# Another pitting of the US health ”care” system **URL:** \ **Category:** The BBQ Pit\ **Created:** [July 26, 2022, 11:00am UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581 "2022-07-26T11:00:55Z")\ **Posts on this page:** 20\ **Page:** 9
**Author:** ![Euphonious\_Polemic](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/euphonious_polemic/32/3002_2.png) [@Euphonious\_Polemic](https://boards.straightdope.com/u/Euphonious_Polemic)\ **Post date:** [July 12, 2024, 8:40pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/161 "2024-07-12T20:40:07Z")
> [@doreen](#): > > in a fee-for-service, Medicare-for-all type, you will still need people to handle billing and payment. You won’t need those people if the government runs the clinics and hospitals and the doctors are employees. In a single-payer system, the doctors are not employees - they are personal corporations. They just bill one single insurance company. This means much, MUCH fewer people needed in the doctors office for billing (mostly just automated) and much MUCH fewer people needed in the government insurance office, because everything is standardized, and simplified. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [July 12, 2024, 9:29pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/162 "2024-07-12T21:29:48Z")
> [@Euphonious\_Polemic](#): > > In a single-payer system, the doctors are not employees - they are personal corporations. They just bill one single insurance company. That’s true for a single payer system which still involves fee for service that is paid for by a single entity but that’s not the only type of UHC there is. There are also systems where everyone must buy a health insurance policy ( Germany is one) and nationalized systems where the government owns most hospitals and clinics and most doctors are government employees. I believe Finland and Sweden use this system. This last type doesn’t involve any insurance billing at all - the clinic or hospital gets a yearly budget, just like most government agencies. There are also systems that combine elements , for example, most hospitals may be run by the government which employs the doctors who work in them while non-hospitalists are not government employees. ( Pretty sure this is how it works in England) And of course, no matter what type of system it is, there may also be a small private system. ---
**Author:** ![Euphonious\_Polemic](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/euphonious_polemic/32/3002_2.png) [@Euphonious\_Polemic](https://boards.straightdope.com/u/Euphonious_Polemic)\ **Post date:** [July 12, 2024, 10:03pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/163 "2024-07-12T22:03:34Z")
> [@doreen](#): > > but that’s not the only type of UHC there is Yes, I realize that. Just pointing out that under this particular UHC system, the costs for handling payments to doctors is way, way cheaper. I imagine under a system like Germany’s this is reduced to basically zero. (I don’t know for sure though). The certain thing is that the current system in the US costs billions of dollars annually for all the people to handle the mish-mosh of insurance schemes. ---
**Author:** ![Atamasama](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/atamasama/32/12961_2.png) [@Atamasama](https://boards.straightdope.com/u/Atamasama)\ **Post date:** [July 12, 2024, 11:15pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/164 "2024-07-12T23:15:21Z")
> [@doreen](#): > > I actually don’t see much in the way of marketing currently - I’ve seen some ads for giant companies like Lenox Hill Radiology or Schweiger Dermatology and the occasional ad in the very local weekly for some smaller groups but that’s it. Up here in the Pacific Northwest (greater Seattle area) I see commercials for hospitals on TV all the time. ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [July 12, 2024, 11:21pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/165 "2024-07-12T23:21:39Z")
> [@kaylasdad99](#): > > But then how would the folks who aren’t involved in diagnosis, treatment or patient care make any money? And what about the yacht salespeople who depend on them? Do you want them to STARVE? Poor widdle leeches would have to get REAL jobs. On the other hand, they would not have to worry about health coverage. I really think our health insurance system in the US stifles free enterprise - do I take my wonderful idea, and start up a business? or do I stay at my boring dronelike job so I can pay for my kids’ medical bills? > [@Cervaise](#): > > As the FTC’s diagram (embedded in the article) makes clear, it’s not just a bunch of unaffiliated middlemen scraping out their cut at each step, it’s also giant vertically integrated megacorps that _present themselves_ as separate companies, inflating prices along the way so the parent benefits. Absolutely maddening. And they pull bullshit crap like changing the formulary mid-year. I have had them do that to me SEVERAL times, which really ought to be illegal. And denying medically-appropriate treatment, and claiming “it’s in the employer’s policy, they made that rule, not us, nuh-uh, no how. Nothing at all to do with us not getting a big enough cut of the proceeds.”. The two mid-year changes were both for asthma inhalers. One of the times, I was switched to a different preventive (steroid) inhaler… which quite literally turned me from pre-diabetic into full-on type 2 diabetic, per blood tests. Luckily, I figured out that the blood sugar changes correlated EXACTLY with the inhaler change, and made them switch me to a different one. Problem solved. Oh, and they re-added the original inhaler back to the formulary, mid-year, without telling anyone. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [July 13, 2024, 3:28am UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/166 "2024-07-13T03:28:08Z")
