Wednesday, July 8, 2015

Healthcare in the USA

This is a collection of links around the 'net about problems with healthcare in the US.

The problems are best articulated by some of the posts by Karl Denninger.  He points out several examples where services in the US cost between 5 and 10 times what they cost in other developed countries.  Given that the patient typically has a copay for that amount, it means that if the services were being billed appropriately, one would not need insurance.  Sadly, this same model is being exported to all countries where healthcare is not socialized.

In addition to a complete lack of transparency; i.e. not knowing how much a service will cost until after the fact, there are often billing errors resulting in overcharging due to mistakes by both providers and insurance companies.  This speaks to the complexities of the whole system.  Most doctors' offices need dedicated staff to handle billing.

Sadly, despite the costs, misdiagnosis and incorrect treatments are very common.  Here's what this article says:
A follow-up study published in 2013 argued that the IOM numbers were a vast underestimate, and that medical errors contribute to the deaths of between 210,000 and 440,000 patients. At the lower bound, that's the equivalent of nearly 10 jumbo jets crashing every week — or the entire population of Birmingham, Alabama dying every year.
An interesting documentary about healthcare is Sicko by Michael Moore.  Things have only gotten worse since this documentary from 2007.  In fact, medical bills are the biggest cause of bankruptcies in the US.   Health, literally, is wealth--it is one's biggest asset, and lack of it could potentially be one's biggest liability.

Increasingly, because of the complexity of dealing with insurance companies, primary care doctors are converting to concierge services where they charge an upfront fee for all services during the year and provide a higher and easier level of access to healthcare.

Personal anecdote about cost of services

This is an excerpt of a bill I received for recent blood tests.  The total charge by the company providing services is $983.78.  This is what someone without insurance would have paid.  With insurance, the negotiated rate is discounted by $892.00.  That is a 90% discount off the list price!  Why are medical providers allowed to gouge people without insurance?  This is pretty typical of almost all services I receive whether it is doctors office visits or surgery.  It pretty much means that these prices are never actually paid because those without insurance most likely will not be able to afford to pay for these services anyway.  These are oppressive business practices and I am surprised and disillusioned to see that they are allowed to affect something as necessary as healthcare services in a country as progressive as the USA.

This also points to the shape of things to come in developing countries as insurance companies take a stronger foothold.

Billing errors

Over the last few years, I have personally witnessed a significant increase in billing errors both by doctors offices and insurance companies.  First off, the bills are extremely cryptic and it takes tremendous effort and focus to cross check between the explanation of benefits, the bills from the service provider, and reimbursements from the flexible savings account.  I have spent hours on the phone sorting out billing issues.  This is like rubbing salt on a wound -- the services are already too expensive for what is received, the insurance deductibles and co-pays are way high, and to top it off we now have to deal with billing issues going back and forth between the insurance company and the provider and undoing incorrect, automatic reimbursements from the flexible savings account.

The phone systems are typically quite bad and disconnections are very common.  Each time you dial in, you have to go through the sequence of prompts and re-verify yourself with the agent (name, SSN, address, etc.) and re-explain the whole problem from the start.

If we make any mistakes (like forgetting to pay), these corporations will come after us by sending the payments to collection and creating all kinds of legal hassles for us.  But we must simply put up with their poor service because we only have a very limited choice of providers through our employer.

If you are not already sick, you will be sick by the time you're done dealing with this!

Over marketed

Another problem with healthcare in the US is that it is over marketed.  Everything from the quality of care to the outcomes of treatment are over-exaggerated by commercials.  Many doctors choose less treatment over more when it comes time to make a choice for their own treatment because they understand the nature of over marketing.

Cost of snake bite treatment

Here's a classic case.
When dad got the bill he almost needed to go to the hospital because it was over $1 million. The exact amount $1.188 Million Dollars! 
Additional reading

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