How do we get these and all the other rights we should have? There was little substantive discussion of healthcare in the 2016 election--just the mindless battle cry of "Repeal Obamacare!" For the 2018 elections, we need to question every person running for office about his or her stance on the myriad specific healthcare issues we care about.
The Democrats could persuade a lot of people get out and vote this year if they developed a national platform that addressed the healthcare problems that are --literally-- destroying the health of the nation.
23
Dr. Pollard used to think that drug users "do it to themselves, they deserve what they get." And he refuses to perform surgery on a 25 yr. old man bc he had an infected heart secondary to drug use? I hope that this doctor offered to get the 25 yo another MD who WOULD perform the surgery. He should not be practicing medicine. Patients be warned. I guess Dr. Pollard thinks its up to him who lives and dies (this would qualify him for a mental health diagnosis." Blaming drug users for medical complications is senseless. If they could stop using they would, its complicated and definitely not about just "saying no."
4
End this nonsense and the need for such articles:
Medicare for All.
Expand medical coverage to pay for dental, eyes, mental health, drug counseling.
Medicare to negotiate national bulk medication, medical equipment and global inpatient service fees.
Free medical training for doctors and nurses who practice in underserved areas/populations for 10 years.
33
I'm now fighting for a new law or regulation to require a 911 operator to notify anyone who requests an ambulance what it is likely to cost. One midwest caller recently got a 20 minute ride to a hospital and was charged $4100. In what other transaction can you buy something without knowing the cost before you buy?
16
If this was really that important, wouldn't it have been a part of the Affordable Health Care Act of 2010?
1
Number 7 is a doozy, though I'd rephrase it as a more general principle: The right to know prices ex-ante. Can you imagine driving off of the lot of a dealership and not knowing how much your car cost you for 3 months? That's insane, but it's exactly how medical services work. Anecdotally, I have *never* received even a brief mention of approximate cost when I'm being referred.
This ties to another item that needs to be on this list. Do not let medical service providers practice price discrimination. This is *the* main reason that prices are not published. In fact, being uninsured usually increases the total bill of the practicing physician because the cashier in charge of pricing assumes a large default rate for uninsured patients, and thus compensates by gouging uninsured patients who actually manage to have enough funds to pay. Furthermore, it's actually possible to bargain down the final bill by as much as 50% or more, well after the procedure has been performed, by bringing proof of inability to pay to the financial wing of most hospitals. The hospital poses this as a "charitable" service, but in reality, it's just a way to create a price discrimination cascade that charges exactly as much as the patient's wallet can bear.
10
My deceased sister had several outstanding medical bills incurred in Florida. The estate laws order the estate payout to: 1. legal fees, 2. funeral expenses, 3.estate administration fees, 4. any bills for care in the last 90 days of treatment, 5.then all others.
For an overnight implantation of a spinal stimulator 10 years ago there was an oustanding balance over $27,000 because she was told on pre-approval of care that her insurer would pay the fees. "Pre-approval" (for those unfamiliar with the term) means that the insurer agrees that something is medically necessary, but the last line of the letter always states that "payment is not guaranteed"
Several months after discharge (and an additional $20,000 in charges) she was told "oops, your insurance company rejected our charges, you weren't really covered at our facility - so now YOU owe us $45,000". My naive sister agreed to pay $100/month for life.
Every month since her death a bill for the balance arrives from the prestigious Mayo Clinic Jacksonville (like clockwork!). I discussed a reduced payout since no insurance company would have ever paid the full retail price of care, but the working poor are expected to cough up the last penny.
As the representative of her estate I will treat the poor Mayo clinic fairly, but they will definitely be the last to be paid from her meager remaining assets (as the Florida law mandates).
Her care may have been state of the art, but the Clinic's compassion has been non-existent.
20
This is a nice read. I am sure we all need to know all of these, but amidst crisis, we dont pay attention and the providers make sure they dont loose profits by informing us.
7
"Twenty percent of people with insurance say they have trouble paying their medical bills..."
How many more people avoid this problem by not using their health insurance in any meaningful way? Like me. Oh I get the basics taken care of...the low out of pocket costs to me. The eye exams and basic checkups - but the bigger stuff that might require something like the ubiquitous and costly MRI...nope. Been putting those explorations off.
Even dental. Sure the exam is covered, the cleaning, a little filling here and there - but anything bigger...not so much, if at all. As too much of dental work is deemed cosmetic, and therefore can be listed on the less coverage ledger.
As an aside, if the idea of protecting the citizenry, the consumers who drive this economy - from predators was in any way supported by this Admin, its appointees, or the REpubs in general...what a wonderful, and truly greater nation this would be. As it stands now, we're being mauled by predators, who are now gaining more and more freedom,and legal protections to do so.
Its our fault according to the Repubs, and its not the job of the WH to even consider protecting us. Rather they are wholly elected to serve their donors and other benefactors. We are bystanders in their world. Bystanders who only muck things up when we demand protections from those with more means and sophistication to exploit us.
Right now we all need protection from a Republican Congress and White House.
15
My mother had dementia. She fell and hit her head on the floor and was injured. I took her to the ER by taxi (save the ambulance for the unconscious). We were there for 9 hours. I had to get the urine sample from her. She got an xray. ER doctor only glanced at her. ER dr. originally wanted to keep her overnight for observation, but the hospital did not want to deal with a dementia patient, so they sent her home. This decision was made by her covering GP, who never saw her, and told me by cell phone. We later received a bill for $27,000 for that ER visit, for which my mother received no treatment or care (I was even told that I should have kept her home with an icepack, but I feared that her caregiver might report me for abuse or neglect). Then we received another bill for $700, for the ER dr. who saw her for a few seconds. I didn't pay these bills. Later I got a letter that told me these bills were a mistake. I can only assume that this is what they would have charged someone without insurance. $3,000 a hour, for a cursory exam and no treatment?
20
This is one of the most vital op-ed pieces ever written. If only it could translate into a political movement or gain the support of some influential members of the 1% something might happen.
16
Well, yes, yes, yes, yes, yes, yes, yes, yes, and yes.
But, of course, this Financial Bill of Rights could easily be made moot by a government regulated single-payer system. More fair, more efficient, and less needful of rights enumeration.
18
The first thing every perspective patient needs to understand, is not to place all their faith in a doctor(s). For work, I have needed to be fitter than 99% of the population. Because of that, my vitals were always exceedingly low for my age, and to doctors, that means healthy. When I burst my appendix, and told doctors that I had, they said nothing was wrong me and left me to rot for two days. It ruined my life, put me out of my job, and left me with webbing holding my stomach together. Several years later, other doctors said there was nothing wrong with my spine. Three months later, after finding a doctor who understood fit people, I had a spinal fusion that removed 20 years of debilitating pain.
If you get a bid from a carpenter, you don't pay him a fee if he turns down the work. I was routinely charged upwards of $400 for doctors to tell me they would do nothing for me, often giving no reason. So when I finally found a doctor who would, I was broke.
American healthcare is still broken. I worked for the government for years, prostituted my body to save others property, and am now broken because of it, mostly unable to work, and have never received a penny in healthcare from the government. I also have few healthcare records because if we ever went to a doctor for a work related injury, we would have been out of work, so we just suffered through any injury we had, and kept working.
The clincher: without records, doctors say there's nothing wrong with you!
7
I know Americans are said to hate the UK's system of socialised medicine, but honestly we have none of the issues described in this article.
Obviously we have private insurance available as a top up to the NHS if you want or need it, but no one ever goes bankrupt trying to pay for a basic life saving medical emergency in the family.
Why don't you just start expanding your medicar programme?
17
I love Rosenthal's work in this field. If I didn't know better I would think this was a riff on A Modest Proposal. Bills in plain English, cool, but then four items about in/out of network complications is just too weird to someone like me who has lived in a single-payer country. I wonder what my friends overseas, some of them Americans, will think of this.
6
The medical insurance enterprise is a quasi-criminal organization.
16
Laws should be passed to prevent surprise bills that result from in patient admissions.
After a recent **inpatient** admission at a large New York city hospital, I began receiving large bills for the services of doctors who were out of network with my plan-
The "in network hospital" turned out to be stocked with out of network doctors. This is particularly egregious and unethical because, unlike out patient medical care, you can't choose your providers when you are in the emergency room or the in patient unit. This really is fraud. I've sent specific detail of my situation to the Attorney General of New York and urge others to do this as well.
24
Absolutely! One unfair charge I have experienced is billing for procedures that the insurance company considers to be experimental, investigatory, and of unproven worth. I received EOBs totally over $25,000 for procedures denied coverage by my insurance provider for such charges. The provider who billed for the charges appealed the denials several times with no success. I spoke to the provider, who told me over the phone, but would not put in writing, that I would only be responsible for $500.00. Determined not to pay one cent for experimental, investigatory, and unproven procedures, I wrote letters of complaint to the provider who ordered the procedures. In fact, I wrote letters of complaint to everyone in the hospital involved with the issue. I told them I did not appreciate being part of an experiment, that I was not going to fund the research of the laboratory that did the procedures, and that I considered the matter fraudulent because I was not informed that experimental, investigatory, and unproven procedures would be used. Because of my persistence, the company dropped all charges. Do not let health care providers stick you a bill for its experimentation and investigation. Thank you.
