procedure, and paying what they asked for at the time of the operation, the surgery center started calling us, demanding money. Guess who gets to untangle billing? [2] We do. Guess who, once the dust settled, turned out to have overcharged us, and eventually cut us a cheque? The surgery center.
[2] Double-whammy - my wife dropped her old insurance two years ago, to switch to mine. Guess who started sending us bills last month? Her primary care provider, because at some point his office realized that she is no longer on her old insurance. Somehow, it's taken them two years to realize this. I'm assuming that the new provider has been paying them all this time, but who even knows at this point?
[3] I must say, my best interaction with the US healthcare system so far has been at a walk-in clinic located in a crummy office with peeling wallpaper, patient examination rooms that doubled as storerooms, a broken water cooler, and a bathroom with a door that mostly closed, located above a laundromat in an, ah, common part of town. The staff consisted of the doctor, who was cycling through patients, and his assistant, who was translating to and from Spanish, juggling papers and photocopies, and doing vaccinations and blood draws. I was in, I had what I needed done, and I was out, with zero billing bullshit. I didn't see any Teslas in the parking lot, though.
I had a relatively minor injury (wrist) from a car accident. Nevertheless, it needed some interventions and I was advised to start PT right away. Was given a referral and a list of in-network providers (for a large insurer). In my (metropolitan) area, I could not find a provider with a less than 3-4 month waiting period within 30 miles.
My step daughter wants counseling - 2 month wait. All three of my closest options for a PCP are "not accepting new patients".
This isn't a problem of socialized medicine. I grew up in Australia, and I know that much.
I live in the US and had to wait months and months for endoscopy, and even a referral to a gastroenterologist who could order an upper endoscopy. I was losing weight rapidly and in moderate pain for 90% of every day. It had nothing to do with what insurance I had. The only way around that was to pay cash... Regular appointment, 6 weeks plus a month for the GI. Cash? Scheduled within a week.
"Universal care is no different. If your surgery is deemed unnecessary, you really have no chance at getting it."
Highly disagreed. I had several unnecessary surgeries as a child in canada. I had some swollen drainage things in my sinuses removed, and the only danger is that I was really sniffly all the time!
"We need to get rid of all insurance companies, allow hospitals and doctors to compete over price (which will reduce prices for everything to true values (instead of $80 Aspirin), and only have insurance for surgeries that are rare and can't benefit from the free market."
Does this mean that the free market means hospitals can choose not to treat patients that are too sick, too black, too gay, etc?
Yeah that sounds a lot like American propaganda about the Canadian healthcare system. All of my family has had their surgeries done in Canada, and while there is a needs-based component the wait times aren't ridiculous.
Publicly funded healthcare may not solve all issues, but it removes the perverse incentive to refuse or reduce care quality because you don't have access to insurance or cash. Free market means shit to me if I'm mid-heart attack, I don't have the time to review pamphlets about why ABC hospital has the best care for the low-low price of $4999!
There are enough heart attacks (and other issues of an emergency nature where it's difficult to go do comparison shopping) that the health care system clearly needs to account for that sort of situation.
Government run care is different in one massive way: It's not a profit seeking entity.
Private insurance, even those run as non-profit, still turn a profit. Does the head of the DHS make 15 Million dollars in year? No? That's the average compensation for private insurance CEOs. Bernard Tyson CEO of non-profit Kaiser Permanente made 16 Million in 2017.[0]
Yes, it's a different problem with universal health care. Here (Canada) the problem isn't oriented around the question of are you rich enough but there's a trade off in wait times. From the Fraser Institute[1]:
> There is also a great deal of variation among specialties. Patients wait longest between a GP referral and orthopaedic surgery (39.0 weeks), while those waiting for medical oncology begin treatment in 3.8 weeks.
Still, the Canadian system is demonstrably better when it comes to outcomes. Canadians live longer than Americans, and have lower infant mortality rates for instance. Canadians also pay half of what Americans do for health care, when everything is accounted for. My partner is diabetic; like most medicines its a fraction of the cost of in the US. A universal system brings with it purchasing power. No system is perfect, but this one seems much better than the American one for the average person.
It's a choice. In my case, I'd much rather the Canadian system over the American. Even when it comes to surgery, I had a vaginoplasty (took 8 months between GP consultation and surgery; $25k surgery paid for by govt). My friend got her tubes tied (took a month; paid for by govt). My other friend was in the hospital for a month (admitted immediately; paid for by govt). My uncle had heart surgery. He did not have to lose his house. My step-dad had hip surgery (took 4 months; paid for by govt). Not to mention all the doctor's visits and tests accrued over a lifetime.
The speed of the health-care system really depends on the specific area of Canada you're in. Health-care is managed by the provinces, and the amount of funding they pour into it can vary wildly. Add to that the fact that medical infrastructures are far from uniform across the provinces, and you get very different results.
I lived for a few years in southern Québec, and I was amazed at the quality of care there. My wife had some pancreatic stones, and it all got dealt with (including 2 surgeries, multiple scans and a 2-week hospital stay) within a couple weeks. No bill. My daughter fell and had a concussion, we were scared about possible brain damage so I took her to the hospital at around 8PM. We were out of there at 6AM after an X-ray, an MRI scan and a few hours of observation. Again, no bill. I had four kids, and I think in total I paid less than $100 for their births, and that was for the food I ate or for parking.
Right now I'm more in central Québec, and the quality of care is a bit lower. It's a pretty rural area, so the budget is probably lower and the points of service are more spread out. Still, I like to know that a medical issue will never bankrupt me.
> The alternative is that everyone gets access to sub-par care.
Sub-par care is excellent when the current reality is that most people don't get access to any care at all.
You must understand that the vast, vast majority of people don't go to doctors. They don't have dentists. When a poor person is in pain they will continue to be in pain until the pain goes away or they die.
When given that versus a shitty but free healthcare system, who wouldn't want to see a doctor? To get $5 prescriptions to medicine that can help them?
And remember, this is assuming the healthcare system will be shitty - universal healthcare has never been repealed in a country that has implemented it. Don't you think if the citizens of these countries were so fed up with free care, they would be protesting and electing candidates that promise to dismantle it? Even Boris Johnson has to tiptoe around privatizing the NHS because he knows how wildly unpopular that would be, even among his conservative constituents.
>Sub-par care is excellent when the current reality is that most people don't get access to any care at all.
>You must understand that the vast, vast majority of people don't go to doctors. They don't have dentists.
Uhh… what? This sounds either out of scope for the US or just wildly inaccurate. Over 90% of Americans have insurance.
Edit: I do not live in a bubble. I stand by this comment, "only" 1/3 delay medical treatment [0]. The claim that the vast, vast majority of people never get it at all is simply false. Fact checks do not bear counterargument in a healthy discussion unless the fact check itself is lie.
And that number is decreasing under the current administration while the rate of medical bankruptcy (even for those with insurance) is also increasing.
Insurance != Healthcare or the financial capacity to see a doctor.
I have excellent insurance through my employer and still pay several hundred a month to cover my and my partners medical needs, on top of the insurance premiums in my paycheck. We are extremely lucky to be able to afford that but it's still nearly $500 a month that could be going to savings, retirement, a safer car, or more. Instead we spend about $6k a year to an inefficient system that doesn't produce better outcomes than universal systems like in Canada.
"Having insurance" != having good insurance that doesn't have eye-watering co-pays and excesses.
If your out of pocket excess is $1000 and you need $900 of treatment, but you also need to make rent, buy gas, feed your family ... well, you don't get the treatment (or you do, can't pay, and are made bankrupt). I think you might live in a slight bubble.
out of pocket limit to $1000 is still a very good plan, out of pocket limits on the plans most people have (usually termed "bronze plans") is well north of $5000
There is also an increasing issue in Canada of minor operations being delayed to the point where major surgical intervention is eventually needed.
With the medical system over-burdened, the system is now fundamentally reactionary in many specialties; delaying anything that can possibly be delayed.
