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Message: <blockquote data-quote="Gradine" data-source="post: 9172348" data-attributes="member: 57112">How it works is basically this:In the US we, for reasons that will become abundantly clear soon*, do not have any kind of government run health-care, so all health-care is by nature private. Private health care, then, by necessity has to be a business, which means investment from, and the need to funnel profits to, shareholders*. And yet, even for a good long time hospital care in the US was still relatively affordable, and most hospitals were able to operate at cost. But then a funny thing was invented: insurance. In particular, private insurance*. Health care was still relatively affordable, but as costs rose that relatively started doing some heavy lifting. Luckily, insurance came in to fill that gap! Insurance is essentially shared risk mitigation, with the middlemen taking their cut off top. Gotta appease those shareholders*, right?But nothing is ever enough, and insurance companies began demanding larger and larger discounts from hospitals and other providers, pushing hospitals past the point where they'd start operating at a loss. Thus, a clever workaround was discovered! Says the insurance salesman, he says "we need something like a 80% discount for our customers at your hospital!" So says the hospital administrator, "So... these swabs cost us 5 cents each, but if we just say they cost $50, we can cut that down to $5 for, so you can tell your bosses you're getting a huge discount, and we get a little extra in our coffers too!" This is, essentially, the story of how U.S. healthcare costs skyrocketed beyond any reasonable measure. It's why you see things outrageous charges on your statements like $500 for a bandaid or whatever. And since every insurance company is cutting deals with every provider individually, it's also why the costs of things are so hugely different from provider to provider.Now, none of that matters to you too much if you've got good insurance. Unfortunately, even today in the U.S. most good insurance is available through employers, who get to negotiate their own huge discounts and also chip in their own portion of the premiums, so freelancers are stuck footing the entire bill for insurance on their own. It's a good thing that we don't live in a world where freelancers are more common than ever, to the extent that an absolutely absurd term like "gig economy" hasn't needed to be invented, right? ...Right?But sure, say you have good insurance. You're only personally paying, what, a few bucks for that outrageously marked up cotton swab. It's not like they charge those ridiculous prices to people without insurance or are out of network. That would be- what's that? Sorry, I'm just receiving word that they absolutely do charge those ridiculous prices to everyone whether they're under a negotiated insurance plan or not. Fortunately (or unfortunately, if you're a hospital shareholder), this pesky thing about Hippocrates or "do no harm" or whatever sort of prevents medical professionals from letting you die for lack of payment, but they're still going to bill you, even if they know you can't pay, which means they show up as losses on the spreadsheet, so those costs have to be passed on to everyone, driving up healthcare costs for everyone in an endless cycle of suck.But sure, say you have good insurance. But then you have a health-care emergency. Let's say you've traveled across and the closest hospital to you is out-of-network for your insurance. Let's say the paramedics that get dispatched to you contract with a hospital out of your network even if you have an in-network hospital the same length of time away. Or let's say you do end up in an in-network hospital, but the doctors they have on contract that take care of you are out-of-network. Guess who's footing the bill for that? Hint: it's not your insurance.But sure, say you have good insurance, and you receive incredibly expensive but life-saving medical care, and it's all in-network. Better hope your insurance claims adjustor doesn't find a reason to deny you coverage! Because they'll look! They'll really... really look. So yeah, given all that it's almost kind of a miracle that only about 2/3rds of personal bankruptcies in the U.S. are due to medical debt.</blockquote>

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