11
Excellent article, but how many people will remember all of this?
4
I once had a gash on my face and my husband took me to the ER. I asked if the doctor was in my network (because the facility was). They told me they could not tell me that until after the doctor had seen me! I promptly left. I knew I'd be in for thousands in balance billing. The next day, I went to an in-network urgent care, got stitches, and the price was $45. The fleecing of the public when they are in dire straits is downright immoral.
30
Do Americans really need our most expensive in the world for-profit healthcare CARTEL? The CARTEL simply negotiates with care and drug providers to maximize mutual profits all around. This is done constantly to the point of causing a consumer uprising. Then they back off a bit. Our system is designed to maximize profit...period. Just remember, before Obamacare, insurers completely had their way with us. It was sold to us as "Freedom"! They spent hundreds of millions to NOT deliver the product we paid for. It was, and still is, the only business sector that can get away with such deceit. Now, ideological Conservative members of Congress want to take us back to the future. No Way!
It's truly time to cut Healthcare Insurers out of the equation and let a government monopsony negotiate for us. Vote for Medicare For All in November.
8
Everyone here is demanding their "rights." So do it- set up a single-payer system, and see what physicians are willing to join, and how hard they are willing to work.
The problem is consumption. We perform excessive amounts of healthcare on people/disease with no legitimate benefit. We could save a fortune by not paying for the ridiculous, like the woman I have in an ICU now.... been there for months, comatose, no hope, but the family (recent immigrants BTW on medicaid) who say "do everything" for this 80 year old.
Yes, you call me harsh, uncaring. I do care- I want to have enough money to pay for reasonable care, to not bankrupt people with curable problems and yes, I want to make the income I deserve.
13
To all who want single payer: remember how you’re treated by every other level and form of government. Those experiences are the ones you want in healthcare?
I’ve had plenty of frustrating experiences with private insurance but nothing as compares to the unaccountable “you’re not my supervisor” attitude of government employees. Think long and hard if you’d trust those same people with all your health decisions.
4
Absurd that we need such a bill of rights. Absurd that we are held hostage by for-profit insurance companies.This is why we need Single Payer universal coverage.
7
I will help get it enacted. Where do I start?
5
Most of these rights are after the fact with respect to treatment. Here are a few more for before the fact:
-Patients are entitled to an upfront estimate for their care.
-In conjunction with cost estimates, they should also receive medical outcome statistics, both local and nationally, for those services.
-Patients are the owners of their test results. They should be entitled to a copy, delivered directly to them not through their doctor, without additional charge.
After all this, however, none of these rights will address the moral hazard inherent in our system. As long as our healthcare system financially rewards all of the the providers for higher cost care, we can expect ever higher cost care.
8
Can we also add the right to be free of the paperwork?
For every encounter I have with a health care provider, I have to wait six to eight weeks to receive all the relevant documents. Then, I have to spread them out on the dining table and try to reconcile all of them.
9
How about doctors ordering unnecessary tests, I moved to a new area, picked up a family doctor who ordered a host of tests for which there was no need. I called my physician where I lived for 36 years and she told me there was no need, she had all my records. Some of the doctors have cross referral arrangements.
5
All of these billing tricks and shocks are a direct result of private insurance companies maximizing profits and providers who are unconcerned with the cost of their services and treatments to patients. The whole system of insurance and medical services is rigged against patients because patients are individuals with no group power and are in no position when they are sick or injured to be shopping for the best deals or asking hospital personnel if they are "in-network" or "Is this procedure covered by my plan?" Obviously, we all need at least the choice of a single, comprehensive, universal insurance plan that standardizes provider fees for services and that all or most providers accept. Like, yes, Medicare.
10
My wife and I lived 16 years in the Netherlands. Our GP(Huisarts) was the gatekeeper to the Dutch health care system. His office staff consisted of a one person receptionist, fax operator, prescription refill person, etc., and the doctor. There was no need for all those other people we are use to seeing in a US GP’s office as the Dutch system is seamless and fairly efficient. All health care providers were on the same page. Oh, and there were quite a few insurance companies competing for our business. Imagine the cost savings here if we had a similar, very practical system with lots of competition by providers.
9
This list is far too short. Control of one's own body must be number one. Number two should be receiving copies of all medical records. My extensive medical history was destroyed by my primary provider merely for being more than ten years old, and without providing notice of doing so. I would have happily brought it home, as there were no other copies.
Another right is not having to sign forms in advance of service.
13
I have tried getting this information from Palo Alto Medical Group in the SF Bay Area. They are the most ridiculous medical group. I can't get a list of prices, I can't get an estimate of charges. I wouldn't get my car fixed without an estimate. That's what we need in healthcare today.
Otherwise, I will be visiting India, Thailand and Mexico for care at 1/10 of the cost.
6
Getting your gastric bypass done in Mexico sounds great until the surgeon accidentally nicks your spleen or you get hospital-acquired MRSA!
Or maybe we just need single payer. Like, now. Our system is complex, inefficient, and deeply harmful. (Unless you think bankruptcy isn't harmful.) That is the advocacy we need, and that needs to be shouted from the rooftops, and voted on, until we've got enough sensible people in power to change our system wholesale. Anything else is putting a band-aid on a gaping wound.
14
Why would a single payer be any more patient friendly than the current system?
2
When I’m sick, there is no paperwork, zero, and no payment. The only item in the article that applies to me would be knowing the costs of elective care. I’m not sure if it’s the law or simple respect, but I am always informed of elective costs to the penny before consenting.
The only time I was hospitalized, intake took seconds: to swipe my hospital card. When the doctor said I was done, I asked where to go to be discharged. He looked confused. “There’s nothing to sign?” I asked. He laughed. “No, you just leave.” So I strolled out.
I live in Québec, where we have single-payer, after having spent 50 years in the States. I would never go back to the U.S system.
8
Why is everyone agreeing with these ideas, patients 'rights'? It's ridiculous - like saying employees don't need unions..We don't need a 'patient rights bill' - how could we EVER enforce our rights, against the vast establishment that is our system of medicine? The whole idea is just garbage..
We need a single payer system, so profit is taken out of medicine. Doctors will still have good jobs, don't worry, guys, but the insurance industry will be taken out of the equation, and our health will become the point of health care! A patient rights bill is like a 'right to work ' state..It does not come close to the central issue..
'th
15
Imagine the billions in profits that insurance companies make being reapplied to direct healthcare.
8
I would love to see an article by the NYT about how much admistrative costs, duplicated through each insurance company, raises healthcare costs in America, relative to other countries that use a single-payer system.
17
Yo!! How about #1 as the right to health insurance as "medicare for all"?
Why is it that you have to be 65 to receive the one of best insurance plan in the country?....that also happens to have one of the best cost control structures.
The USA needs to make a fundamental moral commitment to one principle: "No one has the right to profiteer off of someone else's illness, injury, misery". Doc's and providers should have the right to a decent income....not excessive wealth... and not the right to bankrupt their patients.
Go ahead, call me a socialist. ;-)
29
Excellent on all counts.
The surprise charges by non-network doctors should be against the law. Doctors should not be entitled to gouge patients. Especially in cases of an emergency. That is unethical and should be stopped.
13
It is highly unfortunate that Ms. Rosenthal doesn't bother to examine the problems for physicians who "participate". There is a reason many doctors don't participate with Medicare and other insurance companies. Arthroscopy charges for your pet's surgery will often run 10x higher than Medicare pays for a human. Most doctors now work for large big box groups, reducing the continuity and quality of care. All this is largely attributable to the low reimbursements from Medicare and insurance companies. Instead of demanding "free" care, how about demanding that doctors should be paid at least what your vet might be paid to take care of your pet.
2
You guys really need a universal one payer health care system. We might not have a perfect system here in Canada but we don't have to stay up at night worrying about paying doctor and hospital bills.
16
But it takes you months to book an MRI.
Canadians who can afford it come to the US for treatment, there must be a reason why.
1
The costs of various "recommended" braces. I sprained my wrist; the cost for a recommended brace through Medicare was over $100 - I to make a partial payment of the total cost. I declined. I purchased a wrist brace at a nearby pharmacy for less than $20.
This eliminated and saved any Medicare brace payment.
5
But I would argue that you shouldn't even have had to make that choice.
Your brace should have been free (i.e., paid for by taxes).
2
Amen to all of this! What a greedy world is medicine! But it's just another part of a profit-making, person-denying economic system. Time for a BIG change.
3
I agree completely with Dr. Rosenthal. I'm an internist and a knee x-ray at my own facility cost nine times what it costs at a standalone facility down the street. Of course, there's no telling how much of that is actually paid by the insurance company. And certainly no one was able to tell me up front what my x-ray would cost (I asked). I do know that I received a letter a couple of weeks later that my insurance had covered the complete charge and that my co-pay was being reimbursed. This was followed a week later by a bill for an additional, unpaid bill for $40... The age of obfuscated costs and secret negotiations must come to an end. The ACA demands more transparency but, as far as I can tell, improvement is small to nonexistent.
19
You can demand anything you like. You will continue to get ZILCH until these entiitled people are controlled.
8
Dr. Rosenthal you started this piece with an example of AHA’s first Patients’ bill of Rights. It was the result of many adverse judicial decisions on their members. In this case both the AHA and AMA are MIA as it does not appears to be in their membership interests. Recent mergers of many large institution/systems and organization are a testament to that fact.
