[toomuchtodo]

> US has a 30% tax burden, UK has a 40% tax burden. France and Germany have >50% tax burdens. The last three have some form of nationalised healthcare though, which the US does not.

As a US citizen, I'm happy to have an increased tax burden for legislated vacation/holiday days and 20% of the population not having medical bills they can't pay for.

[fargolime]

It's more like 80% of the population, when considering expenses not covered by insurance. A hospital can charge you for anything and you're legally obligated to pay it.

[pc86]

> A hospital can charge you for anything and you're legally obligated to pay it.

Categorically, unequivocally wrong.

Hospitals cannot just make up charges. They cannot bill you for procedures/tests/services you did not receive (and if they do, you are not "legally obligated to pay it").

I know the anti-US healthcare circle jerk is pretty strong here, but we don't need to just make things up in order to prove a point.

[_delirium]

It's true that they can't just make up services, but they can do a pretty wide range of things and bill you for them, without giving you the price in advance. My dad was in the hospital once, and got something like 20 separate bills, for different services he had no idea he had received (and had no way to verify if he had even received). And my mom actually did get a half-dozen or so bills for services she definitely didn't receive. She went to the ER, checked in, but ended up leaving before getting any services whatsoever: after >1hr waiting in the ER's waiting room, she started calling around to see if she could be seen somewhere else, and left when she found a nearby urgent-care clinic that could see her. They still billed her for a "standard" ER work-up, including line items for a blood test and lab work! She had not had blood drawn, and clearly no lab work was done. Obviously she didn't pay that bill, though: if you really have good evidence that the service was not performed, you can challenge it.

[pc86]

Honestly I'd be shocked if an ER doctor knew the price of a service before doing. They probably know a general range (give or take a few hundred dollars?) for a given test, but even that I'm mostly guessing on.

Unless they're a small operation, I don't know that they'd have any direct visibility into the billing/insurance/finance side of the operation. Maybe that is the issue? I don't know how to combat that in a large hospital setting.

The one time I had surgery I ended up getting 3 separate bills for varying amounts, but any time I asked for documentation about a given procedure or test it was provided in writing well before the due date of the bill.

[fargolime]

I once asked the financial adviser for a hospital, how much the CAT scan will be. He said $1700. On the bill it was $4500. Here's how it really works, according to a relative of mine who works in the billing dept. of a major hospital: each month they decide how much to charge patients for services already rendered, so they can meet their monetary goals for that month.

[fargolime]

> Categorically, unequivocally wrong

Hyperbole much?

They can charge you for services / products rendered and which aren't covered by insurance, and they can charge any price they want and you're legally obligated to pay it. Of 3 times I helped my parents with processing their hospital bills, it was over $10K in non-covered expenses each time.

[pc86]

Is your complaint that a hospital can charge you for a service that was rendered, that they perform services you might have to pay for, or that they assume you're not interested in rate-shopping your surgeon?

Yes, you are legally obligated to pay for services rendered. I think you'll be hard pressed to find someone to argue the opposite, though.

[baconner]

The problem isn't that you have to pay for services rendered. The problem is the pricing and service system is extremely opaque. You can receive services without ever having an opportunity to know what those services are or how much they will cost. And that's not restricted to high emergency care its everything. It's not comparable to paying for services in other industries where pricing is presented up front or at least before services are rendered. The opaqueness leads to price inflation as well so service prices aren't regulated by the consumer market.

For example once my wife had to go to the er and we'd taken great pains to know ahead of time what hospital was covered best under our insurance. Yet the bill contained test services performed in he hospital that were not covered because a room in the hospital was operated by a separate lab company that didn't accept our insurance. There was literally no way for us as consumers to know that one type of blood test regularly covered by our insurance in a covered facility would go through the magic door into an uncovered facility. Price inflation and surprise bills are emergent properties of the system and that needs to change.

I am all for consumers having choice and taking personal responsibility for their care but our healthcare system makes that effectively impossible.

[fargolime]

The observation is, in EU countries with nationalized healthcare you don't get a hospital bill. In the US you can have good health insurance and still get a bill that bankrupts you and leaves you homeless. You can't rate shop in advance of getting rear-ended.

[mikeash]

You previously said "charge you for anything" which is substantially broader than "charge you for services/products rendered."

Reading your previous statement literally (and I saw no reason to read it in any other way), it meant that a hospital could charge you for buying an elephant and you'd be legally obligated to pay.

And you're complaining about other people using hyperbole?

[fargolime]

They can charge you for some pretty ridiculous things, though. My mom got charged $175 every time an assistant nurse checked on her, 4 times a day. It wasn't reduced by insurance; instead they didn't cover it at all, so she was obligated to pay the $5000 charge.

[rhino369]

The working poor get shafted in America, but the middle class gets a better deal. They hardly pay taxes, get employer paid health insurance and vacation.