An American healthcare story

Most people in the world know healthcare in the USA is bonkers and often doctors won't treat you unless you can prove you have the insurance to cover it. But what non-americans might not know is the lengths that medical places go to extract profit from you at every turn.

Here's a real thing that has happened several times:

You're in the ER. Someone you love's health is in the balance. There's a knock on your ER bay door, and someone in business attire walks in with a clipboard.

"Hi, I'm from the hospital—listen, we estimate today is going to cost you roughly $500 after your insurance covers the rest, but if you pay within 48hrs of service, we can save you 20% more off the total, so if you want to take advantage of this offer, pay us $400 right now, and the $500 bill will disappear"

So in this state, you figure sure, at least one thing should go right today, fine, I'll pay it now and save a little.

Ok, yeah, it's really as crass as it sounds. Someone that works for the hospital, trying to maximize revenues, comes in when you're in the middle of a health crisis and starts playing Monty Hall on Let's Make a Deal, concocting weird offers and making you do math when you're worried about someone you love on a slow drip hopefully getting better.

It's fucking gross, from end to end, but it gets worse...

One time we did this, they thought we owed nearly $400, so they said pay us $300 now, and we did to make them go away.

A few weeks later we find out insurance covered more than we thought, and we overpaid by nearly $150. A couple months later the hospital sent us a check for $50, no other explanation.

So $100 went poof into the ledger somewhere.

Profit-driven healthcare is as dumb an idea as profit-driven private prisons. It's hellish and dystopian and leads to really ugly incentives.

The entire world except the US figured out the cost of medicine is easy to handle if it is shared by all. I don't think anything will change in the US in my lifetime, if I really want health security as I get older, I would have to leave the country.

Coincidentally, a friend recently went to an ER in France. They spent all day there getting treated, were handed a month of antibiotics to take after for healing and let go.

The entire bill was around $35.

We recently did an ER visit with four hours of observation, and everything was fine. A couple months later, the bills came up to around $1,200 for one ER visit with full family PPO insurance coverage at an in-network hospital.

Which of these options seems most sane?

I forgot to mention our employer-provided healthcare costs about $15,000 per year, paid monthly. And if you use your healthcare, they only cover about 75% of the high costs.

I'm also reminded that last year when I got an MRI and my insurance called me up several times to pitch a different MRI place than the hospital I've gone to for ten years.

Turns out going to "my" hospital for continued care and my ten-year history of MRIs cost me $850 they refused to cover. All the calls were trying to get me to use a cheaper place in my network since something recently changed in my insurance coverage. They never said it though, I had to put it together after the fact.

Too many people work in the giant medical industry in the US to ever make change possible. We'd have to cut millions of middle managers at healthcare companies who are looking in every nook and cranny for profit.

Everyone else in the world has figured it out though, but the US sticks to what doesn't work and bankrupts thousands daily.