Let me give you a comparison from my personal experience.
My wife was pregnant. The hospital she chose to give birth in specialized in giving birth. Our health plan was administered by a large company, and was used by over 10k employees at our company.
During the pregnancy, I tried multiple times to determine how much the pregnancy would cost. Neither the hospital nor the insurance could tell me any estimate for the cost. I had no way to price shop or save or budget. I was completely at the whims of the hospital and insurance.
Also. They over charged me for at least one procedure.
My wife gave birth at a hospital in our network, but our daughter needed ICU care (in their opinion). We were given no choice in the matter and our child was taken to the ICU. And surprise, surprise, the ICU doctor we had no choice in selecting was not in network, and a low 5-figure bill was racked up for care we didn't really want and our child almost certainly didn't need. Also a very difficult thing to fight when you've got a newborn.
Man, that kind of experience would really make me lose faith in society. My wife needed a caesarian and was rushed to the operating theatre, but at no point was there any thought about cost — I just trusted that the doctors knew their business (and they did). It's so completely natural that anything that can happen while giving birth is covered by our mandatory healthcare insurance that the thought wouldn't cross your mind in the Netherlands (and obviously no bill came).
Hospitals and pharmaceutical companies do funny stuff with pricing worldwide, but at least patients aren't usually bothered with it.
Well nobody really has faith in the system to begin with.
We went into the process battling the system and ended it battling the system.
The various types of care that were provided were all fine and good but the decisions about which care to do, who does it and how much it is going to cost leaves a lot to be desired. But you know that going in.
"Also a very difficult thing to fight when you've got a newborn"
Same for people with a serious disease like cancer. They don't have the energy to spend all their time on negotiating with hospitals ind insurance. They either pay up or go bankrupt.
And when you don't pay, they sell your debt on to collections. Collections will sue to get a judgement against you, which will allow wage garnishment and other types of confiscation. Finally, say goodbye to your credit rating.
They charge because the power in the hospital/patient relationship is so very asymmetric.
Generally, yes, they'll have to see a judge. Not always, but usually. However, it's really common for debt collectors to present a judge with a stack of cases for entry of judgement. Can be a few hundred at once, it's a scaled process. So going before a judge isn't really a barrier for debt collectors.
Of course for a debtor, it's a different ideal. May have to take time off work, find child care, etc. Very unbalanced power in the debtor/creditor relationship.
It is in my country, so why couldn't it be in the USA? Here we always know how much I'm going to pay for a procedure ahead of time, no surprises, procedures have sticker price just like groceries.
- If you have health insurance: you always know ahead of time what hospitals are in network, then the price for all out of pocket expenses are listed in the contract with the insurance company (prices adjusted yearly). You only ever deal with your insurer, out of pocket co-pays came in next months bill, just like a phone bill or credit card bill , it is actually illegal for a doctor or hospital to charge you directly for anything in that case. Any dispute (like the one in the article) is a business matter between the insurer and the hospital, nothing to do with you.
- If you don't have insurance and decide to go for a private hospital: the hospital will sell you a fixed price package for each procedure or a big package for the whole stay, each with a fixed contract signed ahead of time. There is no surprises, no one signs a "blank check" to the hospital like those "service agreements" in the USA.
And that sort of begs the question doesn't it? why isn't buying healthcare basically the same as buying groceries? both are large complex industries with lots of moving pieces that rely on vast networks of distributors. what makes healthcare so special that a person could see a 200x increase in the amount they were quoted for a service vs what they paid?
From my own anecdotal experience, my domestic partner had to be hospitalized for a suicide attempt. The ambulance took her to the hospital in my neighborhood which was in my network. By law they had to place her on a 72 hope suicide watch in the intensive care unit. I called my insurance company to relay all this information and was assured that it would all be covered by my insurance since a) the hospital was in network and b) the treatment was legally required.
Fast forward to 6 months later when I finally get the bill. For $40,000 ... because the insurance company only authorized a 2 day stay in the hospital when state law said the hospital couldn't release her until after the third day and despite the fact that this information was provided to the insurance company both by myself as well as the emergency room staff before she was admitted (I was sitting right next to them as they called, so there is no question they were aware of the circumstances).
The insurance industry is an absolute nightmare and a parasite, providing no value to the ecosystem at a dramatically inflated cost. The sooner it is abolished and healthcare is made a fundamental human right and socialized the better off we will all be.
If we're to exist in a capitalistic society where healthcare has a price tag, then I have a right to see that price and have confidence that it won't change arbitrarily.
Due to the abstract nature and infrequent experience of healthcare solutions in the US, I believe people need to have these abstractions drawn to illustrate the absurdity of it all.
My wife was pregnant. The hospital she chose to give birth in specialized in giving birth. Our health plan was administered by a large company, and was used by over 10k employees at our company.
During the pregnancy, I tried multiple times to determine how much the pregnancy would cost. Neither the hospital nor the insurance could tell me any estimate for the cost. I had no way to price shop or save or budget. I was completely at the whims of the hospital and insurance.
Also. They over charged me for at least one procedure.