The bills we receive from the hospitals or other healthcare delivery agencies are not designed to be understood by anyone let alone a patient. Our billing system is designed to maximize revenue for the provider or the collection agency.
It took a while for facilities to become smoke free, I believe it would take time for the insured patients to actually care for “total cost “ of services instead of just what is my copay and deductible. It is not just the facilities who must provide readable/comprehendible bills but the patient must be concerned about the total cost whether paid by a third party or self-pay.
In order to receive bills that one can understand, we may need to re-engineer the costing/billing and reimbursement system. The easiest is a single payer system as I have found in some EU countries. There are a lot of actual examples of horrendous billing but you have already made that point.
Healthcare is a Basic Human Right for every human. We should work towards it starting with our own population. There is absolutely no reason in this country for any of our resident to go bankrupt for receiving healthcare.
8
Hospitals should. Send out bills, statements even if no balance due so people could know what was charged etc and to check for errors. In my experience errors are not uncommon.
Shopping for insurance will not help. The actuaries are all looking at the same costs.
And by the way, all big drug companies are not Us based.
Thé W admistration disallowed the biggest drug buyer from negotiating prices.
3
In addition, regulation of no show fees. For most service providers, such as mechanics, no shows are a risk of doing business. Physicians and psychologists, however, seem to feel that they are special and can charge fees of any amount for patients who do not show up for appointments. This includes patients whose illnesses are the cause of not being able to keep appointments. I have seen no show fees that exceed what the doctor would have received from insurance reimbursement. If not the very practice of charging a no show fee, then the maximum amount that can be charged should be regulated by law. Doctors cannot be trusted to regulated themselves when it comes to financial matters.
10
At at least one hospital in NYC, some doctors are allowed to maintain their offices on hospital premises even though they REFUSE TOTALLY to see patients who are Medicare primary. How does this fit in with the various tax exemptions that we, the taxpayers, subsidize for the hospital?
26
I receive large quantities of medical mail from doctors. hospitals, Medicare and insurance companies virtually every day. The great bulk of it is incomprehensible.
I have a system for dealing with this. I have placed a large document shredder near the mail slot in my front door. When the mail arrives, I sit on the floor and sort through it. Most of it goes directly into the shredder, usually unopened.
5
Thank you so much for this clear list. Each of us is only moving towards more medical needs. Unfortunately I feel that patient protections, are NOT improving but are on the decline. Our whole society and profoundly the business of medicine, is being deregulated and is profit over patient driven in our GOP controlled era. Maybe in the far future there will reasonable and humane health care. But for now, and now is when each of us finds ourselves in medical need of one sort or another, for now it is not looking good. I am in strong and maintain a low risk lifestyle, in good health, no conditions requiring meds, only routine screenings. But at 60 I am looking at vision decline monitoring, pre cancerous dermatologist monitoring, etc. Having paid for health insurance my entire adult life, and covered now by employer group insurance, for which my employer pays almost 20,000 per year, I am still paralyzed when I sign in for any procedure not knowing if an out of network provider will be involved. I wonder how could I possibly be more proactive, or plan financially for the unexpected, and I realize there is NOTHING more I could do, as patients we are helpless.
6
The most important right was left out — the ability to purchase health insurance from Medicare or through competition. The health insurers have arranged it so that there are regional monopolies, allowing them to boost prices indiscriminately.
Similarly there needs to be negotiated drug prices so that Americans aren’t footing the R&D and advertising bill for the rest of world.
15
Could someone explain what Not for Profit means in the USA today.
Some Health care corporations are not for profits but pay their CEOs and other senior administrators, 10s of millions of dollars in compensation and perks. Is that why they are not for profit? No money left?
20
Trump would simply veto it, or expunge it, or bankrupt it...
1
The concept "network" has no place in medicine. It is merely a way for insurance companies and providers to make money. It was a brilliant addition to insurance. Poor people sometimes can't even get to providers in their "network." Let's throw it out.
8
This information is invaluable. I wonder if maybe one of the answers, until laws make it mandatory for both hospitals and doctors to disclose fees at the point of diagnosis, that maybe we pay the bill with our credit card and dispute the charges with the Credit card company. At least it would hold up the payment until the Credit card company investigates and gives the patient time to get corrections made
3
Totally agree with all of this article, but I would add one thing that really needs fixing. That is the practice of charging people who don't have and usually can't afford health insurance "full retail" for health care. Care under Medicare, Medicaid and (as far as I know) all private insurance is charged out at heavily discounted rates. If providers can perform services for rich people with great insurance for those discounted rates, they should able to price them the same for people who simply can't afford the outrageous price of insurance these days.
17
Good point. Insurers negotiate discounts from 30-50% depending on their market leverage. Give it to everyone who pays cash.
10
This is such a wonderful list! I'd vote for ANYONE who was willing to support legislation like this! Would-be politicians amongst us, this is an issue you can absolutely be elected on!
5
The only right I want is not to have to worry about any of this.
I do NOT want to be a "consumer of health care."
I want to be a patient.
23
This is exactly correct, but It will do us no good to have a bill of rights if we don't elect a new congress and president. Rolling back rights is the current ones' goals, and certainly not giving out any new rights. Vote, donate, canvass.
8
One of the biggest changes in healthcare reimbursement is employers involvement in costs. If they are providing health insurance to their employees, they have a vested interest in demanding transparency and ability to negotiate.
A few suggestions from a well-seasoned professional: (1) get rid of expensive middle management in hospitals. (2) re-think all of the wasteful disposables (waste of money and environmental issues) and most important, (3) Eliminate greed.
4
Good article, but you missed a biggie: The right to be informed about the financial aid policy if the hospital is a not for profit. Some of these policies are incredibly generous, but people often aren't aware of them. Many think if they have insurance the aid policy does not apply to their out of pocket expenses which can be huge these days. But they typically are applicable. We live in the southern Puget Sound and our two non profits have very good policies. For example a family of four earning as much as $73,800/yr. qualifies for a complete write off of their bill; they get a 70% write off if their income goes up to $123,000. A single person earning up to $36,180/yr. also gets a complete write off; 70% reduction if earning up to $60,300/yr. (I am taking these figures right off a grid they provide to patients). So that $1000 deductible is reduced from anywhere between zero and $700. That's a huge benefit.
12
My verbiage in the last sentence got botched up and is not accurate as written. A $1000 deductible would be reduced to Zero in the case of the 100% write off, and $300 in the case of the 70% write off.
2
The recommendations made by Ms Rosenthal should be the primary healthcare policy foundation of Congress.
That is, if Congress were interested in the financial health as well as the medical health of the people in our nation. If Congress or a particular political party is not interested enough, or is too conflicted, then what purpose does this Congress actually serve?
Thank you Ms Rosenthal for your intelligence and your sense of mission.
17
Its a shame that we still have to point out these absurdities, while every other democratic 1st world country has none of these problems. Universal health care is our right, and yet people unwittingly swallow the myth that the ACA is bad for America. It has its flaws, yes, but it is the path to real and lasting universal health care. For years we have heard our health care in America is better and that's why its much more expensive. Yet, you never hear other 1st world countries people complaining about their health care, and it is FREE. In one of Michael Moore's films (about health care) he showed there are no cash registers in pharmacies in the UK. Think about that. We are allowing ourselves to be duped in the name of profit.
13
"In one of Michael Moore's films (about health care) he showed there are no cash registers in pharmacies in the UK. "
Almost right. The National Health Service provides health care which is comprehensive, taxpayer funded and free at the point of service. For medicines there is a small charge (around $12 or so) per prescription with some exceptions. For example as a person over 60 my prescriptions are free.
The reason health care in the US is so much more expensive is not because it is better care, but because of the complex bureaucracies needed to deal with all the admin, and the profit motive.
None of the items on this list of "patients rights" is necessary here in the UK. While the US will never adopt a socialised system like the NHS, eventually universal healthcare, probably in the form of a tightly regulated insurance system like in Europe, will become a reality.
3
Actually, I think the parents of Charlie Gard and Alfie Evans have vociferously complained about their children's health care.
1
Robert, it is not FREE. Our taxes are higher, everything costs more, a gallon { Imp.} of gasoline here costs almost $6 Can. We pay 15% GST on almost everything except groceries. Booze is much more expensive. We don't have universal drug care, physiotherapy etc... are not covered by our provincial Medicare plan. Waiting lists are long for most elective and non-emergency procedures. If a person is not happy with the wait times they can always go to the USA and pay . You still need a good insurance plan for the dentist or the optometrist, usually through your employer, or you are out of pocket, which is hard on lower income families.However when you go to the emergency room the triage system is very effective and no one will die while waiting to see the doctor.The difference is that we believe medical care is a right and not a privilege and you will never see a bill from the doctor or the hospital. We made the decision collectively as a society 50 years ago that all our citizens deserved to have dignity and not have to worry about going bankrupt from worry and medical bills. Thus we willingly pay higher taxes in exchange for ; and the evidence shows, better healthcare outcomes for all our citizens. We don't necessarily have the best system but it certainly seems to work better than yours.