It's saving a penny today to pay a dollar (or a loonie, I should say) tomorrow. It's economically burdensome and, obviously, creates a great deal of unnecessary hardship for those in line.
Nearly every Canadian has anecdotal stories of elderly relatively who had a minor ailment that needed surgery - were delayed for months because they were
low priority - and then needed a larger intervention as the problem compounded over said months.
Where does this show up in the data? How do you measure and value up to a year - which can be more than 10% of an elderly persons remaining life - being mired in uncertainty, discomfort, and pain waiting for a procedure? How do you measure medical efficiency and patient outcomes in this context?
The best way to describe the current system is that doctors (surgeons, in particular) are forced not to look out for the individual patient's best interest, but the best interest of their entire surgical waiting list in aggregate (and this can be dozens of names long).
So, yes, it is in the best interest of Patient X to have the minor operation done this week as there is a strong likelihood of further complications and a worse patient outcome if delayed. However, Patient Y needs a major surgery this week so Patient Y, rationally, gets the higher priority.
> which will reduce prices for everything to true values
wishful thinking.
we already see this with ambulance service. there is an overabundance of supply, but it has not reduced price. in fact, the opposite as all the companies run much less efficiently (less billable time).
people aren't going to shop and buy on price for hospital care. they are going to shop and buy on local presence. for regular doctor visits, the costs are already low.
> Universal care is no different. If your surgery is deemed unnecessary, you really have no chance at getting it.
There is no reason to have it exclusively. Having single-payer healthcare with mandatory participation for residents does not preclude existence of healtcare providers that are outside of that system.
Although it is likely that such providers would be just a small part, as for patients it would have zero monetary marginal cost to use providers that are part of system, so they would likely use providers outside of the system as a last resort or if there are significant non-monetary cost.
> All of my relatives in Canada come over to the US for any major surgery. The reason? The wait time is in years, instead of weeks and some can't get the surgery at all.
I'm in one the largest and wealthiest metro areas of the US, and there is a 6+ month waiting list to see mental health professionals.
> "So wealthy people get access to better care and everyone else has to take whatever is available" The alternative is that everyone gets access to sub-par care.
When I lived in Manhattan, despite living right down the street from some of the best paid surgeons in the country, my wealthy clients would fly overseas to France and Israel for their surgeries.
The fact is that countries with universal health care have better health outcomes, better quality of care, shorter wait times for care, pay half of what the US does and manage to cover all of their citizens. Each of those statements of fact can be cited here[1].
I have thought and thought about this and I have to say that I agree. Right now though, I am ready to shake things up in the US healthcare system and anyone offering a different solution is worth a look. So I am looking at "Medicare for all". I am sick and tired of the current system. So lets try something different even though I would ideally like a free market system where the poor are covered by the Govt and the middle class and rich folks pay out of pocket for MOST things. The moment you remove middlemen like the mafia insurance and overheads like billing companies etc and allow doctors to work directly with patients, watch how prices drop. I guarantee. I mean I pay like $22,000/Year premium for a family of 4. So even if I don't go see a doctor all year, I have paid 22,000. Don't even get me started on deductibles, in/out network , co-pays and all that other crap. Instead, I would prefer going to a doctor and receiving say a $200 bill for a regular visit. np. pay out of pocket. If I don't like that, I go to google and compare prices across other similar practices.
I have a relative who needed emergency surgery in the States. Unfortunately, the billing department would not let her have the surgery, because she was Canadian, and it was Friday, and they didn't have time to deal with it. The surgery had to be rescheduled for the next week, even though the doctor wanted it done immediately. This, despite pleas and offers to pay in cash, in advance – whatever it took.
So, instead the of the rushed surgery, my relative waited. After a day of waiting, she decided to go straight to Vancouver, B.C., where the issue was taken care of immediately, with no wait times.
However, because of the delay, her outcome was significantly worse than it would have been.
Basically, she lost much of her eyesight because of the "billing department."
I strongly support your line of thinking, but there's a number of issues with this viewpoint that I've identified, and I'm not entirely sure how to solve.
The main one is, the (expected) medical costs are different for different populations. In particular, the expensive sub-populations are (1) the elderly (because aging & death), (2) women (because pregnancy) and (3) some children (born with genetic diseases, birth deficiencies etc. but having no income/wealth to pay for them).
If we argue that medicine should be driven by the free markets, we should also allow the free market to take over other things, but we as a society (currently) refuse to do that (IMO for good reasons).
What's the value of old age? Retirees are almost completely non-productive, a drain on the society... you could argue about saving for retirement (it's "free market") but that's a bit of a lie, you can't "save" labour or energy, so there's always a transfer of value from the working population to the non-working population, and as the non-working retired population increases and the working population shrinks, that's going to become a problem one way or another (both in socialized and in individualistic retirement systems). Old age awaits everyone, a populace would probably be feeling very uncomfortable about their own future if they saw poor old people dying on the streets, refused medical care.
What's the value of bearing children? It's kind of parallel to the above, children are an investment into the future (future workers), currently it's on the individual to pay for this investment (pregnancy, career income loss, more housing, education costs) but the society benefits (extracting taxes / parts of the value produced by this future worker). Should women also bear the cost of medical care? You could say there's always a father in the picture, but some people also claim that fathers should have the option of financial abortion (given that they have no say in physical abortion). Generally I argue that there should be incentives for people to have kids (correlated with their income, so that high-income, usually highly educated people, have more of an incentive to have kids - e.g. some kind of negative tax rate).
And finally, what's the value of a human life? Should we condemn a kid to a short life full of suffering just because s/he was born with some mistake in their body? I mean, resources are limited so we always have to make trade-offs, but refusing medical care to kids born to poor parents seems particularly evil.
I'm not sure what the solution is... personally, I'm leaning towards a "highest highs, highest lows" kind of a society - having some kind of social net (regarding medicine, jobs, ...) while also allowing private markets for those who can afford them (i.e. if you want to buy private surgery, you can, if you're wealthy enough). But this needs to be carefully managed so the whole system kind-of works.
The video they show in the page has nothing to do with what the article is about. The person is talking about finding eligibility information for patients for things like worker comp, medicare, etc.
In 2017 financial bureaus changed their scoring system to be more lenient on medical debt and also remove collection reports if paid in full. This stemmed from a state Attorney General settlement against the hospitals that were extorting patients with threats of ruining their credit when disputes between hospitals and insurance companies arouse. Hospitals would just collect from the patients and let the patient deal with the insurance company to recover funds.
Hospitals want this leverage again so they built their own credit system.
The medical system in the US is so awful that I already avoid getting medical care unless it's absolutely unavoidable. I guess I need to add "never go to a private hospital" to that habit.
Same here. Just went to an emergency room with a fever and was charged $700 for 5 minutes with a doctor who told me to go home and stay in bed. I have insurance and had to spend several hours on the phone to get charges reduced to 240.
Did they give you a cost? That's fucking shitty they would encourage you to do something that just earns them money. I fucking hate private insurance (and I worked in it for ~3 years)
Of course they don’t give you a cost. You are essentially signing a blank check. The hospital can charge whatever they feel like and the insurance can pay whatever share they feel like and you are in the middle trying to figure it out.
At this time of the year the urgent care will decide you have the flu, and if your BP is elevated (You have a fever, so it will) they will send you to the ER as a legal liability mitigation.
If you look really bad, they'll refuse to check you in.
It's not clear from this article how people are being "denied care" based on this Experian product; the video example provided appears to be about a special need-based admission offering at a provider, not a normal admissions process. In other words: a check that you're poor enough to require the special service.
Tacking on to your comment, it's important to realize that hospitals do not usually lose money on patients that can not pay for routine procedures (because of generous government subsidies). The substance of this article certainly smells funny (experian is known to be shady), but it is not as nefarious as the author makes it out to be.
