Straightforward healthcare reform would start with eliminating this unprecedented and nonsensical ability for hospitals to engage in arbitrary post facto billing, require well-defined contracts for non-emergency care, and require providers to publish a uniform all-payer rate schedule for emergency/urgent care. Any deviation should result in a non-enforceable invalid bill, with easily claimable punitive damages if such fraudulent charges end up being mistakenly paid.
When I walk into a grocery store, buy some items, and leave there is absolutely no chance that I will later get a bill in the mail from the cashier for their bagging services. If I were to, it would be laughably unenforceable. And yet, this is precisely what the medical establishment feels entitled to do when they refuse to answer basic questions about prices or "network" status of providers, and then send you multiple bills for a single engagement!
While this would do little to help healthcare affordability for those who truly cannot pay, it is a necessary step to creating a functioning market regardless of who is paying. The point we're at now, where even people with the ability to pay have no clue how exactly the system will attempt to screw them, is utterly untenable.
For what it's worth, this is the kind of reform the Republican party could be loudly and persistently pushing if weren't primarily interested in dysfunction. As it stands the only popular avenue for reform I've seen is to punt the whole thing to the government, which I'm forced to reluctantly support even though it feels like giving up on actually solving the problem and letting the organizational cancer metastasize and feed on taxpayer money.
This. Something I've come across is that most of my friends who have ended up in better insuring (and often paying) jobs are somewhat blind to the thievery happening in plain sight because the monthly premiums are conveniently out of sight.
As a thought experiment, congress should simply ban and outlaw employer provided healthcare and force everyone who desires to be insured to make contract directly with Kaiser, Blueshield etc. When you pay north of $2k / month (for a family of four) out of your own pocket for the pleasure of being able to make an appointment in hospital, that just might draw enough ire to effect change.
Of course that should also make employing someone equally cheaper, or allow for equally large salary increase.
I'm one of those people in a better-insuring job, and I still see a lot of thievery happening in plain sight. I recently had a telemedicine visit with my doctor, and the hospital sent me a separate "facility fee" bill for that. Apparently because the doctor was in his office at the hospital, I need to pay out-of-pocket for this non-medical facility charge. Since it's non-medical, my health insurance company doesn't even negotiate a rate for that charge, let alone pay it.
Fortunately my state requires that such fees be disclosed to the patient ahead of time, so I'm going to send in a written complaint pointing to that law and count on this fee being reduced or dismissed. However the fact that I even have to be able to find, interpret, and apply that law is a systemic failure.
holy crap. For the life of me, this is such an incredibly broken mess ! I am amazed that how this medical system came to fruition. Clearly, a functionally medical system is _needed_ (not _wanted_) for a developed country. USA is I guess an exception.
p.s.: come to India, I cant overstate how much better it is.
So as you fly through the air after being ejected in a car crash, make sure to pull out your phone and negotiate upfront pricing with your providers before you hit the ground and are rendered unconscious.
While I agree after the fact billing is stupid, your scheme implies people choose their hospital based on rates as they are flying through the air after being ejected from a car in a crash. Make sure to choose wisely before you black out!
Or, every doctor visit has an attending billing assistant to explain costs of care to both the doctor and the patient.
Because the doctors don't know and don't have time to know.
In the end this is all Republican laissez faire fantasies. We need socialized medicine, like ever other civilized and (by our standards) uncivilized country has.
I have no clue when the Republican party would have been able to push any coherent reform to the health care system. 50 years ago? The modern Republican party exists solely to defend entrenched oligarchies and anticompetitive cartel dominated markets. That's what campaign finance rules reward.
The Democrats also perform the same function, but at least with some attempts at reform around the edges, because that's what their voting block demands.
> require providers to publish a uniform all-payer rate schedule for emergency/urgent care
What I described is just laying out a bare minimum for some semblance of sanity. Your laissez faire straw man fantasy extrapolates as if I am pushing this as a complete solution, but I am not.
In one complete solution most everyone would still have insurance (actual insurance) for such catastrophic events, either purchased themselves, packaged as part of auto insurance, bought through the government as a provider of last resort, supplied as part of a minimum social safety net, etc.
Alternatively, keep right on pushing for Medicare for All! It's orthogonal because there are many things that wouldn't be fully covered by M4A, even in the emergency context (eg a single occupancy hospital room).
The point is that there needs to be some market dynamic to keep prices "real" and allow for straightforward competition between different providers, regardless of who is paying.
(FWIW you could also do some research ahead of time about local urgent care providers, or hear recommendations from other people - for most urgent situations you would not be unconscious and could choose where to go.)
When I walk into a grocery store, buy some items, and leave there is absolutely no chance that I will later get a bill in the mail from the cashier for their bagging services. If I were to, it would be laughably unenforceable. And yet, this is precisely what the medical establishment feels entitled to do when they refuse to answer basic questions about prices or "network" status of providers, and then send you multiple bills for a single engagement!
While this would do little to help healthcare affordability for those who truly cannot pay, it is a necessary step to creating a functioning market regardless of who is paying. The point we're at now, where even people with the ability to pay have no clue how exactly the system will attempt to screw them, is utterly untenable.
For what it's worth, this is the kind of reform the Republican party could be loudly and persistently pushing if weren't primarily interested in dysfunction. As it stands the only popular avenue for reform I've seen is to punt the whole thing to the government, which I'm forced to reluctantly support even though it feels like giving up on actually solving the problem and letting the organizational cancer metastasize and feed on taxpayer money.