Maybe I should explain a little further. The people who actually make the decisions about what is, or is not, covered, don’t seem to have any online presence. ---
**Author:** ![I\_Love\_Me\_Vol.I](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/i_love_me_vol.i/32/521_2.png) [@I\_Love\_Me\_Vol.I](https://boards.straightdope.com/u/I_Love_Me_Vol.I)\ **Post date:** [July 13, 2024, 4:58am UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/167 "2024-07-13T04:58:34Z")
> [@penultima\_thule](#): > > […] Haven’t seen a bill. Any gap will be covered by my private medical cover. > Medication in rebab will be supported by the PBS … _the Corporation for Public Broadcasting, and viewers like you._ Sorry. Just a little bit of Yank TV humor there. ETA: oh my. Just noticed this was a somewhat old-ish post I’m resonding to. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [July 13, 2024, 8:52am UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/168 "2024-07-13T08:52:33Z")
> [@echoreply](#): > > > [@illoe](#): > > > > I recently got a short term prescription for my now-teenager. Again, the kind pharmacist calls to ask about insurance. Uninsured cost is $7.52. > > I recently went through something similar. A short term medication would be $10/month for the full 3 month course from Walgreens, which insurance requires I use, but they refused to cover it. Turns out insurance will only cover that medication if I have a very slow test done. So, if I wanted insurance to cover it, I’d have to go back to the doctor, pay for the test, and wait 6 weeks for results. > > I had the doctor send the prescription to Costco, which doesn’t take my insurance, and it was $20 for the full 90 day supply. My drug insurer recently changed from caremark, which was kinda okay, to expresscript, which is horrendously bad. All my cheap routine meds jumped in cost. So i am now getting all of them directly, without “insurance”, because it’s cheaper to get Esomeprazole from Mark Cuban and just pay for it than it is to get it through expresscript. ---
**Author:** ![glee](https://avatars.discourse-cdn.com/v4/letter/g/b5a626/32.png) [@glee](https://boards.straightdope.com/u/glee)\ **Post date:** [July 13, 2024, 11:53am UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/169 "2024-07-13T11:53:08Z")
I have posted this elsewhere, but I hope it’s helpful in this thread. A while back I felt unwell and my doctor gave me a blood test. When the results came back soon after, he immediately contacted me and told me to pack a bag for hospital as an ambulance would be arriving at my home within an hour. 😲 I had liver sepsis (potentially fatal, but treatable…) On the way, the ambulance attendants were great. They told me to stay calm and that I would be rushed in for treatment. On arrival at the hospital, I spent four days in an isolation ward being pumped full of antibiotics. I was tested regularly and finally pronounced all clear. 🕶 The doctor recommended I spend three more days on a general ward to recuperate and check for any recurrence. After a week, I went home happily. As this was the UK, my treatment was free under the [NHS](https://en.wikipedia.org/wiki/National_Health_Service) (prepaid by my taxes over my working life.) No lawyers or insurance brokers were involved. (Apparently the NHS also save money by bulk-buying drugs.) I shudder to think what that would cost in America. ---
**Author:** ![Dewey\_Finn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dewey_finn/32/4222_2.png) [@Dewey\_Finn](https://boards.straightdope.com/u/Dewey_Finn)\ **Post date:** [July 13, 2024, 3:43pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/170 "2024-07-13T15:43:31Z")
> [@nearwildheaven](#): > > Maybe I should explain a little further. > > The people who actually make the decisions about what is, or is not, covered, don’t seem to have any online presence. Maybe you should because your first post was _far_ too cryptic. As to whether they have online presence, I assume they do. I assume that, like many people, they have Facebook pages and are present on social media sites. Do they post on those sites to explain or defend their companies’ decisions? Of course not, because if their employers are like mine, the employees understand that they are not to speak for the company. Employers have public relations, media relations and social media staff whose job is to post on behalf of the company. ---
**Author:** ![Dewey\_Finn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dewey_finn/32/4222_2.png) [@Dewey\_Finn](https://boards.straightdope.com/u/Dewey_Finn)\ **Post date:** [July 13, 2024, 4:55pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/171 "2024-07-13T16:55:44Z")
Also, social media is _far_ too public a forum to discuss decision on particular cases, given the need to protect patient privacy. ---
**Author:** ![Bookkeeper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bookkeeper/32/281_2.png) [@Bookkeeper](https://boards.straightdope.com/u/Bookkeeper)\ **Post date:** [July 13, 2024, 5:17pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/172 "2024-07-13T17:17:05Z")
Another cost-saving benefit of UHC is that there is no need to have a process (and processing staff) to determine if a patient is covered or not. Everybody is covered. ---