For context, hospitals are only likely to lose money on very complex patient cases, i.e. the kinds of program described in the video. In those situations, it makes sense that hospitals will want to make sure that either (1) the patient will be able to pay or (2) charities or government programs will cover them, once they apply.
Experian's system claims to helps them make that assessment. Will that lead to patients being turned away? Maybe, but it's not a straightforward conclusion, like you imply. The comparison to Uber ratings holds no water.
The reality is that American healthcare is a complicated market with many sources of revenue that aren't patients' bank accounts (charities, govt subsidies, insurance), and it doesn't lend itself well to this kind of oversimplifying analysis.
To be clear: the impression I got from the video was that this was a charity that the provider was offering, not that they were using Experian to validate eligibility for other charities.
The revenue for their charity is most likely dependent on government subsidies that are contingent on the financial status of the patients they're helping.
Even though they're determining eligibility for "their own" charity, they're likely determining eligibility for "other charities", if you follow the money.
I don't know what this has to do with my point; you can do this "follow the money" analysis to take any argument anywhere. On message boards, at least, it seems to turn out that it's almost never a good idea to just "follow the money".
She mentions that the product helps screen for the patient's "propensity to pay". From that I gather that if the patient has a low propensity to pay, then they get denied by the hospital.
This is from the product's lit:
"Predict propensity to pay using our proprietary Healthcare Financial Risk Score, which factors in historical healthcare payment outcomes and the patient’s credit history"
She mentions that the product also lets them pull "FPL", which in this case I imagine means "Federal Poverty Level", in addition to household size. Cincinnati Childrens has some info that might put that info into context: https://www.cincinnatichildrens.org/patients/resources/finan...
She says explicitly that she's pulling that information in the context of eligibility for "the charity program".
Further, unstated, perhaps speculative context: most people who go to the hospital pay through insurance and out of pocket. But if you go to the hospital without insurance, or can't cover your out of pocket component, most (every?) hospital will negotiate a lower rate; almost nobody pays rack rate out of pocket. So what they're calling "charity" might just as likely be the name they give the program where they come up with their real rate on the fly (I've been through this process with a large hospital chain in Chicagoland).
Either way: it doesn't support the post's claim that Experian's health score --- which I'm disinclined to trust, just like everyone else --- is being used to "deny care". That's an argument the article does not appear to marshal evidence to support.
So I've come to the conclusion that the US model of private health care is ultimately doomed and nothing will save it. Of course it's going to kill people in the meantime but it is doomed.
While on vacation recently I ended up listening to the Bear Brooks podcast [1]. It's a little longwinded at times (but it is aimed at non-technical people) but is not a bad way to spend a long drive.
The interesting thing about this story is how advancements in DNA testing have taken us from the simple case of is or is not a match (used in paternity testing and for forensics) to figuring out how much of a match you are. This has created a new field of genetic genealogy that famously led to the identification of the Golden State Killer [2].
So there's a lot of talk about privacy and your DNA but much like having your contact information uploaded by someone else, this is showing that that will be insufficient as your DNA will ultimately be inferred (at least in probability terms) by people who aren't you. There's really no putting this genie back in the bottle.
So take a disease like Cystic Fibrosis. Currently this requires life long medication and care. Depending on the severity, you may require one (or more) lung transplants. All of this is expensive.
So if you have CF and want to get private insurance in the US this may well be a pre-existing condition and excluded. Now this disease is usually quite apparent from birth but there are other diseases that are not (eg Huntington's). If you'd had a test and know you have it the insurance company has a "right" to know it (if you accept the premise of the US health insurance system, which I, of course, do not).
But this is only going to get worse. Ultimately health insurers will able to figure out if you're much more likely to have certain expensive conditions by knowing, say, that a sibling is a carrier (which greatly increases the chances you have it).
Taken to its natural conclusion, the system of private health insurance cannot survive. The only workable solution is group health insurance. Sufficiently large groups statistically even out. That's how insurance is meant to work. This could be a fully public health system or something in between (eg state-level).
So back to the medical credit score. There will be fights over this. At some point you'll have a right to see it and get corrections. This will probably be championed by states since the Federal government seems to have forfeited, well, governing. But all this is just arranging the deck chairs on the Titanic.
Of course there's still the separate issue of costs (in the US) to deal with but one step at a time.
I'm starting to think it's better to not be born (into society today) unless born into a rich family. The sociopaths have no checks & balances and everyone can just watch everything get worse.
I'm pretty much an anti-natalist. I don't want kids personally. I'm still fine with other people having them, but I can't morally justify bringing people into this world just to suffer.
407 comments
[ 0.78 ms ] story [ 314 ms ] threadAlso, from personal experience, the FCRA reports are useless.
The credit reporting agencies report completely different scores to consumers than banks, and give false information about how to increase your real score.
In particular, doing things that benefit banks (such as opening more credit cards) increases the consumer visible scores, but not the scores used in many real estate transactions.
The entire credit reporting industry should be outlawed.
If I owe you money and won’t pay, sue me. If you want to gauge my credit worthiness, look at my income, and check for court decisions against me.
1. The commercial customers can (for a fee of course) arbitrarily customize the metrics they care about. If you're looking for customers for your high APR "accept anyone" card you don't actually want the person with a squeaky clean history who'll never incur interest. But the recommendations do correlate pretty well with getting what most of us would consider better credit. Lower rates, better terms.
2. The CRAs grew naturally out of what happened before this data was available. Experian, for example, is essentially spun out from a mail order catalog company. So what your plan does is just waste everybody's time for a decade or two and then we're back here again but meanwhile the poorest people have no access to credit.
That's exactly what the hospital is doing when it doesn't require payment at the time services are performed.
Sadly, no. It's been all of them, including Experian. This seems flat-out mad to me.
https://www.theguardian.com/business/2015/oct/01/experian-ha...
Periodic reminder that there are more bureaus than just Equifax, Experian, and TransUnion, and all of them buy and sell your data every day. One of them [3] even sells your salary data to prospective employers so that they can negotiate against you more effectively.
1. https://www.thebalance.com/6-small-credit-reporting-agencies...
2. https://www.doctorofcredit.com/two-credit-bureaus-you-should...
3. https://www.theworknumber.com/
The various healthcare leaders use their wealth to strengthen their position through laws.
Most sectors cannot operate like US medical, they are their own beast.
Everyone who can does that. Laws and politics aren't a separate magisterium from business; there are no hard borders here.
That one difference is all that matters.
As a businessman, as much as you can direct the behavior of both your customers and your employees, you can influence the lawmakers. After all, they too want money or things that money can buy.
Violence is just one side of the coin that is power. The other side is voluntary (or technically voluntary but not quite) participation, which is primarily controlled by money. That's what makes politics and markets intertwined.
Street lights? Police and Fire protection? Water access?
The doctor runs credit on you before providing treatment, and because of this erroneous bankruptcy that you may not even know about(credit reports can only be reviewed once per year), you are placed in the hallway instead of being given a private bay despite the increased risk of infection. The hospital wanted to make room for paying customers, you see.
So while it's natural to want to "sell" to "profitable customers" in this case applying free market principals to this makes a complete mockery of our health care system. And given the credit bureaus' track records of high inaccuracy and difficulty in disputing the reports, you're likely to get poorer treatment inexplicably, and entirely by accident.
I remember there was a big outrage about Martin Shkreli's actions. Meanwhile the CEOs of these companies probably get lauded in business magazines.
Calling these miserable, greedy, selfish bastards out for what they are could be a first step. God, how I'm hoping for a socialist revolution to take place within my lifetime...
We've seen that this is something that absolutely doesn't work. They (that's the people who matter) just find a scapegoat and everyone else carries on just as before. Shkreli ended up in prison, but Valeant is still busy making profit off the backs of patients, and despite Hillary Clinton's professed outrage prices for such drugs as Syprine haven't gone down a penny. Netflix has a documentary on the case.
Where is the revolution? Where is single-payer healthcare?
Americans are getting exactly what they voted for.