5
One of the advantages of Kaiser Permanente is that you don't have to guess who is in your insurance network. You have access to all their Drs. If you don't like one for whatever reason you can choose another. When out of a Kaiser network if you have an emergency you can go to the nearest hospital and Kaiser will reimburse you.
4
All of these Rights would be part of a well-designed single-payer Medicare for All plan. Urge your representatives to support HR 676 and Sanders' S.1804. I'm a retired neurosurgeon; this is the only rational way to go.
42
Insurance payments to physicians participating with an insurance plan are generally negotiated to be a certain percentage of the "official or full"fee. Each insurance company may pay a physician a different amount for exactly the same service. Only the uninsured are billed the full fee. And if they were to be given a discount, that then would be considered the actual "full fee" and lead to disputes with insurers about the basis for their discounted rates. Hence the problem in posting real prices. Insane.
Physicians argue that not being able to bill patients for what insurers do not pay would in effect remove all pressure from insurance companies to negotiate in good faith with doctors for a fair fee. Unfortunately patients are in the middle of the dispute.
The seemingly simple solution of seeking care at facilities that employ all caregivers, including physicians, is complicated by salary arrangements that include bonuses for higher production - read as bigger bills or higher RVUs- and perhaps clawbacks for not generating sufficient revenues to meet administrator set targets for productivity.
Single payer universal insurance along the lines of the Canadian system seems to be the way to go. Inevitably in this sort of system there will be rationing of care, waiting lists, annual spending limits, and a need to determine what care will be paid for and what is considered not cost effective in terms of life years added.
5
Rationing is inevitable in the real world. Either it is done based on rational medical considerations, as in most developed countries, or it is done based on the ability to pay as in the United States. The American medical system is designed to meet the needs of the wealthy, not to provide good health care.
21
Two word: Single Payer!
13
Meh. You rely heavily on 'the right to know' or 'the right to be informed"..At that point it is generally too late. I am already in the hospital bed, sick and desperate to be made well.
I don't want choice or to be informed. I want to be assured that as a paying member of our society, (health care coverage paid for out of my paycheck, and I pay for the best I can get) my coverage is complete. If I have elective surgery, like breast reduction, ok, charge me, but if I have been put in an ambulance and then a hospital bed, and wake up the next day, there is no right to charge me for anything.
And that included dental, please!
I had acute kidney failure and the maize of bills, all of which I disputed and all of which were reduced to nothing (a fact I find outrageous!) was insulting. One doctor just showed up at my bed, after it was all over, and I got a bill for 300$ for 'over 30 minutes. ' Who was she? Why was she there? I have no clue. I was out of the hospital an hour later, after a nasty 24 hours.
It's ridiculous. the 'right to be informed' doesn't come close to fixing it.
29
I appreciate your article and agree with its suggestions. I recently was surcharged by my insurer $5,000.00 for failing to notify it within 48 hours of my wife's admission to the hospital.
Really what this requires a good New York Times investigation of the hospitals in a typical metropolitan area to see how much money comes in and where it goes. What, for example, is lost on unreimbursed charity care and malpractice insurance? How much goes to salaries for nurses, doctors, administrators and other non-medical personnel? What is spent on facilities? Since most hospitals, at least in the Northeast, are not-for-profits, the excess of revenue over expenses does not go to shareholders. But how much of a hospital's revenue is effectively profit and where does it go?
15
Thank you for this, Elisabeth Rosenthal. I have read your book, "An American Sickness" and made copious notations throughout - an excellent exposee! Regarding #7 in this article, in which a "high-deductible plan that requires [patients] to pay more than $1,000 before insurers step in," I want to say that I now pay $136 per month just for myself (other family members have their own insurance) and have a $6,000 deductible. Since I loathe doctors and would almost rather die than see one (no pun intended), I consider it catastrophic insurance to cover things like injuries from fluke car accidents. After I spend $6,000, "everything" is covered. But the whole in-network/out-of-network confusion remains.
A couple of years ago, my son was hospitalized for a freak "bleb" on his lung that came out of nowhere. We had big-time insurance at the time, costing hundreds of dollars per month. He spent one afternoon in the hospital for tests. Imagine our surprise to be billed by people in other states for procedures which did not occur by doctors we never heard of. It took MONTHS to straighten it out, and I still think we got thoroughly ripped off (they wore me down, literally). He is now studying to be a chemist and hopes to relocate to a country which offers health insurance to all its citizens.
25
The comment about rearranging the deck chairs on the Titanic is spot-on. Even if a Financial Bill of Rights & price transparency existed (which they won't, as they would require industry regulation that is politically infeasible), they would be impossible to implement. I'm surprised this article was written by a former emergency physician, who must be aware of EMTALA and our duty, as healthcare providers, to provide necessary care regardless of a patient's ability to pay. The ER is one of the worst offenders in ordering costly tests and treatments without first obtaining informed consent or checking for advanced directives, let alone discussing the pros/cons of costs and in- vs out-of network fees with patients (who may not even be in an able condition to comprehend such discussions!). Regulation and a single payer system would seem to be the only solution, and unfortunately, I don't hold high hopes for that happening in this political climate either.
I am a healthcare provider and could provide dozens of anecdotes about the outrages of working in this system. But lack of financial transparency affects us too: I don't always even know which insurance plans I'm listed in-network for, or how our hospital care is billed out. It's not all nefarious doctors taking kickbacks; if we accidentally prescribe something expensive, it's often simply our ignorance and blindness in the same system! The fact that all this masquerades as "consumer choice" is infuriating!
15
If the artificially created shortage of Doctors were removed and many more doctors were trained (free-market), then a lot of problems will go away. Imagine a lot more Health Clinics staffed by MDs that take cash for all routine matters, and insurance kicks in only for larger amounts. I don't care if Medical training is ling and fees are high, no other profession is guaranteed any large compensation, why should doctors get special treatment.
9
Earl Nightingail said that anyone willing to put in the same amount of time and study in any field as medical students do in medicine will make as much money. Doctors' incomes have not sihgnificantly increased since the 1980's, and medical school applications have fallen accordingly. Doctors still make a good living, but don't think that just turning on some spigot will magically produce more physicians.
3
It is troubling when someone suggests that all we need is to make something "free market." First, medical care is not and does not respond to "free market" theory. Suppose you are sitting at home tonight and God forbid you start sweating and having chest pains. Are you going to the nearest emergency room and doing exactly what the ED doctors recommend or will you start calling around, trying to check prices? Second, do we want doctors running specials: you can get an appendix operation this week for $999? Third, I doubt if many professionals other than doctors deal with life and death situations. My son is a pediatric ICU physician and I have seen him come home and cry when he loses a young, innocent patient! Sorry, increasing the number of doctors might improve doctor availability, but this is not the only solution needed to solve the problems with US health care.
5
The compensation schemes for docs vary -- Bigly. Specialists, particularly in the elective arena like plastic surgery, are at the high end. Family medicine, which is needed by most, is compensated at the very low end, and they don't own labs. And, their malpractice fees and student loans are no less than their higher paid paid colleagues. These docs, mostly women, are at the front line of prevention so patients don't end up in ERs. 10-12 years of secondary education and demanding residency reqs and they are paid as much as a junior manager in a marketing department with a 4 year degree in "Communications". Oh yeah - the US version of the Free Market...
2
as editor of the Kaiser-sponsored publication,obviously the author knows that vanishingly few of the financial horrors or lack of reasonable patient rights are factors for Kaiser members.
there are many reasons for this, but one is Kaiser's typically reality based medicine: they rarely run up astronomical bills or suffer huge losses trying to save the unsaveable. there are far fewer surprises because just about everything is house. these advantages sometimes make patients angry, because the go for medical care but expect miracles.
but the Kaiser' business model does not work everwhere: it is as much about insurance (minus the critical element of profit) as it is about medicine. and it is not about growing rich by taking advantage of the sick, the halth, the lame.
alas, not for everyone.
5
Just to be clear: Kaiser Health News has no connection to Kaiser Permanente or the Kaiser Health system. It is an non-profit, independent, non-partisan news project started by the Kaiser Family Foundation (also no relation to KP! -- other than being started by the same family). We produce stories on health and health policy that appear in a wide variety of media outlets, from the NY Times and Wash Post to PBS and NPR. You can check out some of our work on this topic -- the latest from our KHN-NPR "Bill of the Month" series. https://khn.org/news/a-tale-of-two-ct-scanners-one-richer-one-poorer/
4
I have lived in 5 countries; 4 with some type on national health care. The care provided is practical and not oversold. Drugs are not over prescribed. As a cancer survivor I was treated much better than friends who had the same affliction here in the US. And I never had to worry that I would be turned into collections for not paying a bill. There was no bill – nor was there any long wait times. (The anti-single-payer-tribes favorite slam. The longest wait I ever had was here in the US.)
I live in fear that I ever need to use healthcare because I can’t pay all the added fees. The ACA was affordable until this year save for the secrecy and hidden fees. Since the republican dismantle of the ACA, my premiums and deductible have doubled to $1100 per mo/$3500 annually.
This health care system is obscene. We need a fair system like most other countries.
42
I had a 12 hr surgery at Stanford Hospital with a 4 day stay. The bill was for $150 000 but the insurance company had contracted $24 000. You know Stanford is at least covering their costs and then some on $24 000, but to bill for $150 000???
