[badclient]

Also, just so everyone knows, it's pretty easy to negotiate down your bill. The reason healthcare is so expensive is so many people don't pay it. If you are willing to pay say 40% of your bill it's already 25% better than medicare.

This. My Dad is a surgeon and the stories I hear are incredible. Once he operated on a child whose insurance was out of network. So the insurance company writes the parents a check to give to my father. Instead, the parents decide to cash it and never pay for the surgery. So, the parents literally make a few thousand bucks from having their child operated instead of paying that.

[sanderjd]

This is the part I'm always curious about in these discussions: how do people get away with not paying? Is it a debt that is often discharged in bankruptcy or is there some other mechanism by which the debt is erased?

[tracker1]

Well, you can hire a collection agency (who usually gets X% of the collected amount with an $X as a minimum acceptable ammount, usually around 50%).

You, or an agency on your behalf can then have the unpaid amount due as a collection account appear on their credit report, and after that (7 years of no activity) it is supposed to come off. Some unscrupulous collection companies will modify the last account change date to keep it on, but that can be challenged.

You can also take the person to court and have a declaratory judgement, which will stick around on said credit report until paid.

There are also specific laws regarding where the involved parties are as local state laws apply too. It gets a little complicated.

I have two bills on my credit report with agencies that refused to negotiate... and I had an auto loan that was charged off (they repossessed my truck after they broke the payment arrangements that were made when I lost my job, and I refused to pay), after 8 years the collection company had changed the dates several times, I pointed out to the credit reporting agencies that the amount was the charged off amount for over 8 years, and had it successfully removed.

YMMV.

[badclient]

It is a combination. First, healthcare debt isn't weighted as heavily on credit reports. Second, healthcare is one of the few businesses where it is illegal to deny services before payment. You can't walk into a walmart, grab a candy bar and just walk out. With emergency healthcare, you can do just that and sadly, too many people take advantage of it.

[refurb]

To give you an idea of how big of a problem not paying is, I'll relate a story I heard from a small business owner in California:

In an effort to provide his blue collar workers with a decent benefits package, he setup a health insurance plan. After 6 months or so, his HR person came back and said "none of the employees have used the insurance at all!" This was weird since these workers had families and obviously children get sick on a regular basis.

He spoke to his employees and asked why they weren't using their insurance. The answer? Instead of having to pay a $20 co-pay to see a doctor, they could just go to the hospital and say they were uninsured. If they did that, they didn't pay a dime for their healthcare.

[GFischer]

How is that NOT screwed up?

I'm amazed at the ways the U.S. healthcare system is so much worse than most of the rest of the world's.

I guess there are humungous lobbying efforts and entrenched interests to make it stay the way it is.

The caveat being, it also has some of the most advanced medical technology and procedures too, but the day-to-day healthcare is surely the worst.

How it works here in Uruguay:

There are three levels of care

1) Universal (public) healthcare, you just show at the door and you're admitted. The quality is poor (although doctors are mostly good), and some hospital conditions are close to appalling, but it's 100% free (paid by taxpayers blablah), even up to cancer or AIDS treatment (yes, thousands of dollars). Time to treatment is also very bad for surgeries and other conditions.

2) Almost-universal healthcare in a co-op mode (Mutualism, "Mutualistas" and FONASA). Anybody who works or draws a pension has the right to one of those for himself and his children. Quality is decent, and there are some small costs associated (U$ 5 per doctor visit, and a few hundred dollars for major events). Medicine is provided by the hospital at an extreme discount (usually U$ 5 for any medicine, including the ones costing hundreds of dollars. Generics are mandatory whenever possible). The thing is, it's becoming a bit overcrowded and quality is going down, government is over-regulating IMO.

3) Private insurance, US-style. This one can replace 2) although 1) is still free to everybody (double coverage). That one gives access to the very best hospitals, doctors, etc... but it's the most expensive by far, and usually doesn't cover medicines outside of hospital stay.

[lawnchair_larry]

This isn't true. They only have to provide emergency services, and they still charge for them, just not up front. If anyone did that, they would still receive bills in the mail and have derogatory information on their credit report.

Otherwise, please tell me which hospital is giving away free service to the uninsured.

[refurb]

Exactly, these employees would take their children to the emergency room/urgent care. They weren't getting check-ups, but if the kid had a high fever, they would bring them in, get them seen by a doctor, then be on their way.

When asked about billing they simply said "I don't have insurance". Many hospitals, including the DSH (disproportionate share hospitals) write these things off all the time. The hospital just doesn't bother following up. Are you going to spend $200 to chase down a $100 hospital bill?

[justincpollard]

I know you're just providing a hypothetical example, but I think it's common for services provided by doctors or a hospital emergency room to cost quite a bit more than $100; in many cases an order of magnitude more. At the end of the day, I do agree that a hospital will or should make a collection decision based on a cost benefit analysis of some kind, but I think that decision will be to collect a good portion of the time.

[TeMPOraL]

> The hospital just doesn't bother following up. Are you going to spend $200 to chase down a $100 hospital bill?

I think I would. Do it few times at random and get the offenders to pay $1k+, and soon people will stop scamming hospitals. For what I can tell, similar system (random ticket checks + penalties 10x the ticket price) works quite well for public transit in many cities worldwide.

[gscott]

Here in San Diego going to the ER without insurance costs a minimum of $1,000. I once had to do so for my son. Cost for a room was $600, a $40 shin splint cost $250, and I am not sure what else but it was pretty expensive.

[sp332]

That seems odd... I've heard from several sources that insurance companies negotiate prices, while individuals get stuck with even larger bills.

[refurb]

There are many hospitals (often inner-city) that serve a large population of the uninsured. They are quite used to not billing patients for procedures.

[njharman]

Debt is not a crime in the U.S.A. Just don't pay it. Eventually collectors write it off as tax loss.