Also, let's be clear about one more thing. Martin Shkreli is not a free market capitalist, he's a crony. Leveraging state patent systems to create abusive monopolies is not free market capitalism, that is textbook crony capitalism and the enemy of a free market. Without arbitrary state enforcement of medical patents on insulin and epipens, do you think that these would be exceedingly expensive items? Are you being bankrupted by Benadryl? Hardly.
There are absolutely elements of healthcare that are far better serviced by a command economy than a free market, and I think the weird hybrid system in the US is the worst of both worlds in many such cases. But a socialist revolution? Socialism is an authoritarian nightmare that cannot suitably answer any question related to scarcity or competence.
As for "socialism", again you're disagreeing on definitions. To most Americans, Sweden, Norway, Canada, etc. are "socialist".
As far as definitions go, my definition of "socialism" is actual socialism, not social democracy. This quote is overused at this point, but Danish PM Rasmussen explicitly clarifies "I know that some people in the US associate the Nordic model with some sort of socialism. Therefore I would like to make one thing clear. Denmark is far from a socialist planned economy. Denmark is a market economy." Adding central planning to ameliorate some of the rough edges of market economies does not create a socialist state.
Again, most Americans will disagree with you. The definition of a word is whatever most people agree it is.
>This quote is overused at this point, but Danish PM Rasmussen explicitly clarifies
No one in Denmark has any authority to define a word in the English language as used by Americans.
>Adding central planning to ameliorate some of the rough edges of market economies does not create a socialist state.
According to Americans, it absolutely does.
>So no, free market capitalism is not indistinguishable from crony capitalism.
Again, according to many Americans it is.
Here's a challenge for you: pick out 100 different rural counties across America. Go to each county, and take a poll, asking them, "Is Denmark a socialist country?" I guarantee you that a clear majority of those polled will answer "yes".
Just try having a conversation with the average American voter (esp. in rural districts) about "socialism" vs. "social democracy" vs. whatever, and see how far you get. They're probably going to say Denmark is "socialist" because they saw it on Fox News. But these are the people electing the leadership here (or about half of it anyway). We have two "sides", and even many on your side probably would have a hard time with these concepts. It's no wonder things are so broken here, and I don't see how it can get better any time soon when the two sides can't even have a rational discussion because they can't even agree on basic language or concepts.
All in all, we spend about half the median household income each year in health care. When my wife got pneumonia after the flu, we had to drop thousands on an ER visit.
If I wasn't well paid, between our allergies and asthma, we'd probably dead.
Good luck if you fall outside of that list.
[1] https://www.kff.org/medicaid/issue-brief/status-of-state-med...
In other words, it's the same as a tax to pay for healthcare for the country, except it goes to insurance companies, and you have to deal with in network and out of network. Except this tax goes up the older you get (but capped at 3x what youngest/healthiest person pays).
Presumably, if you add up all the insurance premiums paid for every year of a person's life, it should theoretically add up to close to how much the insurance company expects to spend on you (plus some profit, capped at 20% by ACA).
There's always the anecdata that floats around the internet claiming that you can fly to Spain, live their for 6 months, get a hip replacement, and fly back to the US for the same amount as the outpatient surgery costs in the US. It's basically true, though the numbers may have drifted slightly since it first started making the rounds.
> it's the same as a tax to pay for healthcare for the country, except it goes to insurance companies, and you have to deal with in network and out of network
I think this is one of the strongest ways to frame government-provided healthcare. It's no different paying a tax vs paying the company directly, and in the former case you have the whole US government bargaining on your behalf for reasonable healthcare costs (in the case of single-payer a la M4A).
> capped at 20% by ACA
20% is a lot when we're talking about these outrageous numbers.
It’s not 20% net income, it’s 80% of premiums have to be paid out to healthcare providers. There’s still all the costs of operating the insurance organization, and financials of publicly listed health insurance companies show net income in the 3% to 6% range.
For my high wage, my NHS fee would be just under £7k for the year, my taxes just about at 30%.
Granted here in the US, my taxes are ONLY 25%, but my healthcare costs are close to $30k/year.
That $20k difference is ridiculous ($11k more than in the UK when comparing tax+health), and I HAVEN'T gone to the hospital for a heart attack or premature baby or hemophilia, but if my wife did have a baby, it would cost us out of pocket around $8k (according to the likely VERY skewed numbers in my insurance packet).
A colleague I know is 54, he is single, has only catastrophic coverage and pays $1200/mo. Nothing is covered except 40% of any emergency hospitalizations. The bronze plan was $2000 and had a $15k deductible, and also was basically only co-insurance with $30 generics.
The way we are doing this here in the US is literally killing people. Medical debt is increasing.
My little sister-in-law was on vacation and walking along a path on a jetty with handrails, and benches, and dozens of other people. A rogue wave came and hit her and her friend. She was taken under, knocked unconscious and drowned (and died), until a random stranger who was standing near her finally found her and resuscitated her. She was medivaced to a hospital by helicopter that insurance only covered 10% of because she was out of network, she was then treated by a dozen or so doctors for multiple days as she got pneumonia and broken bones, and head trauma, all out of network. She ended up owing close to $100k with her insurance only covering the first $25k. In any other first-world country, she'd be out of pocket maybe a few hundred bucks. Not in collections for being unable to pay $75k for a freak accident.
Being forced to ruin your credit because you got sick or had an accident is sociopathic.
I'm no fan of insurance/hospital bureaucracy, but at least I can go to any specialist doctor I want without having to see a GP first. And I pick the job and insurance provider I want to reduce the amount my family pays each year.
Emergency situations like the last one you mentioned, if they are out of network, are still covered at in network rates, thanks to my insurance plan specifically stating that in their plan documentation. I feel bad for your sister-in-law and am glad she survived, but she did have a not so great insurance plan. I would strongly consider getting a different job or lobbying hard with my workplace HR if I had a plan that would only pay 10% in true emergency situations.
And everyone would get a different job with nice health insurance offerings, if they could.
If my math is correct, employer + employee national health fee for £140k salaried employee is a few quid short of £10k which is still half of my annual health care expense, so my original point still stands.
Look at what it would cost to cover you and your family on the individual market without government or employer subsidies. As a contractor, I pay double what you do on the individual market, and that is only coverage for myself.
Replace "male" with "child free" and this makes sense but suggesting men are subsidizing childbirth is ridiculous.
> and other women specific costs.
https://www.health.harvard.edu/newsletter_article/mars-vs-ve...
> Men die younger than women, and they are more burdened by illness during life. They fall ill at a younger age and have more chronic illnesses than women. For example, men are nearly 10 times more likely to get inguinal hernias than women, and five times more likely to have aortic aneurysms. American men are about four times more likely to be hit by gout; they are more than three times more likely than women to develop kidney stones, to become alcoholics, or to have bladder cancer. And they are about twice as likely to suffer from emphysema or a duodenal ulcer. Although women see doctors more often than men, men cost our society much more for medical care beyond age 65.
I assumed that because before ACA, childbirth was not covered by insurance and insurance pricing based on gender was allowed, and post ACA, childbirth was mandatory and insurance pricing based on gender disallowed, that it must mean that, in general, healthcare costs more for women than it did for men.
But perhaps that's only true for young men and women, if true at all?
And to that I say: fine. I will happily subsidize, through my tax dollars, health care to pregnant women, addicts, the obese, down-and-outers, whoever, so long as it means that everyone has access to doctors and hospitals when they need it.
I am far less worried about paying a few bucks a year to support someone whose condition I will never have, than I am about sustaining this spider's web of private health insurance, with its unaffordable deductibles and an endless list of shady practices. America doesn't need health insurance companies to act as intermediaries between us and our doctors. They add nothing.
Oligarchs know that money has to be spent to keep the plebs just well enough to prevent revolt.
There was a survey that went around a few years, asking Republican voters something along the lines of:
"Would you vote for an Affordable Care Act if it was offered as an alternative to Obamacare?"
A significant amount said "Yes".
