So, basically, if you visit any emergency room then your handing them a blank Check and they can write whatever number on there they want. That's egregious beyond belief. I'm never one to call for legislation and price controls, but in the face of such adversity, I think it may be our last hope. I think they should either provide a quote before they offer the services or there should be a law limiting the amount that can be billed per service.
This is the fundamental problem of treating healthcare like any other market distributed good; you just don't have the ability to use consumer choice.
People using an emergency room are not in a position to negotiate price or seek an alternative service. An unconcious accident victim can't say, "That price is crazy I am going to the hospital across town."
I would say single payer, or a single regulatory arbiter of procedure and drug prices (within a multi payer context).
When you look at the healthcare costs GDP, the single payer systems still tend to come out ahead multi-payer + regulatory oversight (its one more level of abstraction you pay a complexity cost for...).
> I would say single payer, or a single regulatory arbiter of procedure and drug prices (within a multi payer context).
As someone who works for a medical billing agency either would make my life easier, having to juggle dozens of insurance contracts and rates stinks. France does the latter, insurance companies and the state plan negotiate and a single group - at the best this could make a good stepping stone to single payer in the US.
I recently hurt myself and needed an ambulance to take me to an ER. They asked me if the nearest one was ok. Worrying about network was simply not going to be possible, I was in massive pain and wanted it to be helped out asap
Turned out alright, I think. I'm still concerned I'll get an "oh by the way" bill in the mail.
A physician relative pointed out the Dutch healthcare system as a compelling, hybrid public/private alternative to strict single-payer schemes. Gist of his recommendation was that single-payer systems may not be the silver bullet they're touted to be, and that alternative models are being tried out. I.e., viable solutions may turn out to be hybrid healthcare systems, where negative effects can really only be minimized rather than eliminated. https://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands
Germany is two-tier. Public health for the masses, private for those making over 80k or so and healthy.
The public system premiums are a % of income. The private is a flat cost, so as you make more become much more attractive (even costing less in many cases).
Doctors are sometimes private only or have separate private insurance waiting rooms. Hospitals have separate public and private rooms/beds, etc.
It's a two-tier system that works pretty well, at least in comparison to the US system.
My info is a few years dated, but is based on having been a patient in both US and German hospitals. From friends, I've heard the English system is similar in some respects to the German.
Amazingly to me, the German system was instituted under Otto von Bismark in the 1800s.
Aren't the public premiums only a % of income up to a certain cap? So it's not like super high income people would pay an outrageously huge amount to use the public system, they would just potentially pay somewhat more than they would if they got private insurance.
This ensures that the system works better than the US system, as the hospitals do not need to deal with having to treat uninsured patients who cannot pay. This is a major problem for the US healthcare system, and a critical threat to the solvency and continued operation of many hospitals, especially rural hospitals and clinics.
The insurance mandate is a principal component of the ACA. In the US you have to have health insurance or you pay a fine, and there are subsidies to help people pay for insurance. To further lower the number of uninsured in the US would involve increasing the penalties for not having insurance, paired with further expansion of subsidies or Medicaid. Honestly sounds like that area of the Swiss healthcare system is pretty similar to what the ACA provides.
Switzerland also regulates drug prices... and has much tighter governmental oversight over their insurance industries. But is also the most costly by percent GDP of european nations... still much much cheaper than the US though.
In a sense Germany works very similar to Obamacare. Private doctors, health insurances, mandatory insurance for everyone. The difference is that it's much more regulated and the insurances are non-profit as far I know.
Yep. Took my wife to the ER last week for suspect appendicitis or diverticulitis. Last time this happened a CT scan alone was $3k ($11k prior to insurance reduction). My HDP is $4,500 OOP max per family member; $8,500 for family.
What really pisses me off is that the HSA max contribution has not kept up with family OOP max. I contribute the max every year and can't end up with $8,500 saved.
I had a decent insurance plan prior to Obamacare. Now it's 3x as much and a HDP. Don't even have dental insurance anymore; use the HSA for that. Work for a Fortune 100 Company too.
Yes, no argument there. I work for Fortune #75 (hint; it's probably hanging on your wall). Lost dental insurance last year, vision the previous year, and switched to an HDP the year before (with massive premium increases every year). But hey, the stock price was at an all-time high on Friday.
Funny thing about HR directors is that they don't last more than 1 year before rotating out. Don't want them to become too attached to the people they are there to screw.
To be fair, health insurance doesn't HAVE TO be provided through work. It's easier than ever to find a private plan. To the employer it's just another employee cost along with salary so if you didn't ask for a raise when that happened, that's on you then.
I did get a raise; had to threaten to quit, but did get one. It's the HSA contribution limit that pisses me off. I don't have an issue paying, but I'd at least like the benefit of pre-tax $. The HSA limit has not kept up with the ACA OOP limit. Other than inflation adjustments, it's up to congress to raise it.
It's doubtful we would be in a different situation without Obamacare. Health care costs have been rising faster than inflation for literally decades. There are too many bad actors at every level trying to grab whatever they can, while they can.
If you work for a company with 10,000 employees or more and don't have a gold-plated health plan then it is by deliberate effort on the part of the company to save money.
At that level a company that wants a good plan can demand no exclusions for pre-existing conditions (an issue prior to ACA), same-day partner additions, better drug tiers, lower copays, etc. Often they pay less per person than a 1,000 person company does for a much worse plan.
I know because I looked. Two employers ago we got acquired by a very large company (over 80k employees). They paid ~$800/mo for my family. When I moved to a startup, they were paying ~$1200/mo and the benefits were worse. I'm back at a large company again and it's back to ~900/mo for a better plan.