With the same surgery, another surgeon was brought in without my knowledge, out of network which added to my cost. Thus learned after the fact.
Another time at Stanford, the nurse left the IV stand in my room for hours after I was done with it, they charged me per hour for the stand including the mistake of the nurse. When trying to contest this charge, the onus was on me to prove it.
We get great healthcare and I have no complaints about the doctors and their ability to treat, I do gave a seriously problem with medical establishments that are ‘for profit’ because the focus is in the profit not the patient.
31
After an accident, my niece was in an ICU for three weeks plus another week in the hospital. She had surgery on her spine. Her HMO was billed $64,000. Why so little? She was in a very well known hospital in Israel, where she received at least as good care as any place in the US. There is no reason for hospitals to charge what they do here in the US, especially when you endanger yourself by being admitted to one, where errors and pathogens abound. As you found out, many charges are fraudulent.
10
I wish I could say we get great health care. We get TERRIBLE, ABYSMAL health care. Infection control is almost nonexistent, for starters. I could write a book about it. Don't get me started...
3
The only right American patients have is the right to substandard healthcare with a high price tag.
23
Oh yes, as a nurse I endured the demand to add a surgeons name to the operative report even thought he only passed through to kibbutz. I absolutely refused but others didn't. It's leathel in hospitals in many ways.
25
Even if health care providers posted their charges, those figures are a chimera. They should instead be required to provide the amounts they actually accept from insurers, Medicare and Medicaid. Those are generally 1/10, or less, of charges.
17
They should be required to provide both.
10
I have to imagine this would be a win-win. What percentage of hospital charges go uncollected? All this confusion does is ruin people's credit and give business to collection agencies.
10
the whole arrangement cries out for a RICO investigation.
6
How about the right not to undergo "treatment avoidance" for chronic conditions, e.g., pain, sinusitis, insomnia?
5
All hospitals and medical facilities should be required to post their prices and their quality ratings. Health insurance should be written to allow you to shop for price and quality. Bringing transparency to our medical system is the only way we are going to bring down the outrageous cost of care.
We have the most expensive Healthcare system in the world and we get middling results. According to a survey by the Commonwealth Fund, we rank last in wealthy nations in providing healthcare value - results & price.
14
I hear you. I've been sick for 3 years and have yet to get a diagnosis and treatment. Waiting to find out what's wrong after the autopsy.
3
Rosenthal's wonderful piece suggests that if one can conceive of something more corrupt than our political system, it just might be our medical system.
23
This is why the Republican mantra of "shopping" for healthcare is a ridiculous and cynical charade.
Universal Care for All.
67
Terrific article. When my mom died, she was covered by medicare and supplementary insurance through the New York Teachers Union, bless their hearts. Medicare and her supplementary coverage, paid the majority of her bills, over $100,000. Upon her death, her estate was invoiced for $10,000 + for final healthcare services rendered. I spent over a month digging through the morass of charges and fighting with various billing dept.'s. Eventually I made an agreement to pay $1300 +. One specific example was double billing for the Ambulance. It seems that the billing department couldn't figure out whether she being transported to or from the hospital, so they billed her both ways. In 2009 I had a retinal detachment. During my visit with my surgeon, I inquired as to the cost of the surgery. I never received a straight answer. No complaints with his service. He was a gifted and talented surgeon. Though, I couldn't obtain a direct answer as to the cost of surgery. Several weeks ago I woke up with terrible pain in my left elbow. My GP sent me to a specialist Sports Doctor. After X-rays I met with doctor and learned there was no major problems. On my departure, I advised their administrative personnel that I wished to pay additional fees above what my insurance covered which totalled $70 for a doctor recommended support wrap. I Paid the charge and left. Lo and behold. I recently received a bill with additional charges. Why couldn't I obtain a final fee when I inquired?
11
However- If you are 1 of the 15 million undocumented immigrant workers - this means absolutely NOTHING to you! You enter the emergency room then disappear the next day..
6
Sounds wonderful. You should do that, too.
2
What are you talking about? ERs are locked, buzzing people in and OUT, thus making sure of payment before you exit the facility. (Those the ER/Hosptial don’t want to deal with - ie questionable ability to pay? - are left waiting outside the ER.)
This I have experienced, your comment sounds like hearsay, not firsthand experience.
2
Uninsured American citizens do that, too. They just give a fake name and address. Ask anyone who's ever worked in an ER.
This wouldn't happen if we had universal health care like normal countries.
(And under such systems, people without permission to live in the country--tourists, illegal immigrants--are provided true emergency care only. If you break your leg while visiting Britain or Costa Rica, they'll set the bone, put your leg in a cast, and tell you to go home for any further treatment.)
6
I appreciate this, but the intricacies of insurance and healthcare networks are beyond me, and if they are beyond me, they are surely beyond most people. Right now, I would have to be in mortal danger or extreme agony to see any kind of doctor. Too often in the past decade, I have been required to go from primary care physician, to some kind of specialist referral, to innumerable imagings, and on and on, with weeks or months to wait for each appointment, often in pain and worry, and in the end everyone but me has forgotten that I started it all because I had a problem that needed to be solved. The patient should be told up front what the probable causes are and the treatment options for those probable causes. Instead, nowadays every last possible test must be done, the size of your deductible or income be damned, only in the end to find that there is no cure or solution in the world that is not worse than the disease.
15
Missed an even bigger fraud. I received a bill for an out of network Anesthesiologist for over $2000 for a procedure where the surgeon was in network and the facility was in network. When I checked in at the door, the facility accepted my coverage. The surgeon was who I worked through to schedule the procedure had accepted my insurance and was in network. There was NO WAY that I had ANY indication that the Anesthesiologist at the facility was NOT in network. My insurance company tried to get him to accept the in network fee for the procedure. He accepted the amount and continued to harass me for the additional amount. I refused to pay him and he sent it off to a bill collecting agency. We told the agency we would be happy to tell the story in court and finally after 6 months they stopped harassing us. The bill of rights should include: "if the scheduling physician or facility accepts your insurance, any and all other medical professionals and procedures resulting from the scheduled procedure or complications therefrom should be covered by the patient's insurance and reimbursed at the insurance company's in network amounts without recourse to bill additional amounts to the patient or the insurance company."
64
Another example of why hospitals and ambulatory surgery centers are contracting with nurse anesthesiologists. Outcomes the same, fees more reasonable and the nursing skill of patient advocacy. Nurse anesthesiologists rarely bill out of network, because greed is not their motivating factor.
9
the same thing happened to us with anesthes. for husband’s knee surgery. we just paid it; hats off to you for fighting it.
4
My son recently moved out of state where our Blue Shield HMO does not reach. He developed a knee problem which is now subacute. It is actually cheaper to fly him back to the Bay Area from Portland than to have him worked up by an orthopedist in Oregon. I’m charging myself a carbon tax, but seriously, we need universal single payer health care that is portable and crosses state lines.
29
I think what you're doing makes sense...but it is fraud and you could get in trouble misrepresenting for coverage purposes that your son lives in a covered area when in fact, you do and he does not.
beware.
only in America.
2
I would add one more right; the right to a cell phone-free waiting area. Recently, I was lucky enough to be able to move to a different section of the lobby waiting area. Not so when you go to the smaller, dedicated waiting areas for a specific procedure. Some people seem to love sharing their personal conversation details with anyone around. Had I said anything, of course I would have been the one seen as...rude.
3
Do you believe everybody must be silent around you in a public waiting area? I don't understand.
5
Not silent, just respectful. It is possible to speak quietly in a cell phone conversation.
4
Great column. As a medical professional, I see all this on at least a weekly basis. Patients and their advocates should have access to the financial pitfalls of medicine.
10
I agree with all of the outlined steps for better mediacal billing information. Unforuntaely to get any changes made you need lawyers. How many lawyers tell you the price (or even the truth) when asking for services and what the costs might be? Two peas in a pod. It will take individual states to enact laws that do away with some of the worst practices.
4
Reminds me of the old expression: "there ought-ta be a law!" But as long as Republicans in the pay of the 1% and their corporations, including big pharma and the privatized medical facilities, rule the Body Politic, as they would say in NYC, "fuggedaboudit!"
8
It's definitely not just the Republicans. Democrats' loyalty to their donors is equally dangerous, and they have some big donors in health care and big pharma, but especially the health insurance business.
10
One of the saddest aspects of our convoluted healthcare system is how difficult it is to navigate for some of the least able in society. I am well educated and aware of many of the tricks and traps of the medical insurance and billing systems, but I think about how many of the poor, less educated, or elderly people in our society are scammed, refused, and terrorized by the system. Many have to do without essential care or, if they get it, over pay and get locked into predatory loans and harassment by bill collectors. The whole medical insurance system is rotten to the core.
The medical bill of rights you propose is great, but has as much chance of getting through congress as Paul Ryan does of getting into heaven.
26
The whole eldercare system is full of fraud and abuses. Some doctor told me I may have cancer, but I'd rather die of that than linger as my mother did, with dementia. We were lucky not to go bankrupt, and I never could afford to put her in a home, so you can imagine how much fun I had with that. We have untrained family members working as caregivers because the cost for professional care is so high. And basically in most of these homes they just drug up the elderly anyway.