Can't revolt if you're disabled and untreated, tied to your job to keep your kids healthy, incapacitated by treatable illness or weak from hunger.
like I said, they'll call it something else. repeal obamacare and make something new that will basically be medicare for all in some shape or form. it will be a handout to the big insurance, drug, and healthcare companies, I'm sure.
I didn't specify before but I'm talking like 8-12 years down the line.
Or are we more the token outlier with a "worst of all worlds" system?
Around the world, it appears that low costs lead to universal healthcare, not the other way around.
What America needs to do is make it cheaper and easier to become a medical practitioner without taking on half a million dollars in debt and wasting half of one's pre-retirement life. No fancy government program will work without first addressing that issue.
And Medicaid, Medicare, and the Veterans Administration (the three big government run healthcare systems here) all run more efficiently by every measure than any private health insurance system.
Note that I fully recognize the problems that the VA has had, but when you really look at it fairly, they have many parallels to problems in the commercial side of the system, we just don't tolerate that when it comes to government (nor should we).
After Canada implemented universal healthcare, costs rose rapidly before stabilizing: https://www.ncbi.nlm.nih.gov/pubmed/379054
Both private insurance and taxpayer-subsidized programs pay astronomically high prices for healthcare; I haven't seen any examples of Medicare paying European-level prices for services.
I know this feels true because laissez-faire and commie-bashing rhetoric is still common in the Western world, but there have been numerous studies recently showing that the US is the most costly per capita. The next 3 countries (by 2016 numbers) are all places where most things are more expensive because the country and its citizens are relatively rich: Switzerland, Luxembourg, and Norway.
There's even a Wikipedia article about it: https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
Of particular interest is this graph, which breaks it down by public vs private spending: https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
I feel like you didn't read and fully understand my comment.
https://en.m.wikipedia.org/wiki/Public_good
"In economics, a public good is a good that is both non-excludable and non-rivalrous"
"A good is considered non-rivalrous ... if, for any level of production, the cost of providing it to a marginal (additional) individual is zero"
"... a good or service is non-excludable if non-paying consumers cannot be prevented from accessing it."
Edit: Technically oligopoly, not monopoly, though it may tend towards one.
Granted, all of this is pretty much meaningless when you have a government overstepping its bounds and doing what it wants. In that case, it seems the blame of the corrupted system would fall on those corrupting it (the corrupt government allowing itself to be bribed in exchange for monopolies).
Second, what exactly do you mean by "an otherwise public service?" Are you simply saying, in the absence of private medical care, that "medical care" would be purely owned by the government? This seems uninformatively tautological and I get the feeling some other meaning or implication is meant to be attached but I cannot pin it down.
Those 2 are conflated because Citizens United permits lobbyists to sidestep campaign donation limits by allowing industry groups to effectively spend unlimited amounts of money on behalf of or in opposition to candidates.
At the core of this problem is that speech can be amplified with money. Even if we ban selling of speech to others, organizations can still spend the money to host/print/post/billboard/telecast their own messages. Those with money will out message those without.
Is there a way to fix this that doesn't result in government control of political speech?
The first amendment has only been loosely upheld throughout our history. There are many types of speech that are regulated in spite of it.
>Is there a way to fix this that doesn't result in government control of political speech?
We had a system in place prior to Citizens United that didn't turn into government control of political speech. Many other developed countries have limitations on spending money on political speech that don't turn into complete government control of political speech.
There's no reason to assume that a few men in the 1780s got everything right. And a slippery slope argument is no reason to throw up our hands and stop trying to advance egalitarianism.
Those laws exist because capitalist forces incentivize healthcare providers to limit competition.
> which is likely impossible to keep from being corrupt (easy to believe if you've ever met an actual human being).
Have you met any human beings? Try not to be so cynical, damn.
"Please don't submit comments saying that HN is turning into Reddit. It's a semi-noob illusion, as old as the hills."
Yes, I can see that your account was created in 2011 :)
Regardless, I don't think silent downvotes really cut it anymore either - nowadays I tend to run out of them after reading only a couple submissions with active comment threads.
It's those long chains that end up being an out-of-order recital of some famous TV/movie scene that really irk me, personally. Those and similar are cases where the value is only in recognizing the source and getting that dopamine hit, and not in any further contribution to the discussion.
This is peak political corruption.
And of course even where the govt is not funding the product, they are stipulating in detail what it must include. E.g. insurance must include a long list of things from mental health care to nicotine patches, forcing people to go through their insurance rather than through a market where they would negotiate prices.
Instead health plans market to EMPLOYERS (not the consumers of the actual product). Trust me - the service there is pretty amazing! Tax law is designed to in many cases benefit these employer negotiated plans.
Buying people off is the essence of capitalism.
https://news.ycombinator.com/newsguidelines.html
Every time you visit the doctor, the hospital tells experian (by querying the experian system) and then experian resells this information for profit.
There are no bumpers now, ISPs now— just ‘cause!— can sell browsing data. You have a crummy leader at the top & just think all about the ghouls & industry monsters who if they’re not running/control an agency get to run ripshit & fulfill their wishlist by other means.
"As needed" is a definition that most patients would disagree with
This article talks about how Experian have SOC-2 issues, which is a cause for concern, but smaller hospitals with tighter budgets could be inclined to look past it.
In general, it's important to understand that HIPPA doesn't prevent data from being shared, it gives it a legal framework to be shared within. When things go bad, the HIPPA-associated paperwork provides a roadmap for assigning liability.
Liability does get assigned, and companies (providers, insurers, network providers) are held responsible, despite the popular imagination: https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf
HIPAA pertains to PHI and PII (protected health information and personally identifiable information, respectively). The fact of your office visit is not either of those if it's not linked to health information (labs, medical records, notes, itemized bills).
Further, it may be allowed under permitted uses and disclosures as-is, without authorization under the language for payments. I couldn't tell from the article, but the health systems could simply decline to treat you without your authorization for the credit check.
Separately, people love to make healthcare into the bad guy, but it's not a monolith and there are hospitals closing down because they are losing money. There is a systemic problem in the US here, and I bet this is those 2nd/3rd tier markets in smaller systems that can't absorb defaults like nationals can.
False. Directly from HHS, emphasis mine:
https://www.hhs.gov/hipaa/for-professionals/privacy/laws-reg...
“Individually identifiable health information” is information, including demographic data, that relates to:
* the individual’s past, present or future physical or mental health or condition,
* the provision of health care to the individual, or
* the past, present, or future payment for the provision of health care to the individual,
Your prescriptions, hospital admissions, radiology orders, etc are in the hands of any of a dozen third parties before your claim is processed. It is trivial to un-anonymize the data.
Could we classify 'not being able to afford, either time wise, emotional labor wise, or money wise, to deal with the messed up medical billing system' as a pre-existing condition?
How is this not a complete violation of HIPAA?
Are they working around it by having very general HIPAA release forms?
https://www.hhs.gov/hipaa/for-professionals/faq/268/does-the...
> The Privacy Rule permits covered entities to continue to use the services of debt collection agencies. Debt collection is recognized as a payment activity within the “payment” definition. See the definition of “payment” at 45 CFR 164.501. Through a business associate arrangement, the covered entity may engage a debt collection agency to perform this function on its behalf. Disclosures to collection agencies are governed by other provisions of the Privacy Rule, such as the business associate and minimum necessary requirements.
Brokers reselling my health info is far more critical to me than my buying habits.
Is there a "do not sell my health info" checkbox?
Yeah, except, sadly, it'll most likely be "You're welcome to try the hospital across town if you'd like...".
If the hospitals simply want to gain insight on your ability to pay your medical bills, wouldn’t your “normal” credit score be able to provide that insight.
What’s different between your “medical” credit score and your normal credit score?
Edit: Additionally, there are laws in place in the US that state in emergent situations, no hospital (public or private) can deny care - regardless if you can pay or not. So the article title might be a bit sensationalized.