You are getting screwed because the company has decided to do so.
"You are getting screwed because the company has decided to do so."
Ha ha, didn't have to tell me that! I bet my coworkers we won't have company health insurance in a few years. Gotta keep that stock high.
Crazy thing is, now that I'm middle age, and my 401k approaches 7 figures, I'm beginning to care more about fund performance to get me to retirement in 20 years than benefits. It's all coasting from now.
Wouldn't the mandate against dropping coverage for people with pre-existing conditions result in price increases across the board? (Because now insurers can't take your money, and then tell you to fuck off once you get sick.)
You're probably now paying the 'true' cost of healthcare. (Of course, inflated by the peculiarities of the American system.)
They didn't get to be in the fortune 100 by handing out benefits to their resources. Resources are there to benefit the company; not the other way around.
Another approach would be that a hospital actually has to take responsibility for the doctors and all other care teams working inside. Legislation to this effect would work, but in some cities there is enough competition that a marketing campaign along the lines of "guaranteed no out of network bills!" would catch my attention. I'd happily drive an extra hour for that piece of mind. And the reality is that a large number of ER visits are not true time-critical emergencies. Many times the standard admission procedure starts with reporting to the ER.
I spent 4+ hours before a small outpatient procedure at a local hospital trying to find out if the anesthesia group and surgeons were in-network. I never got a straight answer -- no one knew the answer and I was forced to roll the dice.
Hospitals are currently more like co-working spaces where each room (ORs, radiology, etc.) is rented out. The support staff is included, but everyone else is their own small business.
I learned about these independent groups during a jury stint on a medical malpractice trial. This was actually a four way fingerprinting exercise (plaintiff's family, hospital, nurse, physician's group). The incentives in the system are perverse and corrupting. I think the system will need to be reinvented from the ground up.
That was a weird concept for me to learn as well. When your surgeon is in-network, you kind of expect the anesthesiologist to also be in-network. But surprise! $3500 for anesthesia. Not sure how the average person would know to expect this... http://consumersunion.org/2014/08/surprise-your-anesthesiolo...
The thing is, if you're in an emergency room, for the most part, you're there because of a medical emergency. (I know this isn't universally true, etc.)
If you're bleeding, and someone hands you a price quote, what are you going to do?
Or if you're unconscious, they can't even hand you a price quote. (I guess they could shove it in your pocket.)
I know the one time I needed to go to the ER, for emergency surgery, I'd have done it if they'd said it was a million billion dollars, because my life was literally on the line. I wasn't going to go shopping around, because leaving that ER would've meant death.
What's a price quote supposed to do in those situations?
We just need universal coverage, whether single payer or actually universal insurance.
Your text is grey and you may be getting downvoted and I'm not sure why. You are absolutely right and anyone who has ever been to ER will agree. I was in ER a couple of months ago, and it wasn't even a life-threatening issue, but I felt terrible. I went to the closest hospital with ER department (thankfully, it was in-network), and I was going to get their treatment no matter what price quote they hand me (not that I asked). When you're deeply, physically unwell, nothing else matters to your mind.
I think you may be getting downvoted for your last sentence, but the points you're making are very real.
Cost control right now in the medical industry is all up to your insurance provider, from the article it looks like EmCare is skirting this by simply not participating in any (or very few) provider networks.
I work for a medical billing company owned by a competitor to EmCare, we participate it a large number of insurance networks at each site we staff because it's the best way to get reimbursed - I'm rather shocked the hospital didn't investigate how their contracted providers handled insurance contracts and billing.
The problem with trying to provide quotes for emergency services is you don't know ahead of time what E&M code will apply to the visit, what labs will be run, what procedures may be required for treatment, and since physician and facility billing are separate the right hand doesn't know what the left is doing.
I also have some suspicions about the jump from 6% to 28% rates for billing what I assume is a 99285 (highest level non-trauma ED E&M code) and why it may explain the lack of their participation in insurance networks, but I don't want to tread into libel territory so I'll keep my mouth shut.
Disclaimer: I work for MedAmerica Billing Services, Inc. a subsidiary of CEP America - these views, opinions and statements are my own and don't necessarily reflect those of my employer.
> I'm never one to call for legislation and price controls, but in the face of such adversity, I think it may be our last hope.
I'm always one to call for legislation and price controls, because time and time again, without the legislation in place, situations like this arise. It's the sad reality. Regulating companies is apparently our only hope to keep people from constantly being stepped on.
sinks the whole 'the free market will self-police' fallacy. esp re: health and environment, finance, and worker safety, corporations need regulation, badly.
this is a unique situation. Customers can't shop around for the best price because there are laws in place that prevent insurance companies from offering plans that are sufficiently cost effective in such emergency room visits (and a host of other conditions as well). Otherwise, I'm sure someone would have recognized these problems and offered an insurance plan that protects you from this. Free-market can't do anything when it's hands are tied behind it's back.
What if there was a group or coop or company somewhere, where people could get together and collectively fund their health care. Then this entity could make deals with providers like EmCare to ensure that the care provided was as efficient as possible.
Sarcasm aside: this problem is solved, and it's called insurance. Private entities sell it. The government does it too. It works. We just need to make sure everyone actually has it.
The article shows that this issue affects people with insurance.
It's not that the patients don't have insurance, it's not even that they go to a hospital without an agreement in place with their insurer - it's that the ER has a number of people outside that insurance contract, you don't know who they are, you don't get to choose whether they treat you, you just get a bill at the end - despite being insured, and choosing a hospital recognised by your insurer.
