Something horrible

I just learned something horrible about US health care. Now, I have been living it for the past several years, and I know quite a bit about how horrifically stupid the payment system is. Practically every US resident has had at least a minor experience of inconvenience that is incomprehensible to most Canadians. But I just learned from someone something that takes the cake and that I never realized.

OK, so, I always knew that American health care providers, no matter how compassionate, practice wallet-based care. Even the ones who give pro bono care at charity institutions are doing so in the knowledge that they are forgoing payment---and give care only to the very poorest.

So, fine, *sigh*, that is health care kepitalism for you. If you're the uninsured working lower class, you're pretty much screwed. I don't like it, it's inhumane and absurd, but that's what falls out of the belief system that underlies it.

But here's where it gets weird---for people who are lucky enough to have employer-sponsored insurance.

To control costs, US private insurers have special deals with certain family doctors and specialists. The big ones, with a very large number of them. This is called an insurer's "network". Under normal circumstances, this actually works out not all that differently from, say, OHIP (or substitute your province's plan) plus a user fee. If you go to an "in-network" doctor, you show the card, pay a (relatively) small user fee, and you see the doctor or have surgery or whatever. The insurers act like OHIP/whatever in this case and negotiate lower rates for themselves in exchange for driving business to these doctors. So you have to do some due diligence to make sure that you go to an "in-network" doctor. A US insurer is, in theory, like a sort of decentralised provincial provider.

But if you go to an "out-of-network" doctor without insurer-negotiated fees, you either bear the full cost yourself, or many plans pay out 80% and make you pay 20% of that doctor's fee in order to discourage "out-of-network" use. OK, so far so good, you can avoid these doctors. (Actually, many people---Americans---don't realize...)

Or can you? Say you're having surgery. That can involve a bunch of medical professionals. So, you show up, talk to your surgeon's assistant, find out that s/he is "in-network", and get onto the operating table. And it's all good. Right?

Wrong.

Quite a few of those professionals, you see, may NOT actually be "in-network." Particularly anaesthetists and pathologists and so on---the latter you might not meet or know is treating you. Oh, they may be working in the hospital or clinic. But they all bill separately.

So, a few months later, you could find a nasty surprise: a bill from your anaesthetist. And guess what. Being "out-of-network", the anaesthetist or whatever can bill whatever they want, and your insurance can pay either 0% or 80% or whatever. But of course, the anaesthetist has no incentive not to bill thousands of dollars for a half-hour's worth of work.

And despite the fact that you had no idea, you are now in potentially unexpected debt-peonage to an anaesthetist---since medical bankruptcy has been made very difficult.

But, it gets worse. Billing errors abound. What if, say, your "in-network" doctor fails to keep his/her registration with the insurer current. Then the insurer won't pay the full-amount. So, you'd imagine, this is the doctor's responsibility, since s/he made the error, right?

Nope.

It's your job to pay the entire bill, or the portion that the insurer won't pay for "out-of-network" costs. Even though it was the doctor's billing error.

THAT is why people who tell you that medical care should be subject to the "free" "market" should be put in the stocks for months. Not just the inhumanity of the idea---that is ideology---but the inherent lying and fraud involved. That is also why the doctors (specialists) are greatly at fault in the US system, not just the insurers. Because doctors can choose to put their patients into debt-peonage.

I had no idea until someone explained it to me, and apparently many Americans born and raised here have no idea either. You're screwed despite the fact that you have good insurance. So you can do everything right and still be wrong.

A sensible and responsible idea -

which will never fly with US gun nutz.

From here:

[...]sidestep the entire gun control controversy and instead pass state laws that require anyone who owns a gun to carry insurance.

If they have risk factors (like teenagers in the house), their rates go up. If one of their kids sneaks a gun out of the house and gets caught, or uses it to commit a crime, the insurance gets canceled for some meaningful period of time - say, 10 years. And if someone steals your gun and you don't report it in a 24-hour window of you finding out, your insurance is suspended.

If you have a rifle and it's only used for hunting, low rates. If you have a Glock and you carry it in an open-carry town or state, your rates will be very high - because odds are so much higher that innocent bystanders may get caught in a shootout.

The comments after this short item are very informative and they reflect the whole gamut of ambivalence, sense and crazy about firearms / the 2nd amendment that US citizens share. Here's a few that made me chortle.

[...] that would further enrich insurance companies. They are venal and clever enough to offer policies that have the veneer of protection and coverage while not doing so in a practical sense. They would profit handsomely while putting themselves at minimal risk. Think of how they've gamed health insurance.

Accidents and deaths. I think we need to explore this idea. If own a machine that can kill, you should insure it. Motor vehicles and guns. [...] But there is an impossible hurdle - any legislation that requires people to 'declare' the guns they own will never work. The nuts think it is the first step for the government to take guns away. Which brings us to the question - why haven't they come for our cars?

Teabaggers [...] the same demographic as the gun fanatics. Sorry, all rational, reasonable attempts to ameliorate the effects of gun violence are "off the table" by default. Now if your mandatory gun insurance included mandatory gun ownership for all citizens, and the NRA owned the gun insurance company, then you might get somewhere.

"Gun control? We need bullet control! I think every bullet should cost 5,000 dollars. Because if a bullet cost five thousand dollars, we wouldn't have any innocent bystanders .” Chris Rock, Jon Stewart, Stephen Colbert ... why is it comedians are so much smarter than the rest of us?

Remember how our mothers used to fret that rough-housing and various stunts would lead to someone losing an eye? It seems that in the US, the obligatory worship to God the Father will soon be supplanted by the Almighty Right to Bear Arms, if that hasn't happened already. Who cares if politicians, teachers, by-standers get maimed or killed so that some 'murrican men and women can compensate for their feelings of inadequacy, and keep the scary evil monsters at arms' length. Until they look in the mirror, that is.