And given that it’s now a US requirement to have medical insurance, I’m still struggling to understand what this medical credit score is accomplishing.
"There is good evidence to support the idea that acne and associated scarring negatively affect a person's psychological state, worsen mood, lower self-esteem, and are associated with a higher risk of anxiety disorders, depression, and suicidal thoughts."[1]
While Acne probably won't kill you, it certainly won't make you happier and could contribute to suicide if left untreated. We are lucky that acne meds are cheap, but there is nothing stopping those companies from shooting up their prices tomorrow.
[1] https://en.wikipedia.org/wiki/Acne#Prognosis
Also by the way, the requirement to provide care to any walk-in patient only applies to ER's, and only until they have stabilized the patient.
Similarly, if the insurance company for any reason disputes a hospital claim for any reason, up to and including disagreeing with the hospital that the issued treatment was appropriate in lieu of a cheaper treatment, the hospital goes to the patient to foot the bill.
So it is entirely possible to be fully insured and still be forced into unpayable medical debt through factors completely outside of one's control.
It's frustrating to me that this point is very often overlooked in the discussions about health insurance in the US. A lot of people who go bankrupt over medical bills are fully insured and suffer for reasons entirely beyond their control like the hospital an ambulance decides to route them to when they're unconscious.
A Bronze family plan will typically have a $13k deductible. You pay that entire amount out of pocket before insurance kicks in, and it resets annually... so if you're in the hospital December 31 through Jan 1, you might be on the hook for $26k.
There's also nightmare scenarios where the hospital is in-network, but the doctor isn't. https://www.reuters.com/article/us-health-insurance-surprise...
Many states have surprise billing laws to limit what bills you can receive from out of network providers.
There are a lot of subsidized folks on the Bronze plans with zero ability to pay an unexpected $400 bill, let alone a $13k deductible. They're insured, but only technically.
> Also almost all bronze plans cover the first 3 doctor visits with a normal copay, and any preventive care has no copay.
Sure, but I'm referring to the sorts of bills that bankrupt people, not an annual physical.
It became a "requirement" in 2014 with Obamacare, but since the repeal of the individual mandate in 2019, there is no financial punishment (except well, the increased possibility of medical bankruptcy) for not having insurance:
https://www.kff.org/health-costs/issue-brief/how-repeal-of-t...
https://battlepenguin.com/politics/returning-to-america-and-...
> “Emergent” properly means “emerging” and normally refers to events that are just beginning—barely noticeable rather than catastrophic. “Emergency” is an adjective as well as a noun, so rather than writing “emergent care,” use the homely “emergency care.”
Medical debt can still be added to your credit report.
[1] https://www.creditkarma.com/advice/i/how-to-remove-medical-c...
Really, it's disgusting.
credit unions are one of the few pro-consumer entities in the financial world, it would be a shame to smear them
Ideally in 2008 all the "banks" should have gone bankrupt and the vacuum should have been filled with credit unions, instead lawmakers gave the banks $2T as a reward for ruining the US economy so they could float their own debts instead of declaring bankruptcy and enough so they could buy up their competitors to further consolidate the marketplace.
This is true, but many life-saving treatments (such as chemo or radiation treatment for cancer) are not "emergency" treatments, despite being necessary and somewhat urgent.
It’s probably more profitable for them to send a small bill to a poor person than a large bill that is never collected. It’s definitely more profitable to throw the most ludicrous bill at those who can and will pay whatever cost is sent at them. You can also adjust the kinds of treatments given according to likelihood of profit.
I wouldn’t be surprised if the latter case is illegal (or happening or not). I’m pretty sure the former case is perfectly legal, though symptomatic of a bigger problem.
Moves like this erode my opposition to nationalizing the entire US health-care sector. If they're going to cartelize or confederate, patients--which is to say everyone in the country that lives and breathes--will also want a seat at the table.
From a more generous perspective, this may be a tool for price discrimination. Hospitals will charge based on what they think the patient can pay, rather than the actual costs of providing the care. When you receive care, you will be billed for a number that is calculated to make you sigh, flinch, or wince, but not call a bankruptcy lawyer.
This is a symptom of illness in the system, and leaving it untreated seems like a bad idea.
I have no idea if they can require it or not, but I always assumed it was optional because they wouldn't turn away foreigners without SSNs.
https://en.wikipedia.org/wiki/Social_Security_number#Non-uni...
Bear in mind this fact when working on systems that make use of SSNs.
https://www.experian.com/blogs/ask-experian/accounts-may-be-...
> Experian doesn't match information to a person's credit history using only the Social Security number. Experian matches information using all of the identification information provided by the lender, so the account will be accurately shown in your report, even if no Social Security number is provided.
Usually the only time they'll fail to ID you is when you show up to the front desk with no identification and lie about your personal details, which I don't particularly recommend doing.
That's how Canada's healthcare system works, too.
> Government health insurance plans give you access to basic medical services. You may also need private insurance to pay for things that government plans don’t fully cover.
https://www.canada.ca/en/immigration-refugees-citizenship/se...
The above aspect of "wealthy people get to buy nice things" really doesn't contribute anything interesting to the conversation.
Their Standard for basic care is much higher though. You can’t compare that.
In Canada, you get Medicare-like primary care, benefit from price controls on drugs, and can buy secondary coverage to get more. In the US, you get to subsidize drug development for the world and enrich a variety of different cartels.
All of my relatives in Canada come over to the US for any major surgery. The reason? The wait time is in years, instead of weeks and some can't get the surgery at all.
"Once you start running a hospital like a business, you create an environment of perverse incentives. Care is no longer solely based on what's best for the patient, but how that patient's care relates to the hospital's finances."
Government-run care is no different. It doesn't magically solve the issue of treating patients as a number.
"So wealthy people get access to better care and everyone else has to take whatever is available"
The alternative is that everyone gets access to sub-par care.
The answer is an actual free market, rather than another, large middleman monopoly over our health care. We need to get rid of all insurance companies, allow hospitals and doctors to compete over price (which will reduce prices for everything to true values (instead of $80 Aspirin), and only have insurance for surgeries that are rare and can't benefit from the free market.
Monopolies are bad for everyone, whether it's big business or the government.
Maybe rich Canadians think differently, but universal healthcare will always be better for the general population.
Need some physio, but delaying it isn't going to cause ongoing problems? You're going to wait.
If you want to skip the queues then there's affordable private healthcare as well for non-urgent issues ... my plan with BUPA costs my employer £1,600 per year.
Contrast that to the US which could leave a person bankrupt for the same emergency.
Indeed. Even if you have good insurance, getting something like a heart attack, cancer, etc. in the US makes it likely that you'll be bankrupt in the end. I know three people that this has happened to.
I have many more stories, (family member being sent home with an Abdominal aortic aneurysm on the verge of happening (Friday) because the Surgeon didn't have time to perform the surgery until Monday. Guess what happened on Sunday? Guess what else happened a couple of days later?
Wife almost died because she had to wait a month for a specialist. She just couldn't get anyone to take her seriously. Finally got the treatment in an Emergency room (she went septic).
I live in the USA now and have the best medical care in the world for my family.
In my part of the US, that is about the normal wait for that sort of surgery as well. Unless, of course, you're a millionaire.
https://vtdigger.org/2019/06/19/patients-face-frustrating-lo...
> At the beginning of the year, the wait to see a cardiologist at three of Vermont’s rural hospitals was more than 100 days, according to data from state regulators.
> At Southwestern Vermont Medical Center in Bennington, hospital officials reported patients would need to wait nearly 200 days to see a dermatologist.
> As of March, some of the hospital’s specialists, including cardiologists, ear nose and throat doctors, gastroenterologists and psychiatrists could only see between 20% and 30% of patients requesting appointments within 10 days.
The US is certainly not immune from this reality.
https://www.keranews.org/post/shortest-wait-time-see-doctor-...
In other words, you didn't actually need surgery. The system worked as intended.
