[0xBDB]

Yes, so this is where the brains and effort (and time, forgot time) come in.

The anecdotes in your links (that I read - can't get through all of them right now) have a common theme, which is that people died because they either needed very expensive and/or experimental treatment that probably would not be affordably provided to them under any plausible healthcare system, or else they got a bill, decided they couldn't pay it, and did without or tried to self-ration their healthcare.

The correct course of action in that case is to call the healthcare provider and negotiate A) a 90+% discount and B) a payment plan, both of which are pretty readily available in the American system. You have to know that's possible, and you shouldn't have to, but it is possible. Then you reach out to the charities, government programs, and/or nonprofits from my original link to cover what you still can't afford. Same deal if you get screwed by an insurance company as in the Guardian article.

This is, again, not something I'm trying to defend. It's not the way a sane healthcare system would run. But it is a system that works, more or less, for those who know how to work within it.

[zrn900]

> The anecdotes

The anecdotes show that this is not an 'occasional' or 'edge case' thing but a systemic thing. The statistics show that at least 40,000 people die a year for not having enough money for healthcare and these are the people we know. The statistics don't include those who never go to the hospital to avoid risking medical bankruptcy for their families even if they die themselves. Just being in a hospital bed for one night without anything being done costs $3000/night, whereas waiting in the ER without anything being done can cost $100/hour.

https://www.marketwatch.com/story/woman-gets-688-35-er-bill-...

This is a systemic thing. Its not 'not a sane healthcare system'. Its literally a machine that kills people to maximize profit. And it became like this only because people let it and justified this or that other thing in the system.

[0xBDB]

> Just being in a hospital bed for one night without anything being done costs $3000/night

No, it doesn't. It costs whatever you can negotiate it to cost. I've been without insurance; one experience isn't data, but in my experience just telling the hospital you haven't got insurance is, again, good for 90+% off by itself.

https://www.cnbc.com/2020/10/28/you-can-negotiate-your-medic...

Hospitals (ed: non-profit ones, but I'm pretty sure similar rules apply elsewhere) in particular are required by federal law to have 'well-publicized' financial assistance policies.

https://www.irs.gov/charities-non-profits/financial-assistan...

> Its literally a machine that kills people to maximize profit.

If that were true it would do a good job of maximizing profit. It's not even that good. Healthcare margins in the U.S. are 0.7%, which sucks. If you're the proverbial evil billionaire or whatever you'd rather own almost anything else.

https://www.nadapayments.com/blog/what-is-the-average-profit...

The whole reason I started this thread is because it bugs me when we attribute to malice what is obviously stupidity.

[zrn900]

> It costs whatever you can negotiate it to cost

That's a really surreal proposition. People who are sick cannot 'negotiate' anything. People who are recently treated and are recovering from an illness are the same. Something that is life-critical cannot be up for negotiation to start with, but lets allow it for argument's sake.

What if you 'negotiate' and the hospital and the insurance company just reject? Do you have pockets deep enough to fight with their lawyers for years? Do you have the time? One person against corporate behemoths. That defies logic.

> If that were true it would do a good job of maximizing profit

It does. It keeps both the availability of doctors and hospital beds to create artificial scarcity. It does vertical integration and ensures that whatever you do in healthcare ranging from getting insurance to going to hospital, from medicines to secondary care stays within the corporate shareholdership network that owns the entire conglomerate.

> when we attribute to malice what is obviously stupidity.

The reason that the system gets away with murdering people for profit is that people attribute to stupidity what should be attributed to malice. If large corporations are killing people for profit like they are, malice should be attributed to the actions of all the upper echelons of the corporate world rather than any kind of incompetence.

[0xBDB]

> What if you 'negotiate' and the hospital and the insurance company just reject?

If you are sick and can't negotiate, and no one can negotiate on your behalf, or the provider won't negotiate, and if they sue, and if you have no charity assistance, then you will be one of the folks who goes bankrupt from medical bills. I said it was hard, and you can see from that chain of conditionals that it absolutely is, but of course it does happen.

The effects of bankruptcy in the U.S. last seven years, at least as far as credit rating is concerned. Not great, but this is not serious in the way that killing people would be serious, if that happened, which again, it basically doesn't if you can navigate the system.

> It does.

0.7% is an absurdly low profit margin. It just is. The rest of your paragraph is basically true, but doesn't change that. At the same time, the U.S. spends a much higher percentage of GDP on healthcare than most developed nations. Ergo, what the U.S. system is really optimized for is wasting money

Since that is not a rational goal for anyone, it's stupid. Evil at least achieves something for the evildoer. I'll leave it at that.

[zrn900]

> 0.7% is an absurdly low profit margin. It just is. The rest of your paragraph is basically true, but doesn't change that. At the same time, the U.S. spends a much higher percentage of GDP on healthcare than most developed nations.

Where do you pull out that profit margin. The healthcare sector does vertical integration - they keep the patient inside their services - from insurance to hospitals - and milk them.

Your system is not inefficient. It is. The efficiency is for the shareholders. Not for you.

[0xBDB]

> Where do you pull out that profit margin.

From the link I provided.

> The efficiency is for the shareholders.

It's probably worth pointing out that some of the largest American insurance companies are mutuals. They don't have shareholders, or profits. Admittedly this is rarer in health insurance than some other kinds, but State Farm, for example, does a huge health insurance business and sends its excess revenue, if any, back to its policyholder-owners as dividends.

Insurance companies that do make profits do much better than 0.7%, but then imagine how much worse that means doctors and hospitals are doing in order to drive the average down that far. And this was originally about hospital bills. Americans with insurance don't typically get bills from the insurance company, just statements of what they aren't going to pay.

> The healthcare sector does vertical integration

Here you have a point. American antitrust hasn't been good for some time, and tends to be less effective on vertical than horizontal integration. Nevertheless, while I can't immediately find a number on what percentage of American providers are owned by insurance companies, I'm pretty confident it isn't high.

[joquarky]

> just telling the hospital you haven't got insurance is, again, good for 90+% off by itself.

My understanding is that directly charging a different (higher) amount for insurance is considered to be fraud.

[0xBDB]

I'm not a lawyer and I've heard of more ridiculous laws than that, so quite possibly, but even if that's the case, I wouldn't think it would cover billing x and collecting 0.1x when you realize someone can't pay x.

And even if I'm wrong about that, when lacking insurance I didn't encounter a medical provider, including big ones with big compliance offices, who wouldn't do it. But others' mileage may vary.