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Notes -
so how is this similar to the car mechanic bill situation?
besides, all sorts of other professions delivering all sorts of other services with non-fixed costs and complications manage to present agreed upon, known costs and estimates up front and don't send a surprise bill with an absurd amount attached
I've received healthcare at countries all over the world; there, despite the complications you describe w/re pricing, they're able to tell me an estimate which aligns with the bill I receive later. Even when there are complications. Even when a mechanic while looking at the drivetrain notices the transmission needs to be replaced. As far as I know, there is a single industry which does this and only in a single country in the world.
I am sure there are parts of the US which really struggle with medical services and have the problems you're describing, but on net no it is not or else it wouldn't be delivering more total healthcare, with higher salaries, and higher prices than ever.
Are places which ban the above practice more likely to suffer the effects you're talking about? If not, I don't really understand the relevance beyond a general criticism for nonpayment.
"Unnecessarily" doesn't have much explanatory weight, e.g., I promise to pay any bill I think is "reasonable," and I won't unnecessarily refuse to pay any bill I think it reasonable. This statement doesn't really mean anything.
Nothing about this is strictly "necessary" because if it was then it would be done in places which banned the practice except they don't and medical care is still delivered there. An accurate statement would be that they do it because they're trying to extract more money from the patient or their insurance, they don't have negotiating power with the insurance company, and so they're going to go after the weaker position patient.
no one has to be the villain here, but it also doesn't mean by default it's just the patient who has some moral obligation to get screwed and fork over whatever amount some derp bureaucrat decides to send them
I don't doubt that. Judging by the ACA, insurance company lobbying groups will find a way to make it even worse. If the legislation is similar to efforts in my field, it may help some random person like the OP accidentally in certain situations but will mostly be used by megacorps to put them in better negotiating positions.
Healthcare provision outside the U.S. is structurally different in a number of ways that fundamentally change the feasibility of what you describe like:
-Rates of nonpayment being orders of magnitude lower (a huge chunk of ED care is just not paid for by anybody, in most countries some combination of less recalcitrant insurance and single payor takes care of this).
-Our population is sicker and requires more care and more complicated care and more variable care (the number of patients with BMI over 70 in most countries is close to zero and that kind of stuff is more expensive to deal with and more variable than diseases of poverty).
-Other countries can ration and not engage in heroic care
-Related to that most countries don't have the legal environment. Malpractice related stuff is a huge driver of U.S. costs and complexity.
-You don't know what's going on under the hood with your bill, does the health system automatically write off most of the encounter for tourist patients because it's easier than trying to send a bill to another country? Is that care funded by something specific?
-The type of care where this likely to be relevant is stuff I'm doubting you are getting (how are you getting operated on in multiple countries????).
-Where are you getting this impression of U.S. healthcare? Costs are skyrocketing and health is plummeting but that's not a sign of health. Physician salaries have been decreasing relative to inflation for decades, not sure where you think higher salaries are coming from.
-Shockingly people are not willing to work at places which underpay or have a risk of not getting paid at all, this is doubly a problem because it's incredibly hard to get physicians and to a lesser extent midlevels to work outside of a major metropolitan area. Increase the risk of you not getting paid and nobody wants to work there. A hospital can't exist without providers. This is one of the causes of the death spirals leading to hospital closures recently.
-So is your claim that wanting to get paid for doing work "unnecessary?" That kind of attitude is why people are leaving medicine in droves. Not just doctors, nurses too.
-The villain is the health insurance company for not providing the agreed upon service, but if you say "no I'm just going to steal from someone else and demand the right to continue stealing" than the villain includes you. Again we aren't talking about a heart attack here, we are talking about care that shouldn't be initially triaged by an ED.
Yes, I agree healthcare provision is different in many ways, but that also sets the context for this entire discussion and criticism. Your argument is the end-user has a moral obligation to pay whatever $$ bill is sent to them (if you have some restricting condition, you have not yet mentioned it although I would assume you have some sort of "reasonableness" limit). You justify this by saying healthcare providers cannot refuse to provide services.
The main issue I have with this argument is you're using situations which do not account for the overwhelming vast majority of healthcare in order to justify practices and moral obligations. An example is your ringer neurologist to a patient having a stroke with other examples being almost entirely focused on ED care, but this is not representative of the majority of healthcare expenditures. Healthcare providers can and do refuse non-emergency care to people who they know will not pay for it. Perhaps in the context of megacorps and hospital systems, it is true individual doctors cannot de facto refuse care due to billing.
You set this context by essentially requiring the end user who is being screwed to think of it in situations which aren't representative and about individual doctors and other providers who have limited choice with pay structures likely irrelevant of whether or not each individual pays any bill sent to them.
But then, so what? This would be a systemic criticism, not a moral obligation on the final screwed person. The enduser can simply respond with your same moralizing back at you.