If you look at it in terms of economic productivity, the inability of the doctors to schedule this properly was taking some useful out of the workforce and jeopardizing their continued employment and financial stability.
There are plenty of multi-month waitlists in the US for common medical procedure. My wife sees a sleep doctor. Our insurance is fantastic. He has a nice, expensive office in an upscale regional medical center. I don't know which car in the parking lot is his, but there's a lot of nice cars in that parking lot.
It is a ----ing nightmare. Multi-month waiting lists to first see him. Month-long waits for scheduling anything. Three-month wait to schedule a minor surgery. [1] He screws up her prescription changes, the pharmacy won't dispense because he didn't tick some box on a form, and he goes on holiday for a few weeks. His on-calls aren't able to fix the problem, because, well, they aren't on-call for his sleep practice. Guess who can't get her prescription?
And for this privilege, we and my employer pay ~$20,000/year. I suppose we could fire his ass, and switch doctors, with no guarantee that the next one won't be any worse. [3]
[1] Cherry on top - despite being fully covered for the procedure, and paying what they asked for at the time of the operation, the surgery center started calling us, demanding money. Guess who gets to untangle billing? [2] We do. Guess who, once the dust settled, turned out to have overcharged us, and eventually cut us a cheque? The surgery center.
[2] Double-whammy - my wife dropped her old insurance two years ago, to switch to mine. Guess who started sending us bills last month? Her primary care provider, because at some point his office realized that she is no longer on her old insurance. Somehow, it's taken them two years to realize this. I'm assuming that the new provider has been paying them all this time, but who even knows at this point?
[3] I must say, my best interaction with the US healthcare system so far has been at a walk-in clinic located in a crummy office with peeling wallpaper, patient examination rooms that doubled as storerooms, a broken water cooler, and a bathroom with a door that mostly closed, located above a laundromat in an, ah, common part of town. The staff consisted of the doctor, who was cycling through patients, and his assistant, who was translating to and from Spanish, juggling papers and photocopies, and doing vaccinations and blood draws. I was in, I had what I needed done, and I was out, with zero billing bullshit. I didn't see any Teslas in the parking lot, though.
I had a relatively minor injury (wrist) from a car accident. Nevertheless, it needed some interventions and I was advised to start PT right away. Was given a referral and a list of in-network providers (for a large insurer). In my (metropolitan) area, I could not find a provider with a less than 3-4 month waiting period within 30 miles.
My step daughter wants counseling - 2 month wait. All three of my closest options for a PCP are "not accepting new patients".
This isn't a problem of socialized medicine. I grew up in Australia, and I know that much.
Highly disagreed. I had several unnecessary surgeries as a child in canada. I had some swollen drainage things in my sinuses removed, and the only danger is that I was really sniffly all the time!
"We need to get rid of all insurance companies, allow hospitals and doctors to compete over price (which will reduce prices for everything to true values (instead of $80 Aspirin), and only have insurance for surgeries that are rare and can't benefit from the free market."
Does this mean that the free market means hospitals can choose not to treat patients that are too sick, too black, too gay, etc?
Publicly funded healthcare may not solve all issues, but it removes the perverse incentive to refuse or reduce care quality because you don't have access to insurance or cash. Free market means shit to me if I'm mid-heart attack, I don't have the time to review pamphlets about why ABC hospital has the best care for the low-low price of $4999!
Private insurance, even those run as non-profit, still turn a profit. Does the head of the DHS make 15 Million dollars in year? No? That's the average compensation for private insurance CEOs. Bernard Tyson CEO of non-profit Kaiser Permanente made 16 Million in 2017.[0]
Is that really "all the same"?
[0]https://medium.com/@kaiserkeepthrivealive/this-analysis-look...
> There is also a great deal of variation among specialties. Patients wait longest between a GP referral and orthopaedic surgery (39.0 weeks), while those waiting for medical oncology begin treatment in 3.8 weeks.
Still, the Canadian system is demonstrably better when it comes to outcomes. Canadians live longer than Americans, and have lower infant mortality rates for instance. Canadians also pay half of what Americans do for health care, when everything is accounted for. My partner is diabetic; like most medicines its a fraction of the cost of in the US. A universal system brings with it purchasing power. No system is perfect, but this one seems much better than the American one for the average person.
It's a choice. In my case, I'd much rather the Canadian system over the American. Even when it comes to surgery, I had a vaginoplasty (took 8 months between GP consultation and surgery; $25k surgery paid for by govt). My friend got her tubes tied (took a month; paid for by govt). My other friend was in the hospital for a month (admitted immediately; paid for by govt). My uncle had heart surgery. He did not have to lose his house. My step-dad had hip surgery (took 4 months; paid for by govt). Not to mention all the doctor's visits and tests accrued over a lifetime.
[1]: https://www.fraserinstitute.org/studies/waiting-your-turn-wa...
I lived for a few years in southern Québec, and I was amazed at the quality of care there. My wife had some pancreatic stones, and it all got dealt with (including 2 surgeries, multiple scans and a 2-week hospital stay) within a couple weeks. No bill. My daughter fell and had a concussion, we were scared about possible brain damage so I took her to the hospital at around 8PM. We were out of there at 6AM after an X-ray, an MRI scan and a few hours of observation. Again, no bill. I had four kids, and I think in total I paid less than $100 for their births, and that was for the food I ate or for parking.
Right now I'm more in central Québec, and the quality of care is a bit lower. It's a pretty rural area, so the budget is probably lower and the points of service are more spread out. Still, I like to know that a medical issue will never bankrupt me.
Sub-par care is excellent when the current reality is that most people don't get access to any care at all.
You must understand that the vast, vast majority of people don't go to doctors. They don't have dentists. When a poor person is in pain they will continue to be in pain until the pain goes away or they die.
When given that versus a shitty but free healthcare system, who wouldn't want to see a doctor? To get $5 prescriptions to medicine that can help them?
And remember, this is assuming the healthcare system will be shitty - universal healthcare has never been repealed in a country that has implemented it. Don't you think if the citizens of these countries were so fed up with free care, they would be protesting and electing candidates that promise to dismantle it? Even Boris Johnson has to tiptoe around privatizing the NHS because he knows how wildly unpopular that would be, even among his conservative constituents.
>You must understand that the vast, vast majority of people don't go to doctors. They don't have dentists.
Uhh… what? This sounds either out of scope for the US or just wildly inaccurate. Over 90% of Americans have insurance.
Edit: I do not live in a bubble. I stand by this comment, "only" 1/3 delay medical treatment [0]. The claim that the vast, vast majority of people never get it at all is simply false. Fact checks do not bear counterargument in a healthy discussion unless the fact check itself is lie.
[0]https://news.gallup.com/poll/269138/americans-delaying-medic... (2019)
Insurance != Healthcare or the financial capacity to see a doctor.
I have excellent insurance through my employer and still pay several hundred a month to cover my and my partners medical needs, on top of the insurance premiums in my paycheck. We are extremely lucky to be able to afford that but it's still nearly $500 a month that could be going to savings, retirement, a safer car, or more. Instead we spend about $6k a year to an inefficient system that doesn't produce better outcomes than universal systems like in Canada.
If your out of pocket excess is $1000 and you need $900 of treatment, but you also need to make rent, buy gas, feed your family ... well, you don't get the treatment (or you do, can't pay, and are made bankrupt). I think you might live in a slight bubble.
Yes, I pay a lot more tax, but then again, public transport, healthcare free at the point of need etc. etc. are worth it to me.
https://www.theguardian.com/society/2013/sep/12/hospital-dea...
With the medical system over-burdened, the system is now fundamentally reactionary in many specialties; delaying anything that can possibly be delayed.
It's saving a penny today to pay a dollar (or a loonie, I should say) tomorrow. It's economically burdensome and, obviously, creates a great deal of unnecessary hardship for those in line.
Nearly every Canadian has anecdotal stories of elderly relatively who had a minor ailment that needed surgery - were delayed for months because they were low priority - and then needed a larger intervention as the problem compounded over said months.