2
I recently underwent a colonoscopy with removal of three polyps in our local hospital’s ambulatory care department. Copay? $0. Cost for my spouse’s ultrasound at a local private radiology clinic? Again, $0. Bill for my child to see a board certified allergist and undergo skin allergen testing in a community 30 miles away? $0. How is this possible? Simple—I live in Canada where universal coverage and a single payer system put an end to this sort of financial nonsense.
131
but you must pay taxes, right?
in America this is a step or two worse than leprosy!
7
I already pay over half my income for health care and NJ property taxes and other taxes. I'd rather live in Canada where that half of my income would help me, and help the needy, instead of in the US where my money funds churches, rich capitalists and the military.
3
In all the Republican frenzy to dismantle the Affordable Care Act, none of these important matters were ever on the table. Since their legislation passed that negated important aspects of Obama's insurance healthcare reforms, there's been not a word about any of these points in any Congressional discussions. Nor has anyone mentioned the obscene flaws of our prescription drug plans. Shame shame shame on ALL of our legislators.
15
The Affordable Care Act did nothing to correct these abuses in the medical system. It just increased the victim pool.
3
I think we should all boycott the system for as long as our needs allow.
1
I received an itemized bill from my doctor, one of the visits when I got a flu shot. There was a charge for the nurse reading the label of the vaccine bottle, another charge for drawing it up into a syringe and another charge for administering the injection for a discounted total of $105. There was also a separate line item charge for systolic blood pressure and another for diastolic BP. They didn't charge me for that, but it was itemized on the bill.
Hospitals have become the SS. Our health care system is evil.
15
Another Canadian medicare story...I had procrastinated on getting a flu shot this winter. On reading that developing influenza could possibly trigger an MI or related illness, I phoned around my 'hood for a pharmacy that did not require an appointment. After basic paperwork and showing my Medical Card...photo on it, the pharmacist administered my flu shot for no direct cost to me. They bill our Medical Plan. I was just supposed to hang out in the store for a few minutes to make sure there was no adverse reaction.
4
The money-grubbing medical business will never agree to these terms. Their purpose is to maximize profits even at the expense of supplying good medical care.
Anesthesiologists run the biggest scam of all. They are among the highest paid doctors, yet you can't choose. Someone comes by a few minutes before your procedure to ask questions and get your non-informed consent on a paper they shove under your nose while you may be sedated. Is that the person who will take care of you in the operating room? No, it could be anyone from their group, including the least competent and sometimes outside your network, but you can't do anything about it.
There is no reason for any doctor to give up their ordering too many tests if they can bill for them. Their corporations demand more billed items to make a bigger profit. The insurance companies and some hospitals are publically traded corporations which have the duty to make a profit. Until we have a one payer- system, like Medicare for all, there will be no change. Don't hold your breath.
25
One set of clear rules that only change once a year... Universal Healthcare?
13
Let's get a single payer system and get rid of most of these problems!
19
I would refer readers and E. Rosenthal to ccahs.info to learn the actual roots of the consumer rights movement and especially the 'Patient Bill of Rights' which was opposed initially by all the major hospital and medical professional organizations.
CCAHS started in the early 1970's broke the ice on many myths and failures of the hospital and medical care delivered. Exposed in publication after publication, The NYT, the paper of record, then and now, reported many of the facts of these publications and did The Long Island paper, Newsday, on their front page and in editorials along with other media.
I can state without any concern that CCAHS was threatened and told financial support would be withdrawn on more than one occasion. Through its persistence, the face of hospital/medical delivery changed significantly.
The struggle for improvement and enhanced rights will be gained when unfulfilled sections of CCAHS reporting become fait accompli.
ccahs.info is where to start.
2
Medicare for all, now.
7
but even medicare is a mess since it pays only 80% and the remaining 20% gives insurance companies endless opportunities for shell games with the aged. Exception, of course, the AARP United Healthcare, no copays and nearly universal network-- HOWEVER, the AARP coverage costs more than many of the elderly can afford and constitutes a conflict of interest since AARP is a nonprofit organization charged with promoting the interests of the elderly. To my mind, AARP should be busy lobbying for 100% Medicare, not 80%, for the elderly. A big and lavish lobby -- what have they accomplished? Their website posts some hints for finding a job and other silly stuff. You can take an AARP driving class that New York State offers for the same price. I don't see much else that they have done. What happens to the fortune they must be making from selling United Healthcare?
10
To AARP, low-income seniors are chopped liver. Anyone who scans a few of their glossy magazines can see that they are geared to well-to-do retirees. I would like to see an advocacy group for those of us who can't afford a glamorous lifestyle.
1
Agree except that finding a job is not "silly stuff".
All other industrialized countries have some form of universal government run health care, mostly single payor. They get better care as measured by all 16 of the bottom line public health statistics, and they do it at 40% of the cost per person. If our system were as efficient, we would save over $1.5 TRILLION each year.
www.pnhp.org & www.oecd.org & especially https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a...
Some data:
Here are the per capita figures for health care costs in 2016 in PPP dollars:
US - 9507.2
Austria - 5227.3
Belgium - 4839.8
France - 4500.4
Germany - 5550.6
Luxembourg - 7462.8
The Netherlands - 5385.4
Switzerland - 7919.0
Sweden - 5487.5
Denmark - 5199.3
UK - 4192.5
OECD Average - 4003
These figures are from the OECD and are for 2016 and are in PPP dollars which takes cost of living into consideration.
Let's compare some bottom line statistics between the US and the UK which has real socialized medicine.
Life expectancy at birth: UK - 81.1 US - 78.8
Infant Mortality (Deaths per 1,000): UK - 3.8 US - 6.0
Maternal Mortality (WHO): UK - 9 US - 14
As Einstein said,
"The difference between genius and stupidity is that genius has its limits."
21
Dr. Rosenthal's article provides a wonderful new plan for the deck chairs on the Titanic, while ignoring the underlying problem, i.e. that we have the most expensive healthcare system in the industrialized world with quality that comes in 11th when 11 industrialized nations are compared. The solution is not patients demanding that the system rob them in plain English, it's to have a single-payer system that delivers quality, affordable healthcare as right.
136
I agree we should have quality, affordable healthcare. But forcing healthcare providers to be transparent about the outrageous billing process might be a useful step to get us there.
5
Very well put. I couldn't believe that price controls weren't the #1 Right listed. Regardless of how many payers we have, what we need is a standardized price list that all payers and providers are required to use regardless of network status. Why not use Medicare's price list? Of course, why not allow Medicare to negotiate prescription drug prices (no, it is not allowed to do this under current law) and require all payers to use those prices too?
These steps actually show respect for patient rights and address the most pervasive side effect of American medicine: the financial fleecing.
7
Reading the very helpful comments about additional rights patients should have and things we should be on the watch for with medical billing, one thing is abundantly clear:
We need to blow up our entire health care billing and payment system and start fresh.
Medicare for all!
17
Well, yeah, but just think. If you require service from the fire department, you don't have any of these worries. Why is that? Because the government pays for the fire department. Everyone gets fire service service, and nobody has to worry what it costs.
It wasn't always like this. In colonial Philadelphia, there was no fire department. Each fire insurance company had its own private fire department. When you bought insurance, you got a medallion to put on your house. If a fire truck from the Green Tree company came to a burning house that had a Penn Mutual medallion, they would let it burn to the ground. After this happened a few times, a municipal fire department was established, a socialized fire department. I imagine that the people who lived in brick houses gripped about paying for the people who lived in wooden ones.
Surely health care is at least as important as fire fighting.
What Conservatives fail to realize is that some things like health care are best done by cooperation, by government, while some things are best done by individuals or private businesses. Their problem is that they cannot distinguish one from the other.
30
There are still small towns and rural areas in the U.S. where the fire department will not help you unless you pay your annual subscription fee. I'm not making this up.
7
Well said but why not eliminate networks, let providers choose to accept the fee schedule or to state in advance that they charge more than the allowable from the carrier. Then the patient can choose to accept the higher fee and pay the additional amount.
President Clinton was correct to say that this system is the craziest thing he has ever seen.
5
Some time ago I had two identical procedures performed in-hospital about a year apart. 80% of the first bill was covered by my insurance but the second bill was triple the first bill and most of it rejected by the insurance company. We found that parts of the second bill had been incorrectly coded. Hours on the phone with the hospital and appeals to the insurance company got me nothing but threats and accusations of criminally trying to change the record. Finally after writing to the hospital CEO they sent a letter to the insurance company admitting the error. It was rejected because the appeals window had closed. I was still liable.
I am now retired and on Medicare and the relief I feel is indescribable. The burden of financial worry and anxiety is gone and CMS/hospital agreements preclude the kind of problem I had.
Medicare for all.
53
I was a board certified Emergency Physician in a head on car accident. When I refused an unnecessary ambulance a policeman twisted my broken wrist and hand cuffed me to the gurney. When I refused permission for exam and treatment "assault and battery" in the ER, I my wrists and ankle were belted to the gurney. When I refused 5 CAT scans after a superficial exam I was sedated, but never given medicines for my severe pain.. Nothing serious was found and I treated myself for the next month.
Then I got bills of $14000 for the ER and $4000 for the CATs. When I was threatened by a nurse to turn me to a collection agency, I threatened mail fraud and never got another bill.
