Why Europeans Don't Get Huge Medical Bills

[Recursion]

https://www.theatlantic.com/health/archive/2019/04/do-europeans-get-big-medical-bills/586906/

There is, however, a way to eliminate those bank-busting surprise medical bills without eliminating health insurance. Just ask Europe. Several European countries have health insurance just like America does. The difference is that their governments regulate what insurance must cover and what hospitals and doctors are allowed to charge much more aggressively than the United States does.

When I described surprise medical bills to experts who focus on different western-European countries’ health systems, they had no idea what I was talking about. “What is a surprise medical bill?” said Sophia Schlette, a public-health expert and a former senior adviser at Berlin’s National Association of Statutory Health Insurance Physicians. “Seriously, they don’t happen here.”

Almost all Germans are covered by a variety of health insurance, such as “sickness funds,” which are financed through taxes. Almost all doctors and hospitals accept these plans. About 90 percent of Germans never see a bill for their doctor visits, and the rest are covered by private insurance, which usually reimburses whatever they get charged. According to the researchers Roosa Tikkanen and Robin Osborn at the Commonwealth Fund, there’s a flat co-pay for people who are hospitalized, capped at a maximum of 280 euros—or about $315 U.S. dollars—for a 28-day stay. And doctors, too, are not allowed to charge more than the payment rates that are negotiated between the sickness funds and the doctors’ associations. A very small number of the country’s physicians are private and don’t accept the sickness funds, but they have to tell patients how much they’ll charge before a patient is treated, removing the surprise element.

In France, there are no provider networks, so no doctor can be “out-of-network.” Doctors’ associations negotiate their fees with the universal public health-insurance program every few years. As a result, says Paul Dutton, a history professor at Northern Arizona University who has studied the French system, “I’ve walked into an office [in France] with my kids where it’s just a receptionist and a doctor. There’s not these back-office wars” over what to charge patients. Some French doctors choose to bill above the government-mandated amount, and this can indeed lead to extra medical bills, Tikkanen and Osborn told me. But 95 percent of the French population also has private secondary insurance—often included in an employer’s benefit package—that helps cover the doctors who “extra bill.” Doctors have to post their fees on their walls, and you can ask how much the visit will be before you book an appointment. In the United States, it’s easier to find out how much it costs to park at a hospital than to get an electrocardiogram there.

[Blues Heron]

1. One of our hospitals here charges $7,000/day

not sure why we're putting up with this outright theft and abuse, but some people like the situation as is I guess.

[Mosby]

2. control what hospitals charge.

That's the key.

Personally I don't think the "free market" works for the hospital system so I support nationalization of hospitals.

At some point something radical will have to be considered, the health care industry will eventually crash the economy.

[Recursion]

3. There's no price discovery possible here

I liked what the article said about France: doctors can charge whatever they want above the negotiated price but they have to tell you beforehand how much it will be. Sure, nobody shops around in an emergency, but that's really not most of our healthcare use. I would definitely have shopped around for my apnea sleep study if there had been any way of getting a straight answer about how much it would cost.

[dixiegrrrrl]

4. i racked up a 3,000 ER bill in Feb.

My bill was 154.00.

I am for Medicare for all, assuming that, if it were national, it would be essentially the same as it is now in coverage plus vision and dental.
except for Part D....don't need that if the rip off prescription prices are curtailed.

We could easily afford it, by scrapping a half dozen welfare for the rich laws. At some point universal health care that really works for the people is gonna have to be a demand, instead of a foreign concept.

IMHO, of course.

[Dirty Socialist]

5. Are these insurance companies

Are they for profit, non profit, or somewhere in between?

[Recursion]

7. Varies by country

In France the insurance is for-profit (but it's just for charges above the mandated rate). In Germany the "sickness" insurance is a regional co-operative and so not-for-profit, but the "extra" insurance is for-profit. In the Netherlands both types are for-profit. In Switzerland both are not-for-profit.

Honestly I think the for-profit status of insurance companies is a red herring; most Blue Cross providers are not-for-profit but they aren't noticeably cheaper. Meanwhile Anthem provides most of the Medicaid insurance in the country, and it's for-profit and does it incredibly cheaply because the government tells them they have to.

[JCMach1]

6. We need a Truth in Billing Act

And tough price controls

[nuxvomica]

8. If the Republicans were smart, they'd advocate these systems as a counter to MFA

It sounds like a market-based system, just not a "free market", whatever the hell that really is. Price honesty and cost containment are key, and reasonable. But as long as the health-care industry controls them their masters will not budge. They have to make extreme profits and have total control over the transactions, regardless of the damage to everyone else. Even if medicare-for-all isn't politically viable it's important to push it to force some re-thinking.

[Recursion]

9. McCain talked about it before he picked Palin

After that he sold out to the crazies and had to run on the idea that American healthcare is perfect; the party has been stuck there ever since.

It's a shame because if the GOP had been willing to deal and add some price transparency (and, hell, I'd even throw in tort reform though I don't think it's a great idea) we would have wound up with a better bill.