One, not a tourist. Two, your claim is that the healthcare system may automatically writes off tourist patients (I wasn't a tourist) and don't even bother at point of contact to tell them the cost and ask for payment? not that they give a bill they don't think will be paid
this criticism doesn't even stand on the face of it, it's little more than handwaving
knocks, stitches, broken bones, nose bleeds, etc., the kind of care which is being discussed as the example in the OP
again, you're using specific situations not described in the OP to justify obligations in other different situations
summaries of total delivered services, avg pay, total cost, number of ppl employed in industry, etc.
more money being spent and more people being employed to deliver healthcare to a populace which gets sicker and sicker every year isn't exactly a ringing endorsement of the healthcare being delivered let alone the healthcare system
no, my claim is that the practice described in the op isn't "necessary" and that the word "necessary" has little meaning in your sentence
I cannot find any support that "people" are leaving medicine in drones: more people work in "healthcare" now as doctors, nurses, etc., than ever before
yeah, well no one is saying that
Nurses are leaving bedside nursing in droves and while some specialties are keeping up with retirement rates we are slipping behind our overall healthcare needs.
My problem is not that OP has a moral requirement to pay a bill no matter how stupid it is, it's that he doesn't know if it's stupid or not in this case, he (and everyone else) is blaming the wrong parties (the PA has no idea what's being charged and has no control over it, blame the insurance company or the hospital/practice management group that owns the PA). He also went to an inappropriate level of care and was surprised that costs were excessive. If you get admitted and demand to be in the ICU instead of on the floor it'll be your fault when the bill is an order of magnitude higher.
if you're going to design a system for the purpose of extracting more money by surprise fucking over patients, don't be surprised when they're angry or refuse to pay
Again, the entity extracting more money and surprise fucking over the patient isn't the hospital or the healthcare provider it's the insurance company.
OP paid the insurance company for a service (covering healthcare needs) and then the insurance company was like lol nah we aren't going to do that, and instead of refusing to pay the insurance company or complaining about the insurance company they take it out on essentially a third party with no control.
If I wire transfer some money to 419 scammers and then walk into a bank and punch an employee in the face for allowing me to get scammed then I'm the asshole.
The ED is literally required by law to provide care regardless of insurance status, ability to pay, or appropriateness of that level of care. There's literally nothing the ED can do to stop this, it's OP's job to go to an appropriate level of care, think critically about whether an ED visit is required, investigate his insurance, or get new insurance.
OP and the Hospital are both victims of the insurance company being an asshole.
But if, hypothetically, the OP didn't have insurance and just wanted to pay cash, do you think the bill would have been any lower? My impression is that paying cash for healthcare in the US is strangely difficult, expensive, and prices just as (if not more) opaque.
Short version: costs are weird, sometimes outright unknown (the accounting for some stuff gets bizarre), charges are generally inflated as a result an annoying dance with insurance companies and the federal government to get things paid for (ex: for a lot of stuff medicaid and medicare pay less than cost so things get...creative and the insurance company goes "we'll pay you 1.05 times the cost...").
Professional fees are like likely to do this because it's a little more obvious to pay out a portion of a staff members salary based off of how long the encounter is supposed to go (very doctors, NPs, or PA are self-employed these days, almost everyone is "owned" sometimes by a hospital but also by....).
Based off the absurdly inflated price and and the lack of willingness to negotiate (most health systems will be flexible with cash pay) (and also the fact this is the ED) the PA was probably owned by a practice management group which is when a PE firm buys a physician group and does things like cut salaries, raise prices, and be an asshole (and give the money back to whoever is invested in it). It's a huge problem right now.
It is also possible that this primarily driven by what happens when your insurance company just refuses to pay for things but that's less likely.
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again, the healthcare industry and hospital systems are participants with agency in this game which designed this setup as part of the negotiating game with insurance companies
this new bank employee analogy is even worse than your car mechanic one
Negotiating prices for services is not "extracting" money unexpectedly, being unaware of what the insurance will cover is not "surprising fucking over," the insurance knows what they will pay for and we often don't and have to fight them, even for clearly necessary stuff.
Hospitals can't know (as in knowing and changing your decisions as a result is illegal, specifically for emergency medicine) what the insurance is going to do, the agency is extremely limited.
In response to this sort of fuckery places have literally closed their EDs. Hospitals are going out of business at record rates and posting record lows for profit. Meanwhile the insurance companies are posting record highs.
What are they supposed to do? Break the law and not treat the guy? Just not get paid and then go out of business? Stop victim blaming.
And that's completely ignoring the other layer of this which I can't verify with the details OP provided, but the PA is probably owned by a third party - a private equity group that does enjoy the revenue associated with skull fucking patients and everyone in healthcare would love for that behavior to get banned but we don't have any control...
I don't know how the fuck the scummy companies won the psyop where they blame everything on doctors who have zero administrative or financial control.
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