Zuckerberg San Francisco General attempts to excuse price gouging


uuuuHHH… Balance billing on emergency services has been banned in California since 2009. I’m really confused about the Vox article. Is SFGH balance billing patients for emergency services?


Dear USA.
Have you thought about having an actual healthcare system (ie something that set up to heal people, not just make money)?
The rest of the world.


Now, now, let’s not let little things like compassion and respect for the human condition get in the way of draining everyone’s bank account into theirs. /sarcasm


That having been said, I had my gall bladder taken out last year- my cost after co-pays and whatnot was 2-3 grand; the invoices for everything was about ten times that amount, before the ‘negotiated’ insurance rates and other accounting shenanigans. All I can say is that I am glad that my employer has a very good insurance program for it’s employees.


As far as I can tell, for its residents, Singapore is single payer with an additional tax on them in the form of a compulsory savings plan. Medical plans in the private sector do exist but only utilized by about 20% of citizens just as you would expect to happen if the US went single payer but without the mandatory savings plan.

Japan is interesting in that the cost of care is fixed and set by public policy and the government pays 70% of the bill (which by the way is a MUCH larger percentage than what US private insurance covers) and leaves the remaining balance to be paid by the patient. Fixed costs are the big snag when discussing exporting this model. In geographically large and diverse nations like the U.S. fixing prices is problematic at best. Instead, we fix compensation.


An aspect of the system in Singapore that I was a fan of was the mandatory publishing of price lists by providers. As of 1/1/2019, we have that in the U.S., too, and it seems fairly useless. Our price lists aren’t “real” since actual prices are negotiated with insurers, or discounted for low-income, uninsured patients. They also aren’t useful at all for emergency services, as the article pointed out. No one’s going to shop around from an ambulance even if they are conscious.

I agree with you that mandatory health savings accounts are, in effect, a (regressive) tax for health care. It’s not ideal (although I still appreciate being able to use an HSA in the U.S. so I can pay my medical bills with pre-tax income—maybe I should ask my doctor if I have Stockholm Syndrome).

I don’t know about the fixed pricing…I agree with you that it is problematic. It would certainly be unpopular with free market-minded Americans. I guess I don’t understand how Medicare for All would be effective without negotiated, capped, or fixed pricing. Wouldn’t for-profit providers just continue to overcharge patients who are on the hook for everything beyond Medicare’s compensation? Supply, demand, and competition don’t work for healthcare prices like they do in other markets.


Medicare fixes the compensation based on procedure. Under a single payer system, the entity may charge whatever they like but they will only be paid according to the Medicare schedule. Our lawmakers will need to include a mandatory bill adjustment agreements for private healthcare providers to adjust the bill to the payment schedule. The adjustment would need to cover 100% of the uncovered expenses.

Privately insured patients (those who choose to buy their insurance) would do the same. If you carried Blue Cross Blue Shield or some other private insurance they would have already negotiated that bill reduction. This is how it already works for private insurance so I see no need to alter the model in any way. For example, Cigna may only pay $1200/day for inpatient services on some plans no matter the level of care provided or the procedures performed (I’ve actually seen exactly this agreement in place). The daily bill may be say $10,000. The adjustment is typically 70%. So, the bill is reduced to $3,000, the payment is $1200, leaving the patient portion $1,800 for a $10,000 charge. The patient portion of 20% or $2000 is reduced to $1800 to pay the balance.


One of my friends just had her gallbladder removed (in fact she had her follow up today) and it cost her exactly nothing as our NHS service just gets on with it without asking for any money before or after.


Well to be fair, we have a really expensive military to pay for. Maybe if we spent less on that we too could afford to splash out for fripperies like health care. Oh, or maybe if we slightly increased taxes on the very rich.

Clearly however we would far rather have the fancy military and low taxes on the rich unlike (consults notes) the so-called United Kingdom which for some unknown reason prioritizes the lives of it’s citizens.

(or if I were in a less sarcastic mood I could discuss how the NHS has much longer wait times for many procedures, but I would also have to admit that private healthcare exists in the UK and basically just gets shorter wait times from the same staff and acts as an additional funding source to the NHS…and it all seems like a better system then ours here)


As a cost per head our military isn’t exactly cheap, and we keep jumping in on the same conflicts as you guys.

I agree that the wait times can be a little long for some non-urgent or life threatening procedures, but if something is needed urgently it generally just happens.
And this is likely to get worse if we go through with brexit as we will loose even more staff from the already understaffed services.

Overall I don’t think the waits are too bad (at least for anything myself of friends/family have needed), I have always been able to see the GP (general practice doctor) same day when I have needed to, or been able to make an appointment for a relatively convenient time. The only times I have had a hospital referral it has been within a short period of time.

Every time I see someone post a US medical bill that adds up to more than some houses cost for some relatively minor life event I feel so grateful for the NHS.


Not everyone recovers financially from bankruptcy. There is more to it than just the credit rating.


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