Patients have a right to refuse unnecessary care as well as reasonable charges. The capitalist system is designed to charge what the market will bear. 10-15% of total medical costs are due to high insurance overhead and 20-25% are due to overdiagnosis and overtreatment.
24
And 10-20% are due to outrageous charges for tests, drugs and treatments as compared to the costs in other wealthy developed countries with better bottom line public health statistics.
Read:
http://www.nytimes.com/interactive/2014/health/paying-till-it-hurts.html...
6
Scary story. Hospital refused to give me painkillers after a procedure, even tho' the pain center was right down the hall in the hospital. Now I sneak a bottle of water and a bottle of Advil in my purse when I go the hospital. That probably saved me a $10,000 bill for a Tylenol, if they had agreed to give it to me, and it wouldn't have killed the pain anyway.
1
radiology, lab, OB, and ORs are the profit centers of a hospital. ERs and beds are loss leaders.
I RECENTLY underwent surgery to remove a cancerous tumor from my kidney (and, incidentally the kidney). The doctor actually asked what insurance I had before telling me how many days I would be in the hospital! Not exactly medical decision, eh? They also required me to pay their estimate of both my deductible and my co insurance BEFORE he would operate. I was told that whatever I overpaid would eventually get paid back to me in the form of check (incidentally, THEY don't take checks). Here we are, two months later and I was told that they can take up to 120 days to get my money back to me. My life was held hostage and now my money is, too! BTW I paid $1600 and am owed over $950 back.
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Hy Nabors, that is very frightening! "Your money your life"! Sounds like a heist. Health 'care' in the US is in complete contradiction to the basic ethical tenet of medicine: The Hippocratic Oath.
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10. The right to not be subjected to a wallet biopsy before treatment is administered. Thank you, Tony Soprano, for calling the practice to our attention.
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My husband's father was an M.D. and a hospital administrator for many years, retiring around the time the patient's bill of rights was published. He recalls very well that it was positively received in their household, albeit at the same time retaining the generational attitude that "the doctor is always right", largely by virtue of their extensive training and study. Times change, and the idea of fully formed consent indeed does apply to all aspects, not the least being the financial, of health care. And in today's world, that responsibility has to lie first with the patient.
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I'm a physician, and I'm equally fed up with trying to figure out whether I'm in network or not for a particular insurance. If I sign a contract with company X, I get a list of plans from X that I'm part of and a list of plans from X that I'm not part of. It's never as simple as being in-network with all of X's plans, and I have zero choice in the matter. A year later, X inevitably decides to eliminate some of the plans and create more of the plans. However, they don't inform me of which of the new plans consider me in-network. I can try calling, but it's almost impossible to speak to a human, much less a human that knows what is actually going on. I good first step would be to require regular letters to every in-network physician listing which plans the physician is in-network with, and which plans consider him/her out of network.
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Sounds like another argument for single payer.
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the best and cheapest solution may be to eat right, get enough exercise, stay out of drafts, and be ready to die when your time comes.
IOW, opt out of the whole racket.
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My sister in law did all that, never smoked and got lung cancer anyway. We have Monsanto to make sure that we all get sick so we can support the medical industrial complex.
Thank you, Dr. Rosenthal! As a fellow physician, I would add one more right: the right to a true and honest "informed consent" when any treatment, including medications, is prescribed for any condition. After a 41 year medical career, I know that patients are typically prescribed medications, including psychotropic medications (24% of American adult women are taking an anti-depressant!!), without their informed consent. NYT had a recent excellent article on anti-depressant withdrawal, which received nearly 9,000 comments. My comment attempted to describe the thinking I used in providing informed consent to my 25,000 patients. Rarely did I ever meet another physician who regularly went to the trouble of spending the time to do this with their patients. Shame on us! I retired from medicine when I got fired from my mental health clinic job for refusing "to stop talking to my patients". Psychiatrists have become prescription writing machines and doing a thorough informed consent discussion with our patients simply takes too long, as far as the cutting-corners administrators are concerned. Shame on them! Patients have a right to know what these "wonder drugs" do and don't do and what side-effects they may have to endure, as well as how difficult stopping them may be. Thank you NYT!
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My brother is a doctor, and he has said that his first order of business with any new patient is to find out what medications they are taking. He sometimes finds that a series of doctors have given them a series of medications, some of which are supposed to counteract the side effects of previous meds, some of which cancel out or duplicate the effects of previous meds.
And in a few cases, what is wrong with them is not something that can be medicated away.
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I am also regularly chastised for spending too long with my patients! But I so often find patients who've signed consent forms but can't describe to me anything about the procedure they've consented to (let alone the risks), who can't even accurately name a condition they've had surgery for or a prescription medication they take. Some of this is lack of personal responsibility on the patients' parts, but a large part is lack of informed consent, clarity, and education on the healthcare providers' behalf. Unfortunately, the time spent talking & educating patients is not valued in this system; most of my visits are billed under a bundled code rather than billed by time, so it's an environment in which we simply can't AFFORD to talk with patients anymore! The idea that our patients can truly be informed consumers with regard to COST, when we cannot even achieve reliable informed consent for the CONTENT of medical care, sadly seems like a pipe dream to me without reforming the whole system.
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I think the whole system does need reform!
Most of the comments from all the people in this forum that rant and rave against the cost of healthcare I am certain come from lawyers, plumbers, electricians and financial world workers that charge and expect huge amounts of money for the work they do. Academic institutions train future doctors who are residents and these residents earn a pittance for the hours that they work and the work that they do. People walk into emergency rooms in the US and expect top dollar treatment without paying a cent upfront. The list of travesties goes on and on. The bottom line is that there are a lot of people that work in the trenches of healthcare and work very hard and under a lot of stress. They need to be compensated. Don’t play by one set of rules for yourself and another set of rules for another industry
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I yet to meet an electrician or plumber who couldn't quote me (quite accurate) how much the project will cost.
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@Dr. No: with the cryptic, incomprehensible and not-disclosed-in-advance billing practices we have today, still the pay inequities you talk about persist. May I suggest that the outrageous bills do not compensate the people who actually work in healthcare?
Seems to me the fees are not going to pay those who provide services. It's going to the healthcare systems and drug companies. The outrageous billing practices are driving up the costs for everyone in the US, and driving some families into debt due to costs that were not disclosed and could not be foreseen. Just compare our costs - high - and our healthcare results - middle to lower part of the list -- whenever compared against other countries around the world.
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But all he/she has to do is estimate the time it will take. What is the cost of mal-practice insurance for an electrician or plumber?
I work in healthcare, and #5 is in my mind the most important. Patients are being sent home from the hospital instead of getting rehabilitation because their doctors and hospitals are getting kickbacks. Yes, they get paid more if the patient gets less. And what’s really brilliant is that doctors convince the patients that is for their own good. The patients never know, never attribute the problems they have 3 months later to the fact they did not get needed rehab. Patients believe that their doctors are looking out for them, when in fact their is a conflict of interest.
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You are better off out of the hospital where, sooner or later, they will kill you. They touch garbage pails, pick things up off the floor, put them in your mouth. I kid you not.
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One simple patient right: To be treated regardless of ability to pay. A universal health insurance policy covering everyone is the only way doctors can fulfill the Hippocratic Oath.
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Most of these comments sound like people sitting around coffee houses planning the Grand Revolution. Let’s just start getting one state legislature to legislate one of these rights into law, then one more, then one more ....my vote as the place to start is price regulation of emergency charges, require that they be limited to Medicare allowed charges. There is no free market in emergency care and no natural limitation on rapacious piratical fees. It wouldn’t cost the government anything.
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No, it wouldn't cost the government anything, but it would cost politicians their campaign contributions from special interests and lobbyists. That's more pertinent.
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Always ask for your list of covered and non-covered benefits from your insurance company. Yearly. Most people have not a clue really, then are shocked when it is not a covered benefit.
One thing else is to understand how your hospital or clinic unbundles services and bills each separately. Before you have an elective procedure, ask about that. Even covered preventative services like a colonoscopy can be unbundled, meaning that perhaps the anesthesiologist, who is billing separately, isn't covered. Even though they may say it is a covered service. Unfortunately, it is still buyer beware. And many times, depending on what code is billed by the providers, we never know until we received the EOB (explanation of benefits).
Billing, which feels like bilking) is a ridiculous and a profit driven practice.
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One more: publicly available professional resumes on all licensed healthcare professionals. This includes schools attended, degrees earned, professional licensure in every state licensed, professional certifications, clinical interests,research interests, and all conflicts of interest- actual and potential.
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11 years ago I had open heart surgery at a major NYC hospital and my HMO required that it all be "pre-certified," which it was, and the surgery was successful. A month or so later I got the hospital's bill - 6 figures - including what the out-of-network cardiac ICU physician charged. But at the bottom was what my HMO paid, 5 figures, and the only amount due was my $100 deductible.
A few months later, another bill, for almost $12,000 because it seems the assistant surgeon took no insurance and my HMO wouldn't pay. I was advised to write them that the surgeon was a "no-choice" physician, which did the trick, and I got a check for about $600 MORE than the surgeon's bill - "interest" for late payment.
I paid the hospital what it billed me, pocketed the rest, and remain the only person I know who made $500 on their own open heart surgery.
A Patient's Financial Bill Of Rights is absolutely needed.
