I pretty much agree with everything you said here. And it’s not just Republicans or Democrats. It’s both. When the ACA came about, the Democrats controlled both houses of Congress, and the Presidency. It was my hope that major reform could take place within these behemoths. This was an opportune time to really straighten out insurance dominance, runaway drug prices (Big Pharma), and mega sized hospital systems. None of these reforms happened, and it’s because all of these industries have HUGE lobbying budgets and control our members of Congress (regardless of party affiliation). To believe otherwise is foolish.

Slight re-direct.

What do people think of Spot insurance? ($25/month with ~$20,000 coverage for injuries resulting from athletic activity). I first noticed them as partners of USACycling. I didn't particularly like the USAC deal because though it's a huge discount over retail ($40/year for USAC members), it seems to not cover cycling events that aren't USAC-sanctioned (which is a good chunk of my cycling).

Seems a good deal for those with crappy (or no) insurance. My insurance is pretty good, so I haven't been tempted yet.

So how does USAT insurance cover you if you are racing out of your state?

This is really eye opening

It's a secondary policy, so you have to have out of pocket expenses and your primary policy has to cover stuff. They won't exactly cover you as much as they will reimburse you.

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Washed up footy player turned Triathlete.

This is what happens when you have to actually pay the made up number that they get from the wheel of random bullshit.

To give you an idea of how ridiculous this is. I had knee surgery in 2019. PCL revision and LCL reconstruction.

Hospital and doctors billed for around 100k. Insurance only paid around 27k. What other industry in the world bills at 4x what they are actually going to get paid. That said I’m actually impressed they didn’t bill more, emergency room plus “emergency” surgery. And it only got billed as twice my planned surgery that is pretty surprising.

My mother in law who thinks she’s knows everything about everything was complaining about this for her mother saying they billed whatever stupid number for the ER visit she had. I’m like who cares it’s all made up and the points don’t matter. Until you see what they actually accept as payment the number they made up is just that a made up inflated number.

This is why the whole “I want to see what the price is up front” is a ridiculous argument for hospitals, I doubt most places even have someone that could give you the contract rate for your specific insurance company. If they did they wouldn’t have to bill at inflated prices and let the system determine what to actually pay.

Afaik, a lot of the incentive for inflated bills is that they can write off enormous unpaid sums against taxes. btw, half a million people in the US work in medical billing. That's 5 times the size of the IRS. One of the reasons why 50% of your insurance premiums go on admin costs.

In theory the new CMS hospital price transparency regulations should help here, but given there's a 21 page FAQ ( https://www.cms.gov/...-asked-questions.pdf ) and an analysis of the data from KFF ( https://www.healthsystemtracker.org/...ng-the-cost-of-care/ ) has lots of compliance gaps in addition to more core problems like the data not being directly comparable between hospital (due to what is included in the dollar amounts) means there's still a long way to go here.

The CMS is toothless. See this lovely blurb at the end of the FAQ: "What happens if a hospital does not comply? [snip] ...may assess on a hospital a civil monetary penalty not in excess of $300 per day...".

Less than $300/day. That rounds to zero in a hospital's budget.

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-Mark Rebuck, http://www.markrebuck.com/

In full transparency I am a Canadian and I work for a global healthcare equipment company. All systems have there flaws our included. That said given the Private aspects of the US system you have effectively created a secondary industry around healthcare that actually provides zero clinical value. This would be insurance, adjudication, bill payments and collections, claims clearing and all the dispute resolution that goes with these tasks. I am sure someone here can correct me on the actual number but I seem to remember seeing a presentation several years ago that this represented close to a trillion $'s in additional spend not directly related to the care of patients. Imagine if that was actually spent on healthcare! That is not to say that there are not private plans for paramedical, dental etc. in other countries including Canada but they are far less complex and costly.

"world wide in an emergency as long as it costs no more than double the price of being treated at home"

Don't go to Hawaii......only double the cost would be a dream.

Or the USA in general - I have travel insurance for that.

Expecting to know the price up front is not ridiculous just because the system, which is where the ridiculousness lies, is unable to do so. I don't know the detail of the US system, and many countries have issues with the structure of their health system financial arrangements, but from what I do know the US does always come across as the least fit for purpose system in the developed world..... As a previous poster noted, it seems to be entirely driven by extreme capitalism and a complete denial of all else.

The entire US healthcare system is one big grift. At least that’s how it feels. I have decent healthcare insurance since I can afford it. One type of drug I take which different manufacturers have similar drug the insurance company constantly drops coverage and if I want to stay on it have to have my doctor show them other covered drugs don’t work for me. I just stay on same one because using the GoodRx app at the pharmacy allows me to pay same price as insurance would cover. The system is all a scam. I went to a specialist at a hospital which was covered by my insurance but the MRI facility at that hospital was NOT covered by my insurance.

If one wants to understand insurance and insurance companies, study casinos and the gambling industry.
The house may pay out on occasion, but the house does not lose.

I don’t doubt it at all. Every year when our company reviews our health insurance package options. We usually have like 5 to choose from. I’m reasonably intelligent and trying to comprehend the differences and determine which option is best for me is a nightmare.

THIS

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http://www.jt10000.com/

Wow you guys in America really get ripped off medically.

In australia what he had done would have been free given the accident.

In the example of elective surgery months after to fix something, it would be a few thousand.

I’m glad I don’t live in the land of the free country.

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