Where does this show up in the data? How do you measure and value up to a year - which can be more than 10% of an elderly persons remaining life - being mired in uncertainty, discomfort, and pain waiting for a procedure? How do you measure medical efficiency and patient outcomes in this context?
The best way to describe the current system is that doctors (surgeons, in particular) are forced not to look out for the individual patient's best interest, but the best interest of their entire surgical waiting list in aggregate (and this can be dozens of names long).
So, yes, it is in the best interest of Patient X to have the minor operation done this week as there is a strong likelihood of further complications and a worse patient outcome if delayed. However, Patient Y needs a major surgery this week so Patient Y, rationally, gets the higher priority.
wishful thinking.
we already see this with ambulance service. there is an overabundance of supply, but it has not reduced price. in fact, the opposite as all the companies run much less efficiently (less billable time).
people aren't going to shop and buy on price for hospital care. they are going to shop and buy on local presence. for regular doctor visits, the costs are already low.
There is no reason to have it exclusively. Having single-payer healthcare with mandatory participation for residents does not preclude existence of healtcare providers that are outside of that system.
Although it is likely that such providers would be just a small part, as for patients it would have zero monetary marginal cost to use providers that are part of system, so they would likely use providers outside of the system as a last resort or if there are significant non-monetary cost.
I'm in one the largest and wealthiest metro areas of the US, and there is a 6+ month waiting list to see mental health professionals.
> "So wealthy people get access to better care and everyone else has to take whatever is available" The alternative is that everyone gets access to sub-par care.
When I lived in Manhattan, despite living right down the street from some of the best paid surgeons in the country, my wealthy clients would fly overseas to France and Israel for their surgeries.
The fact is that countries with universal health care have better health outcomes, better quality of care, shorter wait times for care, pay half of what the US does and manage to cover all of their citizens. Each of those statements of fact can be cited here[1].
[1] https://www.healthsystemtracker.org/chart-collection/quality...
So, instead the of the rushed surgery, my relative waited. After a day of waiting, she decided to go straight to Vancouver, B.C., where the issue was taken care of immediately, with no wait times.
However, because of the delay, her outcome was significantly worse than it would have been.
Basically, she lost much of her eyesight because of the "billing department."
That's the States for you.
The main one is, the (expected) medical costs are different for different populations. In particular, the expensive sub-populations are (1) the elderly (because aging & death), (2) women (because pregnancy) and (3) some children (born with genetic diseases, birth deficiencies etc. but having no income/wealth to pay for them).
If we argue that medicine should be driven by the free markets, we should also allow the free market to take over other things, but we as a society (currently) refuse to do that (IMO for good reasons).
What's the value of old age? Retirees are almost completely non-productive, a drain on the society... you could argue about saving for retirement (it's "free market") but that's a bit of a lie, you can't "save" labour or energy, so there's always a transfer of value from the working population to the non-working population, and as the non-working retired population increases and the working population shrinks, that's going to become a problem one way or another (both in socialized and in individualistic retirement systems). Old age awaits everyone, a populace would probably be feeling very uncomfortable about their own future if they saw poor old people dying on the streets, refused medical care.
What's the value of bearing children? It's kind of parallel to the above, children are an investment into the future (future workers), currently it's on the individual to pay for this investment (pregnancy, career income loss, more housing, education costs) but the society benefits (extracting taxes / parts of the value produced by this future worker). Should women also bear the cost of medical care? You could say there's always a father in the picture, but some people also claim that fathers should have the option of financial abortion (given that they have no say in physical abortion). Generally I argue that there should be incentives for people to have kids (correlated with their income, so that high-income, usually highly educated people, have more of an incentive to have kids - e.g. some kind of negative tax rate).
And finally, what's the value of a human life? Should we condemn a kid to a short life full of suffering just because s/he was born with some mistake in their body? I mean, resources are limited so we always have to make trade-offs, but refusing medical care to kids born to poor parents seems particularly evil.
I'm not sure what the solution is... personally, I'm leaning towards a "highest highs, highest lows" kind of a society - having some kind of social net (regarding medicine, jobs, ...) while also allowing private markets for those who can afford them (i.e. if you want to buy private surgery, you can, if you're wealthy enough). But this needs to be carefully managed so the whole system kind-of works.
Hospitals want this leverage again so they built their own credit system.
If you look really bad, they'll refuse to check you in.
For context, hospitals are only likely to lose money on very complex patient cases, i.e. the kinds of program described in the video. In those situations, it makes sense that hospitals will want to make sure that either (1) the patient will be able to pay or (2) charities or government programs will cover them, once they apply.
Experian's system claims to helps them make that assessment. Will that lead to patients being turned away? Maybe, but it's not a straightforward conclusion, like you imply. The comparison to Uber ratings holds no water.
The reality is that American healthcare is a complicated market with many sources of revenue that aren't patients' bank accounts (charities, govt subsidies, insurance), and it doesn't lend itself well to this kind of oversimplifying analysis.
Even though they're determining eligibility for "their own" charity, they're likely determining eligibility for "other charities", if you follow the money.
This is from the product's lit:
"Predict propensity to pay using our proprietary Healthcare Financial Risk Score, which factors in historical healthcare payment outcomes and the patient’s credit history"
She mentions that the product also lets them pull "FPL", which in this case I imagine means "Federal Poverty Level", in addition to household size. Cincinnati Childrens has some info that might put that info into context: https://www.cincinnatichildrens.org/patients/resources/finan...
Further, unstated, perhaps speculative context: most people who go to the hospital pay through insurance and out of pocket. But if you go to the hospital without insurance, or can't cover your out of pocket component, most (every?) hospital will negotiate a lower rate; almost nobody pays rack rate out of pocket. So what they're calling "charity" might just as likely be the name they give the program where they come up with their real rate on the fly (I've been through this process with a large hospital chain in Chicagoland).
Either way: it doesn't support the post's claim that Experian's health score --- which I'm disinclined to trust, just like everyone else --- is being used to "deny care". That's an argument the article does not appear to marshal evidence to support.
While on vacation recently I ended up listening to the Bear Brooks podcast [1]. It's a little longwinded at times (but it is aimed at non-technical people) but is not a bad way to spend a long drive.
The interesting thing about this story is how advancements in DNA testing have taken us from the simple case of is or is not a match (used in paternity testing and for forensics) to figuring out how much of a match you are. This has created a new field of genetic genealogy that famously led to the identification of the Golden State Killer [2].
So there's a lot of talk about privacy and your DNA but much like having your contact information uploaded by someone else, this is showing that that will be insufficient as your DNA will ultimately be inferred (at least in probability terms) by people who aren't you. There's really no putting this genie back in the bottle.
So take a disease like Cystic Fibrosis. Currently this requires life long medication and care. Depending on the severity, you may require one (or more) lung transplants. All of this is expensive.
So if you have CF and want to get private insurance in the US this may well be a pre-existing condition and excluded. Now this disease is usually quite apparent from birth but there are other diseases that are not (eg Huntington's). If you'd had a test and know you have it the insurance company has a "right" to know it (if you accept the premise of the US health insurance system, which I, of course, do not).
But this is only going to get worse. Ultimately health insurers will able to figure out if you're much more likely to have certain expensive conditions by knowing, say, that a sibling is a carrier (which greatly increases the chances you have it).
Taken to its natural conclusion, the system of private health insurance cannot survive. The only workable solution is group health insurance. Sufficiently large groups statistically even out. That's how insurance is meant to work. This could be a fully public health system or something in between (eg state-level).
So back to the medical credit score. There will be fights over this. At some point you'll have a right to see it and get corrections. This will probably be championed by states since the Federal government seems to have forfeited, well, governing. But all this is just arranging the deck chairs on the Titanic.
Of course there's still the separate issue of costs (in the US) to deal with but one step at a time.
[1]: https://www.bearbrookpodcast.com/
[2]: https://en.wikipedia.org/wiki/Golden_State_Killer