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When my eldest daughter was 14, she needed a very serious dental operation. When I tried to find out exactly what was covered,our rep told me unofficially that they would only pay for laughing gas in any dental procedure. When I told this to the surgeon, he said there was no way he would use anything as unreliable as laughing gas on a 14 year girl for this operation. If I insisted on laughing gas, I would have to find another surgeon. So I told him I would pay him and see if I could get the money back from my insurer.
The operation went fine and when I submitted the bill, the insurance company refused to pay for the anesthetic, $800. After yelling, I finally got the name and address of someone with authority in the insurance company.
I wrote a letter to her and received no reply, but a week later I got a check for $200. So I sent her a longer letter, and I got the surgeon to write a letter, a copy of which I also sent. Again, no reply, but I got a check for $200. I began to see a pattern. So I sent her the same letter with another copy of the surgeon's letter. A week later, I got another check for $200.
The next time I sent the letter that referred to the surgeon's letter, I omitted the surgeon's letter to see if anyone would notice. A week later I got a check for $200. Now I had the entire $800 they owed me, but purely as a matter of scientific curiosity, I sent them the letter again. A week later I got another check for $200.
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I'd have kept sending letters! :->
So many of these are issues with being in or out of network. Require providers to charge everyone the same price for the same procedure. Doing the same procedure doesn't cost more to perform on people with different insurance, so don't let them charge differently.
Hint: we're partway there. CMS won't let you charge them more than anyone else. Extend that to everyone.
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Yes, these should be rights.
We should eliminate these financial traps that completely undermine trust between patients and physicians. For example, we could ask our congressional representataives to pass the Expanded & Improved Medicare for All (House Bill 676).
Quoting from the bill:
"This bill establishes the Medicare for All Program to provide all individuals residing in the United States and U.S. territories with free health care that includes all medically necessary care, such as primary care and prevention, dietary and nutritional therapies, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care.
Only public or nonprofit institutions may participate. Nonprofit health maintenance organizations (HMOs) that deliver care in their own facilities may participate.
Patients may choose from participating physicians and institutions.
Health insurers may not sell health insurance that duplicates the benefits provided under this bill. Insurers may sell benefits that are not medically necessary, such as cosmetic surgery benefits."
Once the financial pitfalls to good medical care are eliminated, we could start to address the many other issues that currently degrade our medical system, like the disincentives for physicians to be as careful and as caring as they would like their family members' doctors to be.
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It's a good list of common sense expectations which shows how little commonsense exists in health care.. It would , with the permission of Ms Rosenthal, and the Times, make a good list of rights to forward to every representative, state and federal, of the readers represented here, to prod them to take action to make this a requirement.
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"When I pick up bread and yogurt at the supermarket, I don’t have to guess what they might cost."
Well, no. A number of years ago, I did an IT contracting job in North Carolina. One night, I went to the nearest supermarket to pick up a few items. Standing on line, I commented that there were no unit prices. I was told that they didn't have to tell me the price until I paid for the item!
To bring this back to the medical field, my daughter moved to Indiana. We were shocked at medical billing practices there vs. New York, even when se went with New York Insurance. And when she aged out and had to get Indiana insurance, the "rules" just blew my mind.
Medical billing is a racket that should be shut down!
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Note that the supermarket was Food Lion. Others did have unit pricing even though it wasn't required.
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And how about "authorization" as well...according to my insurance company an MRI is ok annually for a particular preventative condition; this was to be my 3rd and last year per my primary care doctor....is there were no changes, we didn't do it again.
I was not authorized, according to the doctor's office; the insurance company had no record of denial or request; the hospital knows nothing.
PS: My previous primary care practice has a billing department in Manila, Philippines.
And the first I ever heard of a "facility fee" was in NH...but nobody I asked knew what or why it was so, including the insurance company (which didn't pay it).
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Single payer, AKA improved and expanded (traditional) Medicare for all would take care of a lot of these problems and set the stage for improvement in others. There are bills in both the House and the Senate, both gaining sponsors. It's beyond time for an efficient, economic, secure and humane solution to the problems caused by prioritizing profits over patients. Everybody in, nobody out!
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Wow! So striking that we have allowed our non-system to be so difficult and expensive -- especially for those who can afford it least. It is long past due for us to update requirements, as Elisabeth Rosenthal suggests.
Beyond that, we should give very serious consideration to adopting an IMPROVED MEDICARE for EVERYONE. (This does not mean privatizing Medicare, as some are promoting these days.) By eliminating the hundreds of insurance carriers and thousands of individual plans the resulting SINGLE PAYOR system should save about $500 BILLION per year in excessive overhead.
That includes staff employed by each provider and the insurance carriers for functions that do not contribute to care, but are required to deal with the multitude of financial variations. Insurance carriers go to great lengths to try to avoid or delay paying for medically necessary care, while ensuring the flow of dollars to higher ranked employees and their investors.
Now is the time for full consideration of all the options. Let our representatives know that we expect no less.
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Insurance, including health insurance, is a lottery. You pay your money and take your chances. When you need coverage, you might just win. As for those legislators who are "free marketers," fine. But let's have a real free market and real competition. Let the private insurers compete against a Medicare-for-all kind of system. Let the better system win. Such a system would not be free for the insured, but it would be less costly and more reliable than the current for-profit insurance system. And as for people complaining that givernment can't do anything right, I have yet to hear of anyone fighting to get OUT of Medicare onc e covered. Finally, for all the "small government" advocates: yes, such a system would add to the government's role, but think of all the state insurance commissions that would not have to have staff to evaluate a plethora of health insurance companies and plans every year in every state.
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Yes. Let’s not pass simple bill such as limiting emergency charges to Medicare allowed charges, one small fix that wouldn’t cost government a dime and would only help a few tens of millions. Let’s hold out for that perfect comprehensive legislation that would upend all budget projections and mobilize millions of rent seekers in opposition. That has worked so well.
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This piece is one of the best pieces I've ever read in the NYT on any topic. Much food for thought – and I don't even live in the USA but in Far North Queensland.
In my view, this piece is part of the bigger whole, which are all the services we pay for directly or indirectly. Most of us are used to demanding refunds for shonky goods but fail to assert our consumer rights when it comes to services.
Services include those provided privately and by government: medical care; schooling; child care; local policing; road repair; religious services; birth care; death care; nursing care; sporting clubs; banks; credit cards; financial advice; flights; holiday accommodation; rental accommodation.
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How about not being responsible for care you did not ask for or approve? I fell once and cracked a rib. It was the 4th of July, so police were everywhere and they called an ambulance to take me 1/4 mile to the nearest ER. I could easily have taken a cab. The ambulance service billed me $1200.
How can doctors and hospitals and other providers get away with charging patients for care they did not ask for or agree to? If a plumber came in and unclogged my drain without my having asked, any court would say I am not responsible for the bill. If an ER department orders a needless MRI that I did not ask for and would have deemed unnecessary had the issues and charges been explained to me, I am still on the hook.
Why is there no case law here? Or is there? Any lawyers out there?
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You can refuse ambulance transport at the scene of an accident if you're coherent and competent. You can refuse to go to the ER. Even if "taken" to the ER, you can refuse any treatment offered. You can refuse to sign a consent for treatment. Even if every doctor in the ER says you need a test or treatment and you feel strongly about it, you can leave AMA (against medical advice). Ask why you need a specific test/treatment, and if it's not explained to you to your satisfaction, don't get it.
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The pertinent words here are "coherent and competent". Is it ethical to gouge patients if they are not?
Prices should be available at all stages of treatment, with up-to-date data on your specific bill if you want it. If the insurance companies cannot handle your case in real time, then they are not providing the service we are paying for.
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People don't "consume" health care. They receive it. And it should be provided everywhere, at nominal cost, to everyone who needs it. That's called democracy.
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The availability of health care at nominal cost is highly desirable in my view. But who pays? If not the individual patient, presumably the state must pay--with funds raised by taxes. The question of need, however, is not always so simple, for many reasons.
None of this, however, has anything at all to do with democracy. It has to do with notions of a social contract that may or may not exist within a given democratic society.
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I would gladly pay more taxes for single-payer healthcare, since it would be less than I pay for the for-profit insurance companies. The insurance companies have created our current system with its multitude of prices for the same procedure, and the massive administrative load to deal with all the different price structures. The network system increases costs by selective billing.
We need a simpler system that doesn't pander to the greed of corporations.
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America - the land of price gouging.
6
Looking at the bigger picture, every patient should demand Universal Healthcare such as Medicare For All.
Why are we allowing insurance corporations to profit over our essential health care? Over 50 million are without care and those with insurance face high premiums and costs. If other civilized countries offer health care for all their citizens we should be able to. It would even result in lower overall health costs.
Over 60% of the people want this, but our politicians and media remain beholden to corporations. Plus, over 45,000 people die each year because of lack of insurance. It is time to take care of the people in this country.
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Why would anybody in the industry agree on this? Obviously there is no financial incentive to be transparent in healthcare.
Unfortunately the only way this would change is if the government stepped in. But this is politically impossible at this time.
Ultimately the best cost savings would come from government negotiated healthcare insurance. Perhaps it wouldn’t work to replace the private insurance industry but might be feasible to at least allow people to buy into it. But again, politically impossible at this time.
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