**Author:** ![OttoDaFe](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ottodafe/32/356_2.png) [@OttoDaFe](https://boards.straightdope.com/u/OttoDaFe)\ **Post date:** [July 13, 2024, 8:17pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/173 "2024-07-13T20:17:37Z")
> [@Bookkeeper](#): > > … Everybody is covered. Which, to all Right-Thinking Americans™, is heresy. The very idea that some unworthy person\* might get a benefit to which (in the RTA’s mind) they are not entitled is enough to drive them into a froth. Part of the problem is that they’ve been conditioned to think of everything as a zero-sum transaction. So if anyone, anywhere is gaining, they must be losing. It’s bad enough when applied to tangibles such as health benefits, but among the MAGAsses it seems to have gotten to the point where it’s applied to simple human dignity (but that’s a topic for another time&place). \* Meaning anyone other than an RTA. ---
**Author:** ![carrps](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carrps/32/2957_2.png) [@carrps](https://boards.straightdope.com/u/carrps)\ **Post date:** [July 13, 2024, 8:34pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/174 "2024-07-13T20:34:54Z")
> [@puzzlegal](#): > > My drug insurer recently changed from caremark, which was kinda okay, to expresscript, which is horrendously bad. About ten years before I retired my company changed to Expresscript. It didn’t affect me, because I have Kaiser, but it was so bad they went back to the old plan the next year. ---
**Author:** ![Alessan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/alessan/32/465_2.png) [@Alessan](https://boards.straightdope.com/u/Alessan)\ **Post date:** [July 13, 2024, 10:12pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/175 "2024-07-13T22:12:59Z")
> [@OttoDaFe](#): > > Which, to all Right-Thinking Americans™, is heresy. The very idea that some unworthy person\* might get a benefit to which (in the RTA’s mind) they are not entitled is enough to drive them into a froth. Americans would happily spend $10 to prevent $1 from going to someone who doesn’t deserve it. ---
**Author:** ![Bill\_Door](https://avatars.discourse-cdn.com/v4/letter/b/50afbb/32.png) [@Bill\_Door](https://boards.straightdope.com/u/Bill_Door)\ **Post date:** [July 14, 2024, 12:35am UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/176 "2024-07-14T00:35:18Z")
> [@Max\_S](#): > > This is called surprise billing and it’s worst with anesthesiologists. My sister was injured in a fall from a bicycle. The hospital they took her to was in network, as was the person who took the x-rays. The person who read the x-rays was not, and she was billed thousands of dollars. ---
**Author:** ![Dewey\_Finn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dewey_finn/32/4222_2.png) [@Dewey\_Finn](https://boards.straightdope.com/u/Dewey_Finn)\ **Post date:** [July 14, 2024, 12:47am UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/177 "2024-07-14T00:47:33Z")
A [law](https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills) was passed a couple of years ago that’s supposed to prevent this sort of surprise billing, though I guarantee that the medical-insurance industry fought it every step of the way, and then tried to figure out ways to sidestep it. ---
**Author:** ![Mighty\_Mouse](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mighty_mouse/32/7776_2.png) [@Mighty\_Mouse](https://boards.straightdope.com/u/Mighty_Mouse)\ **Post date:** [July 14, 2024, 12:58am UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/178 "2024-07-14T00:58:49Z")
They simply keep doing it and then only adjusting it if the patient fights it. I am in Massachusetts where we have a state law in addition to a federal one prohibiting it. It hasn’t stopped it from happening to me twice since then. One instance is in my OP for this thread. You have to report it to the state department responsible before they will adjust it to the network price. I bet a lot of people don’t fight it. I bet a lot of states do not have as active and aggressive an enforcement agency as Massachusetts. ---
**Author:** ![BippityBoppityBoo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bippityboppityboo/32/5745_2.png) [@BippityBoppityBoo](https://boards.straightdope.com/u/BippityBoppityBoo)\ **Post date:** [July 14, 2024, 5:40am UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/179 "2024-07-14T05:40:07Z")
> [@Mighty\_Mouse](#): > > I bet a lot of states do not have as active and aggressive an enforcement agency as Massachusetts. I bet you are right. In fact, I’d be surprised if there is more than one that is as active~California? My best healthcare years were spent in Massachusetts. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [July 14, 2024, 5:48am UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/180 "2024-07-14T05:48:56Z")
When my first child was born i got a bill for an out of network provider. I said it must be an error because the name of the provider was male, and i hadn’t seen any men in the entire course of pregnancy care. They told me it was the guy who read the ultrasound. I pointed out that i had not been given a choice as to who read the routine, non-emergency scan, and that it was their error to give it to someone out of network, and that i refused to pay. I guess i got lucky, because they ultimately accepted that they were at fault, and the bill went away. [Previous page](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581.md?page=8) [Next page](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581.md?page=10)